m FTC liiiFft i&t!' *.* i^ I ■•s'-'.'ii: 1f» ' : ^> . • * i' : Sir !&J '#& s»';os». .:6»*3> o> medicine Nlllllllllll NLM 00105135 7 NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Serrice WORKS ON OBSTETRICS, DISEASES OF WOMEN, and CHILDREN. PUBLISHED BY Lindsay & Blakiston, Medical Publishers and Booksellers, No. 25 South Sixth Street, Philadelphia. JUST READY. A Manual of Midwifery. Including the Signs and Symptoms of Pregnancy, Obstetric Operations, Diseases of the Puerperal State, &c, &c. By Alfred Meadows, M.D., Member of the Royal College of Physicians, &c, &c. First American from the Second London Edition, with numerous Illustrations. Price,. . . $3.00 11 Those who read the first edition of this work will bear us out in thinking that Dr. Meadows's Manual forms one of the most convenient, practical, and concise books yet published on the subject. It was especially good as a student's manual, and the author has, in his second edition, sought to make it of equal value to the practitioner. The part which treats of obstetric operations has been well revised, and has received nu- merous additions, and the several chapters on Unnatural and Complex Labors likewise comprise much new matter. Upwards of ninety new engravings have been inserted in this edition, and, with a view to facilitate reference, the author has furnished it with a very full and complete table of contents and index. We can cordially recommend this manual as accurate and practical, and as containing in a small compass a large amount of the kind of information suitable alike to the student and practitioner."— London Lancet, May 6,1871. Cazeauxs Great Work on Obstetrics. A Theoretical and Practical Treatise on Midwifery, includ- ing the Diseases of Pregnancy and Parturition. Fifth Amer- ican, translated from the Seventh French Edition. Revised and Annotated by S. Tarnikr, Adjunct Professor in the Faculty of Medicine of Paris. Greatly enlarged and im- proved. Over i 100 royal octavo pages, with numerous Litho- graphic and other Illustrations on Wood. Price, bound in cloth, bevelled boards, . . $6.<;o " " leather,.......7.50 The Change of Life in Health and Disease. A Practical Treatise on the Nervous and other Affections incidental to Women at the Decline of Life. By Edward John Tilt, M.D. From the Third London Edition. In one volume, Octavo. Price,........$3.00 " The great abilities of Dr. Tilt, his extensive knowledge and his literary power, are well shown in this book, and we are pleased to say that it has substantial and peculiar merits. It contains many sage, practical recommendations, and will amply repay perusal."—Edinburgh Medical Journal. Dillenberger s Handy Book Of the Treatment of Women and Children's Diseases, ac- cording to the Vienna Medical School. Part I. The Diseases of Women. Part II. The Diseases of Children. Translated from the Second German Edition, by P. Nichol, M.D. One volume 1 2mo. Price,......$1.75 The Practice of Medicine and Surgery Applied to the Diseases and Accidents incident to Women. By W. H. Byford, A.M., M.D., Professor of Obstetrics and Diseases of Women and Children in the Chicago Medi- cal College, &c. Second Edition, Revised and Enlarged, with additional Illustrations. Price, ... 9-,- 00 The rapid sale of the first edition of this book, which was exhausted in a little more than a year, has enabled the author to carefully revise the whole work add manvTm provements and to make a large addition of new matter, without, however material increasing the size of the volume. uowever, materially Byford on the Chronic Inflammation and Displacements of the Unimpregnated Uterus. A New, En- larged, and thoroughly Revised Edition, with numerous Illus- trations. Price,............$3>00 '• This work will be found particularly useful to general practitioners. The different subjects are treated plainly and concisely, and just such information is given as will be of the most practical value. While prolixity is avoided, nothing of real importance is omitted. In preparing the second edition it has been the object of the author to add to the usefulness of the work by thoroughly revising, correcting, enlarging, and illus- trating it."— Cincinnati Medical Repertory. The Diagnosis and Treatment of Diseases of Women, including the Diagnosis of Pregnancy. By Graily Hewitt, M.D., Lecturer on Midwifery and Diseases of Women and Children at St. Mary's Hospital Medical School, &c. New Edition, with a new series of Illustrations. $5.00 A Practical Treatise on the Diseases of Chil- dren. By J. Forsyth Meigs, M.D., Fellow of the College of Physicians of Philadelphia, &c, &c, and William Pepper, M. D., Physician to the Philadelphia Hospital, &c, &c. Fourth Edition, thoroughly Revised and greatly Enlarged. Over 900 royal octavo pages. Price,.....$6.00 "The most thorough and practical work on the subject now before the profession." A Practical Treatise on the Diseases of In- fancy and Childhood. By Thomas Hawkes Tanner, M.D. The Second Edition, Revised and Enlarged, by Alfred Meadows, M.D., London, M.R.C.P., Physician to the Hos- pital for Women, and to the General Lying-in Hospital. One volume, Octavo. Price,.......$3-5° A Clinical Treatise on the Diseases of Chil- dren. By Thomas Hillier, M.D., Physician to the Hospi- tal for Sick Children, and to University College Hospital, &c, &c. Octavo. Price.........$3.00 The Surgical Diseases of Infancy and Chila- hood. By J. Holmes, M.A., Surgeon to the Hospital for* Sick Children, &c. Second Edition, Revised and Enlarged'. Octavo. Price,............$9<°i> The Functions and Disorders of the Repro- ductive Organs in Childhood, Youth, and Advanced Life. By William Acton, M.D. A New American from the last London Edition. Octavo. 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THE MEDICAL STUDENT'S YADE MECTJM. A COMPENDIUM OF ANATOMY, PHYSIOLOGY, CHEMISTRY, POISONS, MATERIA MEDICA, PHARMACY, SURGERY, OBSTETRICS, PRACTICE OF MEDI- CINE, DISEASES OF THE SKIN, Etc. Etc. GEORGE ipNDENHALL, M. D., ^ PROFESSOR OP OBSTETRICS ANT' m-EASES OF WOMEN AND CHILDREN IN THE MEDICAL COLLEGE OF OHIO, MEMBER OF THE AMERICAN MEDICAL ASSOCIATION, ETC. ETC. TENTH EDITION. r>y co WITH TWO HUNDRED AND TWENTY-FOUR ILLUSTRATIONS. PHILADELPHIA: LINDSAY & BLAKISTON 1871. Wt3 (V\533 mi YY\ Entered, according to Act of Congress, in the year 1867, by LINDSAY & BLAKISTON, in the Clerk's Office of the District Court of the United States for the Eastern District Ol Pennsylvania. PREFACE TO THE FIFTH EDITION. In presenting the fifth edition of this compend to Medi- cal Students, the only apology which it is necessary to offer is the rapid sale of the four former ones; and this has been considered as sufficient evidence that the work has proved useful. The careful revision which the present edition has under- gone, makes the work more complete, and gives it, the author trusts, higher claims to a favorable reception. The object is to furnish the Student of Medicine with a short and succinct view of the most important facts and principles which engage his attention during his pupilage, in order that he may refresh and fix more firmly upon his memory what he has read and heard, as well as to enable him properly to arrange his knowledge so as to use it in the most advantageous manner. With such a Vade Mecum many leisure moments may be rescued from entire loss, whether occurring in the class- room, before or between lectures, while in attendance at the hospital, or elsewhere, and turned to good account. These short intervals of time, when singly considered, may seem of little value; but, taken in the aggregate, and use- fully employed, may be of great consequence. (") 12 PREFACE TO THE FIFTH EDITION. It is also believed that the present edition will be found useful as a Pocket Manual to the young Practitioner, serv- ing to refresh his memory on elementary subjects, and on practical points, in cases of emergency. By reference to it, he will be able to bring before his mind the principal points of subjects (perhaps partially forgotten), that may be im- portant and useful, under circumstances not permitting a reference to more voluminous and extensive works. These we consider to be the legitimate objects of all works of this description, and, when used as intended, they cannot but be of great practical advantage. No claim is made to originality; it is strictly a compila- tion from standard authorities, intended to present, in a brief space and compact form, the outlines of generally admitted truths of Medicine. We have, therefore, drawn freely from the best sources within our reach, and copied ideas —and in some cases the words, — of the different authors that have been used. This general acknowledg- ment is due, although a reference to the particular wo^ks may be unnecessary. Cincinnati. CONTENTS. PART I. ANATOMY. PAGE Definition of Anatomy................. 25 Skeleton.................................... 26 Trunk......................................... 29 Spine .................................... 29 Cervical Vertebrae................... 29 Dorsal Vertebrae..................... 30 Lumbar Vertebras ................... 30 Sacrum ................................. 30 Coccyx.................................. 31 Ossa Innominata..................... 31 Thorax ................................. 32 Ribs..................................... 32 Sternum................................ 32 Bones of the Head...................... 33 Cranium................................ 33 Os Fronds ............................. 33 Ossa Parietalia........................ 33 Os Occipitis............................ 33 Ossa Temporum...................... 34 Os Sphenoides........................ 35 Os Elbmoides......................... 36 Bones of the Face .................. 36 Ossa Maxillaria Superiora......... 36 Ossa Palati ............................ 37 Ossa Nasi.............................. 37 Ossa Unguis........................... 37 Ossa Malarum......................... 38 Ossa Spongiosa Inferiors.......... 38 Vomer .................................. 38 Os Maxillnre Inferius............... 38 Ossa Triquetra........................ 38 Os Hyoides............................ 40 2 PA 81 Bones of the Superior Extremi- ties ......................................... 40 Scapula................................. 40 Clavicle................................. 41 Humerus............................... 41 Bones of the Forearm.............. 41 Ulna .................................... 41 Radius ................................. 41 Bones of the Hand.................. 42 Carpus.................................. 42 Metacarpus............................ 42 Phalanges . ........................... 42 Bonks of the Inferior Extremi- ties ........................................ 42 Os Femoris............................ 42 Tibia..................................... 42 Fibula................................... 43 Patella.................................. 43 Tarsus .................................. 43 Metatarsus............................. 43 Phalanges.............................. 43 Cartilage................................... 43 Ligaments................................... 44 Ligaments of the Lower Jaw..... 45 Ligaments of the Vertebrae....... 45 Ligaments of the Pelvis........... 45 Ligaments of the Ribs.............. 46 Ligaments of the Shoulder....... 47 Ligaments of the Elbow........... 47 Ligaments of the Wrist............ 48 Ligament6 of the Fingers......... 48 Ligaments of the Hip............... 48 (13) 14 CONTENTS. PAOE Ligaments Ligaments of the Knee-joint ..... 49 Ligaments of the Ankle............ 50 Integuments................................ 50 Muscles..................................... 51 Muscles of the Trunk................. 52 Muscles of the Abdomen.......... 52 Muscles of the Male Perineum... 51 Muscles uf the Female Perineum. 55 Muscles of the Thorax ............ 57 Muscles of the Back................ 58 Muscles of the Neck ............... 58 Muscles of the Head ami Face.... 59 Muscles of the Upper Extermity 61 .Muscles of the Shoulder........... 61 Muscles of the Arm ................. 61 Muscles of the Forearm............ 62 Muscles of the Inferior Extremity 63 Muscles of the Thigh............... 63 Muscles of the Lei;.................. 65 Organs of Digestion.................... 67 Teeth.................................... 68 Tongue ................................. 69 Palate.................................... 70 Glands of che Mouth............... 70 Pharynx................................ 71 (Esophagus............................. 71 Abdomen............................... 72 Regions of the Abdomen.............. 72 Chylopoietic Viscera.................. 74 Stomach .............................. 74 Intestines.............................. 76 Small Intestine....................... 76 Large Intestine....................... 77 Assistant Chylopoietic Viscera... 78 Liver.................................... 78 Gall-bladder........................... 78 Spleen................................... 79 Pancreas................................ 79 Urinary Organs ......................... 79 Kidneys................................. 79 Bladder................................. ,S] Organs of Generation in the Male 81 Organs of Generation in the Fe- male ................................. 85 Drgans of Respiration................ 87 Larynx.................................. 88 Trachea.............................. _ 89 Lungs............................."". 8g Pleura...............................' gi pag« Circulatory System................... "' Heart................................... y2 Arteries ................................... ^4 Aort.................................... »•» Internal Carotid.................... 5)6 External Carotid.................... 96 Internal Maxillary................. 97 Arteries of the Brain.............. 97 Subclavian Artery................. 97 Axillary Artery..................... 98 Brachial Artery..................... 98 Ccelie Artery ........................ 99 Superior Mesenteric Artery...... 100 Inferior Mesenteric Artery...... 100 Primitive lliacs..................... 100 Internal Iliac Artery.............. 100 External Iliac Artery............. 100 Femoral Artery..................... 100 Anterior and Posterior Tibial Arteries............................. 101 Venous System .......................... 101 Vena Cava Descendens........... 102 Vena Innominata.................. 103 Vena Azygos........................ 103 Subclavian Vein .................... 103 Veins of the Superior Extremity 104 Vena Cava Aseendens............ 104 Primitive Iliac Vein............... 104 Veins of the Inferior Extremity 105 Absoiibent or Lymphatic System.. 105 Lacteals and Lymphatics......... 105 Thoracic Ducts...................... 106 Nervous System......................... 107 Spinal Marrow....................... ]07 Urain................................... 108 Nerves................................. ] ]2 Olfaetory Nerve..................... ]]2 Optic Nerve.......................... \\2 Motor Oeuli.......................... 112 Patheticus............................ 113 Trifacial.........................'.'.!'." 114 Motor Externus..................... 154 Facial and Auditory............... 115 Glosso-pharyngeal."................. 115 Pneutnogastric................... ' ]i5 Accessory............................. 115 Hypoglossal......................... 117 SkNS"8...................................... 118 J'ye .................................... 118 Ear..................................... ijg Great Sympathetic Nerve.......... 12c Spinal Nerves..................... 12<- CONTENTS. 15 PART II. PHYSIOLOGY. PAGE Natural Bodies......................... 127 | Organic and inorganic Bodies... 127 Distinctions between Animals and Vegetables................... 127 Ultimate Elements.................. 12S Organic Elements.................. 128 The Tissues........................... 131 Functions of Man....................... 133 Animal Functions — Functions of Relation................................. 134 Sensibility............................ 134 External Sensations............... 136 Sense of Touch —Palpation..... 137 Sense of Taste—Gustation...... 138 Sense of Smell — Olfaction...... 139 Sense of Hearing-— Audition.... 140 Sense of Sifiht — Vision.......... 141 Muscular Motion....................... 145 Table of the Muscles............... 147 Functions of Expression—Lan- guage ............................... 151 Ciliary Motion....................... 152 Nutritive Functions................... 153 Digestion.................................. 153 Food — Aliment..................... 153 Hunger................................ 155 Prehension of Food................ 155 Deglutition........................... 156 Chymification....................... 156 Chylification........................ 158 Defecation............................ 160 Thirst.................................. 160 Absorption................................. 161 PAGl Absorption, External Absorption.............. 161 Chylosis............................... 162 Ly in pilosis ........................... 163 Venous Absorption................. 164 Internal Absorption............... 164 Accidental Absorption............ 164 Respiration............................... 165 Inspiration........................... 165 Expiration............................ 166 Sanguification—Hematosis....... 167 Circulation............................... 169 Blood.................................. 170 Action of the Heart................ 171 Action of the Arteries............. 172 Nutrition.................................. 174 Cell Doctrine......................... 174 Formation of Cells.................. 175 Calorification........................... 176 Secretion.................................. 177 Exhalant Apparatus............... 177 Follicular Organs................... 177 Glandular Organs.................. 177 Exhalations.......................... 179 Follicular Secretions............... 181 Glandular Secretions............... 181 Reproductive Functions............ 182 Generation................................ 183 Ages......................................... 186 Individual Differences among Mankind................................. 187 Temperaments....................... 187 Constitution and Idiosyncrasy.. 188 PART III. CHEMISTRY. Chemistry................................. 191 Cai.ouK 191 Conduction of Caloric............. 191 Reflection of Caloric............... 192 Tiansmission of Caloric........... 192 Equalization of Temperature.... 193 PAGJ Caloric, Effects of Heat on Matter......... 193 Specific Heat......................... 194 Latent Heat........................... 194 Evaporation.......................... 196 Light........................................ 197 Optics.................,................ 197 16 CONTENTS. Light, Theories of Light................. 197 Solar Light .......................... 197 Terrestrial Li^ht.................... 198 Electricity............................... 198 Attraction and Repulsion......... 199 Induction of Electricity........... 200 Leyden Jar........................... 200 Electrometers and Electroscopes 201 Galvanism................................. 201 Voltaic or Galvanic Circle....... 201 Galvanic Battery.................... 202 Electrolization....................... 203 Electro-Magnetism................ 204 Specific Gravity........................ 205 Nomenclature........................... 205 Affinity.................................... 207 Symbols.................................... 209 Oxygen............................... 210 Combustion........................... 211 Hydrogen............................. 211 Nitrogen.............................. 213 Compounds of Nitrogen........... 214 Atmosphere........................... 214 Carbon................................. 217 Sulphur............................... 219 Compounds of Sulphur............ 220 Phosphorus........................... 222 Boron.................................. 224 Silicon................................. 225 Selenium.............................. 226 Chlorine........................,..... 226 Compounds of Chlorine........... 227 Iodine.................................. 233 Bromine............................... 235 Fluorine.............................. 236 Ammonia.............................. 238 Compounds of Hydrogen and Carbon............................. 239 Hydrogen and Sulphur............ 241 Hydrogen and Phosphorus...... 242 Nitrogen and Carbon.............. 242 Metals...................................... 244 Metals of the Alkalies............. 246 Potassium............................. 246 Sodium............................... 248 Lithium............................... 250 Ammonium........................... 251 Metals of the Alkaline Earths 251 f{rium...............................'. 251 strontium....................... nc» Calcium....................... " ois'q Magnesium.....................]_ '" 254 Metals of the Earths Proper..... 255 Aluminum.................... '" o,. PAO» Metals which decompose Water at a red heat......................... "°" Manganese .............................. 2oo Iron....................................... 257 Zinc.................................... 260 Tin.................................... 261 Cobalt................................. 262 Nickel.................................. 262 Metals which do not becompose Water at any temperature...... 263 Arsenic................................ 263 Antimony............................. 266 Copper................................. 267 Lead.................................... 268 Bismuth............................... 269 Metals the Oxides of which are reduced to the Metallic state by a red heat......................... 271 Mercury............................... 271 Silver.................................. 274 Gold.................................... 276 Platinum.............................. 276 Alloys and Amalgams................ 277 Salts........................................ 277 Organic Chemistry..................... 280 Vegetable Chemistry................. 281 Vegetable Acids........................ 2S2 Organic Salt Bases, on Vegetable Alkalies................................ 285 Neutral Substances, the Oxvoen and Hydrogen of which are in THE SAME RATIO AS IN WATER...... 287 Oleaginous, Resinols, and Bitu- minous Substances................... 287 Spirituous and Ethereal Substan- eES......................................... 291 Coloring Matters....................... 292 Substances which r>o not belong to either of the preceding sec- tions............................ 093 Spontaneous changes of vegeta- ble matter....................... 293 Germination......................... 294 Animal Chemistry............... 294 Analytical Chemistry............,,.. 296 Table of Symbols, and EqihVa. lents of Elementary Substan, ces...„. ......... _..................... ?9g CONTENTS. n PART IV. POISONS. PAGE Definition................................. 301 Acids........................................ 301 Alkalies and their Salts........... 302 Earths and their Compounds...... 303 Baryta................................. 303 Lime.................................... 304 Alcohol and its preparations..... 304 Volatile Oils.......................... 304 Chlorine .............................. 304 Iodine................................. 305 Bromine .............................. 305 Metals...................................... 305 Antimony............................. 305 Arsenic................................ 306 Copper ................................ 307 Gold................................... 308 Iron.................................... 308 Lead................................... 308 Metals, Mercury............................... 309 Silver................................. 309 Tin ..................................... 310 Zinc.................................... 310 Phosphorus........................... 310 Glass, or Enamel .................. 310 Vegetable Poisons..................... 310 Aero-Narcotic Poisons............ 311 Narcotic Poisons.................... 311 Poisonous Mushrooms ............ 312 Animal Charcoal as an Antidote for Poisons........................ 312 Animal Poisons........................... 313 Poisonous Fish ..................... 313 Poisonous Serpents................ 314 Cantharis Vesicatoria.............. 314 Venomous Insects.................. 315 Saliva of the Rabid Dog......... 315 PART V. MATERIA MEDICA AND PHARMACY. PAGE Materia Medica—Definition........ 319 Operation of Medicines........... 319 Primary and Secondary Opera- tion ................................. 319 Influences modifying the Ac- tion of Medicines............... 320 Forms of Medicines............... 320 Administration of Medicines ... 321 Classification........................... 324 Table of Classification............ 325 Astringents.............................. 327 Vegetable Astringents.............. 328 Oak Bark ............................. 328 Galls................................... 329 Kino................................... 329 Catechu................................ 329 Rhntany.............................. 330 Logwood.............................. 330 2* PAGE Vegetable Astringents Cranesbill............................. 331 Blackberry Root.................... 332 Uva Ursi.............................. 332 Pipsissewa ........................... 334 Red Rose............................. 334 Persimmon........................... 334 Creasote.............................. 334 Mineral Astringents................. 335 Alum................................... 335 Lead .................................. 335 Acetate of Lead..................... 336 Tonics....................................... 336 Pure Bitters............................. 337 Quassia................................ 337 Goldthread........................... 338 Gentian................................ 339 CONTENTS. PAOE PunE Bitters, Columbo............................. 339 American Centaury ............... 339 Bitters of Peculiar oh Modified Properties............................. 340 Peruvian Bark....................... 340 Dogwood.............................. 341 Wild Cherry Bark................. 341 Chamomile........................... 342 Uoueset................................ 342 Virginia Snakeroot................. 343 Myrrh................................. 344 Angustura ........................... 344 Cuscarilla Bark..................... 344 Aromatics................................. 344 Orange Peel.......................... 345 Cinnamon............................. 345 Canella ................................ 345 Cloves................................. 345 Nutmeg................................ 345 Black Pepper........................ 345 Cubebs ................................ 345 Pimento .............................. 346 Cardamom ........................... 346 Aromatic- Seeds..................... 346 Peppermint .......................... 346 Spearmint ........................... 346 Calamus ............................. 348 Mineral Tonics ........................ 348 Iron.................................... 348 Copper ................................ 349 Zinc................:................... 349 Bismuth .............................. 350 Silver................................... 350 Mineral Acids........................ 350 Arterial Stimulants.................. 351 Red Pepper .......................... 351 Oil of Turpentine.................. 351 Phosphorus .......................... 351 Carbonate of Ammonia........... 351 Nervous Stimulants, or Anti- • spasmodics ............................. 351 Musk................................... 352 Castor................................. 352 Assafostida........................... 352 Valerian .............................. 352 Cerebral Stimulants................. 353 Alcohol................................ 353 Opium................................. 354 Lnctucarium.......................... 354 Henbane.............................. 355 Hops .................................. 356 Camphor.............................. 356 Deadly Nightshade................. 356 Thornapplc........................... 357 Bittersweet.......................... 357 Hemlock.............................. 35s Arterial Sedatives ................ 358 Antimony............................. 359 Nervous Sedatives.................... 359 Foxglove............................. ;i,;,) Prus.-icAcid ....................... 361 Tobacco .............................. 361 Emetics .................................... 361 Ipecacuanha ........................ 302 Lobelia............................... 362 Milk-weed ........................... 363 Bloodroot............................. 364 Tartar Emetic....................... 364 Sulphate of Zinc.................... 365 Sulphate of Copper ............... 366 Cathartics................................ 366 Vegetable Cathartics............... 367 Manna................................. 367 Purging Cassia ..................... 367 Castor Oil............................. 367 Rhubarb.............................. 367 Senna ................................ 367 American Senna.................... 368 Butternut............................. 369 Aloes................................... 369 Jalap................................... 370 May-apple ........................... 370 Scammony........................... 371 Black Hellebore .................... 372 Colocynth............................. 372 Gamboge ............................ 373 Elaterium ............................ 374 Croton Oil ........................... 376 Mineral Cathartics.................. 376 Sulphur................................ 376 Magnesia ............................. 376 Saline Cathartics .................. 376 Sulphate of Soda .................. 376 Sulphate of Magnesia ............ 376 Sulphate of 1'ntassa............... 376 Supertartrate of Potassa......... 376 Tartrate of Potassa ............... 376 Tartrate of Potassa and Soda... 376 Phosphate of Soda................. 377 Citrate of Magnesia ............... 377 Calomel.......................... 3-7 Enemata............................. 3^ Diuretics ........................ v-g Squill.......................... "' ^ 3^-g Meadow Saffron .................... 379 Indian Hemp ..................\ 370 Dandelion .................. or-q Juniper Berries....................' 330 Wihl Carrot..............'.'.7.7.'.'.'.'.'.' 3,«-'0 Parsley Root..............'.7.7.7.7.'.' 380 Turpentine................ .....3^ £"P!,iva..............77777777 'm Tar.................................... ,,82 Cantharides.................. " ogg Carbonates of Potassa'.'.'.'.'.'.'.'.'.'.''' 38' Acetate of Potassa..............'" 332 Bitartrate of Potassa.........7' ' 382 CONTENTS 19 PAGE I Diuretics, Nitrate of Potassa.......,........ 382 Spirit of Nitric Ether ............ 382 Diaphoretics............................. 383 Nauseating Diaphoretics........... 383 Ipecacuanha ....................... 383 Tartrate of Antimony and Po- tassa................................. 383 Dover's Powder..................... 383 Refrigerant Diaphoretics......... 383 Citrate of Potassa.................. 383 Acetate of Ammonia.............. 384 Nitrate of Potassa ................. 384 Spirit of Sulphuric Ether........ 384 Alterative Diaphoretics........... 384 Guaiacum............................. 384 Mezereon ............................. 384 Sassafras.............................. 384 Sarsaparilla.......................... 385 Expectorants ........................... 385 Senega ................................ 387 Black Snakeroot.................... 388 Ammoniac........................... 388 Assafoetida............................ 388 Balsam of Tolu..................... 388 Balsam of Peru..................... 389 Storax ................................ 389 Benzoin .............................. 389 Copaiba .............................. 389 Myrrh................................. 389 Galbanum ........................... 389 Elecampane.......................... 389 Wood Naphtha..................... 389 Emmenagogues .......................... 389 Aloes.................................. 390 Black Hellebore.................... 390 Guaiacum............................ 390 Savine................................. 390 Cantharides.......................... 390 PAGE Epispastics............................... 390 Spanish Fly........................„ 391 Rubefacients............................ 391 Escharotics............................. 392 Demulcents.............................. 392 Emollients................................ 392 Diluents................................... 393 Medicines Unclassified ............ 393 Nux Vomica........................ 393 Arsenic................................ 394 Mercury.............................. 394 Iodine................................. 395 Antacids................................... 396 Anthelmintics........................... 396 Pinkroot.............................. 396 Pride of China..................... 396 Wormseed ........................... 396 Tin .................................... 398 Pomegranate Bark................. 398 Table of Signs and Abbrevia- tions ...................................... 399 Examples of Extemporaneous Prescriptions ........................ 400 Weights and Measures.............. 40S Dietetic Preparations............... 409 Quantities of Opium in Differ- ent Preparations .................. 414 Table of the Alcoholic strength of Wines................................. 415 Table showing the difference between Minims, Drops and Grains of various Medicinal Preparations of the Pharmaco- poeia of the United States....... 416 PART VI. SURGERY. PAGE Inflammation............................ 419 Suppurative Inflammation....... 420 Ulcerative Inflammation......... 421 Mortification......................... 422 Erysipelas............................. 423 Furunculus, or Boil................ 424 Anthrax, or Carbuncle............ 424 PAGI Inflammation, Pernio, or Chilblain ............... 425 Frostbite.............................. 425 Burns ................................. 425 Wounds............,........................ 426 Incised Wounds..................... 426 Punctured Wounds................ 428 20 CONTENTS. Wounds. Penetrating Wounds.............. 42S Contused Wounds.................. 428 Lacerated Wounds.................. 429 Poisoned Wounds.................. 429 Gunshot Wounds .................. 429 Abscesses.........................>....... 430 Ulcers ..................................... 430 Simple Ulcer........................ 431 Indolent Ulcer ..................... 432 Scrofula................................... 433 Gonorrhoea................................ 434 Syphilis.................................... 435 Tumors...................................... 436 Fractures................................. 437 Fracture of the Lower Jaw...... 438 Fracture of the Vertebras......... 439 Fracture of the Ribs.............. 440 Fracture of the Sternum......... 440 Fracture of the Clavicle.......... 440 Fracture of the Arm .............. 442 Fracture of the Forearm........ 443 Fracture of the Patella........... 446 Fracture of the Thigh............ 446 Fracture of the Leg.......... .... 451 Compi und Fracture................ 452 Luxations................................. 453 Dislocation of the Lower Jaw... 453 Dislocation of the Clavicle....... 455 Dislocation of the Arm.............456 Dislocation of the Forearm...... 457 Dislocation of the Thigh......... 460 Dislocation of the Knee ......... 465 Dislocation of the Ankle......... 406 Diseases of the Bones and Joints 466 Caries.................................. 466 Caries of the Spine................ 467 Necrosis............................... 467 Exostosis.............................. 468 Spina Ventosa....................... 468 Osteo-Sarcoma........................ 468 Mollities Ossium .................... 468 Rachitis, or Rickets............... 469 Coxalgia, or Hip Disease........ 469 Fungus Articuli, or White Swel- ling.................................. 470 Hydrarthus, or Dropsy of a Joint................................. 470 Movable Cartilage................... 470 Anchylosis............................ 47O Diseases of the Arteries........... 47] Aneurism.............................. 471 Aneurism by Anastomosis........ 472 Varicose Aneurism................. 472 Diseases of the Veins................ 473 Cirsocele and Varicocele.......... 473 Inflammation of Veins, or Phle- bitis ................................. 474 PAOl Injuries of the Head.............•••• 474 Fractures of the Skull........... 474 Concussion of the Brain.......... 475 Compression of the Brain........ 475 Inflammation of the Brain....... 476 Fungus Cerebri, or Encephalo- cele.................................. 477 Diseases of the Eye.................. 477 Conjunctival Ophthalmia......... 477 Sclerotic Ophthalmia.............. 478 Iritic Ophthalmia, or Iritis...... 479 Psorophthalmia..................... 479 Pterygium ........................... 480 Ecanthis.............................. 480 Opacity of the Cornea ........... 480 Ulcer of the Cornea............... 481 Staphyloma........................... 481 Hypopion ............................. 481 Hydrophthalmia.................... 482 Obliterated Pupil................... 482 Procidentia Iridis................... 482 Cataract .............................. 482 Amaurosis............................ 485 Fistula Lachrymalis............... 485 Strabismus........................... 485 Hordeolum........................... 487 Encysted Tumors of the Fye- lid................................... 487 Entropion............................. 487 Ectropion.............................. 437 Diseases of the Nose and An- trum....................................... 488 Polypus of the Nose .............. 488 Ozcena................................ 4.88 Fungus, or Polypus of the An- trum ................................ 488 Diseases of the Mouth............... 488 Hare-lip............................... 438 Ranula................................. 48g Malformation of the Fruenum Ling"*............................. 489 Enlarged Tonsils................... 489 Elongation of the Uvula......... 489 Epulis, or Tubercle of the Gums. 490 Diseases of the Neck................ 490 Extraneous Bodies in the (Eao- Phngus.............................. 490 Stricture of the Oesophagus...... 490 Removal of Extraneous Bodies from Larynx and Trachea .... 491 Bronchocele, or Goitre............. 491 Torticollis, or Wry Neck.....'..'.'.' 491 Hernia...................................... 491 Inguinal Hernia..................... 493 Femoral Hernia..............7.7.7." 496 Umbilical Hernia........777!"..7.7.7' 497 Congenital Hernia.........777.7.7. 497 Artificial Anus....................... ^ CONT PAGE Diseases of the Rectum............. 498 Prolapsus Ani....................... 498 Hemorrhoids........................ 498 Fistula in Ano....................... 499 Diseases of the Testicle and Penis..................................... 499 Hydrocele............................. 499 Ha matocele.......................... 501 Phyraosis.............................. 501 Paraphymosifi........................ 501 Diseases of the Urethra and Bladder................................. 501 Fistula in Perineo ................. 502 Retention and Incontinence of Urine................................ 502 Urinary Calculus.................... 504 Amputation................................ 506 Amputation at the Shoulder- joint................................. 507 Amputation above the Elbow... 508 Amputation at the Elbow-joint. 508 Amputation of the Forearm..... 509 Amputation of the Wrist-joint.. 510 PAGE The Pelvis................................ 523 Sacrum ............................... 523 Coccyx................................. 523 Innominata........................... 523 Sacro-sciatic Ligaments.......524 Divisions of the Pelvis............ 524 Diameters of the Pelvis........... 524 Measurements of the Superior Strait.............................. 525 Measurements of the Inferior Strait............................... 525 Axes of the Pelvis................. 526 Inclination of the Pelvis......... 526 Planes of the Straits............... 527 Deformity of the Pelvis............ 528 The Fcetal Head........................ 528 Diameters of the Child's Head.. 529 Sutures and Fontanelles........... 530 Menstruation............................. 531 Derangement of the Function of Menstruation..................... 532 :nts. 21 PAGE Amputation, Amputation of the Leg............ 510 Amputation of the Thigh......... 511 Ligature of Arteries................ 512 Ligature of the Common Caro- tid ................................... 513 Ligature of the External Caro- tid.................................... 514 Ligature of the Humeral Ar- tery ................................. 514 Ligature of the Radial Artery.. 514 Ligature of the Ulnar Artery... 514 Ligature of the External Iliac. 514 Ligature of the Femoral Artery 515 Ligature of the Posterior Tibial Artery.............................. 515 Ligature of the Anterior Tibial Artery.............................. 516 Paracentesis............................. 516 Escharotics............................. 517 Hemorrhage from Leech-Bites... 518 Club-foot — Talipes.................. 518 Inversion of the Toe Nail......... 520 PAGE Pregnancy................................. 533 The Membranes..................... 533 The Placenta........................ 534 The Foetal Circulation............ 535 Changes in the Uterus from Impregnation..................... 537 Development of the Foetus....... 537 Extra-uterine Pregnancy......... 638 Signs of Pregnancy................ 539 Table of the Signs of Pregnancy 540 Treatment during Pregi;ancy... 542 Abortion .............................. 54'j Action of the Uterus............... 54J Retroversion of the Uterus....... 544 Anteversion of the Uterus........ 545 Obliquities of the Uterus......... 545 Term of Utero-gestation.......... 545 Labor....................................... 546 Stages jf Labor..................... 546 Conduct ot a Labor................ 547 Laceration of the Perineum...... 550 Sore Nipples ........................ 550 PART VII. OBSTETRICS. 2-2 CONTENTS. Labor, Natural or Unassisted Labor.... 551 Mechanism of Labor............... 552 The Presentations.................. 554 Presentation of the Breech....... 555 Presentation of the Feet.......... 557 Presentation of the Knees........ 557 Labors in which the Presentation is Natural, but rendered Diffi- cult or Preternatural............ 557 Flooding............................. 558 Convulsious........................... 558 Syncope............................... 558 Hernia................................. 659 Bad Position of the Head......... 559 Face Presentations................. 659 Turning................................ 561 The Forceps.............................. 564 Locked or Impacted Head....... 569 Uterine Hemorrhage............... 569 Accidental Hemorrhage........... 569 Unavoidable Hemorrhage........ 573 Puerperal Convulsions............ 575 Inversion of the Uterus............ 576 1 he Forceps, Twins............................ ..... 5?3 Presentation of the Arm and Shoulder........................... 578 Prolapsus of the Umbilical Cord 5S J Rupture of the Uterus............ 5^2 Turning, or Version............... 582 Deliveries performed by Instru- ments applied either to the Mother or Child.................. 585 Premature Delivery................ 588 Puerperal or Peritoneal Fever... 588 Puerperal Mania.................... 589 Phlegmasia Dolens................. 689 Diseases of Children................. 590 Gum Rash............................ 590 Jaundice............................. 590 Flatulent Colic...................... 590 Convulsions........................... 590 Dentition.............................. 590 Diarrhoea.............................. 591 Aphtha, or Thrush................. 591 Early Sigas of Disease in Chil- dren ................................. 591 PART VIII. THEORY AND PRACTICE OP MEDICINE. PAGE Disease.................................... 595 Organic and Functional Disease 595 Semeiology and Diagnosis........... 597 Percussion................................. 598 Auscultation............................. 601 Auscultation of the Chest......... 603 Auscultation of the Respiratory Apparatus.......................... 603 Respiratory Murmur............... 603 Normal Respiration................ 603 Pathological Phenomena......... 604 Alterations in the Intensity of the Respiratory Murmur...... 605 Loud Respiration................... 605 Feeble Res] iration................. 605 Absent Rhythm..................... 605 Frequency of Respiration........ 606 Continuity of Respiration......... 606 Duration of Respiration........... 606 Auscultation of the Chest, Prolonged Expiration............. 607 Alterations in the Character of the Respiration................... 607 Harsh Respiration.................. 607 Bronchial or Tubular Respira- tion .................................. 608 Cavernous Respiration............ 608 Amphoric Respiration............. 609 Abnormal Sounds.................. 609 P'euritic Friction................... 609 Rales................................... 610 Sonorous Rale....................... 610 Crepitating Rale.................... 610 Sub-crepitating Rale............... 61] Cavernous Rale.................... fi|2 Crackling, Crumpling, Ac........ 612 Auscultation of the Voice......... 612 Physiological Phenomena........ 612 Pathological Phenomena......... 613 CONTENTS. 23 PAGE Auscultation of the Chest, Bronchophony....................... 613 (Egophony............................ 613 Pectoriloquy......................... 614 Amphoric Voice..................... 614 Metallic Tinkiing................... 614 Auscultation of tfe Heart......... 615 Physiological Phenomena........ 615 Pathological Phenomena......... 616 The Impulse......................... 616 The Rhvthm......................... 617 The Sounds.......................... 617 Abnormal Sounds or Murmurs.. 618 Anaemic Murmurs.................. 621 Pericardial Murmurs............... 621 Functional Signs of Disease....... 621 Fever....................................... 622 Intermittent Fever................. 624 Remittent Fever.................... 626 Hectic Fever........................ 627 Yellow Fever........................ 627 Continued Fever.................... 627 Typhoid Fever...................... 629 Typhus Fever....................... 630 Inflammation of the Alimentary Canal and Accessory Organs...* 631 Stomatitis............................ 631 Glossitis.............................. 634 Tonsillitis............................. 635 Parotitis............................... 635 Acute Gastritis...................... 635 Chronic Gastritis.................... 636 Acute Enteritis...................... 636 Dysentery............................. 637 Chronic Enteritis................... 638 Acute Peritonitis.................... 638 Acute Hepatitis..................... 639 Chronic Hepatitis................... 639 Organic Diseases of the Liver... 639 Inflammation op the Nervous System ................................... 641 Cephalitis............................. 641 Phrenitis.............................. 641 Arachnitis............................ 641 Cerebritis.............................. 642 Inflammation of the Respiratory Organs.................................. 642 Pneumonia........................... 642 Pleuritis.............................. 645 Laryngitis............................ 646 Acute Laryngitis.................... 646 Chronic Laryngitis................. 647 Tracheitis, or Croup............... 648 Acute Bronchitis.................... 648 Chronic Bronchitis................. 649 Phthisis Pulmonalis............... 650 Emphysema of the Lungs........ 653 PAGl Diseases op the Urinary Organs.. 654 Nephritis.............................. 654 Cystitis................................ 654 Bright's Disease..................... 654 Diabetes.............................. 655 Lithiasis.............................. 657 Diseases of the Heart............... 658 Pericarditis........................... 658 Endocarditis......................... 659 Rheumatism.......................... 659 Gout.................................... 660 Eruptive Fevers........................ 660 Variola................................. 660 Varicella.............................. 661 Rubeola............................... 661 Scarlatina............................ 662 Hemorrhages............................ 663 Hemorrhage from the Nostrils... 663 Hemorrhage from the Lungs.... 664 Hemorrhage from the Stomach.. 664 Phlegmasia Dolens................. 665 Diseases op the Brain and Ner- vous System........................... 665 Apoplexy.............................. 665 Paralysis.............................. 666 Epilepsy.............................. 667 Chorea .... ............................ 667 Convulsive Affections of Infants 668 Asthma................................ 669 Neuralgia of the Face.............. 670 Mental Derangement.............. 670 Delirium Tremens.................. 071 Hooping-cough..................... 671 Asphyxia.............................. 672 Diseases of the Stomach and Bowels.................................. 673 Diarrhoea.............................. 673 Cholera Morbus..................... 674 Cholera Epidemica................. 674 Flatulent Colic...................... 677 Bilious Colic......................... 677 Coliea Pictonum..................... 678 Constipation........................ 679 Obstruction of the Bowels....... 679 Prolapsus Ani ....................... 681 Worms in the Alimentary Canal 682 Chronic Diseases of the Skin...... 684 Order 1st. — Vesiculae............ 685 Eczema............... 685 Sudamina............ 685 Herpes............... 685 Scabies .............. 686 Order 2d. — Bullae................. 686 Pemphigus.......... 686 Rupia................. 686 Order 3d. —Pustulae ............. 687 Ecthyma............ 687 Acne.................. 687 24 CONTENTS. PAGE Order 3d.— Impetigo........... 688 Favus................ 688 Order 4th. — Exanthemata....... 689 Roseola............... 689 Urticaria ............ 689 Erythema............ 689 Order 5th. —Papulae............... 690 Lichen............... 690 Prurigo............... 690 PAOJ Order 6th. — Squamae ............ 691 Pityriasis............ 691 Lepra ................ 691 Psoriasis............. 692 Ichthyosis........... 692 Order 7th. —Tuberculae.......... 692 Lupus................ 692 Order 8th.—Maculae ............. 692 Purpura.............. 692 THE MEDICAL STUDENT'S VADE MECUM. PART I. —ANATOMY. Q. What is Anatomy? A. The science of organization. How is it divided ? Into Vegetable and Animal. How is Animal Anatomy divided? Into Human and Com- parative. What is Human Anatomy ? The Anatomy of man. What is Comparative Anatomy ? The Anatomy of all other / animals except man. How is human anatomy divided ? Into Descriptive, or Special, Surgical, General, and Pathological. What is Descriptive, or Special Anatomy ? That which de- scribes the form, size, position, and connections of organs in a healthy condition of the body. What is Surgical Anatomy ? That which treats of the relation of one part to another, and has also been termed Regional Anatomy. What is General Anatomy ? That which treats of the structure of the simple tissues of the body; and is synonymous with Histology. What is Pathological Anatomy ? That which relates to the dis- eased structure of the organs. Under what divisions is human anatomy studied ? Osteology, or a description of the bones. Syndesmology, of the ligaments. Myology, of the muscles. Splanchnology, of the viscera. Aden- nlogy, of the glands. Angiology, of the vessels. Neurology, of the nerves. Dermology, of the skin. What are the ultimate elements of the body ? Carbon, nitro- 3 (25) 26 . ANATOMY. gen, oxygen, hydrogen, phosphorus, sulphur, iron, calcium, sodium, potassium, &c. What are the organic elements? Gelatin, fibrin, albumen, mucus, fat, &c. Skeleton. What are the organs of support to the animal frame ? The bones; they give firmness and strength to the body, afford points of attachment for the numerous muscles, give shape to the animal, and afford protection to some of the more important organs ; such as the encephalon, medulla spinalis, heart, lungs, &c. Their form and disposition are always adapted to the offices they are designed to fulfil. What is the bony framework of the human body called ? Skeleton. What is the natural skeleton ? When the bones are held together by their natural connections of ligaments, cartilages, &c. What is an artificial skeleton ? When the bones are held to- gether by artificial means. Suppose a line, called the median, drawn from the top of the head, downward through the middle of the skeleton, will these two sides be similar ? Yes, the bones of the two sides will be per- fectly alike: and where bones are divided, the two halves will be symmetrical. What are the regional divisions of the skeleton ? Head, Trunk, Superior, and Inferior extremities. What is the number of bones in persons of middle age ? For the trunk—twenty-four true vertebrae, one sacrum, four coccygeal, two innominata, twelve ribs on each side, and one sternum. For the head — eight in the cranium, fourteen for the face, and one hyoid. For the upper extremities — thirty-four to each side. For the inferior extremities—thirty-two to each side. In all two hundred and eleven, not including the bones of the tympanum and teeth. In early life the number is greater, and in old age diminished, by the growing together of bones originally distinct. How are bones divided in regard to their shape ? Into long, short, flat, and irregular. The long bones are found principally in the limbs, and are composed of a shaft and two extremities. Short bones are irregularly cuboidal in form, spongy in texture internally, ANATOMY. 27 with a thin crust externally. The short bones are the vertebras, coccyx, carpal and tarsal bones, patellae and sesamoid bones. Flat bones consist of two layers of dense bone with an intermediate cel- lular structure, which is called diploe. Irregular bones are those which are not distinctly referable to either of the above divisions; but are of a mixed character, being partly short and partly flat. The temporal, sphenoid, ethmoid, superior maxillary, inferior max- illary, palate, inferior turbinated bones, os hyoides, and sacrum present examples of this class. What is an eminence on a bone called ? Apophysis or process when united, and epiphysis when separated by cartilage ; the shaft or body of a bone is termed its diaphysis. What other names are applied to eminences of bone depending upon their shape, situation, and use ? Heads, when convex, roundish, and smooth. Necks, when smaller at the middle, and increased towards the extremity. Condyles, when the head is large and unequally rounded. Tubercles, or tuberosities, when uneven, rough, and irregular. Spines or spinous processes, when sharp or pointed. Cristoe, when there are long and sharp eleva- tions. Coronoid, if the termination is in a sharp edge. Mastoid, styloid, coracoid, &c, from their resemblance to certain other things. Oblique transverse, &c, from relative situations. Tro- chanters, when they serve to turn a bone. What names are given to depressions ? Cotyloid, when deep and cup-like. Alveoli, or sockets, as the sockets for the teeth ; and, glenoid, when superficial. How are bones divided in regard to density? Into compact and cellular; the former is situated externally, and the latter internally. What is the composition of bones ? Animal and earthy matter. The minute analysis of which is gelatin, 32 parts ; phosphate of lime, 51 parts ; carbonate of lime, 11 parts : fluate of lime, 2 parts ; phosphate of magnesia, 1 part; and muriate of soda, 1 part. The bones also contain a little iron, manganese, silex, alumina, am] phosphate of ammonia. Upon which of these primary constituents does the hardness of the bone depend ? The earthy, and may be obtained by calcination. How may the animal part be demonstrated ? By immersion for some time in dilute muriatic acid, the earthy parts will be dissolved, leaving the animal. 28 ANATOMY. What is the structure of bones ? They are composed of two structures, compact and cellular; the former is situated externally, and the latter internally. The compact structure is fibrous, but arranged in lamina. Running through these fibres we have the Haversian canals, which communicate with small lenticular exca- vations known as the lacunce or corpuscles of Purkinje, by pores or tubuli, which also connect these lacuna} together. They are well supplied, through this arrangement, with blood-vessels, nerves, and absorbents. ■ What is meant by Periosteum1? It is the fibrous membrane which surrounds bones except at their articular cartilages, and receives the insertion of tendons, ligaments, aponeuroses, &c.; that portion of this membrane situated on the skull is called peri- cranium. Its use is also to conduct the blood-vessels to the bones, give protection and shape to them, and to secrete bone in the growing state, or in fractures. What is meant by the medullary membrane ? It is a very deli- cate membrane of areolar tissue lining the internal and cellular structure of bone which secretes the medulla, and serves the pur- pose of an internal periosteum. Are bones perfectly ossified at birth ? No: the ends of the long bones are cartilaginous ; the carpus and tarsus are nearly in the same state, and the processes generally are very imperfectly developed. What are the stages of ossification ? There are three. The first is the gelatinous, mucous, or pulpy, which exists during the first month ; second, cartilaginous, commencing with the second month; and third, osseous, or calcific, which commences at the end of the second month in some of the bones : when ossification commences, the color of the cartilage becomes deeper, and in the middle of a yellow color; the vessels dilate, carry red blood, and a red point is perceived in the centre of the cartilage, which is called punctum ossificationis, from which the deposit increases on its surface. The long bones commence by a small ring, which extends itself. The flat irregular bones commence by one or more points, and radiate to the periphery. The short bones may have a single point or several, and they all grow by successive depositions on the outer surface or at the ends. At what age are bones most dense ? At the middle period of ANATOMY. 2e« • the sagittal, which unites the two parietal; the lambdoidal, joining the parietal and occipital; and the two squamous, connecting the squamous part of the temporal and the parietal. In the lambdoidal are frequently found small bones called ossa Wormiana, or Tri- quetra, and occasionally these are found in the other sutures. The uses of the sutures are not fully settled among anatomists and physiologists. What are the principal varieties of sutures? The serrate^ where the union is formed by two borders of different bones pos- sessing serrated edges. The squamous, where the union ia formed by the overlapping of the bevelhsd edges of the two con- tiguous bones. The harmonia, where there is a simple apposition ANATOMY. 39 of contiguous surfaces, being more or less rough and retentive. The schindylesis, where there is a reception of one bone into a sheath or fissure of another. What is the structure of the bones of the cranium ? They are composed of two tables united by cellular substance called diploe, which begins to show itself at two or three years of age. The internal table is thin and brittle, and is called vitreous. How many bones enter into the composition of the Orbit ? Seven; the frontal, the malar, the superior maxillary, the planar plate of the ethmoid, the unguiform, sphenoid, and palate. What are the characteristics of the Nasal Cavity ? Irregular, separated from its fellow by a septum, and has three distinct meatuses or passages. Fig. 4. The superior has the posterior ethmoidal cells,8 the sphenoidal cells, and the spheno-palatine foramen opening into it; its situation is between the superior and middle7 turbinated bones. The middle meatus is found between the middle and inferior turbinated bones,10 with the frontal sinus, anterior ethmoidal cells,8 and the antrum u opening into it. The inferior is between the inferior turbinated bone l0 and the floor of the cavity, is the largest, and has the nasal duct opening into it. The anterior opening is called the anterior nares, and the poste- rior opening the posterior nares. Where is the Zygomatic Fossa situated ? On either side of the head, and is formed by the parietal, sphenoid, temporal, and frontal 40 ANATOMY. bones; the zygoma bounds it externally,.and it is occupied by the temporal muscle. Where is the Pterygo-Maxillary Fossa ? At the bottom of the zygomatic fossa, and is formed by the superior maxillary, palate, and sphenoid bones. Its shape is triangular, base upwards; the ganglion of Meckel is contained in it, and gives off branches which pass through foramina opening upon this fossa. Where is the Os Hyoides situated ? At the root of the tongue within the circle of the lower jaw, and insulated, having no con- nection with any other bone except by muscles and ligaments. It is composed of a body, and a greater and lesser cornu on each side ; and is developed by five points — one for the body, and one for each cornu ; eleven pairs of muscles are attached to this bone. Superior Extremities. How are the superior extremities divided ? They are divided on either side into shoulder, arm, forearm, and hand. What composes the Shoulder ? The clavicle and scapula, which occupy the superior, lateral, and posterior parts of the thorax. What are the characteristics of the Scapula ? It is on the poste- rior part of the thorax, and extends from the second to seventh rib inclusive; it is triangular, has an anterior face called venter, and a posterior face or dorsum, a superior edge or costa, an ex- ternal edge or inferior costa, and a posterior or internal edge, termed the base; has three angles — one superior, one inferior, and the other anterior or external; a spine running from the poste-' rior edge obliquely towards the anterior angle, rapidly increasing until it rises and is elongated forwards and upwards, and overhangs the shoulder-joint, and is called the acromion process; a cervix, coracoid process, and a glenoid cavity, for articulating with hu- merus. It is developed by six centres ; one for the body, one for the coracoid process, two for the acromion, one for the posterior border, and one for the inferior angle ; articulates with the clavicle and humerus ; and has sixteen muscles attached to it viz • —sub- scapularis, supra and infra-spinatus, omo-hyoid, levator ano-uli scapulas, rhomboideus major and minor, serratus magnus Ion. head of triceps, teres minor and major, long and short tendon of biceps, trapezius, deltoid, pectoralis, minor and coraco-brachialis ANATOMY. *» The ligaments attached to the coracoid process are the coracoid, coraco-clavicular, and humeral, and the costo-coracoid membrane. What are the characteristics of the Clavicle ? It is a long bone situated transversely at the superior and anterior parts of the chest, extending from the sternum to the acromion process of the scapula ; it is compared in shape to' the letter /, and is divided into body, sternal, and scapular extremities. It is developed by two centres ; articulates with the sternum and scapula; and has six muscles attached to it, viz: — sterno-mastoid, trapezius, pectoralis major, deltoid, subclavius, and sterno-hyoid. What are the characteristics of the Humerus ? It is cylindrical, both extremities enlarged ; the superior is called its head, which is hemispherical, and attached to the body of the bone by the neck; it has two tuberosities, external and internal, between which is the bicipital groove ; two sigmoid cavities ; one receives the coronoid, and the other the olecranon process of the ulna ; and two condyles. The part between the extremities is termed body. It is developed by seven centres ; articulates with the glenoid cavity of the scapula, and with the ulna and radius; and has twenty-four muscles attached to it. In the motions of the shoulder joint it is suscepti- ble of elevation, depression, advancing, retreating, circumduction, and rotation. What are the bones of the Forearm ? The ulna and radius. What are the characteristics of the Ulna ? It is situated on the in- side of the forearm with the little finger; nearly straight, much larger at the upper than at the lower extremity; the upper or humeral extremity has an olecranon and a coronoid process, with the greater sigmoid cavity between them for articulating with the humerus, and the lesser on the radial surface of the coronoid for articulating with the head of the radius; the lower extremity has a styloid process and an articular surface for articulating with the carpus, and one for articulating with the radius. It is developed by four centres ; articulates with the humerus and radius ; and has twelve muscles attached to it. What are the characteristics of the Radius? It is the rotary bone of the forearm, shorter than the ulna, situated exteriorly to it, and extends from the os humeri to the wrist; it is smaller at the upper than at the lower extremity ; and has a head, neck, tuberosity, and styloid process. It is developed by three centres, 4* 42 anatomy. articulates with the humerus, ulna, scaphoid, and semilunar bones; and has nine muscles attached to it. The forearm executes upon the arm, flexion, extension, and lateral inclination. What composes the Hand? The carpus, metacarpus, and phalanges or digiti. What are the bones of the Carpus ? There are two rows : in the first are the.scaphoides, lunare, cuneiforme, and pisiforme ; in the second are the trapezium, trapezoides, magnum, and unciforme. Where is the Metacarpus situated ? Between the carpus and phalanges of the fingers and thumb, and are five in number. How many Phalanges are there ? Fourteen ; three for each finger and two for the thumb ; the bone adjoining the metacarpus is the first, the middle is the second, and the other the third. Inferior Extremities. What are the bones of each inferior extremity ? The os femoris, tibia, fibula, patella, tarsus, metatarsus, and phalanges. What are the characteristics of the Os Femoris? It is the largest bone in the human body; at its superior extremity it has three well marked eminences, the head, and greater and lesser trochanters ; the head is supported by the neck, which projects from the body of the bone between the trochanters; the line between the trochanters is called the linea quadrata. Its inferior extremity is larger, and divided into two parts, the internal and external condyle. The linea aspera begins broad, rough, and flat, on a level with the trochanter minor; as it descends, it becomes more elevated, and its lower extremity divides into two superficial ridges, one running to each condyle. It is developed by five centres; one for the shaft, one for each extremity, and one for each trochanter ; and has twenty-three muscles attached to it. Its motions consist in extension, flexion, abduction, adduction, rota- tion, and circumduction. What are the bones of the leg? The tibia, fibula, and patella. What are the characteristics of the Tibia? It is on the internal side of the leg, and extends from the thigh to the foot; it is the longest and largest bone in the body, except the femur; the supe- rior extremity is much larger than the inferior ; its inferior internal part is called the internal malleolus. It has also an elevation called ANATOMY. 43 spinous process, and another called the tubercle ; it is developed by three centres ; one for the shaft, and one for each extremity ; and has ten muscles attached to it. Flexion, extension, and partial rotation, are the motions of the leg upon the thigh. What are the characteristics of the Fibula ? It is at the external side of the tibia, and extends from its head to the foot; its inferior and external part is called the external malleolus. This bone is developed by three centres ; and has nine muscles attached to it. The tibia and fibula articulate below with the astragalus. What are the characteristics of the Patella? It is small, inter- mediate to the thigh and leg, and placed on the front of the knee- joint ; its anterior face convex and rough; and its circumference is nearly oval, with the long diameter transverse. How is the foot divided ? Into tarsus, metatafsus, and toes or phalanges. What composes the Tarsus? Seven bones; viz., os calcis, the astragalus, the naviculare, the cuboides, the cuneiforme externum, cuneiforme medium, and cuneiforme internum. Cartilage. ' What are the characteristics of Cartilage ? It is a substance of a white or pearly color, hard, flexible, very elastic, found in various parts of the body, especially on the articular surfaces of bones, the end of the nose, the edges of the eyelids, the ear, wind pipe, end of ribs, &c. It contains no red blood-vessels, nerves, > nor lymphatics. The chemical analysis is : gelatin, 44.5 ; water, 55 ; phosphate of lime, 0.5. How are the cartilages divided? Into articular, or those which cover the surface of bones in movable joints ; the interarticular, or those which are interposed between the ends of bones to form a movable socket; the connecting, or those which unite the articular surfaces of bones by an immovable union, as the sutures of the skull, the connections between the bones of the pelvis, &c. ; and the cartilage of cavities, or those which form the larynx, trachea, part of the nose, &c. What is the membrane surrounding cartilage called ? Peri ^ chondrium, and it is similar to the periosteum. 44 ANATOMY. Of Ligaments. What are the characteristics of the ligamentous or desmoid tissue, called also fibrous tissue ? It may be known by its white- ness, firmness, the unyielding nature of its materials, and its fibrous arrangement. It is very generally diffused in the human body, and has a very close connection with the cellular texture ; it also serves the purpose of connecting the bones in their articulations. The sensibility of this system is extremely obscure ; the usual mechanical and chemical irritants do not affect it; it may, however, be pro- V' duced by a twisting motion, or when under a state of inflammation, as in gout, rheumatism, &c. There are two kinds, the white, found in tendons, fasciae, and most of the ligaments; and the yellow, which is found in the ligamentum nuchas, in many vessels and ducts, and is elastic. What is meant by Ligaments ? They are those organs which tie the bones together, and in the movable joints are divided into the capsular, and the funicular. The first are open at the end, and envelope the ends of the bones, extending from one to the other; the second are mere cords, extending from one bone to' the other, and may be flattened, round, or oval; they may be either internal or external to the capsular ligament; their study is called syndesmology. What are the characteristics of the Fibro or Ligamento-carti- laginous system ? It partakes of the character of both ligament and cartilage, and the constituents of which consist of a strong fibrous matter, intermixed with cartilage. What are the different forms of articulation that are met with in the human body called ? Synarthrosis, amphi-arthrosis, and diarthrosis. In the first of these, the bones are immovably con- nected with each other. Amphi-arthrosis is a joint intermediate, in aptitude for motion, between the immovable synarthrosis and the movable diarthrosis; it is of a mixed character, being partly lined by synovial membrane, and partly by the intervention of inter- osseous ligaments. Examples of this union may be seen in the connection of the vertebras. Diarthrosis is the movable articu- lation : of which we have examples in th& great number of the joints of the body. ANATOMY. 45 What is meant by a Synovial membrane ? It is a membrane lining each movable articulation, reflected over the internal face of the capsular ligament and the articular cartilages ; it is a perfect sac, and differs from the capsular ligament in having no opening in it; it is white, thin, semi-transparent, and soft, belongs to the class of serous membranes, and the fluid secreted by it is called synovia, the use of which is to diminish friction, and facilitate motion. What are the structures entering into the composition of a joint ? Bone, cartilage, fibro-cartilage, ligaments, and synovial mem- brane. What enters into the Articulation of the Lower Jaw? Besides the bones tipped with their cartilages, there is a capsular ligament, an internal, external, and stylo-maxillary ligament, and a small triangular ligament discovered by Caldani, two synovial mem- branes, an interarticular cartilage, and an erectile tissue. The movements of the lower jaw are depression, elevation, a forward and backward movement, and a movement from side to side. Fig. 5. What are the Ligaments of the Vertebrae ? The intervertebral, anterior and posterior* vertebral, a capsular*'1 at the articula- tions of the oblique processes, interosseous, ligamentum nucha?, ligamenta filava (23 pairs) ; between the occiput and atlas are the anterior and posterior, between the second and firs,t vertebrae and the occiput are the lacerti ligamentosi, transverse? with the upper and lower4 appendices, oblique or moderator,6 and middle or straight ligaments. What are the Ligaments of the Pelvis ? The anterior and pos- terior'0 coccygeal, ilio-lumbar, sacro-spinous,9 sacro-iliac,& pos- 46 ANATOMY Fig. 6. terior sacro-sciatic,13'14 anterior sacro-sciatic,16'16 obturator,11 an- terior pubic and the sub or inter-pubic ligaments. What are the Ligaments at the posterior articulation of the Ribs ? The anterior or radiating,2 inter articular* two capsular for the head of each, and one where they are articulated with the transverse processes of the vertebrae, the internal transverse? the external transverse, and middle costo-transverse ligaments. ' What are the ligaments of the anterior articulation of the ribs ? There are two, an anterior' (Fig. 8), a posterior, and the costo- xiphoid ligaments; also a synovial membrane imperfectly developed. What are the ligaments and parts concerned in the articu- lations of the anterior end of the clavicle? The capsular' and interclavicular2 ligaments; an interarticular cartilage;* two 41 Fig. 9. synovial membranes ; and the rhomboid3 ligament, connecting the first rib with the clavicle. What is meant by the Articulation of the Shoulder? It is the junction of the clavicle to the upper part of the sternum and V first rib; of the scapula to the clavicle; and of the humerus to the scapula. What ligaments are concerned in the scapuloclavicular articu- tions? The capsular, the coraco-clavicular2 which is divided into the conoid and trapezoid, bifid, coracoid,4 and the triangular3 ligaments, or coraco-acromialis.3 What ligaments are concerned in the scapulo-humeral articulation ? The capsular,5 the long head of the biceps,"1 coraco-humeral6 or ligamentum adsci- titium,6 and the glenoid ligament, which surrounds the glenoid cavity. This joint is capable of every variety of mo- tion, viz : — of movement forwards and backwards, of abduction and adduction, of circumduction and rotation. What are the ligaments of the elbow joint? The capsular1 (Fig. 10), an- nular,5'6 and3 (Fig. 11), or coronary external* (Fig. 10), and internal late- ral2'2 (Fig. 11), ligaments. What ligaments are situated between the radius and ulna? The interosseous5 (Fig. 11), the round* (Fig. 11), ligaments (or liga- mentum teres*), and the capsular (Fig. 11), or sacciform at their lower extremities. 48 Fig. 10. Fig. 12 What are the ligaments of the wrist-jcint ? The internal5 (Fig. 12) and external6 lateral, capsular,6 dorsal, radio-ulnar,2 and palmar3 ligaments. The movements of the joint are flexion, ex- tension, adduction, abduction, and circumduction. There are also ligaments connecting the second row of the carpus with the meta- carpus;8 a capsular ligament9 for the carpo-metacarpal joint of Fig. 13. the thumb, and one for the meta- carpo-phalangial joint,10 and an external lateral " for the same joint; a capsular ligament12 of the metacarpo-phalangial articu- lation of the index finger, late- ral1313 ligaments for similar articulations, and inferior pal- mar 14-14 ligaments. What are the ligaments of the iliofemoral (Fig. 13) or hip arti- culation? The cotyloid, which tips the margin of the acetabulum, the interarticular or round and the capsular9 ligament The ANATOMY. 49 movements are flexion, extension, adduction, abduction, circumduc- tion, and rotation. The cut represents the sacro-vertebral,2 the ilio- lumbar,3 the anterior portion of the sacro-iliac* The lower part of the anterior vertebral,1 PouparVs ligament,6 and that portion of it called GimbernaVs,'1 the accessory9 of the hip-joint, and the obturator5 ligaments. What are the ligaments and parts concerned in the knee-joint? The capsular ligament, or involucrum generate, the ligament of the patella8 (Fig. 15), a posterior1 (Fig. 14), or ligament of Fig. 14. Fig. 15. Fig. 16. Winslow1 (Fig. 14), internal5 and external6 lateral (Fig. 14), and two crucial2'3 (Fig. 15) ligaments. This joint has also two semilunar cartilages6''' (Fig. 15), and its motions are those of flexion and extension. The superior peroneo-tibial articulation l0 (Fig. 15), and the interosseous ligament; " the posterior superior peroneo-tibial ligament9 (Fig. 14). Fig. 16 represents a longi- tudinal section of the knee-joint, showing the cellular structure of the lower end of the femur and tibiae,' the patella3 with its liga- ment,4 the large bursas6 under it, the ligamentum mucosum,10 the anterior crucial ligament," and the tendon of the quadriceps femoris.2 How are the tibia and fibula united together ? They are united superiorly by an anterior and posterior ligament, and a synovial membrane; inferiorly also by an anterior and posterior liga- 5 D 50 ANATOMY. ment; and the bodies of these bones are united by an interosseous ligament. _ What are the ligaments of the ankle-joint ? An ^perfect cap- sular. an internal, and an external lateral ligament. What ligaments connect the os astragalus and os calcis. lhe interosseous, posterior, and deltoid ligaments. What connects the astragalus with the scaphoides? It is connected above by a broad thin ligament; below by two ligaments, internal and external calcaneo-scaphoid, °What connects the calcis with the cuboides ? The superior and inferior calcaneo-cuboid ligaments. Of the Integuments. What is meant by the integuments of the body ? The cellular and adipose substances, and the dermoid covering. What are some of the properties of cellular tissue ? It is an elementary tissue, generally disseminated over the whole body; found beneath the skin ; between muscles ; connecting membranes and other parts; entering into their composition ; indispensable to their texture; and precedes them in the development of the foetus. It is composed of cells which communicate freely with each other, and may be distended either with air or other fluids, and from its elasticity when the distension is removed it will return to its original shape. Where is the adipose structure found ? Between the skin and the fascia, in the layers of condensed cellular substance, next to the muscles, as the face, neck, trunk of the body, buttocks, limbs, palms of the hands, soles of the feet, &c. In chemical composi- tion— for which, see Animal Chemistry — it differs from all other parts of the body in containing no nitrogen. It is enclosed by cellular substance. What is meant by the dermoid covering? The skin; its sebaceous and perspiratory organs; the nails; and the hair. How many lamina does the skin consist of ? Two, the cutis vera, and the cuticula. What was formerly called rete mucosum, and which contains the coloring matter, is merely the deeper ot more recently formed portion of the cuticle or epidermis. ANATOM Y. 51 What is understood by the sebaceous organs ? The follicles and glands which furnish the oily exhalation that lubricates the surface of the skin. What is meant by the perspiratory organs? They are bodies called sudoriparous glands, contained in the cutis vera and subcu- taneous cellular tissue. They each consist of a cylindrical tube, generally extending from the under surface of the true skin to the surface of the cuticle. The first portion is tortuous, and collected into a small spherical ball surrounded by fat vesicles, from which the tube proceeds in an irregular and tortuous manner to the surface, and opens by a conical orifice on the ridges of the cutis vera made by the papillas tactus. What are the nails ? They may be considered as a continuation of the cuticle, supply its place on the extremities of the fingers and toes, and correspond with the talons and hoofs of animals. They are devoid of organization. Each one consists of a root, a body, and a free extremity. What are the hairs? They are cylindrical filaments found on most parts of the skin excepting the palms and soles. They have no blood vessels or nerves, but probably have a species of intersti- tial circulation. Of Muscles. What are the properties of muscles ? They are the organs of motion, and are characterized by redness, softness, irritability, contractility, and by being formed of long, parallel fibres, which are arranged into fasciculi; each fibre extending the whole length of the muscle, considering the length as represented by the ten- dinous beginning on one hand, and the tendinous termination on the other. How are they divided ? Into voluntary and involuntary. What is meant by the myotility of muscles ? It is their power of contraction, elongation, and remaining fixed. What does a muscle consist of? A belly and two extremities; the one that is fixed is called the head or origin, and the other is the tail or insertion. Those which surround orifices are called 52 A \ A T O M Y. sphincters. The belly or body is the fleshy part, and .he extremi- tics are tendinous. In the most simple muscles, the fibres run m the direction of their length, and are termed fusiform. Those which run obliquely from a tendon or bone are called semi-pennah. Those which converge obliquely to a tendon in the centre are called pennati. Others again are formed of a congeries of smaller muscles, the fibres of which run in different directions and intermix with tendinous matter, as the deltoid and subscapular. Muscles are composed of bundles of fibres, each consisting of filaments; the filaments are divisible into fasciculi, and each fasciculus con- sists of a number of primitive particles or sarcous elements held together by a tough, delicate, and elastic membrane called sarco- lemma. They are well supplied with blood-vessels and nerves. Various stimuli applied to muscular fibre will cause contraction. The general phenomena manifested by, or capacity of a muscle, are termed myotility ; they are contraction, elongation, and power of remaining fixed. Upon what does the strength of a muscle depend ? Upon the number of its fibres; so that those whose fibres run obliquely are stronger than those which run longitudinally. How are tendons distinguished ? By their white and shining appearance; they have no elasticity or power of elongation or contraction ; they have two general shapes : funicular, or like cords ; and membranous,2 or resembling an aponeurosis. Trunk. Abdomen. Where is the fascia superficialis abdominis situated ? Beneath the skin of the abdomen, and consists of a layer of condensed cellu- lar substance. It is laminated, admits of being dissected into layers, and encloses the lymphatic glands in the groin. What are the origin, insertion, and use of the following muscles? Obliquus externus.'2 (See Fig. 17.) Origin, eight or nine inferior ribs. Insertion, ensiform cartilage, linea alba pubis, A NATOM Y. 53 Poupart's ligament,14 and anterior two-thirds of the crest of the ilium. Use, to compress the abdomen. Obliquus internus.'8 Origin, fascia lumborum, crest of ilium, and external third of Poupart's ligament. Insertion, into the cartilages of the seven inferior ribs, ensiform cartilage, linea alba, symphysis, and upper edge of the pubis. Use, to bend the body and compress the abdomen. Fig. 17. Cremaster. Origin, Poupart's ligament and obliquus internus Insertion, tunica vaginalis testis, and scrotum. Transversalis. Origin, fascia lumborum, crest of ilium, Poupart's ligament, and seven lower ribs. Insertion with the obliquus internus. Use, to compress the abdomen 5* 54 ANATOMY. Rectus.'6 Origin, pubis. Insertion, ensiform cartilage, and to the cartilages of the fifth and sixth ribs. Use, to bend the trunk, and compress the abdomen. Pyramidalis." Origin, pubis. Insertion, linea alba. What other parts are exhibited by Fig. 17 ? Common tendon of the internal oblique and transversalis ;19 crural arch ;w fascia lata femoris;21 saphenus opening, external abdominal ring,5 and PouparVs ligament.'* Where is the fascia transversalis situated ? It covers the abdomen, lies under the muscles and in front of the peritoneum ; it is continuous with the iliac fascia which surrounds the posterior part of the peritoneum, and the pelvic fascia which surrounds that portion of peritoneum in the cavity of the pelvis. The internal abdominal ring is situated in it. The term ring is liable to be misunderstood ; it means here simply that point where the fascia transversalis ceases to cover the abdomen, and com- mences to cover the cord ; it is very thin at this place, and an artificial dissection may readily form an opening or ring with a well defined edge, although it does not exist in the natural state of the parts. Fig. 18. Diaphragm1'2-3 (Fig. 18). The greater muscle. Origin, xiphoid cartilage, the cartilages of the last true and all the fals* ANATOMY. 55 ribs. Insertion, cordiform tendon.—The lesser muscle or crura,8'10, Origin, the bodies of the first four lumbar vertebrae. Insertion, cordiform tendon. What parts are to be noticed about the dia- phragm ? The ligamentum arcuatum,5 point of origin of the psoas magnus,6 the small triangular space behind the sternum4 covered only by serous membrane, and through which hernias sometimes pass; hiatus articus," foramen oesophageum,12 foramen quadratum,13 and a small opening for the lesser splanchnic nerves.7 Quadratus lumborum.'5 Origin, spine of ilium. Insertion, transverse processes of lumbar vertebrae, and last dorsal. Use, to bend the trunk to one side and forwards. Psoas muscles.'* Origin, the lumbar and dorsal vertebras, Insertion, cavity of the pelvis, and lesser trochanter. Iliacus internus. Origin, transverse process of last lumbar ver- tebra, crest of ilium, and iliac fossa. Insertion with the psoas muscles into the femur. Use, to bend the thigh and body. What are the muscles of the male perineum ? Sphincter ani,* externus and internus, erector penis,2 accele- rator urince' or ejaculator seminis, transversus perinei,3 levator ani,5 compressor urethral, and coccygeus.6 What are the muscles of the female perineum ? Sphincter vagince,''2'' erector clitoridis,3'* transversus perinei,5'" levator ani,1 sphincter ani.9 68 ANATOMY. Fig. 20. ANATOMY. 57 Fig. What are the origin, insertion, and use of the following muscles ? Trapezius.''2 Origin, occipital bone, ligamentum nuchae, last cervical, and the dorsal vertebras. Insertion, clavicle, acromion process, spine of the scapula. Use, to draw the parts in the several directions of its fibres. Latissimus dorsi.* Origin, dorsal spines, fascia lumborum, sacrum, ilium, and three or four last ribs. Insertion, humerus. Use, to draw the os humeri downwards, and backwards. Rhomboideus major and minor."''2 Origin, ligamentum nuchae, and dor- sal spines. Insertion, base of the sca- pula. Use, to draw the scapula up and back. What other muscles are situated on the back ? Levator anguli scapulae,'0 splenius capitis'3 and colli,'* sacro-lum- balis2 fFig. 22J, longissimus dorsi3 spinalis dorsi* (Fig. 22), musculi ac- cessorii, cervicalis descendens,5 trans- versalis cervicis,6 trachelo-mastoideus,1 complexus,% semi-spinalis colli" and dorsi,'" multifidus spinas,'6 rectus capi- tis posticus major'3 and minor,'2 ob- liquus superior '* and inferior,'3 interspinales, intertransversarh, levatores costarum,'1 spinalis dorsi* serratus major anticus,22 and serratus inferior posticus'6 (Fig. 21). Thorax. (See Fig. IT.) What are the origin, insertion, and use of the following muscles ? Pectoralis major.' Origin, sternal half of clavicle, anterior sur- face of sternum, cartilages of the third, fourth, fifth, and sixth true ribs. Insertion, humerus, anterior edge of bicipital groove. Use, to draw the arm inwards, forwards, and to depress it. Pectoralis minor.6 Origin, upper edge of fourth, fifth, and 58 ANATOMY. sixth ribs. Insertion, coracoid process of scapula. Use, to draw it in, and down. Subclavius.5 Origin, first rib. Insertion, clavicle. Serratus magnus.*''0 Origin, eight or nine superior ribs. In- sertion, base of scapula. Use, to draw it forwards. Intercostales external." Origin, eleven inferior ribs at their external, inferior edges. Insertion, superior edge of ribs beneath. Infernal. Origin, eleven ribs internally, from the lower edge of each. Insertion, inner lip of the rib beneath. Use, to draw the ribs together. Triangularis sterni. Origin, lower part of sternum. Insertion, cartilages of fourth, fifth, and sixth ribs. Use, to diminish the cavity of the thorax, pectoralis minor.6 Neck. Fig. 23. What art the origin, insertion, and use of the platysma my- oides?'9 (Fig. 24.) Origin, cellular membrane over deltoid and pectoral muscles, and from the clavicle. Insertion, chin and fascia of the lateral and inferior parts of the face. Use, to elevate tlifl skin of the neck. Sterno-cleido-mastoideus'3''2". Origin, sternum and clavicle. ANATOMY. 59 Insertion, mastoid process and transverse ridge of the occipital bone. Use, to draw the chin towards the sternum. What other muscles are there of the neck, the names of which mostly indicate their attachment ? Sterno-hyoideus, sterno-thy- roideus, thyreo-hyoideus, omo-hyoideus, mylo-hyoideus,'* stylo- hyoideus* stylo-glossus,9 stylo-pharyngeus,'0 genio-hyoideus, longus colli, rectus capitis anticus major, minor, and lateralis, scalenus anticus,20 medius21 and posticus.2' Head. Face. Fig. 24. What are the origin, insertion, and use of the occipitofron- tal?' Origin, superior transverse ridge of the occipital bone and mastoid process. Insertion, integuments and muscles of eye- brows. Use, to corrugate the forehead and elevate the supercilia. Corrugator supercilii. Origin, internal angular process of os 60 ANATOMY. frontis. Insertion, middle of eyebrow. Use, to draw the lower part of the forehead into vertical wrinkles. Compressor naris.5 Origin, root of ala nasi. Insertion, into its fellow, and lower part of os nasi. Orbicularis palpebrarum.2 Origin, nasal process of os maxil- lare superius, internal angular process of os frontis, and from os unguis. Insertion, orbitar and nasal processes of maxillary bone and palpebral ligament. Use, to close the eyelids. Levator labii superioris et alee nasi6 Origin, nasal and orbitar processes of superior maxillary bone. Insertion, side of ala nasi, and upper lip. Use, to draw the upper lip and ala nasi upwards. Levator anguli oris.7 Origin, anterior part of superior maxih lary bone. Insertion, corner of the mouth. Use, to raise the angle of the mouth. Zygomaticus major and minor*-9. Origin, fore part of malar bone. Insertion, corner of the mouth. Use, to draw the corner of the mouth towards cheek bone. Depressor labii superioris et alee nasi." Origin, inferior part of upper maxillary bone. Insertion, side of ala nasi and contigu- ous part of upper lip. Use, to depress the upper lip and ala nasi. Depressor anguli oris.'5 Origin, base of lower jaw. Insertion, corner of mouth. Use, to draw the corner of mouth downwards. Depressor labii inferioris.'6 Origin, basis of lower jaw. In- sertion, side of lower lip. Use, to draw the lower lip downwards, Levator menti et labii inferioris. Origin, incisive fossa of lower jaw. Insertion, integuments of the chin. Use, to raise the integuments of the chin. Buccinator.'2 Origin, coronoid process of lower maxilla and back part of upper maxilla. Insertion, corner of mouth and con- tiguous parts of upper and lower lips. Orbicularis oris. '3 This is a sphincter muscle which surrounds the mouth ; consequently, it has neither origin nor insertion. Lower Jaw. Temporalis. Origin, semicircular ridge on parietal bone, tem- poral fossa, and fascia. Insertion, coronoid process of lower jaw. Use, to pull it directly up. ANATOMY. 61 Masseter.'0 Origin, superior maxillary bone and zygoma. In- sertion, outer surface of angle of lower jaw. Pterygoideus internus. Origin, internal side of external ptery- goid plate. Insertion, inner side of angle of lower jaw. Use, to ylose the jaw and produce a grinding motion. Pterygoideus externus. Origin, outer side of external ptery- goid plate. Insertion, internal part of neck of lower jaw. Use; same as former. Digastricus''2 (Fig. 23). Origin, groove at base of mastoid process; in its course it is attached to the os hyoides by a liga- ment. Insertion, inner side of base of jaw. Use, to open the mouth. Upper Extremity. Shoulder. What are the origin, insertion, and use of the following muscles ? (See Fig. 21.) Deltoides. Origin, lower edge of spine of scapula, acromion, and outer third of clavicle. Insertion, humerus, near its middle. Use, to raise the arm. Supra-spinatus.'7 Origin, scapula above its spine. Insertion, great tuberosity of humerus. Use, to raise the arm and turn it out. Infraspinatus. '8 Origin, scapula below the spine. Insertion, great tuberosity of humerus. Use, to roll the arm. Teres minor.'9 Origin, inferior costa. Insertion, great tube- rosity of the humerus. Use, to rotate and draw the arm down and back. Teres major.20 Origin, inferior angle of scapula. Insertion, inner edge of bicipital groove. Use, to rotate the arm inwards, and draw it back. Subscapularis.* Origin, subscapular fossa. Insertion, small tubercle of humerus. Use, to draw the arm down and roll it in. Arm. Biceps.2'9'5''220'2' Origin, coracoid process and edge of glenoid cavity. Insertion, tubercle of radius. Use, to flex the forearm. 6 62 ANATOMY. Fig. 25. FiS" 26> Coraco-Brachialis." Origin, coracoid process. Insertion, in- ternal side of humerus near the middle. Use, to draw the arm up and forward. Brachialis internus.'9''7 Origin, centre of humerus. Insertion, coronoid process of ulna. Use, to flex the forearm. Triceps extensor cubiti.'6 Origin, neck of scapula, outer side of humerus, ridge leading to internal condyle of humerus. In- sertion, olecranon process. Use, to extend the forearm. Forearm. What class of muscles take origin from the internal condyle and anterior part of ulna ? The fexors and pronators. ANATOMY 63 What are the flexors and pronators ? Pronator radii teres* flexor carpi radialis,5 palmaris longus,6 flexor carpi ulnaris.8 Flexor digitorum sublimisperforatus.7 Origin, inner condyle and radius. Insertion, second phalanx. Use, to bend the second phalanx. Flexor digitorum profundus per for ans. Origin, ulna, radius, and interosseous ligament. Insertion, last phalanx. Flexor longuspollicis. Origin, radius. Insertion, last phalanx of thumb. Pronator radii quadratus. Origin, anterior surface of ulna. Insertion, anterior part of radius. What class of muscles take origin from the external condyle and posterior part of ulna ? The supinators and extensors. What are the supinators and extensors? Supinator radii longus,'3 extensor carpi radialis longior and brevior, extensor carpi ulnaris, extensor digitorum communis, supinator radii brevis, extensor ossis metacarpi pollicis manus,'* extensor minor pollicis manus, major pollicis manus, and indicator. Inferior Extremity. Thigh. What are the origin, insertion, and use of the following muscles ? Tensor vaginae femoris* (Fig. 28). Origin, ilium. Insertion, fascia lata. Sartorius.5 Origin, anterior superior spinous process of ilium Insertion, upper end of tibia. Use, to bend the leg and draw it obliquely in. Rectus femoris.6 Origin, anterior inferior spinous process and margin of acetabulum. Insertion, patella. Vastus externus.7 Origin, below trochanter major and outer edge of linea aspera. Insertion, unites with rectus. Vastus internus.8 Origin, on a level with trochanter minor and from inner edge of linea aspera. Insertion, unites with rectus. Criorcus. Origin, anterior and external part of femoris. In- sertion, unites with rectus. Use of these four to extend the leg. 64 anatomy. Gracilis.15 Origin, symphysis and descending ramus of the pubis. Insertion, internal surface of tibia. Use, to flex the leg. Pectineus.'2 Origin, horizontal portion of pubis. Insertion, upper part of linea aspera. Use, to draw the thigh inwards and forwards. Adductor longus.'3 Origin, anterior surface of pubis. Inser- tion, middle third of linea aspera. Adductor brevis. Origin, anterior inferior surface of pubis, Insertion, superior third of linea aspera. Adductor magnus.'* Origin, descending ramus of pubis, ramus and tuberosity of the ischium. Insertion, internal condyle and ridge leading to linea aspera. Use, these three muscles draw the thigh inwards. ANATOMY. 65 Glutceus maximus.9 Origin, posterior third of spine of ilium, sacrum, os coccygis, and sacro-sciatic ligament. Insertion, be- tween trochanter and linea aspera, linea aspera and fascia lata. Use, to draw the thigh back and keep the trunk erect. Glutceus medius.3 Origin, spine of ilium and dorsum. Inser- tion, great trochanter. Use, to draw the thigh back and out. Glutceus minimus. Origin, dorsum of ilium. Insertion, great trochanter. Use, to abduct the thigh and rotate the limb inwards. Pyriformis9 (Fig. 2*7). Origin, sacrum, sciatic ligament, and ilium. Insertion, root of trochanter major. Use, to rotate the limb in. Gemini.'2 Origin, one from root of the spine of ischium, the other from tuberosity. Insertion, root of trochanter major. Use, to rotate the limb in. Obturator internus." Origin, pelvic margin of foramen thyroi- deum, its membrane and plane of the ischium. Insertion, fossa of trochanter. Use, to rotate the limb out. Quadratus femoris.'3 Origin, tuber ischii. Insertion, great trochanter and line leading to the lesser. Use, to rotate the limb out. Obturator externus. Origin, obturator ligament. Insertion, fossa at root of trochanter. Use, to rotate the thigh out. Biceps flexor cruris.'6 Origin, long head, tuber ischii; short head, linea aspera low down. Insertion, head of fibula. Use, to flex the leg. Semi-tendinosus.18 Origin, tuber ischii. Insertion, tibia. Use, to flex the leg. Semi-membranosus. Origin, tuber ischii. Insertion, external condyle of femur, and head of tibia and fibula. Use, to flex the leg. Leg. Tibialis anticus.3 (Fig. 29). Origin, head and spine of tibia, interosseous ligament. Insertion, great cuneiform bone and first metatarsal. Use, to present the sole obliquely in. Extensor longus digitorum pedis.* Origin, heads of tibia, fibula, and interosseous ligament. Insertion, last phalanx of the four external toes. Use, to extend the toes. Peroneus tertius.6 Origin, fibula. Insertion, metatarsal bone of little toe. Use, to bend the foot. 6* E 66 ANATOMY. FiC. 10 Fig. 30 Extensor proprius pollicis pedis5 Origin, middle third of fibula and tibia. Insertion, second phalanx of great toe. Use, to extend it. Peroneus longus.7 Origin, head of fibula and tibia. Insertion, metatarsal bone of great toe and internal cuneiform. Use, to extend the foot and incline the sole outwards. Peroneus brevis.8 Origin, lower half of fibula. Insertion, base of metatarsal bone of little toe and cuboid bone. Gastrocnemius.'0 Origin, upper and back part of condyle of femur and ridge above it. Insertion, os calcis. Soleus.9 Origin, external head from superior third of fibula; internal head, middle third of tibia, unites with the above and forms the tendo-Achillis. Insertion, os calcis. Use, to extend the foot. ANATOMY. 67 Planiaris. Origin, back part of femur. Insertion, os calcis. Popliteus.6 Origin, depression on outer condyle. Insertion, upper part of tibia. Flexor longus digitorum pedis perforans.7 Origin, flat surface of tibia, fascia, &c. Insertion, last phalanx of four lesser toes. Flexor longiis pollicis pedis.9 Origin, inferior part of fibula. Insertion, last phalanx of great toe. Tibialus posticus.8 Origin, tibia, fibula, and ligament. Inser- tion, os naviculare. Use, to extend the foot, and present the sole inwards. Organs of Digestion. What are the organs of digestion ? The organs of digestion Fig. 31. ( p A NATO MY. consist iu an uninterrupted canal extending from the lips to the anus, and of numerous glandular bodies placed along its course. This canal, called alimentary, is divided into three portions, the superior, middle, and inferior. The superiors composed of the J mouth, pharynx, and oesophagus ;'-2 the middle, of the stomach1 and small intestine;^6'6 the inferior, of the large intes- tine.9''0'"''2'13''* The glandular bodies are the salivary glands, pancreas, liver, spleen, and a large number of muciparous glands extending along the whole course of the canal. Fig. 32. Teeth. What are the characteristics of the teeth ? They are the hardest portions of the body, and bear an analogy to bone. The greater part of their length is implanted into the alveolar processes of the jaws; this part is called the root; beyond this is a portion em- braced by the gum called the neck; and the free or projecting part is the body or corona, What is the number of teeth in the adult? Thirty-two ; sixteen in each jaw, and are classified from their shape into eight incisors, four cuspated, eight bi-cuspated, and twelve molar. Of what are teeth composed ? They are composed of three substances, one of which is ivory, or 6one-like, called dentine;2 one is enamel;3 and the other is called crmta petrosa, or cementum.' The enamel forma the periphery of the body of a tooth," as is known by its whiteness, brittleness, semi- transparency and hardness. It is fibrous, and the fibres are placed so as to pass from the surface towards the centre of the tooth, so that the friction is applied against their extremities. Its composition is principally phosphate of lime with a small portion of gelatin. The osseous portion is the im>- abnndant; it forms the root, neck and body, except the crust of enamel on its periphery. ANATOMY. 69 The cement covers all the surface of the tooth that is not invested with enamel. Internally there is a cavity,4 filled with a soft pulpy matter, which receives an artery, a vein, and a nerve. The arteries of the teeth of the upper jaw come from the alveolar and infra-orbitar, and the nerves from the second branch of the { fifth pair; the arteries of the lower teeth come from the internal maxillary, and the nerves from the third branch of the fifth pair. What is understood by the deciduous teeth? They are teeth peculiar to infants, and are twenty in number, ten in each jaw; on either side are two incisors, one cuspidatus, and two molares. Some of them fall out about the seventh year, and all of them by the fourteenth. The order of their appearance is as follows : — Two central incisors, from the sixth to the eighth month. Two lateral incisors, from the seventh to the tenth month. The first molar on each side, from the twelfth to the fourteenth month The cuspated, from the fifteenth to the twentieth month. The second molar, from the twentieth to the thirtieth month. At birth there are the rudiments of fifty-two teeth in the two jaws ; twenty deciduous and thirty-two permanent. How are the deciduous teeth removed ? By the absorption of the roots. Tongue. Where is the tongue situated ? Fig. 33. It extends from the os hyoides pos- teriorly to the incisor teeth anteri- orly. It is divided into base, body, and tip. What muscles compose the tongue ? The styloglossus,3 hyo- glossus* genio-hyoglossus,5'6'7 and lingualis9 form the principal bulk; besides these there are the superfi- cial lingual muscle, transverse lingual muscles,w and the vertical lingual muscles, which are small fibres running in different direc- tions, as their names indicate. 70 ANATOM Y. How art the papillce of the tongue divided ? Into papillae maxima? or capitatce, mediae, villosce, and filif ormes ; and occupy the anterior two-thirds of this organ. What other parts are there to remark about the tongue ? The frcena-epiglottidis, frcenum linguae, foramen caecum, and raphe. The tongue is supplied with arteries principally from the lingual branch of the carotid ; and with nerves from the hypoglossal, the fifth pair, and the glossopharyngeal. Palate. WThat composes the palate ? It is composed anteriorly by the palatine processes of the superior maxillary and palatine bones, covered by the lining membrane of the mouth below, and pituitary membrane above ; posteriorly is a membranous portion called the soft palate, which has an oblong shape and continued from the hard palate posteriorly; in its centre is the uvula, from which proceed the two crescentic doublings called the lateral half arches, which are divided into anterior and posterior. In the depression between these is the tonsil gland. The space bounded in front and behind by these lateral half arches, is the fauces ; and the anterior opening into it is the isthmus of the fauces. The muscles of the palate are the isthmi constrictor faucium, palato-pharyngeus, circumflexus, or tensor palati, levator palati, and azygos uvulae. Glands. How are the glands of the mouth divided ? Into muciparous and salivary. What are the muciparous glands ? They are the labial, buccal, lingual, palatine, and the tonsils. The buccal, labial, and palatine are, properly speaking, salivary glands. What are the salivary glands ? The parotid, its excretory duct is called the duct of Steno; it is the size of a crow quill, and opens opposite to the second large molar tooth of the upper jaw • the submaxillary, its duct is called the duct of Wharton • and the sublingual, its duct is called ductus Riviniani. ANATOMY. 71 Pharynx. What are the characteristics of the pharynx ? It is a large membranous cavity, situated between „. „. J Fig. 34. the cervical vertebrae and posterior part ^-^1—^ of the nose and mouth, and extends \^~ ttk from the base of the cranium to the lower part of the cricoid cartilage and fifth cervical vertebra, where it is con- tinued into the oesophagus ; it has seven foramina opening into it, viz. : poste- rior nares, two; Eustachian tubes, two ; mouth, larynx, and oesophagus. It consists of three coats; the external or muscular is composed of three mus- cles on each side, one above the other — a cellular, intermediate, and an in- ternal, or mucous coat. The muscles forming the muscular coat are the con- strictors inferior,1 medius, and supe- rior.3 The arteries which supply it are the superior and inferior pharyngeal on each side. WThat are the characteristics of the (Esophagus2 (Figs. 31 and 37) ? It is a tube continuous with the pharynx, in front of the spine, behind the trachea, ten or twelve Hues in diameter, increases in size from above downwards, and ter- minates at the cardiac orifice of the stomach, at a point opposite the tenth s' dorsal vertebra. In the thorax, it passes down in the posterior mediastinum, with the aorta on the left, and the vena azygos on the right. It has three coats, the muscular, cellular, and mucous, and is united .to adjacent parts by loose cellular substance. The muscular coat consists of two laminae, the longitudinal and the cir- cular. Its arteries are derived from the inferior thyroid, the tho- racic aorta, and the gastric. 72 ANATOMY. Abdomen. How is the abdomen bounded? Inferiorly by the iliaci inte the psoas, and levator ani muscles; on the front and sides by Fig. 35. five pairs of abdominal muscles ; posteriorly by the lesser muscles of the diaphragm, quadrati lumborum, the lumbar vertebras, and the sacrum. How many kinds of viscera are contained in the cavity of the abdomen ? Three : one is engaged in digestion and assimilation, another in the secretion and excretion of urine, and the third in generation. % How is the abdomen divided? Into arbitrary regions : consider a line or plane as extending across the abdomen about two inches below the umbilicus from the superior part of the crista of one ilinm ANATOMY. 73 to the corresponding point of the other side.1'1 Draw on each side a line perpendicular to the first by commencing at the ante- rior inferior spinous process of the ilium, and carry it up to the diaphragm:23 then extend a fourth line across the abdomen pa- rallel with the first, and intersecting the two last where they strike the cartilages of the ribs.4'4 It is seen that these four lines or planes, with the assistance of the parietes of the abdomen, furnish nine regions. The central one above is called the epigastric, and the lateral the right and left hypochondriac.5'5 The central in the middle is the umbilical,7 and the lateral the right9 and left1' lumbar. The central below is the hypogastric,9 and the lateral the right'° and left'° iliac. The scrobiculus cordis, or pit of the stomach, is the hollow in the epigastric region. The regio pubis " is the region for two inches around the symphysis pubis. These two last are termed subordinate divisions. What position relative to these regions does the liver occupy? Nearly the whole of the right hypochondriac, the upper half of the epigastric, and the right superior part of the left hypochondriac. Where is the spleen situated ? In the posterior part of the left hypochondriac region. Where is the stomach2 (Fig. 36) situated ? Moderately dis- tended, it occupies the lower half of the epigastric region and the right inferior portion of the left hypochondriac. Where is the small intestine3 situated? Moderately distended by flatus, it occupies the umbilical region, the hypogastric, portions of the iliac on each side, and also the upper part of the cavity of the pelvis, when its viscera are empty. Where is the large intestine* situated ? It begins in the right iliac region, ascends through the right lumbar and right hypochon- driac, passes into the lower part of the epigastric, or upper part of the umbilical, according to the state of distension of the stomach, thence into the left hypochondriac, left lumbar, and left iliac, passes into the pelvis, and descending in front of the sacrum, terminates in the anus. Where is the pancreas6 situated ? Transversely in the lower back part of the epigastric region, extending from the left hypo- chondriac to the right side of the spine, and is placed behind the stomach, which covers it. 7 74 ANATOMY. Fig. 36. Where are the kidneys and capsules resales situated ? In the posterior part of the lumbar re- gions on each side of the spine. Where are the urinary bladder "> and rectum7 situated? In the cavity of the pelvis, and between them in the female are the uterus, ovaries, and vagina. What is understood by the peri- toneum ? It is a serous membrane lining the abdomen and reflected over the periphery of nearly all the viscera. It is a complete sac, with no opening into it, except in the female through the Fallopian tubes. What are the processes of the peritoneum ? There are four, and are known by the general name of omentum, epiploon, or caul. They are called omentum minus, or he- patico-gastricum,'2 omentum ma- jus or gastro - colicum,13'14' '■"*'' omentum colicum,'8 and the omen- tum gastro-splenicum, besides some other smaller reflections. What are the characteristics of serous membranes? They are thin, transparent, and white, resemble compressed cellular mem- brane, invariably assume the form of perfect sacs, are distinct one from another, and secrete a serous fluid for the lubrication of their internal surfaces. Chylopoietic Viscera. Stomach. What are the characteristics of the stomach ? It is a hollow viscus, situated in the epigastric region, of a conoidal shape, curved upwards, and presents two faces, two orifices, two curvatures and two extremities. The faces are called anterior and posterior A NATOMY. 75 Fig. 37. The orifices are named cardiac and pyloric. The curvatures are the small3 and great, or upper and lower. It has four coats or laminas, viz: peritoneal, muscular, cellular, and mucous. Its muscular coat is collected into fasciculi, and pass in three directions, longitudinal, circular, and oblique. The glands of Brunner are situated near the cardiac and pyloric orifices. It is very vascular; its arteries being branches of the coeliac, are the gastric, right and left "•; tro-epiploic, and the vasa brevia. The first to the lesser curvature ; the second and third along the great curvature; and the last, from four to six in number, to its great cul-de-sac. The veins terminate in the vena portarum. Its nerves come from the par vagum and the semilunar ganglion of the sympathetic. 76 ANATOMY. Intestines. What is the length of the intestinal canal from the pylorus to the anus? From thirty to thirty-five feet; and is divided by anatomists into the small and the large intestine. Wliat are the characteristics of the Small Intestine V'6'6'6 It commences at the pylorus, and terminates in the right iliac region by a lateral aperture in the large intestine. It is four-fifths of the length of the whole canal, being from twenty-four to twenty-eight feet, cylindrical; the upper end is larger than the lower, decreasing gradually as you proceed downwards. It has four coats like the stomach, which have the same names. The course of its muscular fibres is longitudinal and circular. Its mucous coat is thrown into folds or duplicatures, called valvules conniventes, in the direction of the circumference, and are segments of circles. On this coat are numerous small projections, called villi; hence it is sometimes termed villous coat. Each villus is composed of an artery, vein, and lymphatic, or lacteal. Its mucous glands are situated in the cellular coat, between the muscular and mucous, and their ducts open on the surface of the latter. They are solitary and aggregated ; the former are glandules solitaries or Brunneri, and are found principally in the duodenum, and upper portion of the small intestine ; the latter are called glandulce agminatce or Peyeri, and exist in the lower part of the small intestine. How is the small intestine divided ? Into duodenum,* jejunum,6 and ileum;6 the latter two have no mark of distinction, and are sometimes called the mesenteric portion. The duodenum is about twelve inches long, and is the commencement of this canal. The upper two-fifths below the duodenum is called the jejunum, and the lower three-fifths the ileum. What is the Mesentery ? It is the process of peritoneum which serves to connect the small intestines to the posterior parietes of the abdomen, and extends from the left side of the second lumbar vertebra to the right iliac fossa ; this attachment is called the root, and is about six inches long. Its laminae contain the superior mesenteric artery and vein, lymphatic or lacteal glands and vessels ramifications from the solar plexus of the sympathetic nerves and cellular and adipose tissue. ANATOMY. 77 What are the characteristics of the Large Intestine ? It exceeds in diameter the small, and receives the effete matter there- from. It is not so regularly cylindrical*; the surface is arranged into three series or longitudinal rows of projections, separated by transverse depressions. It commences at the inferior end of the small intestine, and terminates at the anus. It is divided into three parts ; the commencement, below the insertion of the ileum, about two inches in length, is called the caecum,7 or caput coli; the remaining portion, until it reaches the pelvis, is called the colon,9''0'" when it takes the name of rectum.'3 The appendix vermiformis6 is a worm-like process attached to the inferior portion of the coecum. What is meant by Mesocolon? A duplication of peritoneum, which fixes the large intestine to the posterior parietes of the abdomen. How many coats has the large intestine ? Four, bearing the same name as those of the small intestine. The peritoneal coat has small duplicatures containing fat, and called appendices epiploiccs; the muscular coat has two layers of fibres, the longi- tudinal, and transverse or circular; the mucous coat has but few villi, but its muciparous glands and follicles are very numerous. Where is the ileo-colic valve ? At the junction of the ileum and caput coli or coecum. What is meant by Mesorectum? It is that duplicature of peri- toneum which attaches the rectum to the sacrum. From what is the large intestine supplied with blood ? A part of the superior mesenteric, the whole of the inferior mesenteric, and the internal pudic arteries; the veins empty into the vena porta- rum ; the nerves are derived from the solar and hypogastric plexus of the sympathetic. What are the characteristics of mucous membranes? They line the internal surfaces of the hollow viscera, and form an internal tegument to the body, analogous to the skin. They are of a soft, spongy consistence, easily yield to mechanical violence, and are dependent upon the surrounding cellular coat for their strength 7* 78 ANATOMY. Assistant Chylopoietic Vucera. What are the characteristics of the Liver? It secretes the bile, and is the largest gland in the human body. Its whole superior face is in contact with the diaphragm ; on the left is the spleen, below are the stomach and transverse colon, and behind are the vertebrae and ascending cava. It is about ten inches in length, six or seven wide, and weighs in the adult four to five pounds. It is divided into lobes, called right and left. The former is the larger, and has elevations on its surface, called lobulus spigelii, and lobulus quarlus. On the under surface are five fissures, viz . longitudinal, of the ductus venosus, transverse, one for the gall- bladder, and one for the vena cava. What are the ligaments of the liver ? The falciform or sus pensory, the ligamentum teres, the right lateral, the left lateral, and some anatomists give the name of coronary to that duplicature of peritoneum, at the junction of the suspensory and lateral liga- ments. The liver has also a proper coat connecting it with the peritoneum. What are the bloodvessels? They are of three kinds : the vena portarum, the hepatic artery, and the hepatic veins. What comjioses it? Acini, or granulations, each of which is complete in itself, having the above-named bloodvessels, the origin of a branch of the hepatic duct, called porus biliarius, lymphatic vessels, and nerves. What is the capsule of Glisson? It is a condensed lamina formed out of a white and yellow elastic cellular fibrous tissue, at the bottom of the transverse fissure of the liver, which invests the vena portarum, hepatic artery, and biliary ducts, and follows them throughout the substance of the liver. What are the characteristics of the Gall-bladder? It is a reservoir for the bile, fixed on the under surface of the great lobe of the liver, to the right of the umbilical fissure ; its shape is an oblong pyriform sac, and is about three inches in length. It has three coats, a peritoneal, a cellular, and a mucous. Its artery is a branch of the hepatic ; its veins empty into the vena portarum, and its nerves come from the sympathetic. Its duct, called cystic, unites at an acute angle with the hepatic duct, and forms the ANATOMY. 79 ductus communis choledochus; these ducts have two coats: ai. external, fibrous, lamellated, and extensible; and a mucous. What are the characteristics of the Spleen ? It is in the poste- rior part of the left hypochondriac region, bounded above by the diaphragm, below by the colon, on the right by the great end of the stomach, and the pancreas. Its color varies from deep blue to dark brown ; it is usually about four and a half inches long by two and a half wide. Its artery, called splenic, is a branch of the coeliac, its vein empties into the vena portarum ; the lymphatics are numerous and remarkably large, and its nerves are derived from the solar plexus. It has no excretory duct, and its use is not ascertained ; but it most probably serves as a diverticulum in case of congestion. What are the characteristics of the Pancreas ? It is fixed in the lower and back part of the epigastric region, bounded in front by the stomach which conceals it, and is between the two laminae of the mesocolon, about six or seven inches long, two wide, and flattened before and behind ; its right extremity is enlarged into a head or tuber, sometimes called the lesser pancreas. It is of a light gray, or pink color, and consists of lobules. The arteries which supply it come principally from the splenic ; the veins empty into the splenic; and the nerves come from the solar plexus. It secretes a salivary fluid, and is the largest of this class of glands. Its excretory duct is called ductus Wirsungii, which either pene- trates the ductus communis choledochus, or the duodenum, verv close to it. Urinary Organs. What are the urinary organs ? The kidneys, renal capsules, bladder, ureters, and urethra. What are the characteristics of the Kidneys ? They are two glandular bodies for the secretion of urine, situated on either side of the spine, extending from the upper margin of the eleventh dorsal to the lower margin of the second lumbar vertebra; the right is ten or twelve lines lower than the left; they are hard, solid, of a brown color, a compressed ovoidal shape, excavated on the margin, which is applied to the spine, and resemble the common kidney bean ; they are about four inches long, and two wide, and weigh each three or four ounces, have no peritoneal coat, but have 80 ANATOMY. a well marked capsule; the arteries are tailed the renal 01 eraul- gent, and are branches of the aorta; the veins take the same name as the arteries, and are equal to them in number. The substance of the kidneys is divided into cortical2 (Fig. 38), and medullary or tubular.3 The cortical, or secretory substance forms the circumference, and is on an average about two lines in thickness. It consists of a number of tortuous tubes of Ferrein, in which the urine is first formed. The tubular portion consists in from twelve to eighteen conoidal fasciculi called the medullary cones of Malpighi,3 with their bases towards the cortical portion ; their apices converge towards the centre, are free, and project so as to form the papillae renales.3 Each fasciculus or cone is capable of subdivision into small pyra- mids of Ferrein, and each pyramid consists of a number of straight tubes of Bellini or tubuli uriniferi, into which the tortuous tubes of Ferrein empty. The apex of each cone is called p)apilla renales, and in the centre of each papilla is a slight depression called foveola; it is received into the infundibulum, into which the urine is carried as it oozes from the orifices of the papilla. What composes the excretory duct of the kidney ? The ureter7 which commences in the centre of the kidney, by an enlargement called pelvis;6 this branches off superiorly into three or four por- tions called calices,* one above, one below, and one or two inter- Fig. 38. mediate. Each of these calices is divided at its free extremity into three or four short funnel-shaped terminations, called infundibula.5 These terminations em- brace, each by its expanded orifice, the base of a papilla, so as to permit the lat- ter to project into it, and distil its urine there; The pelvis of the kidney as it emerges from the fissure becomes reduced to a cylindrical canal, which is properly the ureter;7 it is about the size of a goose quill, descends into the pelvis, and penetrates obliquely the coats of the bladder, ten or twelve lines behind its neck3 (Fig. 39), and is composed of two coats or laminas. ANATOMY. 81 What are the Renal capsules' (Fig. 38) ? They are two small bodies, one on either side, placed upon the upper end of the kidney, of a yellowish-brown color tinged with red, have no excre- tory ducts, and are the most distinctly developed in the foetus. The arteries are derived from the aorta, the renal, and phrenic arteries ; the vein of the right side empties into the vena cava: that on the left side into the renal vein. The nerves are supplied from the renal and phrenic plexuses. What are the characteristics of the Bladder (Fig. 39) ? It is the reservoir for the urine, placed in the pelvis just behind the symphysis of the pubes. The superior end is called the upper fundus;5 the lower end the inferior fundus;6 and between the two is the body ; the neck is its place of junction with the urethra. It consists of four coats, the peritoneal, muscular, cellular, and mucous; and is retained in its place by seven true ligaments, viz : two anterior, two lateral, two umbilical, and the urachus; and by four false, viz : two anterior, and two posterior. The first four are formed by the pelvic fascia ; the two umbilical by the obliteration of the umbilical arteries of the foetus; and the false ligaments are reflections of the peritoneum The internal face of the mucous coat presents at its inferior part the vesicle triangle,3'3-* with its smooth centre7 behind and below the neck, occupying the space between it and the orifices of the ureters. The uvula vesicas* is at the anterior angle of the triangle, which sometimes presents an obstruction to the introduction of the catheter. Organs of Generation in the Male., What do the male organs of generation consist of? The testi- cles, and the penis, with their appendages. How is the Penis formed ? By common integuments, cellular tissue, the corpora cavernosa, and the corpus spongiosum urethras. What are the characteristics of the Urethra? It is a canal whose length varies, and extends from the neck of the bladder to the extremity of the glans penis. The first part penetrates the prostate gland,'3 and is called the prostatic portion;'* on its in- ferior surface is a doubling, which constitutes the verumontanum9 or caput gallinaginis.8 Between the prostate and the bulb'8 is the membranous portion,'5 about eight or ten lines long; the F S'i ANATOMY hi lance of the urethra is lodged in the corpus spongiosum from its commencement at the deep perineal fascia to the meatus urinarius ; this canal varies in its dimensions in different parts, What other parts are to be ob- served in Fig. 39 ? The ureters,* orifice of the ductus ejaculatoris? ducts" from the prostate gland, with the neck of the bladder above, one of Cowper's glands,'6 with the orifices of their excretory ducts,'7 corpora cavernosa,'9 erector penis muscle,26'27 accelerator urince mus- cle,2*-25 and prostate gland.'2''3 What are the characteristics of the Vesiculcs seminales ? They are two convoluted tubes, one on each side, two inches in length, placed on the lower fundus of the bladder, between it and the rectum, and behind the prostate gland; they are composed of two coats. The excretory duct of each vesicle is about a line and a half long, when it joins with the vas deferens of the same side; a common canal is formed called ductus ejaculatorius, which is eight or ten lines long, runs parallel with its fellow, and opens at the lateral anterior face of the caput gallinaginis. What are the characteristics of the Prostate gland,'2''3 (Fig. 39) ? It is a body about the size of a horse-chestnut, fixed on the neck of the bladder, and penetrated by the urethra. Its secretion is emptied into the prostatic portion of the urethra by fifteen 01 twenty excretory ducts. What is the situation of Cowper's glands ? They are two in number, one ou each side, situated in advance of the prostate, between the laminae of the triangular ligament. ANATOMY. 83 What are the characteristics of the Testicles ? They are two in number, one on each side of the scrotum, of an oblong form, com- pressed laterally, an inch and a half long, one inch in breadth, eight or ten lines in thickness, and enveloped by the scrotum, dartos, tunica vaginalis, tunica albuginea, and tunica vasculosa. The scrotum is a continuation of the common skin, common to both testicles, symmetrical, and divided by a middle line called raphe. The dartos is within the scrotum, and forms two sacs, one for each testicle. The tunica vaginalis is rigidly comparable to a double night- cap, one portion adhering firmly to the tunica albuginea beneath, and the other loosely reflected over the testicle. The tunica albuginea' is the proper coat of the testicle, and is in immediate contact with it; it is dense, strong, white, and fibrous. The tunica vasculosa is the nutrient membrane of the testis; situated immediately within the albuginea, enclosing the substance of the gland, and sending processes inwards between the lobules. The glandular portion of the testicles consists of a congeries of convoluted tubes called tubuli seminiferi,3'3 amounting to three hundred in number, and each nearly seventeen and a half feet iu length, forming hanks held together by cellular substance. The vasa recta* are terminations of the tubuli seminiferi, which unite near the centre Fig. 40. of the testicle, in a complicated arrangement, called rete vasculosum5 testis. The vasa efferentia6 (from twelve to eighteen ducts) proceed from the rete vas- culosum testis,5 and penetrate the corpus Highmorianum,2-2 and tunica albuginea. Each one is then convoluted upon itself into a conical body, the conus vasculosus.7 Each cone, at its base, has its tube entering successively into the tube of which the epi- didymis is formed. The epididymis8 is formed of a single convoluted tube of the fourth of a line in diameter; at the lower end it becomes less convoluted, turns upwards, and obtains the name of vas deferens.'0 84 ANATOMY. What forms the Spermatic cord? It is a fasciculus of about half an inch in diameter, and may be felt passing from the upper end of the testicle to the abdominal ring. It is formed by the vas deferens, spermatic artery, and veins, lymphatics of the testicle, and the nerves ; covered by a cellular substance called tunica va- ginalis communis, and the cremaster muscle. The Cremaster muscle is derived from the internal oblique and transversalis, completely envelops the cord, and draws the testicle upwards. The vas deferens'° is the proper excretory duct of the testicle ; it is a white tube, about a line and a half in diameter, and has a cartilaginous feel; from the internal abdominal ring, it dips down into the pelvis by the side of the bladder, and termi- nates in the urethra, after uniting with the duct from the vesicula seminalis ; this common duct is called the ductus ejaculatorius. What is understood by the Perineum? The space included between the anus, arch of the pubis, and the tuberosities of the ischia. What are the fasciae and muscles of the perineum ? Perineal fascia,17 the triangular ligament of the urethra,'5 and the pelvic fascia.13 The perineal fascia " is beneath the superficial fascia, and is dense, thin, and tough; in front it is continuous with the dartos,18 behind with the base of the triangular ligament15 by its anterior lamina,16 also with the anal fascia,19 a portion of the pelvic fascia 13 Beneath this the muscles of the perineum are situated. ANATOMY. 8ft The triangular ligament15 occupies the arch of the pubis; the shape is indicated by the name. It is perforated by the mem- branous portion of the urethra about an inch below the symphysis, and separates the pelvis from the perineum; it joins the perineal and anal fasciae.21 Cowper's16 and the prostate gland7 is situated between its two laminas,'6'21 the posterior of which is usually called the fascia of the prostate. What other parts are exhibited by Fig. 41 ? The bladder,2 the ureter* vas deferens,5 right vesicula seminalis,6 recto-vesical fold of the peritoneum,3prostate gland,7 neck of the bladder,8 prostatic portion9 of the urethra, membranous portion,'0 deep fascia,22''9 levator ani.20 The pelvic fascia surrounds that portion of the peritoneum which lines the pelvis, and is continuous with the transversalis and iliac fasciae. The anterior ligaments of the bladder12 (Fig. 41), ob- turator fascia, and recto-vesical fascia, are processes of this. The muscles are the erector penis, accelerator urinas, transversus perinei, sphincter ani, coccygeus, and levator ani. (See Figs. 19 and 39.) Female Organs of Generation. What are the organs of generation in the female ? The vulva, vagina, uterus, Fallopian tubes, and the ovaria. What constitutes the Vulva? The vulva consists in the mons veneris, the labia externa, the labia interna, or nymphas, the clitoris, the vestibulum, the orificium urethrae, the fourchette, and the fossa navicularis. These are called the external organs. Wfhere is the Mons Veneris and the other external organs situ- ated ? The mons veneris is an accumulation of cellular and adi- pose substance covering the pubes. The Labia Externa are two bodies of a similar texture to the mons veneris, running parallel from it in a downward and backward course, where they unite and form the posterior commissure, or fourchette. The Clitoris is directly beneath the superior union, or origin ol the labia; it consists of two crura which unite and form its body, the external termination of which has been called its glans. The Nymphas, or Labia Interna, are two similar bodies depend- ing from the clitoris, which separate and run downwards towards the os externum. 8 86 ANATOMY. The Vestibulum is a depression twelve or fifteen lines long, be- tween the labia interna. It is bounded above by the clitoris aud below by the orifice of the urethra. The Orifice of the urethra is found between the inferior portions of the nymphas, at the inferior part of the vestibulum. The canal of the urethra is about 1^ inches in length. The Orifice of the vagina is below the orifice of the urethra, and immediately under the symphysis pubis. The Hymen is a membranous expansion at the orifice of the va- gina, and partially closing it. The Carunculce myrtiformes are small fleshy vascular bodies situated at the external orifice of the vagina, upon which in the virgin state the hymen appears to spread itself. The Fourchette is a semilunar fold in advance of the hymen. The Fossa navicularis is the space below the vestibulum and fourchette, and anterior to the orifice of the vagina. The Perineum is the space directly behind the inferior termina- tion of the labia and before the anus, about an inch and a half in width. What are the internal organs ? The vagina, uterus, and uterine appendages. What are the characteristics of the Vagina? It is a thin mus- culo-membranous canal, leading from the vulva to the uterus, from four to six inches in length, between the bladder in front and the rectum behind, flattened, so as to bring its anterior and posterior surfaces in contact, has three tunics, an external cellular, a middle muscular, and an internal mucous. At its anterior end is the corpus spongiosum vaginae, or plexus retiformis. The sphincter vaginae muscle surrounds its anterior orifice. The Hymen is placed at the anterior orifice, for the purpose of closing it more or less perfectly. What are the characteristics of the Uterus ? It is a compressed pyriform body, two and a half inches long, and one and a half in diameter at its widest part. Its posterior face convex, anterior nearly flat, about one inch in thickness, and divided into fundus body, and neck. The fundus is the part between the Fallopian tubes at the superior extremity, the neck is the lower cylindrical portion, and the body is the part intermediate to the two. Its cavity is triangular, with the sides convex, and the inferior angle ANATOMY. 87 presents towards the opening into the vagina called os tineas. The mucous glands or lacunas in the neck are called ovula Nabothi. It *■ has three coats, a serous or external, a middle which is muscular, and an internal or mucous. The muscular coat is composed of longitudinal, circular, and oblique fibres. This organ is supplied with blood by the uterine and spermatic arteries ; with nerves from the aortic plexus, and from the hypogastric nerves and plexus. being a mixture of sacral and sympathetic nerves. What are the Ligaments of the uterus ? The broad or lateral, the anterior, the posterior, and round ligaments. What are the Fallopian tubes ? They are two musculo-membra- nous canals, one on either side, in the superior part of the broad ligaments of the uterus, four inches long, extending from the upper angle of the uterine cavity to the side of the pelvis, where their extremities are loose, and expanded into a trumpet shaped mouth, called their fimbriated extremities, They serve to conduct the ovum from the ovaries to the uterus. What are the characteristics of the Ovaries ? They are two in number, one on either side, situated on the posterior face of the broad ligaments, of a compressed ovoid shape, about half the size of the male testicle. They have two coats : a peritoneal, and the tunica albuginea, which corresponds with the same coat of the testicle. Their arteries are the spermatics ; and their nerves are from the spermatic plexus. The proper tissue of the ovary (called its stroma) consists of dense cellular substance containing within its areolae a number of small vesicles called Graafian, one of which is matured and thrown off at every menstrual period in a state of health, leaving behind a corpus luteum. From whence do the female organs of generation derive their bloodvessels and nerves ? Principally from the internal pudic and other branches of the hypogastric arteries ; their veins run into the hypogastric ; and their nerves come from the sacral and hypogastric plexuses. Organs of Respiration. What are the organs of respiration ? The larynx, trachea, and lungs. 88 ANATOMY. Larynx. What aie the characteristics of the larynx '2 (Fig. 42) f It is an irregular cartilaginous tube, forming the upper part of the wind- pipe ; it is below the os hyoides and root of the tongue, bounded behind by the pharynx, and laterally by the primitive carotid arte- ries and internal jugular veins, and contributes essentially to the formation of the voice. Five distinct cartilages enter into its structure ; they are one thyroid, one cricoid, one epiglottis, and two arytenoid. The thyroid is the largest, and forms the prominence in the upper part of the neck, called pomum Adami. It has two processes on each side ; one called cornu majus, and the other cornu minus The cricoid is below the thyroid, forms the base of the larynx, and articulates with the trachea. Its form is that of a thick ring compressed laterally,'and is three times as high posteriorly as it is anteriorly. The arytenoid cartilages resemble triangular pyramids curved backwards, are about six lines long, and are placed on the upper margin of the cricoid cartilage behind. The epiglottis is situated on the posterior face of the base of the os hyoides; its general shape is that of an oval disk. The ligaments of the larynx are the crico-thyroid, the middle thyreo-hyoid, the lateral thyreo-hyoid, and the thyreo-arytenoid, two in number, on each side of the larynx, one above the other, three lines apart. These last-named ligaments also have the name of ligamentum vocale; and the portion of the larynx which is formed by them, and the pouches between them which are called the ventricles of Galen, are the structures essential to the formation of voice. The opening between the two lower ligaments is called the rima glottidis; and the space between the upper ligaments and the duplicature passing from the arytenoid to the epiglottis, is called glottis. The muscles of the larynx are the thyreo-hyoideus, crico-thy- roideus, crico-arytenoideus posticus, and lateralis, thyreo-uryte- noideus, arytenoideus-obliquus, and transversus, thyreo-epiglot- iideus, and aryteno-epiglottideus. ANATOMY. 89 The nerves of the larynx come principally from the superior and inferior laryngeal branches of the par vagum. The arteries are branches of the superior and inferior thyroid. Trachea. What are the characteristics of the trachea ? " It is a cylindrical canal four or five inches long, and nine lines in diameter ; it opens into the larynx above, and terminates in the thorax opposite to r/~ the third dorsal vertebra, by two branches called bronchias. The structures which enter into the composition of the trachea are carti- lage, ligamentous fibre, muscle, glands, and mucous membrane. The cartilage preserves the shape, and consists of from six- teen to twenty distinct rings, which are deficient at their posterior third. The ligamentous structure exists between the proximate margins of the rings, and fills up the intervals between them so as to render the tube perfect. The deficiency in the rings posteriorly is sup- plied in part by condensed cellular substance. The muscular structure exists at the cartilaginous deficiency in the posterior third ; the fibres pass in a transverse direction be- tween the interrupted extremities of the rings; it is between the condensed cellular substance and the mucous membrane of the trachea. The mucous membrane lines the whole internal portion, from the larynx to the bronchias, throughout all their ramifications. The bronchi have the same structure and arrangement as the trachea ; after ramifying into a number of subdivisions, they termi- nate in the lobules of the lungs. Where is the Thyroid Gland situated? It is placed on the first and second rings' of the trachea, and on the sides of the larynx united in the centre by its isthmus. Where is the Thymus Gland situated? Between the trachea and upper extremity of the sternum. Lungs. What are the characteristics of the lungs?'3'14'16 They are essentially the seat of the process of respiration, and occupy nearly the whole cavity of the thorax. They are two bodies of a grayish- 8 * 90 ANATOMY. Fig. 42. pink color, separated by the heart and its great vessels, ard each forms an irregular cone with the apex above. The right lung is divided into three lobes, and the left into two. Each lobe is divided into distinct lobules, united by cellular tissue. The lobules are subdivided into fine air-cells ; these cells commu- nicate laterally in the individual lobules, but not with the cells of different lobules. These air-vesicles are united together by cellular tissue, forming the parenchyma through which blood and air-vessels ramify. Each lobule has a ramification of the bronchial tube sent to it. The bloodvessels are of two kinds: the pulmonary,5'15 and bron- chial. The former is for the aeration of the blood, and the other for the nourishment of the lungs. The nerves come from the par vagum and sympathetic. What composes the Root of the lungs ? The root of each lung ANATOMY. 91 is formed by the pulmonary artery, and two veins, the nerves, bronchias, lymphatic vessels, and glands, covered by the pleura, where it extends from the lungs to the pericardium. Pleura. What is the arrangement of the pleurae ? They are two in number, afford a perfect covering for each lung, and are reflected over the adjacent sides of the pericardium, and the interior peri- phery of the thorax. That portion of the pleura which covers the lung is called pleura pulmonalis, and that which lines the thorax is the pleura costalis; the two sides being alike. They receive blood from the bronchial and intercostal arteries, and nerves from the intercostals. The pleurae divide the thorax vertically into two parts; this septum is called Mediastinum, and contains the heart with its coverings and great vessels. The mediastinum is divided into three portions. The anterior passes from the front of the peri- cardium to the posterior face of the middle line of the sternum. The posterior passes from the posterior face of the pericardium to the dorsal vertebras. The superior is within the circuit of the first ribs and sternum. What are contained in the posterior mediastinum ? The thoracic aorta, the oesophagus, the vena azygos, the thoracic duct, and the par vagum nerve of both sides. What are contained in the superior mediastinum ? A part of the remains of the thymus gland, descending vena cava,7 transverse vein, or vena innominata, the top of the arch of the aorta,6 arteria innominata,8 left carotid,9 left subclavian,'0 trachea," oesophagus, phrenic nerve, and par vagum. Circulatory System. What is the apparatus by which the circulation is effected ? The heart, which in man consists of four cavities; the arteries, veins, and capillaries. What are the course and description of the circulation ? The blood, after getting to the right auricle, is emptied by its contrac- tion into the right ventricle, from which it is forced through the branches of the pulmonary artery into the lungs. It is returned 92 ANATOMY. through the four pulmonary veins to the left auricle of the heart, which contracts and throws the blood into the left ventricle, from which it is propelled, by its contraction, into the aorta ; it is then distributed to the whole body by its small branches, from which it is collected by corresponding veins, into the ascending and de- scending cava, that empty into the right auricle. It will, there- fore, be seen that there are two circulations — the greater or sys- temic, the arteries of which contain red blood, and the veins dark or venous blood ; and the lesser or pulmonic, the arteries of which contain dark blood, and the veins red or vivified blood. What is meant by the capillaries? They are the extreme vas- cular ramifications which form the connection between the arteries and veins. Of how many coats are the arteries composed? Three: an external, a middle, and internal coat. The external or cellular coat is condensed cellular substance, formed into a cylinder, the fibres of which run in every direction. The middle coat, called also muscular, proper, or tendinous, is of a light yellow tinge, the fibres of which are circular, and possess elasticity. The internal coat is sometimes called nervous and arachnoid; it is a thin serous membrane. Cellular substance, vessels, and nerves also enter into the struc- ture of arteries. The bloodvessels which nourish the arteries are called vasa arteriarum. Of how many coats are the veins composed ? Three : an ex- ternal, a middle, and an internal coat, analogous to the corres- ponding coats of the arteries, but more delicate in their texture. Heart. Where is the heart situated? In the thorax between the ster- num and spine, having the lungs on either side, and the tendinous centre of the diaphragm below. It is surrounded by its proper membrane, the pericardium; its weight is about six ounces, greatest length about five and a half inches, and its base about three and a half inches in diameter. It is divided into four cavities ; two of which are called auricles, and two ventricles. The auricles form the base of the heart, and the ANATOMY. 93 ventricles its body. The right auricle and ventricle form the right side of the heart, and the left auricle and ventricle form the left side. What are the characteristics of the right auricle ?2 It is an oblong cuboidal cavity, joined at its posterior superior angle by the descending vena cava, and at its posterior inferior angle by the ascending cava. In front it is dilated into a pouch called sinus, the upper extremity of which is elongated into a process with indented edges, called auricle, or auricular portion. On the septum between the auricles is the fossa oralis, which is surrounded by its annul us, or the isthmus of Vieussens; below the fossa ovalis is the Eustachian valve. At the orifice of the large coro- nary vein is the valvula Thebesii. The opening into the right ventricle is the ostium venosum. In this auricle are fasciculi of muscular fibres called musculi pectinati. What are the characteristics of the right ventricle?* It is of the form of a triangular pyramid, forms the greater part of the anterior surface of the heart, and is about three lines in thickness. Its internal surface is covered by muscular fasciculi called columnce carnece; from some of these, small tendinous cords are sent to the valves, called chordae tendinece. The valves, three in number, between this ventricle and auricle are called tricuspid. The open- ing for the pulmonary artery is above, and furnished with three valves called semilunar, or sigmoid, which have in the centre of their edges a small cartilaginous body called corpusculum auran- tii. Between the outer face of each valve and the artery is a pouch called the sinus of Valsalva. What are the characteristics of the left auricle ? Its figure is more regularly quadrangular than the right. Its tip or ear-like portion is situated at the left of the pulmonary artery, and it is longer, narrower, more crooked, and more notched than the right. The opening between the left auricle and ventricle is also called ostium venosum. What are the characteristics of the left ventricle?3 The shape of its cavity resembles a long ovoidal or conical body, with its parietes about eight lines in thickness. Its internal surface has the same arrangement as the right ventricle, in having the fleshy columns called columnce carnece. The ostium venosum on this side is fur- nished by valves called the mitral, two in number, the margins of 94 ANATOMY. which are also furnished with chordae tendineae. The orifice of the aorta is furnished with three semilunar valves, corresponding ex- actly with those at the origin of the pulmonary artery, except that they are thicker and stronger. The sinuses of Valsalva also exist in the same manner. What are the bloodvessels of the heart ? They are the right and left coronary arteries, and great and lesser coronary veins. Where are the nerves of the heart derived from ? Principally from the cervical ganglions of the sympathetic ; they follow the coronary arteries in their distribution. What is understood by the Pericardium ? It is a membranous sac enveloping the heart. It consists of two layers, an external fibrous and an internal serous. The serous layer lines the fibrous and is then reflected over the heart and roots of the vessels. The internal cavity of the heart is lined by a serous membrane called endocardium, duplicatures of which with fibrous tissue form the valves. Arteries. What is the great trunk of the arterial system called ? Aorta. What are the branches of the aorta ? The right and left coro- nary arteries3'* which go to the substance of the heart. Fig. 43. 8 9__ ^ oi 11 ANATOMY. 96 Fig. 44. From the arch; the arteria innominata,7 the left primitive carotid,'0 and the left subclavian arteries." From the thoracic portion; the bronchial, one for each lung, and sometimes two or more, the oesophageal, which are five or six small twigs, the posterior arteries of the mediastinum, and the inferior intercostals on each side, which supply the ten lower inter- costal spaces. From the abdominal portion ; the phrenics,' two in number, the coeliac2 the superior mesenteric9 the capsular,6 one or more on each side, the emulgents'1 and spermatics,'0 one on each side, the inferior mesenteric," the lumbar,8 five on each side, and the middle sacral '2 arteries. It then terminates in the primitive iliacs. 96 ANATOMY. How is the Arteria Innominata divided ? Into right subcla- vian and right primitive carotid. How are the Carotids on each side divided ? Into internal1 and external carotids,2 opposites to the os hyoides. What are the arteries given off by the Internal Carotid?3 The lymi anic, th« anterior meningeal, the opthalmic, the communi- Fig. 45. eating artery of Willis, the choroid, the anterior and the middle cerebral. What are the branches given off by the External Carotid Ar- tery?2 The superior thyroid* the lingual,5 the facial6 (which gives off the submental,7 the inferior labial, the inferior coronary,' and the superior coronary9), the mastoid, the parotidean, the in- ferior pharyngeal," the occipital,'0''2''2 and the posterior auricu- lar, '* when it divides into two large trunks, the internal maxillary? and the temporal.15 The occipital,,0-12-12 gives off the cervical ,3 ANATOMY. 97 The temporal gives off the transverse fasciae,- the middle tem- poral f and the anterior'8 and posterior temporal.'6 The internal maxillary* (Fig. 46) sends off the following branches : the arteria tympanica,7 the arteria meningea parva,h the meningea magna8 or media, the maxillaris or inferior Fig. 46. dental,'0 the temporalis profunda, two in number, pterygoideoe, buccalis, maxillaris superior," infra-orbitalis,'2 palatina supe- rior,'3 pharyngea superior,'5 and the spheno-palatina,'* which is the terminating trunk. What are the branches given off by the Subclavian arteries (Fig. 47) on each side ? The vertebral6 the inferior thyroid, 9 98 ANATOMY. which gives off the ascending or superficial cervical ? superior intercostal," internal mammary,'3 profunda ccrvicis,'0 and poste- rior cervical;" after passing the subclavian muscle, it is called axillary artery5 to the lower margin of the arm-pit; and from fhis place to the elbow-joint, it is called brachial'° (Fig. 48). What are the branches of the Axillary Artery9 (Fig. 4 i) ? The Fig. 48. Fig. 49. superior scapular, four external mammary,"',2 inferior scapular* and the anterior and posterior circumflex. What are the branches of the Brachial Artery?10 The pro- found,'0'5 the small profound,'6 nutritious, and anastomotic;'7 it then bifurcates into the radial'2 (Fig. 49), and ulnar'5 in front of the brachialis interims muscle. ANATOMY. 99 What are the branches of the Radial Artery? The recurrens radialis,'3 superficialis voles, dorsalis carpi, magna pollicis, radialis indicis,47 and the palmaris profunda, which forms the arcus profundus. What are the branches of the Ulnar13 Artery ? The recurrens ulnaris,'8 the interossea anterior and posterior, and dorsalis manus. It then forms the arcus sublimis '6 (from which branches are sent that supply the fingers, called digital), and terminates by a branch which joins the arteria magna pollicis. Fig. 50. What are the branches of the Coeliac Artery?6 It divides into three trunks : the gastric,7 hepatic,8 and splenic.'* This division is sometimes called tripus Halleri. The gastric artery7 passes along the lesser curvature of the stomach. The hepatic artery8 gives off the pyloric,9 right gastric or gastro- epiploic," which is distributed to the right half of the great curva- ture of the stomach ; the main branch goes to the transverse fissure of the liver, and divides into the right and left branches. The cystic '3 is given off from the right. The splenic'* artery gives off the pancreatic,'5 the left gastric,'7 which is distributed to the left half of the great curvature of the stomach, an 1 the vasa brevia,K which are given off just before 100 ANATOMY. this artery enters the spleen ; they are five or six in number, and distributed upon the great extremity of the stomach, between the cardia and left gastric artery What are the branches of the Superior Mesenteric Artery?"1 There are three colic arteries, called ileo-colica, colica-dextra, and colica-media, besides the principal distribution to the small intestines. What are the branches of the Inferior Mesenteric Artery? The superior, middle, and the inferior colic arteries; and the superior hemorrhoidal. Fig. 51. How are the Primitive Iliacsi (Fig. 51) divided? Into two trunks, called internal6 and external.3 What are the branches of the Internal Iliac Artery ? The ilio- lumbar,'6 lateral sacral,'8 obturator,'7middle haemorrhoidal,'3vesi- cal,'0 uterine, gluteal,'9 and the ischiatic.7 The isehiatic gives off the internal pudic," which again gives off the lower haemorrhoidal,'6 perineal,"-'2 urethro-bulbar,'3 ramus superficialis, dorsi penis, and the cavernous artery of the penis. What are the branches of the External Iliac? The epigastric,* and circumflex of the ilium. What is the extent of the Femoral Artery, and what are its branches ? It extends from the crural arch to its perforation of the adductor magnus ; and gives off the superficial artery of the abdomen, external pudics, piofunda femoris (which divides into v ANATOMY. 101 external and internal circumflex); the first, second, third, and fourth perforating, and the anastomosing arteries. What is the extent of the Popliteal Artery and its branches ? It is a continuation of the femoral after its passage through the tendinous insertion of the adductor magnus; extends to the opening in the interosseous ligament, and gives off the superior internal,9 superior ex- ternal,9 middle, inferior internal and inferior external articular arteries, and the gastrocne- mial; it then divides into the anterior and posterior tibial, "-'2 arteries. What are the branches of the Anterior Tibial Artery? The recurrent tibial, internal and external malleolar, tarsal, metatarsal, dorsal artery of the great toe, and joins with the ex- ternal plantar in the sole of the foot. What are the branches of the Posterior Tibial?"''2 The peroneal,'3''* the internal and external plantar ; this last unites with the anterior tibial artery, and forms the arcus plan- taris, which gives off the digital and the per- forating arteries. Venous System. What is the office of the veins ? To collect the blood from the arteries in all parts of the body, and return it to the heart. > What is their general arrangement? There are two accom- panying each artery wherever the part is intended for locomotion; besides which there is an abundant class 01 superficial, or subcu- taneous veins, which form a vascular net-work over the whole body. Those accompanying the arteries are termed venae comites, and take the names of the arteries which they accompany. In some other cases, two arteries empty into one vein. What is their structure? Their coats are much thinner than the arteries, but similar to them in structure. The internal coat is 9* Fig. 52. 102 ANATOMY. thrown into duplicatures or valves, which are more abundant in the superficial than in the deep-seated veins. What are the great trunks of the venous system called ? Vena cava ascendens* and descendens' (Fig. 53). Fig. 53. Fig. 54. ANATOMY. 103 What veins form the Vena Cava Descendens ? The two venae innominatcs.2-3 What forms the Vena Innominata? It is formed on either side by the junction of the subclavian* with the internal jugular.5 What venous trunks discharge into the vena innominata, or descending cava ? Inferior thyroidal, vertebral, superior inter- costal, internal mammary, vena azygos, and some others of smaller size. What veins form the Vena Azygos ? '7 The ten inferior inter- costals of the right side, and four or six of the left; it anastomoses inferiorly with some of the veins of the abdomen. Those on the left form the Hemi-Azygos,'8 and empty into the other by a branch.20 What parts are represented by Fig. 54? The external' and internal2 iliac veins, vena cava ascendens3 and descendens with the termination of the vena azygos into it;8 middle* and lateral sacral5'5 veins; origin6 and trunk7 of the greater azygos vein from the lumbar veins ; also that of the lesserl0 or hemiazygos, from the lumbar veins9 of the left side, and its termination" into the greater. The termination of the superior I3I3,13and right or nine inferior intercostals l2'12'12 in the greater azygos; the five infe- rior intercostal14'14'14 veins opening into the lesser; the recepta- culum chyli,'5 thoracic duct,'6''6'6 with its termination17 in the angle formed between the left subclavian '9 and internal jugular;,Ja right thoracic duct. 's What forms the Internal Jugular Vein5 (Fig. 53) ? It ex- tends from the base of the cranium, where it communicates with the lateral sinus on each side, to the internal margin of the first rib. Its commencement is enlarged into what is called its gulf, or sinus. What forms the External Jugular6 (Fig. 53), and where does it terminate ? It is a continuation of the temporal, receives the facial, and lingual, and sometimes superior thyroid and occipital veins. It usually terminates in the subclavian. Where is the Subclavian (Fig. 53 * and Fig. 5419) situated ? It extends from the axillary to the vena innominata, and goes under the subclavian muscle, in front of the subclavian artery ; and where it passes over the first rib, the scalenus anticus muscle is between them, the vein being in front of it. What forms the Axillary Vein, and where is it situated ? The 104 AN ATOM Y. anion of the basilic with the brachial vein. It is in front of the axillary artery, included in the same sheath, and involved with the axillary plexus of nerves. At the under surface of the clavicle it takes the name of subclavian. How are the veins of the superior extremities arranged ? Into deep seated and superficial. The former take the names of the arteries which they accompany, and are two to each artery. The latter are divided into two principal trunks : the cephalic and basilic. What is the situation of the Cephalic Vein ? It is the trunk coming from the thumb and forefinger, receives several small branches on its course, and terminates in the axillary vein. What is the situation of the Basilic Vein ? It begins by the trunk from the ulnar side of the hand, receives branches in its course, and, by its union with the brachial, forms the axillary vein What is the situation of the Median Vein? It is in the middle and front of the forearm ; its trunk ascends, and below the bend of the arm divides into two ; one branch going to the cephalic vein, and called median cephalic, and the other going to the basilic vein, and called median basilic. Where is the Vena Cava Ascendens8 (Fig. 53) situated, and what branches does it receive ? In front of the spinal column to its right, and extends from the junction of the primitive iliac veins (which unite to form it opposite the fourth lumbar vertebra) to the right auricle of the heart, where it empties. It receives the middle sacral,' lumbar,'2-'2 right spermatic,'3'1* emulgent,'5 capsular, he- patic,'6 and phrenic veins. The left spermatic opens into the left emulgent. What forms the Primitive Iliac Vein on each side ? The junc- tion of the external and internal iliacs opposite the sacro-iliac symphysis. What forms the Internal Iliac'° or Hypogastric Vein ? It arises by venous branches corresponding with the distribution of the hypogastric artery, some of which are termed plexuses ; and are the haemorrhoidal, vesical, sacral, pudendal, xderine, and vaginal plexuses; and the gluteal, obturator, and ileo-lumbar veins. What forms the External Iliac9 Vein ? It is a continuation of the femoral, and receives the epigastric and circumflex iliac veins, which correspond with the arteries of the same name. ANATOMY. 105 What is the arrangement of the veins of the inferior extremities ? Into deep seated and superficial. The former follow the course of the arteries, take the same name, and are two for every artery as far up as the ham, and also for the muscular arteries of the thigh. What are the superficial veins ? The saphena minor and major. What is the situation of the Saphena Minor? It commences near the external side of the top of the foot and external ankle; the trunk ascends along the back of the leg superficially, and termi- nates in the popliteal vein. What is the situation of the Saphena Major? It commences at the internal part of the foot; its trunk passes upwards in front of the internal ankle, internal face of the leg on a line with the pos- terior margin of the tibia, and is continued on a line with the pos- terior margin of the sartorius muscle; it then terminates in the femoral vein, about twelve or eighteen lines below Poupart's liga- ment. From whence is the Vena Portarum derived ? The viscera of the abdomen, and corresponds with the superior and inferior mesen- teric arteries, and the coeliac, with the exception of the hepatic branch. What is meant by the Sinus Portarum ? The vena portarum, when it reaches the transverse fissure of the liver, divides into a right and left branch, at right angles with the main trunk, but in a line with one another; these constitute the sinus portarum. Where do the terminating branches empty ? Into the venae hepaticce. Absorbent or Lymphatic System. What are the absorbents? They are small, pellucid, transpa- rent, cylindrical tubes, whose office is for instertitial absorption, and also to take up the nutritious part of our food. How are the absorbent vessels divided ? Into lacteals and lymphatics. The former are those which absorb the chyle, and the latter are found in other parts of the system; their structure is similar, and they differ only in the fluid with which they are occu- pied. They are also divided into superficial and deep seated. What are lymphatic glands ? They are flattened, ovoidal bodies, of a reddish-ash color, indurated, and of a variable volume, through 106 ANATOMY. which the lymphatic vessels have to pass on their way to the tho racic duct. The vessels that enter them are called vasa inferentia, and those that depart vasa ejferenlia. Where are they found ? In clusters, below the occiput, under the ears and jaw, along the side of the neck, in the axilla, root of the lungs, mesentery, loins, pelvis, &c. What are the main trunks called ? Thoracic Ducts.'3''* What are the course and arrangement of the thoracic ducts ? The Ift thoracic ductK is the main trunk of the absorbent sys- tem. It begins about the second or third lumbar vertebra. Shortly after its commencement it is dilated, and this dila- tation is called the reservoir of Pecquet, or receptaculum chyli. '2 The thoracic duct enters the thorax between the crura of the diaphragm, ascends to the fourth dorsal vertebra, when it inclines to the left side, ascends into the neck near the head of the first rib ; it then turns downwards14 and forwards, over the left subclavian artery, and discharges into the point of junction of the left subclavian, and internal jugular veins. It is commonly about the size of a crow- quill. The right thoracic duct, '5 or, as it is sometimes called, the right brachioce- phalic, is about one inch long, and de- scends to empty itself into the junction of the right internal jugular with the right subclavian veins. It is formed by the lymphatic trunks of the right side of the head and neck, from the right upper extremity, and the superficial lymphatics of the right side of the thorax, and parts adjacent to it. What else is represented by Fig. 55? The aorta,''2-3 arteria innominata,* left carotid,5 left subclavian,6 superior cava;7 the two venae innominata8 internal jugular,9'9 vena azygos.'0 Fig. 55. ANATOMY. 107 Nervous System. What is the essential ingredient of this system ? A peculiar animal matter called neurine. How is the nervous .system divided ? Into the central or inter- nal part, composed of the brain and spinal marrow; and the external, or peripheral portion, which consists in the nerves of the brain and spinal marrow; and into the sympathetic system of nerves. The central portion is composed of two kinds of substance ; one called medullary, and the other cineritious. The peripheral portion, or the nerves, are formed by parallel fasciculi, the finest filaments of which are composed of a tube filled with nervous matter. The sheath of the nerves is called neuri- lemma ; it envelopes the nerves, and also forms an envelope for each particular fibre and fasciculus, and is an extension of the pia mater and dura mater along the nerves. There are three modes by which these fasciculi unite with each other : by anastomosis, plexus, and ganglion. Spinal Marrow. What are the characteristics of the spinal marrow3 (Fig. 60 and Fig. 56) ? It is within the vertebral cavity, and extends from the first vertebra of the neck to the first or second of the loins, inclu- sive. It has four membranes—dura mater, pia mater, membrana dentata, and tunica arachnoidea; its general form is cylindrical, flattened slightly before and behind ; its substance is of two kinds —cineritious and medullary. It is divided by sulci into four fas- ciculi or cords on each side, viz: Anterior or motor columns, which give origin to the motor roots of the spinal nerves. Lateral columns, which are divided in function be- tween motion and sensation, and have been described by Sir Charles Bell as the respiratory tract. Pos- terior, or columns of sensation, which give origin to the sensitive 108 ANATOMY roots of the spinal nerves. Median posterior columns, which have no separate function assigned to them at present. The spinal marrow gives off from its sides thirty pairs of nerves ; eight of them are called cervical, twelve dorsal, five lumbar, and five sacral. The spinal nerves are formed from two roots —an anterior1 or motor, and a posterior2 or sensory, which are separated by the ligamentum denticulatum. A ganglion is formed on the posterior root, beyond which the two roots unite, and proceed to their proper destination. The arteries of the spinal marrow are derived from the verte- brals, intercostals, lumbar, and sacral. Brain. What is understood by the encephalon or brain? It is that part of the central portion of the nervous system contained within the bones of the cranium ; of an oval shape, surrounded by three membranes, the dura mater, tunica arachnoidea, and pia mater. Its substance is divided into cineritous and medullary. The brain is divided into Medulla Oblongata; Protuberantia Annularis, or Pons Varolii; Cerebrum; and Cerebellum, each of which are symmetrical, and consist in right and left halves, per fectly alike. What are the processes of the dura mater ? Falx cerebri, ten- torium cerebelli, and falx cerebelli. What are the sinuses of the Dura Miter? Superior longitu- dinal, lateral (one on each side), inferior longitudinal, sinus quartus or rectus, petrous (two on each side, the superior and inferior), cavernous (one on each side), circular, and the occipi- tal. The arteries that supply the dura mater are the anterior meningeal, a branch of the internal carotid ; the middle meningeal and meningea parva, branches of the internal maxillary ; the infe- rior meningeal, from ascending pharyngeal and occipital arteries; and the posterior meningeal from the vertebral. The nerves are derived from the nervi molles and vertebral plexus of the sympa- thetic, from the Casserian ganglion, the opthalmic nerve, and some- times from the fourth. What is the Torcular Herophili? It is the union between the longitudinal, the fourth, and the lateral sinuses. ANATOMY. lOf What are the characteristics of the Medulla Oblongata6 (Fig 57) ? It extends from the superior margin of the first cervical vertebra to the middle of the basilar process of the os occipitis. On its under surface, on each side, is the Corpus Pyramidale' (Fig. 59.) The Eminentia Olivaria (Fig. 593 and Fig. GO23) are two bodies, one on either side, at the external margin of the pyramidal bodies, with the corpus fimbriatum in the centre, and the olivary tract '* (Fig. 60) which goes to the optic tubercles. The Corpora Restiformia (Fig. 594 and Fig. 606), one on either side, are placed at the lateral margins of the medulla oblongata, posterior to the olivaria, and are a continuation of the posterior portion of the medulla spinalis. Between the corpora restiformia, on the superior face of the medulla oblongata, is an excavation, named from its shape calamus scriptorius, which forms a part of the floor of the fourth ventricle of the brain. What are the characteristics of the Pons Varolii (Fig. 57,5 Fig. 59,2 and Fig. 607) ? It is a large projecting body, placed at the top of the medulla oblongata upon the junction of the body of the sphenoid bone with the basilar process of the os occipitis, convex, and about one inch in diametr. Four crura proceed from it. What are the characteristics of the Cerebellum,2'2 (Fig. 60) ? It is in the posterior fossa of the cranium, separated from the posterior lobes of the cerebrum by the tentorium, and connected with the pons Yarolii by the crura of the cerebellum. It measures four and a half inches in the transverse diameter, two and a half in thickness, and about the same from before backwards. It has on its superior face the sulcus superior cerebelli ; another on the inferior surface, called the sulcus inferior cerebelli. The superior middle ridge is called vermis superior, the anterior extremity of which is from its elevation called monticulus cerebelli. The vermis inferior is a ridge occupying the deep sulcus which divides the cerebellum on its inferior surface into hemispheres. The central part of the cerebellum is formed by the vermis superior and inferior, and is the fundamental portion. The valve of Vieussens arises from the cerebellum under the anterior part of the base of the monticulus. The corpus rhomboideum, or dentatum, is in the middle of the trnnk of the arbor vitas. The cerebellum is associated with the 10 HO ANATOMY. spinal cord and cerebrum by three pairs of pedicles, viz : corpora restiformia; processus cerebello ad testes; and crura cerebelli. What are characteristics of the Cerebrum? It weighs about three pounds; it is ovoidal, measures about six inches in its antero-posterior diameter, five inches in breadth, and four or five deep. It is separated by the longitudinal fissure into hemispheres, the right and left. At the bottom of this fissure is the corpus callosum, which connects the two hemispheres together. The hemispheres are each divided on their under surface into three lobes, anterior, middle, and posterior. The anterior is anterior to the fissure of Sylvius; the posterior rests on the tentorium, and the middle is between these two. . The periphery is formed into convolutions, called gyri, and these are separated by fissures called sulci. The Crura Cerebri " (Fig. 60) are two thick white cords which issue from the pons Yarolii, are about eight lines long, mutually diverge to each side to enter the thalami optici, and are separated by a fissure, which is the third ventricle of the brain. The Eminentia Mammillaria, or Corpora Albicantia3 (Fig. 571, are two small bodies, one on each side, situated near the anterior extremities of the crura cerebri, and are connected with the thalami optici by two white cords; they are the anterior extremity of the crura of the fornix. The Infundibulum* (Fig. 57) is placed immediately before the eminentia mammniaris. It is flattened, conoidal, half an inch long, base upward, and its apex going downwards and forwards. Its base is hollow, and opens into the third ventricle, but the point is closed. The Pituitary Gland is situated in the sella turcica. The Tuber Cinereum* (Fig. 60), or Pons Tarini, is a portion of the under surface of the crura cerebri, and forms part of the floor of the third ventricle. The Thalami Optici5 (Fig. 60, divided vertically), two in num- ber, called also Ganglia Postica, are situated on the superior face of the crus cerebri, about an inch and a half in length, and eight lines broad and deep. The thalami are medullary externally, cortical, and medullary internally, and united to each other by the vommissura mollis. The Corpora Striata, or Ganglia Cerebri Antica, are two ANATOMY. Ill pyriform bodies, situated before the thalami, at the bottom of the lateral ventricles. They are two and a half inches long, convex in their upper surface, eight lines broad at the front, and taper back- ward to a point. The Septum Lucidum is between them in front, but posteriorly they diverge so as to admit the thalami between them. The Taenia Striata is placed in the angle formed between the internal margin of the corpus striatum and the external one of the thalamus opticus. It is a small medullary band commencing near the anterior crura of the fornix, and observing the course of the curved fissure in which it is placed; it goes to the posterior end of the corpus striatum. The Corpus Callosum is placed at the bottom of the fissure which separates the two hemispheres, and may be brought into view by slicing them off to a level with it. It is then seen to be a medullary layer uniting the mass of the two hemispheres for two- fifths of the long diameter of the brain, about eight lines in breadth, marked by a middle line called raphe, and forms the roof of the lateral ventricles. The Fornix or Trigone Cerebral is placed immediately below the corpus callosum. It is triangular, the base of which is behind, and the apex in front, about an inch and a half long in its body, and one inch wide at the base, which is beneath the corpus cal- losum, continuous with it, and gives the fornix the appearance of being a part of the same structure doubled on itself. The Septum Lucidum is a partition placed vertically in the middle of the brain, and extends from the corpus callosum above, to the fornix below; between its lamina is situated the fifth ventricle, or ventriculus septi. The Pineal Gland is beneath the posterior margin of the fornix, upon the superior part of the tubercula quadrigemina. The Velum Interpositum is a reflection of pia mater, separating the pineal gland from the fornix, and the fornix from the thalami nervorum opticorum. Its edges contain a plexus of veins called the plexus choroides. The Tubercula Quadrigemina are situated on the superior face of the crura cerebri, and just behind the thalami. They consist of four rounded elevations, separated by a crucial furrow. The larger pair is above, and called nates, and the other is called testes.1 Under these is a passage called the aqueduct of Sylvius. Fig. 60. 112 ANATOMY. How many Ventricles of the brain are there ? Four; fivo lateral, placed one in either hemisphere of the cerebrum, the third, between the two thalami, and the fourth under the cerebellum. The Lateral Ventricles each consist of a body and three pro- cesses, called cornua. The cornua are named from their position anterior, posterior, and lateral, or inferior. In the posterior cornu are seen the hippocampus minor. In the inferior, or lateral cornu, is found the cornu ammonis, or hippocampus major, terminated by theses hippocampi. The Third ~V-entricle is bounded below by the pons tarini, crura cerebri, and the eminentias mamillares; and above by the velum interpositum and fornix. The Fourth Ventricle is bounded in front by the tuber annulare, and medulla oblongata ; behind, by the fundamental portion of the cerebellum ; above, by the valve of the brain and tubercula quad- rigemina ; laterally, by the medullary prolongations from the cere- bellum to the tubercula quadrigemina, and is open below when the pia mater is removed. Nerves. The following nerves are in pairs, and the description of one side applies equally to the other : — Where does the Olfactory Nerve arise from ? By three fasciculi or roots from the basis of the brain at the corpus striatum, and coalesce in the fissure of Sylvius. They unite, and at the anterior extremity this nerve is enlarged into what is termed the bulb, which sends from its under surface filaments to the Schneiderian membrane through the cribriform plate of the ethmoid bone. Where does the Optic Nerve,8'8'9 (Fig. 60) arise from? It arises by a broad flattened root, a portion from the thalamus opti- cus9 (Fig. 60), and another part from the tubercula quadrigemina; it also adheres to the crus cerebri, and passes under it. The optic nerves of the two sides are fused together, and form what is called their chiasm2 (Fig. 57), or crossing; after this they separate, and each one passes through the optic foramen of its respective side. Where does the Third Pair7''0 (Figs. 57 and 60) of nerves, or Motor Oculi, arise from ? From the internal face of the crus cerebri11 (Fig. 60), two lines in advance of the anterior margin of the tuber annulare5 (Fig. 57). It penetrates the orbit, through 113 the sphenoidal fissure, and it is distributed to most of the muscles of the eyeball. Where does the Fourth Pair8-'2 (Figs. 57 and 60) of nerves, or Patheticus arise from ? It arises by two filaments from the upper Fig. 58. 10* 114 ANATOMY. Fig. 59. anterior face of the valve of the brain. It goes to the orbit through the sphenoidal fissure, and is distributed to the superior oblique muscle. Where does the Fifth Pair9'5''6 (Figs. 57 and 60) of nerves, or Trifacial, arise from ? By several distinct filaments from the medulla oblongata, but emerges from the pons Varolii5 (Fig. 57), or tuoer annulare. They unite, and form the semilunar ganglion, or ganglion of Casser5 (Fig. 58), which sends off three branches, viz: the first, or opthalmic,6 through the sphenoidal fissure; the second, or superior maxillary,7 through the fora- men rotundum ; and the third, or in- ferior maxillary,* through the foramen ovale. Their general distribution is to the orbit, the face, and the tongue. What other parts of the fifth pair and adjacent parts are represented by Fig. 58? The orbit,' antrum High- morianum2 tongue, frontal branch'1 /4(f| of the opthalmic nerve dividing into //,\| '2 external and internal, lachrymal,'* nasal," internal nasal,'2 external na- sal,'3 external and internal frontal,'* infra-orbitar, '5posterior dental,'6 mid- dle dental,'7 anterior dental,'8 labial and palpebral,'9 pterygoid21 from Meckel's ganglion, anterior branches22 of the third branch, lingual,23 inferior dental,2* its mental branches,25 auricu- lar branches,27 mylo-hyoid.28 Where does the Sixth Pair10''1 (Figs. 57 and 60) of nerves, or Motor Externus, arise from ? From the base or upper extremity of the corpus pyra- midale. It passes into the orbit by the sphenoidal fissure, and is dis- tributed upon the abductor oculi mus- cle. ANATOMY. 115 Where does the Seventh Pair "-18 (Figs. 57 and 60) of nerves, or Facial and Auditory, arise from ? That portion of the seventh pair, called the facial, or portio dura, arises by two branches from the medulla oblongata. It emerges through the stylo-mastoid foramen, and is distributed to the muscles and skin of the head, having the name of pes anserinus. That portion called the Auditory, or portio mollis'9 (Fig. 60), arises from the medullary striae on the surface of the calamus scrip- torius, and from the corpus restiforme. It penetrates the meatus auditorius internus, and is distributed to the labyrinth of the ear. Where does the Eighth Pair12 (Fig. 57), arise from? That portion of the eighth pair called Glosso-pharyngeal (Fig. 59,6,7'8 and Fig. 6020), arises from the posterior cord4 of the medulla oblongata. It emerges8 through the foramen lacerum posterius, and is distributed to the tongue and pharynx. That portion called Pneumogastric (Fig. 59,10'"'12 and Fig. 602I), arises from the corpus restiforme4 of the medulla oblongata. It passes out through the foramen lacerum posterius, and is dis- tributed to the organs of respiration, and to the stomach. That portion called the Accessory9 nerve arises from the poste- rior fasciculus of the medulla oblongata, and spinal marrow. It is formed by the union of six or seven roots from the spinal marrow, and three or four from the medulla oblongata, and passes into the cavity of the cranium through the foramen magnum, passes out again through the foramen lacerum posterius, and is distributed to the muscles and integuments of the neck. What other parts are represented in Fig. 59 ? The ganglion'0 of the pneumogastric, its plexiform ganglion" lower down, and its trunk ; '2 its pharyngeal branch, which, along with a branch from the glosso pharyngeal8 and superior laryngeal,'5 forms the pha- ryngeal plexus.'* We then have the cardiac'6 branches given off; also the recurrent laryngeal," anterior, '8 and posterior pulmo- nary. '9 It then forms the oesophageal plexus,20 and terminates in the gastric branches.2' Where does the Ninth Pair13'22 (Figs. 57 and 60) of nerves arise from ? By several fasciculi, from the fissure which separates the corpus pyramidale' (Fig. 59) from the corpus olivare,3 on the medulla oblongata. It gets out of the cranium through the ante- 116 ANATOMY. Fig. 60. rior condyloid foramen, and is distributed to the muscles of the tongue. From whence are the arteries of the brain derived ? From the internal carotids and vertebrals. The internal carotid passes into the cranium through the carotid canal; when it reaches the anterior clinoid process, it sends off the ophthalmic artery to the orbit. It is then distributed to the brain by the arteria choroidea, arteria callosa, or anterior cerebri, arteria nommunicans anterior, and the arteria cerebri media. ANATOMY. 151 Fig. 61. The vertebral arteries' (Fig. 61) are branches of the subclavian, and pass tnrough the transverse processes of the six superior ver- tebras of the neck, enter the cranium through the occipital foramen, and continue till they reach the posterior margin of the tuber annu- lare, when the two coalesce, and form a single trunk called the basilar.6 Before this union, it sends off the spinalis posterior3 and anterior,2 and the inferior cerebelli.5 The basilar gives off the arteria superior cerebelli;7 it then divides into the posterior artery of the cerebrum,8 one on each side. These last arteries are joined by the arteria communicans posterior,9 which completes the circle of Willis. How is the Circle of Willis formed ? Anteriorly and laterally by the internal carotids'010 and their branches ; the posterior part by the basilar,6 and its bifurcation, and forms a free communication Detween the vessels of the two sides of the brain. What other branches are represented by Fig. 61 f The ante- !1$ AN ATOMY. rior cerebri,'3 middle cerebral,'2 anterior communicans,'* and thi< ophthalmic." Senses. From what source is the pituitary membrane supplied with nerves ? From the olfactory, or first pair, and from the fifth pair. From what source are the bloodvessels of the nose derived ? From the internal maxillary, and the ophthalmic arteries. Eye. What constitutes the organ of vision ? The ball of the eye, and its auxiliary parts. What are the auxiliary parts of the eye ? The eyelids, or pal- pebral supercilia, ligamentum palpebrale externum, conjunctiva, glands of Meibomius, cilia, muscles, lachrymal apparatus, con- sisting of the lachrymal glands, lachrymal duct, lachrymal sac, lachrymal caruncle, semilunar valve or fold, and puncta lachrymalia. The muscles are the levator palpebras superioris, the four recti, and two oblique. What nerves supply the orbit of the eye ? They are derived from the motor oculi, or third pair, the trochlearis, or fourth pair, the first branch of the tri- geminus, or fifth pair, and the motor oculi externus, or sixth pair. What arteries supply the orbit of the eye? The ophthalmic, which has numerous branches. What forms the ball of the eye ? It is formed by concentric tunics, and humors contained in them. The tunics are the sclero- tica3'3 and cornea''1 (Fig. 62) externally; the choroidea*'* and the iris8 next in order- and the retina" internally. ANATOMY. 119 The humors are the vitreous,'2 which constitutes the principal part of the eyeball; the crystalline,'5 which is in front of the vitreous;18'18 and the aqueous, between the crystalline and the cornea. The choroid coat,*'* is united at its anterior margin to the scle- rotica by the ciliary ligament. The pigmentum nigrum is spread over the whole internal sur- face of the choroid, between it and the retina. The vitreous humor '8 is composed of the tunica hyaloidea '3 and a thin fluid. What other parts are represented in Fig. 62 ? The ciliary ring or ligament5'5 with its internal surface,6 ciliary body8 posterior or chamber9 of the aqueous humor, termination of the retina,12,12 canal of Petit,'6 and optic nerve'7 with its investment. Ear. How is the ear divided ? Into the external ear, the tympanum, and the labyrinth. Of what is the external ear composed ? It is formed of the ex- terior portion commonly called the ear, and by a canal which leads internally to the tympanum. The outer portion is divided into pinna and lobus; the former is the cartilaginous portion, and the latter is soft and pendulous, attached to its inferior portion. The different parts of the external ear are, the concha, meatus auditorius externus, the helix, antihelix, fossa innominata, tragus, and antitragus. The muscles of the external ear are very feebly developed, and are helicis major and minor, tragicus, antitragicus, transversus auriculae, attolens auriculae, retrahens auriculae, and the anterior auriculae. What is the situation of the Tympanum? It is interposed be- tween the meatus auditorius and the labyrinth. It is three lines in depth, six in the antero-posterior diameter, and the vertical mea- surement about the same. The membrana tympani is situated between the meatus externus and tympanum, and is composed of four lamina. The floor of the tympanum is marked by a rising called the pro- montory, and openings called the foramen ovale and foramen 120 ANATOMY. rotundum; the latter in the dried bone is the opening to the cochlea. The eminentia pyramidalis is a small eminence, projecting from the posterior part of the tympanum ; it is hollow, and communi- cates at the other end with the canal of Fallopius. The Eustachian tube is at the fore part of the tympanum, and communicates at the other extremity with the pharynx. The bones in the tympanum are the malleus, incus, orbiculare, and stapes, whiclr are successively articulated, so as to form a chain. The muscles which move these bones are the laxator tym- pani, tensor tympani, stapedius, and the laxator tympani minor. What is the situation of the labyrinth? It is placed on the inner side of the tympanum, and is divided into three portions, the vestibulum, semicircular canals, and the cochlea. The nerves which are spent in part or wholly upon the organ of hearing are the auditory, portio dura, and trigeminus, or fifth pair. The Great Sympathetic Nerve. What is meant by the Sympathetic Nerve ? It consists of two chains of ganglia extending from the base of the cranium to the lower extremity of the sacrum. These ganglions are united to- gether by an intermediate nervous cord, and send off filaments to adjacent organs ; there is one of them for each intervertebral space, except those of the neck. The ganglion of Ribes unites the two halves of the sympathetic system superiorly, and has been consi- dered as its origin; inferiorly, they are united by a ganglion on the median line of the coccyx, It supplies all the internal organs of the body through plexuses, which take the name of the artery which they accompany. What is the arrangement of the Sympathetic at its upper por- tion ? There are six cranial ganglia, the ganglion of Ribes; gan- glion of Laumonier, called also ganglion caroticum, or ganglion cavernosum; the lenticular or ciliary ganglion; the sphenopala- tine ganglion, or ganglion of Meckel; the otic ganglion, or gan- glion of Arnold; and the submaxillary ganglion. How many Cervical Ganglions are there ? Three, a superior. middle, and inferior. The first is oDposite to the transverse process of the second cer« ANA TOMY. 121 vical vertebra, and behind the internal carotid artery. It has many oranches, some of which communicate with the anterior trunks4 of the first, second, and third cervical nerves ; sends a branch2 also to the carotid plexus, and one to the second cervical ganglion ; it connects5 also with the facial, eighth, and ninth nerves, and with the pharyngeal plexus. Some branches join to form the superior cardiac nerve,6 which goes to join the cardiac gan- glion. The middle is opposite to the space between the fifth and sixth cervical verte- bra. It is small, sometimes wanting, and rests upon the inferior thyroid artery, and is often called thyroid ganglion. It joins the first and third cervical ganglion, and is connected to the anterior trunks of the third, fourth and fifth cervical nerves, and sends the middle cardiac nerve to join the cardiac plexus. The inferior is formed in the interval between the head of the first rib and the transverse process of the last cervical vertebra. It joins the sixth, seventh, and eighth cervical nerves; also the middle cardiac nerve7 and cardiac plexus, by means of the inferior cardiac nerve.8 Where is the Cardiac Plexus situated ? Between the arch of the aorta and the lower part of the trachea and bronchias. It is formed principally from the branches sent by the three cervical ganglions of the sympathetic of each side ; there are filaments also from the recurrent and the par vagum. This plexus is distin- guished by the softness of its texture, and its branches may be divided into anterior, posterior, and inferior. How many Thoracic Ganglions of the sympathetic are there ? Twelve ; they are placed on or near the heads of the ribs, are connected together by the main cord of the sympathetic, and receive filaments from the dorsal nerves. 11 122 ANATOMY. What are the Branches of the thoracic ganglions ? The great splanchnic nerve'2 arises by small branches from the sixth, to the ninth or tenth thoracic ganglions, inclusive. The small'* splanchnic nerve is derived from the tenth and eleventh thoracic ganglions. . Where is the y Bterno-maMoideu* Splenius capitis, Sterno-mastoideus Rectus anticus major, Complexes. Part of trapezius, minor, Trachelomastoideus, Splenius capitis, Rectus posticus major, '• co]]j Assisted W<™ the lower jaw « « minor, Trachelo-mastoidem, is fixed) by Obliquus capitis superior. Complexus. Mylo-hyoideus, Genio-hyoideus, Genio hyoglossus, Digastrici. 148 PHYSIOLOGY. Forwards by Platysma myoides, Sterno mastoideus, Diga*tricus, Mvlo-hyoideus, Genio-hyoideus, Genio-hyosilossus, Omo-hyoidei, Sterno hyoidei, Thyro-hyoidei, Rectus anticus minor, Longus co)U. THE NECK IS MOVED Backwards by Part of trapezius, Rhomboideus minor, Serratus posticus superior, Splenius capitis, " colli, Complexus, Trnchelo-mas toideus, Traversalis colli, Inter-spinalis colli, Semi-spinalis colli, Rectus posticus major, " " minor, Obliquus capitis superior, " " inferior, Scaleni postici, Levator scapulae. Laterally by Various combinations of tho«< muscles wbich separately move it forwards and back- wards, assisted by the sca- leni, inter-transversal is, and recti laterales. Forwards by Rectus abdominis, Pyramidalis, Obliquus externus abdominis, Obliquus internus, Psoas magnus, " parvus. Assisted {when the arms are carried forwards) by Pectoralis major, " minor, Serratus magnus. THE TRUNK IS MOVED Backwards by Trapezius, Rhomboideus major, Latissimus dorsi, Serratus posticus superior, " " inferior, Sacro-lumbalis, Longissimus dorsi, Spinales dorsi, Semi-spinales dorsi, Multifidus spinae, Inter-trausversales dorsi et lumborum. Laterally by Obliquus externus, " internus, Quadratus lumborum, Longissimus dorsi, Sacro-lumbalis, Serrati postici, Latissimus dorsi. THE SCAPULA IS MOVED Upwards by Trapezius, Levator scapulae, Rhomboidei. Downwards by Lower part of trape- zius, Latissimus dorsi, Pectoralis minor. Forwards by Pectoralis minor, Serratus magnus. Backwards by Part of trapezius, Rhomboidei, Latissimus dorsi. THE HUMEEUS IS MOVED Forwards by Fart of deltoid, Part of pectoralis ma- jor, Assisted in some cir- cumstances by Biceps, Coraco-brachialis. Forwards by Biceps, Brachialis anticus, Pronator teres. Assisted by Flexor carpi radialis, " eub'.imis, " ulnaris, Supinator longus. Backwards by Part of deltoid, Teres major, " minor, Long head of triceps, Latissimus dorsi. Inwards by Part of pectoralis ma- jor, Latissimus dorsi. THE FOREUtM IS MOVED Backjoards by Triceps, Anconeus. Rotated inwards by Subscapularis. Assisted occasionally by Pectoralis major, Latissimus and terel major. Outwards by Supra-spinatus, Infra-spinatus, Teres minor. Rotated inwards by Pronator teres, Flexor carpi radialis, Palmaris longus, Flexor sublimit, Pronator quadratus. Outwards by Biceps, Supinator brevis, Extensor secundi internodfl. PHYSIOLOGY. 14S THE CARPUS IS MOVED Forwards by Flexor carpi radialis, Palmaris longus, Flexor sublimis, Flexor carpi ulnaris, Flexor profundus. Flexor longus pollicis. Backwards by Extensor carpi radi- alis longior, Extensor carpi radi- alis brevior, Extensor secundi in- ternodii, Indicator, Extensor communis digitorum, Extensor proprius pollicis. Outwards by Flexor carpi radialis, Extensor carpi radi- alis longior, Extensor carpi radi- alis brevior, Extensor ossis meta- carpi. Extensor primi inter- nodii. Inwards by Flexor sublimis, " carpi ulnaris, " profundus, Extensor communis digitorum. Extensor minimi di- giti. Extensor carpi ul- naris. THE THUMB IS MOVED Iiwards andforwads, across Vie palm, by Opponens pollicis, Flexor brevis, " longus. Outwards and back- wards by Extensor ossis meta- carpi pollicis, Extensor primi inter- nodii, Extensor secundi in- ternodii. and for- wards, away from the other fingers, by Abductor, Assisted by part of the Flexor brevis. Backwards and in- wards, to the other fingers, by Adductor, Extensor primi inter- nodii, Extensor secundi in- ternodii, Forwards, or flexed, by ■Flexor sublimis, " profundus, Lumbricales, Interossei, Flexor brevis digiti minimi, Abductor digiti mi- nimi. Forwards by Psoas magnus, Iliacus, Tensor vaginae femo- ris, Pectineus, Adductor longus, " brevis. THE FINGERS ARE MOVED Backwards, or ex- Outwards, to radial tended, by border, by Extensor communis, Abductor indicis, Extensor minimi di- Abductor digiti mi- giti. nimi, Indicator. Interossei. THE THIGH IS MOVED Backwards by Gluteus maximus, Part of gluteus me- dius, Pyriformis, Obturator internus, Part of adductor mag- nus, Long head of biceps, Semi-tendinosus, Semi-membranosus. Inwards by Psoas magnus, Iliacus, Pectineus, Gracilis, Adductor longus, " brevis, " magnus, Obturator externus, Quadratus femoris. Inwards by Abductor digiti mi- nimi, Interossei. Outwards by Tensor vaginae femo- ris, Gluteus maximus, " medius, " minimus, Pyriformis. THE THIGH IS ROTATED. Inwards by Tensor vaginae femo- ris, Part of gluteus me- dius, And, when the leg is extended, by Sartorius, Semi-tendinosus. 13* Outwards by Gluteus maximus, Part of gluteus me- dius, Pyriformis, Gemellus superior, Obturator internus, Gemellus inferior, Quadratus femoris, Obturator externus, Psoas magnus, Iliacus, Adductor longus, " brevis, " magnus Biceps cruris, slightly. 150 PHYSIOLOGY. THE LEG IS MOVED Backwards, or flexed, by Semi-tendinosus, Biceps, Sein i-membranosus, Gracilis, Sartorius, Popliteus. Extended by Rectus, Crureus, Vastus externus, " internus. THE FOOT IS MOVED Forwards, or flexed, by Tibialis anticus, Extensor proprius pollicis. Extensor longus di- gitorum, Peroneus tertius. Backwards, or ex- tended, by Gastrocnemius, Plantaris, Soleus, Flexor longus torum, Flexor longus licis, Tibialis posticus, Peroneus longus, " brevis. digi- pol- Inclined inwards by proprius Extensor pollicis, Flexor longus digi- torum, Flexor longus pol- licis. Tibialis posticus. Outwards by Peroneus longus, " brevis, Extensor longus di gitorum, Peroneus tertius. Backwards, or flexed, by Abductor pollicis, Flexor brevis digi- torum, Abductor minimi di- giti, Flexor longus pol- licis, Flexor digitorum, Flexor accessorius, Lumbricales, Flexor brevis pollicis, Adductor pollicis. Flexor brevis minimi disrili, Interossei. Forwards, or tended, by Extensor longus di- pi torum, Extensor proprius pollicis, Extensor brevis di- gitorum. THE TOES ARE MOVED ex- Inclined inwards by Abductor pollicis, Interossei. Outwards by Adductor pollicis, Adductor digiti mi nimi, Interossei.* What are the Attitudes which man is capable of assuming? They are divided into the active and the passive: the former re- quire a muscular effort; the latter do not, as when the body lies in a horizontal position. Does the attitude of standing require muscular effort ? It re- quires the action of the extensors. How are the Movements of the body divided ? Into partial and locomotive ; the former simply changes the relative situation of * Quain's Human Anatomy, by Quain and Sharpey, Amer. edit, by Lmdy i 465, Philadelphia, 1849. PHYSIOLOGY. 151 parts of the body, and the latter the relation of the whole body to the soil. What are the Locomotive movements ? Walking, leaping, run- ning, swimming, flying, &c. Of the Function op Expression, oe of Language. What is included under this head ? Those varieties of muscular contraction by which man and animals exhibit their feelings, and communicate the knowledge of such feelings to each other; and comprises two different sets of actions. What are they ? Those addressed to the ear, producing the phenomena of voice ; and those appreciated by sight and by touch — or the gestures. What is meant by the Voice, or Phonation ? It is the sound produced in the larynx while the air is passing through it. The modifications by which speech is produced are effected in the cavity of the mouth and in the fauces. What organs are concerned in the production of the voice ? The muscles concerned in respiration, the larynx, the mouth, and nasal fossae What are the conditions necessary to the production of the voice ? That air shall be sent from the lungs through the glottis, where it may throw certain parts into vibration, and then make its exit by the mouth and nasal fossae ; volition is, however, also required to cause the necessary action of the muscles of the larynx for its pro- duction and modification. What are the evidences that the voice is produced in the larynx ? One is that, if an opening is made below the larynx, the voice is lost; another is, that the voice of an animal may be produced, or a resemblance to it, by forcing the air into the tracheal extremity towards the larynx, provided we approximate the arytenoid carti- lages ; but if this is not done, no voice is produced by the air in passing. Also, if the muscles moving these parts are paralyzed •rom any cause, the voice is lost. What nerves preside over the muscles concerned iu the formation of the voice ? The superior and inferior laryngeal nerves, the last of which is called recurrent. By what portion of the larynx is the voice produced ? The infe- 152 PHYSIOLOGY. rior ligaments, which vibrate distinctly during the production of the voice, and upon which it evidently depends. These ligaments are, therefore, essentially the organs of voice, and are called the chordce vocales. They are operated upon, and modified in their action, by the muscles appropriate for that purpose. The respective actions of the different muscles are as follows :— Govern the Pitch of the Notes. m (_ . ., ... ") ("Depress the front of the thyroid cartilage on the cricoid, ■g Lrico-tnyroidei I ............J ftnd stretch the TOCal ijgaments; assisted by the aryte- g J bterno-thyroidei j j^ noideus and crico-arytenoidei postici. bo "J |! | Thyro-arytenoidei \.....f Elevate the front of the thyroid, and draw it towards the <; (.Thyro-hyoidei J....... L arytenoid, relaxing the vocal ligaments. Govern the Aperture of the Glottis 3s Crico-arytenoidei postici..............................Open the glottis. S> 1 ~ . ., ,, . , ) C Press together the inner edges of thu | [ss^Wtate,lto,|.....................{t^tenoid cartiia*e' -d cte the ** Those only which relax or stretch these ligaments are concerned in the production of the voice. The intensity or volume of the voice depends mainly upon the force with which the air is sent from the lungs, and the size of the larynx. The difference between the male and female voice depends essentially upon the difference in the size of the larynx. The dif- ferent notes are produced by different degrees of tension of the chordae vocales, or ligaments. The timbre or quality of the voice depends upon the condition of the cartilages of the larynx, and the aptitudes of pari& of the organ for vibration, depending upon a variety of circumstances connected with the larynx and accessory parts. Fig. 5. Ciliary Motion. What is understood by ciliary or vibratory motion ? Cilia, b, are little hair-like processes which cover some forms of epithelium, a, and are visible by the aid of a microscope. These cilia have the the property of moving or being moved, resembling, when in mo- tion, a field of wheat over which the wind is blowing, first depressed, Dunglison's Physiology, 7th edition. PHYSIOLOGY. 153 and then returning to its original state. It is of great importance in the animal economy. They move towards the outlets, and propel the secretions in that direction. The cause producing this motion is not known; it seems to be molecular, and independent of the vital condition and stimuli affecting it, such as narcotics, electricity, &c. Nutritive Functions. What are the nutritive functions ? Digestion, absorption, res- piration, circulation, nutrition, calorification, and secretion — seven in number. What is effected by these functions ? The composition and decomposition of the body. Digestion. What is digestion ? It is that process to which food is subjected so as to render the nutritive portion of it fit for absorption. What are the digestive organs ? They consist of a long canal of variable dimensions at its different parts, and communicating externally by two openings — the mouth and the anus. What is meant by food or aliment? All substances which, when received into the digestive organs, are capable of being con- verted into chyle. How are animals characterized from the food upon which they subsist ? The carnivorous, or those feeding on flesh; the pis- civorous, on fish ; the insectivorous, on insects ; the phytivorous, on vegetables; the granivorous, on seeds; the frugivorous, on fruits; the graminivorous and herbivorous, on the grasses; and the omnivorous, on both animal and vegetable food. To which of these does the digestive apparatus of man belong ? Intermediate between the carnivorous and herbivorous ; it is, there- fore, omnivorous, although he is capable of living on either vegeta- ble or animal diet, to the exclusion of the other; but when confined to one alone from infancy, the corporeal and mental development is generally inferior to that produced by a mixed diet of vegetables and animals. Will man or animals thrive and live when restricted to any single PHYSIOLOGY. article of diet ? They will not for any considerable length of time ; a variety, whether animal or vegetable, or both, appears to be necessary to health. (For references to this figure, see Anatomy, pages 74, 15.) What is the division of aliments proposed by Dr. Pereira ? The Aqueous, Mucilaginous or Gummy, Saccharine, Amylaceous, Ligneous, Pectinaceous, Acidulous, Alcoholic, Oily or Fatly, Pro- teinaceous, Gelatinous, and Saline. From these simple aliments our compound aliments are formed. What forms the basis of all drinks ? Water. How are drinks classified by Dr. Pereira ? 1. Mucilaginous, farinaceous, or saccharine drinks. PHYSIOLOGY. 155 2. Aromatic or astringent drinks. 3. Acidulous drinks. 4. Animal broths, or drinks containing gelatine and osmazome 5. Emulsive or milky drinks. 6. Alcoholic and other intoxicating drinks. Liebig divides aliments into azotized and non-azotized. He con- siders the azotized to be for the nutrition and reparation of the animal tissues; hence he calls them "plastic elements of nutri- tion.''1 The non-azotized are designed to supply the materials for animal heat and respiration, hence called "elements of respira- tion." It has been proposed to call the first nutritive elements, and the latter calorifacient. What is understood by a Condiment ? A substance which pro- motes digestion, and is taken with food for that purpose ; and also sometimes adds to its sapidity. What are the different parts of the digestive operation ? Hun- ger, prehension of food, Oral or Buccal digestion or mastication, Deglutition, Chymification, the Action of the Small Intestine, the Action of the Large Intestine, and Defecation, or the Expulsion of the feces. The first six of these belong to the formation of chyle : the others relate to the excrementitious portions of the food. The digestion of solids requires all these processes : that of liquids comprises only thirst, prehension, deglutition, the action of the stomach, and of the.small intestine. What is Hunger ? It is an internal sensation, the seat of which is invariably referred to the stomach, and proceeds from changes in this organ. It indicates the want of solid aliment. Thirst indicates the want of a liquid. What are the general effects of hunger on the system. Debility and diminished action of every organ, except, perhaps, of the ab- sorbents, which are supposed to be increased. From what source are the nerves of the stomach derived ? The eighth pair and the great sympathetic ; but to which of these the sensation of hunger is referable is not clearly settled. What are the organs of Prehension of Food? The arms and the mouth. What changes are effected upon the food in the mouth ? The principal is Mastication, by which the food is prepared by minute division for the action of the solvent. This mechanical disintegra- 156 PHYSIOLOGY. lion is materially aided by Insalivation, while, at the same time, the saliva changes the chemical composition of the mass. The reaction of this fluid is alkaline (dependent upon the basic phos- phate of soda), varying at different times, being the greatest during and after meals. The substance upon which the peculiar proper- ties of saliva depends is termed Ptyalin, an albuminous compound which acts the part of a "ferment: " Sulphocyanogen is also uni- formly present. This fluid is made up from the secretious of the buccal and salivary glands. The products of the different salivary glands have different degrees of efficacy in this part of the digestive process ; and the quantity is estimated at about three and a half pounds daily. The saliva exerts a chemical action on the farina- ceous elements of food by changing starch or dextrine into grape sugar, while no action is exerted upon nitrogenous compounds. What organs are brought into action in Deglutition ? The mouth, pharynx, and oesophagus. It has been divided into three stages : in the first, the food passes from the mouth into the pharynx; in the second, it clears the aperture of the glottis and nasal fossae, and attains the oesophagus; in the third, it clears the oesophagus and enters the stomach. What are the nerves distributed to these parts ? The glosso- pharyngeal to the mucous surface of the tongue and fauces, and is the excitor nerve ; and the pharyngeal branches of the pneumo- gastric are the motors; there are also some branches of the fifth pair, which may be considered as associate excitor nerves ; and the associate motors are branches of the hypoglossal. What is meant by Chymification ? It is that part of the true digestive action by which food is converted into a pultaceous mass, termed chyme, and is exclusively a gastric act. What changes occur in the stomach after food is swallowed ? The mucous membrane becomes florid; the different secretions take place in greater abundance, and become mixed with the food. After some interval, longer in some cases than in others, the pyloric portion contracts, which sends the food into the splenic portion, tb*n it dilates, and this alternation goes on during the i*hole timt >f digestion, and is called peristole; it is limited at first to the pyloric portion, but at length it is extended to the other portions, *o that the whole stomach participates in this kind of movement. This movement, which is produced by .alternate PHYSIOLOGY. 157 contraction and relaxation of the circular fibres of the stomach, facilitates the admixture of the food with its secretions. The operations performed, therefore, in the stomach, are the gentle oscillatory or vermicular motions, and the admixture of the food with the different secretions of the stomach and upper portion of the alimentary canal, which are the principal agents of the diges- tion performed in the stomach. What is the nature of the process of Gastric Digestion? The principal agent is the Gastric Juice, which is secreted by the peptic follicles ; it is a clear, transparent, colorless, or slightly yellow fluid, with very little viscidity. It is decidedly acid ; but, with regard to the nature of this acid, there is a discrepancy among chemists. Bernard, Thomson, Lehman, Smith of Philadelphia, and others, affirm that it is Lactic acid. Hydrochloric acid has also been detected, and they may both be present and contribute to its solvent power. Other acids have also been detected, but can hardly be considered as its normal constituents. The peculiar organic ferment of this fluid is Pepsin, which combines with many acids; and, when in union with acetic and muriatic acids, its solvent power is increased. The quantity secreted depends rather upon the general requirements of the system than upon the quantity of food introduced into the stomach. A definite proportion only of aliment can be perfectly digested in a given quantity of fluid, and, should the former be in excess, it will remain in the stomach or pass into the bowels in a crude state, and produce disease of some kind or other. The condition of the nervous system, and the state of integrity of the pneumogastric nerve, influence greatly the pro- duction of this fluid, and therefore decidedly affect the digestive process. It is the principal agent, therefore, by which chemical solution and reduction of the food are effected, and Chyme is formed. This liquid (the chyme) is of a pultaceous consistence, but varies greatly in its composition and appearance, according to the proportion of the different elementary substances entering into the composition of the food, always, however, having a strong acid reaction. Azotized substances are dissolved by the gastric juice, while no action is exerted upon starchy, saccharine, or oleaginous matters. A.ny change which may take place in the starchy particles in the H 158 PHYSIOLOGY. stomach is entirely dependent npon the presence of the salivary fluid. Oleaginous matters are merely reduced to a state of minute division, and are diffused in a state of suspension through the chyme. Albuminous matters, or the Protein compounds, are completely dis- solved, their chemical properties are altered, and they are brought into one uniform condition, that of albuminose, which is a state best adapted for subsequent assimilation. In this condition they seem to form definite combinations with the solvent fluids which have received the name of peptones. In this process the convert- ing power is exerted by the pepsin, while the solvent power is due to the acid. The solvent power of the gastric juice is influenced by tempera- ture ; it requires a heat from 96° to 100°, and is retarded if re- duced below this point; and if raised above it the gastric juice is decomposed and its solvent power destroyed. It is also influenced by motion ; by the removal of the matters already reduced or dissolved, which may be done by absorption in part, and also by the escape of the reduced portions through the pyloric orifice; and by the state of minute division and incorporation with aqueous fluid. The Chyme, or product of gastric digestion, contains matters in solution, and also much that is only reduced and mechanically suspended; the solution progresses somewhat after it has passed into the intestinal tube. Digestion, therefore, is not completed in the stomach, but only advanced. The time occupied in this por- tion of digestion varies very much, depending upon the kind of diet used ; but three or four hours is probably about an average. What is the nature of the process of Intestinal Digestion ? Soon after the chyme enters the duodenum it is subjected to the action of the bile, the pancreatic fluid, and the secretion from the glandula? in the walls of the intestine itself (proceeding chiefly perhaps from the glands of Brunner), which is called Succus Entericus. The pancreas resembles the salivary glands, and its secretion strongly resembles the saliva in its general appearance; it is clear, colorless, slightly viscid, and alkaline; but the nature of its animal principle is not precisely the same, although it is also capable of converting starch into sugar, and therefore subservient to the con- tinued digestion of the farinaceous part of food during its passage through the small intestines; which power, however, is shared by PHYSIOLOGY. 159 the succus entericus. According to M. Bernard, the essential purposes of the pancreatic fluid is to promote the absorption of fatty matters, by reducing them to an emulsion which is capable of finding its way into the lacteals. The Biliary secretion is also received into the duodenum, but its exact agency in the process of digestion is not well understood. It is ascertained, however, that it has the effect of checking destructive chemical changes in the chyme; fermentation and acidity in the alimentary canal is thus prevented. It also promotes peristaltic action ; but animals may live for a long time where the bile is carried off from the system artificially, although they will in time die from inanition. The Succus Entericus is a colorless, viscid liquid, invariably alkaline iu its reactions. It has the remarkable property of exert- ing a solvent action on albuminous bodies, scarcely inferior to the gastric juice, and also the power of converting starch into sugar in nearly an equal degree with the saliva and pancreatic fluid. The fluid of the small intestines, compounded of these different secre- tions, possesses the peculiar power of dissolving, or of reducing to an absorbable condition, alimentary substances of every class, a property possessed by neither of the fluids composing it, separately. It completes the conversion of starchy into saccharine matter, it emulsifies oleaginous matters, redissolves albuminous compounds which have been precipitated by the admixture of bile, and com- pletes the solution of this class of substances which have been imperfectly dissolved in the stomach. It is therefore enabled to complete the preparation of all the compounds called for by the varied wants of the system. The processes of digestion and con- version are probably continued during the entire passage of the aliments along the intestinal canal, while the products are gradually being withdrawn by the action of the absorbents, so that, by the time the mass reaches the coecum, little remains except the innu- tritions ami insoluble portions of the food, together with the excre- mentitious parts of the bile and other secretions. The contents of the intestine are alkaline until thoy arrive at the coecum, when they become acid. What is the office of the Large Intestine ? It acts as a reservoir and excretory canal for the feces. Where is the fecal matter formed, and what does it consist of? 160 PHYSIOLOGY. In the large intestine, and consists of the excrementitious part of the food, as well as of the juices of the upper part of the canal, which have been subjected to the digestive process ; of the secre- tions poured out from the lower part of the intestines; and of the substances which have escaped the digestive action of the stomach and small intfstine. The chemical composition varies according to the nature or' rhe food ; its quantity, the kind of digestion, &c. What is meant by Defecation ? It is the expulsion of the feces from the rectum. What is Thirst? It is the desire for drink, and is an internal sensation resembling hunger, arising from the necessities of the system, caused by a constant drain of the fluid portions of the blood. What are the exciting causes of thirst ? Febrile and inflamma- tory diseases, loss of fluid from any cause, long speaking or singing, certain kinds of diet, and habit. Where is the seat of the impression of thirst ? Principally in the back part of the mouth and fauces; but whether primarily there, or produced by sympathy with the condition of the stomach, is not certain. Can the sensation of thirst be allayed by injecting water into the stomach without its being applied to the fauces, or by injecting it into the blood-vessels ? It can. What change is produced in the blood by abstinence from liquids ? It becomes more and more deprived of its watery portions Is the mechanism of deglutition of liquids the same as solids ? It is. What changes occur in liquids when swallowed ? They acquire the temperature of the stomach, and become mixed with the secre- tions contained in it; some of them undergo chymification in whole or in part, and others do not; and of those that do not, some are absorbed directly from the stomach without change ; and others are not, until they act upon the secretions of the stomach, by which they undergo some change, and then they are afterwards absorbed. Those liquids which are converted into chyle are either changed wholly into chyme, or else a part of it is separated which undergoes this process, and the aqueous or fluid portion remaining is then absorbed without change, either from the stomach, or else from the small intestine. PHYSIOLOGY. 161 What is meant by eructation ? It is the escape of gas from the stomach. What is meant by regurgitation? It is when liquid or solid food, instead of air, ascends from the stomach into the mouth. What is meant by rumination ? It is the faculty of returning the food from the stomach into the mouth, to be again subjected to mastication and deglutition. What is Vomiting? It is an inverted action of the stomach by which its contents are expelled, and is always preceded by both local and general disturbance. It differs from regurgitation in the sensation that precedes, the retching that accompanies, and the fatigue that generally succeeds it; regurgitation is not usually ac- companied by indisposition, while vomiting always is to a greater or less extent. In what order ar,e the phenomena of vomiting exhibited ? When it is caused by substances taken into the stomach, the first impres- sion is made on its nerves, and transmitted from them to the ner- vous centres, from which it is reflected to the diaphragm and abdominal muscles in such a manner that they are thrown into con- traction, and press upon the stomach; this organ also contracts from the pylorus towards the cardia; and by this combination of efforts the contents are ejected from the stomach into the oesopha- gus, and out of the mouth. Absorption. Wh.it are the different kinds of absorption ? They are of two kinds—the external and internal; the former includes the absorp- tion wh" fill up spaces that might otherwise be vacant. What organ secretes the synovial exhalation ? The synovia] PHYSIOLOGY. 181 membrane, which is situated within the articular capsules and the bursae mucosae. What organs exhale the coloring matter of the skin ? They consist of a glandular parenchyma, or organ of secretion, in the substance of the true skin, a little below the papillae, with excretory ducts, which deposit the matter between them. What is understood by the areolar exhalations ? Those that are effected in parenchymatous structures — as the humors of the eye, &c. What is the cutaneous transpiration or exhalation termed when invisible? The insensible transpiration or perspiration : and when it is perceptible, it is called sweat. It is secreted by a glandular parenchyma, situated in the skin, which secretes the fluid, with ducts opening on the surface of the body for its discharge. The quantity of this fluid is varied by a great variety of circumstances. What is understood by the pulmonary transpiration ? It is a secretion thrown off from the surface of the air-passages and lungs, resembling very much that thrown off by the skin, and is nearly identical with it in chemical composition. How are the Follicular secretions divided ? Into the mucous and the cutaneous. What is the product of the secretion of the mucous follicles or crypts called ? Mucus. What are examples of the follicular secretion of the skin ? The secretion on the face, which has the appearance of worms when forced through the external aperture of the follicle ; the humor of Meibomius, and of the caruncula lachrymalis. What are the glandular secretions ? They are the milk, sperm, urine, bile, pancreatic juice, saliva, and tears. What secretes the tears ? The lachrymal gland; but, as we generally meet with them, they are mixed with the secretions of the conjunctiva, caruncula lachrymalis, and follicles of Meibomius. What is the apparatus for the secretion of the saliva ? A parotid gland, a submaxillary, and a sublingual, on each side. What secretes the pancreatic juice ? The pancreas, which re- sembles very much the salivary glands. What is the apparatus for the secretion of bile? The liver, nepatic duct, gall-bladder, cystic duct, and the ductus communis choledochus. 16 182 PHYSIOLOGY. What peculiarity is there in the structure of the liver ? It in supplied with two kinds of blood —the arterial and the venous From which of these the bile is secreted is yet unsettled. What are the substances found in bile ? Cholesterine, bilic acid, biliverdin, and some earthy salts. What uses does the bile subserve in the animal economy ? A por- tion passes off with the excrementitial part of the contents of the alimentary canal; another portion renders fatty matters soluble, and capable of being absorbed by the lacteals, and probably con- verts sugar into fatty matter. It contrains hydro-carbon in large quantity, the separation of which from the blood is of importance to the condition of that fluid. What is the apparatus for the secretion of urine? The kidneys, ureters, bladder, and urethra. What is the object of this function ? It appears to be to depu- rate the blood, by separating from it the elements of the substances of which the urine is composed. It is purely excrementitial, and it is the nitrogenous compounds that are eliminated. What is the analysis of healthy urine, according to Berzelius ? In 1000 parts it consists of: water, 933-00 ; urea, 30-10 ; sulphate of potassa, 3-71; sulphate of soda, 3-16; phosphate of soda, 2-94; chloride of sodium, 4-45; phosphate of ammonia, 1 65; muriate of ammonia, 1 -50 ; free lactic acid, lactate of ammonia, animal matter soluble in alcohol, and urea not separable from the above, 17#14; earthy phosphates, with a trace of fluate of lime, 1-00 ; lithic acid, 1-00 ; mucus of the bladder, 0-32 ; silex, 0-03. What are the organs termed glandiform ganglions ? They are the spleen, thyroid, thymus, and supra-renal capsules. The uses of these are not well settled. Of the Reproductive Functions. What is the object of these functions ? The preservation of the species ; and the different functions tending to this result are treated of under the following head : — PHYSIOLOGY. 183 Generation. To what class of bodies is this function peculiar ? To organized bodies exclusively. What is understood by univocal generation ? It is where gene- ration is effected by a process requiring the pre-existence of an organized being; and equivocal generation is where generation is supposed to take place spontaneously, by extraneous influences, without requiring a parent. This last theory is not generally ad- mitted, although advocated by many. What is the simplest form of generation ? It is where an animal, at a certain period of its existence, separates into several fragments, each of which forms a new individual. This is called fissiparous generation, or generation by spontaneous division. What is meant by gemmiparous generation ? It consists in the formation of buds, sporules, or germs, on some part of the body; these become developed, drop off, and form as many new individ- uals. In both these forms generation is executed by a single in- dividual. Higher in the scale we have separate organs, which are divided into the male and female ; some organized bodies have both in the same individual; but as we ascend in the scale to the superior animals, they are separated, and belong to distinct individuals, in which case copulation becomes necessary. What are the varieties of this kind of generation where copula- tion is necessary ? In the first place, the ovum may be fecundated, laid by the female, and hatched out of the body, which is called oviparous generation. Secondly. The process of laying may commence, and the fecun- dated ovum pass so slowly, that it is hatched before it is expelled. This is called ovo-viviparous generation. Thirdly. The fecundated ovum may be detached from the ovary soon after copulation, and then deposited in a womb or uterus, there to be developed until the proper period for its expulsion, after which it may be further nourished by a peculiar and appropriate secretion furnished by the mother. This is viviparous generation. Lastly. There are animals provided with pouches, into which the young, born at an early stage of their growth are received and aourished with a secretion furnished by the mother from glands 184 PHYSIOLOGY. situated in these pouches. These are the marsupial, and the opos- sum may be considered as the type. The young are also sometimes born with the shape peculiar to them, and at others with forms which are changed materially, as in the papilio, or butterfly. What are the different acts necessary for reproduction in the human species ? Generation, or the formation of germs. Copulation, or the union of the sexes. Fecundation, or the vivification of germs. Conception, or the retention of the vivified germs. Gestation, or pregnancy. Parturition, delivery, or accouchment. Lactation, or the nourishment of the infant with milk. What are the male organs of generation ? The two testes; the excretory ducts of these glands, called vasa deferentia ; the vesi- culce seminales; two canals, called ejaculatory ; and the penis. What secretes the sperm, or fecundating fluid of the male ? The testicles ; when formed, it is received into the tubuli seminiferi, and passes along them to the epididymus, the vas deferens, and the vesiculae seminales, where it is deposited, until it is discharged into the urethra during venereal excitement. What are the female organs ? They are those inservient to copulation and fecundation, and those for gestation and lactation. What is understood by Menstruation? It is the periodical discharge of a bloody fluid from the vulva, occurring once in about twenty-eight days, and lasting from three to six days. This dis- charge is called the catamenia, menses, flowers, &c, and con- tinues during the whole time the female is capable of conceiving, from puberty to the critical age, or time of its cessation. This process is accompanied by the maturation and discharge of an ovule from the ovary, which occurs once every twenty-eight days in health, and is the essential action of the sexual function. What organ gives out this fluid ? It is an exhalation or secre- tion effected from the internal surface of the uterus. Is menstruation necessary to impregnation ? As a general rule its appearance denotes the capability of being impregnated, and its absence the want of capability ; yet there are exceptions to it. Where does fecundation and conception occur ? In the ovarium. PHYSIOLOGY. 185 What period elapses after fecundation before the ovum arrives in the uterus ? About ten or twelve days. How may the hypothesis of generation be divided ? They may be classed under two heads—the system of epigenesis, and that of evolution. What is understood by the system of Epigenesis? It is the theory which supposes the new being to be formed of materials furnished by both sexes, the particles of which previously possesed the necessary arrangement for constituting it; and it is also sup- posed that these particles have a controlling agent or force which regulates their affinity, different from the ordinary forces of matter, and this force has been termed cosmic, plastic, nisus formativus, &c. &c, What is understood by the theory of Evolution ? This theory supposes that the new individual pre-exists in some shape in one of the sexes, but requires to be vivified by the other, in the gene- rative act, after which commence the developments or evolutions which result in the formation of a distinct being. How are the advocates of this theory divided ? Some of them suppose that the germ exists in the ovary of the female, and requires only the vivifying influence of the male sperm to cause its evolution. These are called ovarists. Others suppose the male sperm to con- tain the rudiments of the new being, and that the female merely affords it a nidus and pabulum during its development. The latter are called spermatists, seminists, and animalculists. What is understood by the doctrine of omne vivum ex ovo, as advocated by Harvey ? It supposes all animals to orginate from an ovum, or egg, and that this is furnished by the female. In the human being, they are vesicules, ovules or ova, which exist in the ovaria, one of which matures, and is thrown off every twenty-eight days, wanting only to be fecundated by the male to be evolved and produce a living being. What is the most modern view of this subject, as adopted by physiologists ? It is a modification of the theory of epigenesis. They believe there must be a union of materials furnished by both sexes, otherwise it is impossible to explain the similarity of confor- mation to both parents; that the secretion of the male, the sperm cell, is united to the ovule furnished by the ovarium of the female; and that the embryo results from a union of these products, im- 16* 186 PHYSIOLOGY. pressed with life from the instant of such union, and with a greater or less resemblance to one or the other parent. In wnat manner does the fecundating fluid of the male reach the ovaries ? This is still a disputed question amongst physiologists; some alleging that it passes from the vagina into the uterus, thence along the Fallopian tubes to the ovaries ; others suppose it to be transmitted from the vagina to the ovaries, through the interven- tion of special absorbents, but these have not as yet been proved to exist. The former theory seems the more probable, and that it is promoted by ciliary action. Is there any consciousness of fecundation on the part of the female at the moment of its occurrence. There are no symptoms that can be depended on. At what period, in the human female, is conception most likely to occur ? Immediately before and after the menstrual period ; particularly the latter. What is the proportion of twin cases in this country ? About one in seventy-five. Ages. How are the different ages divided ? Into infancy, comprising the period from birth until the second dentition; childhood, that between the second dentition and puberty; adolescence, that between puberty and manhood ; virility, that between youth and old age ; and old age. How is the period of infancy divided ? Into that after the child is ushered into the world until the first dentition, comprising about seven months. Secondly. The period of first dentition, and is considered to include the period between seven months and two years. Thirdly. The balance of the period of infancy. Through what period does childhood extend ? From the seventh to the fifteenth year, or to the period of puberty. Through what period does adolescence extend ? From about the fifteenth to the twenty-fifth year in men, and from fifteen to twenty-one in women. How is the period of virility or manhood divided ? Into three periods-—crescent, confirmed, and decrescent virility. The first of these extends from the age of twenty-five to thirty-five in the male, and from twenty-one to thirty in the female ; the second, from thirty* PHYSIOLOGY. 187 five to forty-five in the male, and from thirty to forty in the female ; the third, from forty-five to sixty in the male, and from forty to fifty in the female. What is understood by old age ? It is the period when every- thing retrogrades, and comprises three periods o^stages : incipient, or green old age, extending to seventy years; confirmed old age, or caducity, to eighty-five years ; and decrepitude, from eighty-five upwards. Individual Differences among Mankind. How are the differences designated ? By the terms temperament, constitutions, idiosyncrasies, acquired differences, and the varie- ties of the human species, or the different races of mankind. Temperaments. What is understood by temperaments ? They are those indi- vidual differences which consist in such disproportion of parts, as regards volume and activity, as to sensibly modify the whole or- ganism, but without interfering with the health; and, therefore, being a physiological condition. How are the temperaments divided ? Into the sanguine, the bilious or choleric, the melancholic, the phlegmatic, and the nervous. What are the characteristics of the sanguine temperament? There is a predominance of the circulatory system, characterized by a strong, frequent, and regular pulse; ruddy complexion; animated countenance ; a good and distinctly-marked shape ; firm flesh ; light hair ; fair skin ; blue eyes ; great nervous susceptibi- lity ; quick conception ; ready memory ; lively imagination ; addic- tion to the pleasures of the table ; and amorousness. The diseases of this temperament are generally violent; and are seated in the circulatory system — as fevers, inflammations, and hemorrhages. What are the characteristics of the bilious or choleric tempera- ment ? The pulse is strong, hard, and frequent; the subcutaneous veins are prominent; the skin is of a brown color, inclining to yellow ; hair dark ; body moderately fleshy ; muscles firm and well- marked ; the passions violent and easily excited ; temper abrupt and impetuous ; great firmness and inflexibility of character ; bold- 188 PHYSIOLOGY. ness in the conception of projects, and untiring perseverance in their fulfilment. The diseases are generally combined with more or less derangement of the hepatic system, which is considered to be prominently developed. What are the characteristics of the melancholic temperament? The vital functions are feebly or irregularly performed ; the skin assumes a deeper hue ; the countenance is sallow and sad; the bowels are torpid, and all the excretions are tardy; the pulse is hard and habitually contracted; the imagination is gloomy, and the temper suspicious. What are the characteristics of the phlegmatic, lymphatic, or pituitous temperament ? They are soft flesh; pale skin; fair hair ; weak, slow, and soft pulse ; figure rounded, but inexpressive; the vital actions more or less languid ; the memory not tenacious, and the attention vacillating; with aversion to both mental and corporeal exertion. What are the characteristics of the nervous temperament? The nervous system is predominant. The muscles are small, soft, and, as it were, wasted ; a slender form, generally ; great vividness of sensation ; and promptitude and fickleness of resolution. The dis- eases incident to a predominance of this temperament are of the hysterical and convulsive kind; or those usually denominated nervous. These distinctions are not always well marked, and the different temperaments are usiially blended together, so as frequently to render it difficult to decide which one predominates. Constitution and Idiosyncracy, &c. What is understood by the constitution of an individual ? It is the mode of organization proper to that person ; and they are as numerous as the individuals themselves. What is understood by idiosyncracy? It is a term applied to the peculiar disposition which causes an individual to be affected by extraneous bodies in a way different from that which they affect mankind in general. PART III. CHEMISTRY. (189) PART III. —CHEMISTRY. What is Chemistry ? It is the science which makes known the composition of bodies, and the manner in which they comport with each other. Caloric What is understood by the term caloric ? It is the cause or agent producing the sensation and phenomena of heat. What are some of the properties of caloric, or heat ? It has been supposed to be a subtle fluid, the particles of which repel each other, and are attracted by all other subetaw es; it is impon- derable ; expands, and is present in all bodies; transferable from one body to another; tending to an equilibrium in three ways — by direct contact, by conduction, and by radiation. The generally received opinion now is, that the phenomena of heat are caused by vibrations of a very subtle etherial medium. What are the principal conditions which influence the communi- cation of heat by direct contact2 The degree of contiguity, and the conducting power of substances ; electricity is excited as caloric passes from one body to another. How are bodies divided in regard to their power of conducting caloric ? Into conductors, and non-conductors; among the former are the metals, and among the latter, or those which conduct very imperfectly, are glass, wood, charcoal, fluids, gases, and porous substances generally. With regard to the relative conducting power of the metals, they stand in the following order : Gold, the best; then, silver, copper, iron, zinc, tin, lead, and platinum. Are liquids good conductors ? Liquids have scarcely any con- ducting power; but when heat is applied to the lower portiou of 192 CHEMISTRY. them, ascending and descending currents are established; the heated particles, being expanded, rise, and colder ones descend to take their place; so that very soon every particle of the fluid is heated by direct contact with the heated portion of the containing vessel. If the heat is applied at the top, the liquid is scarcely heated at all, except at the surface. What is understood by the radiation of caloric ? When heat passes from one body to another, independent of a medium, there- fore in vacuo, it is termed radiation; and the heat so distributed is called radiant or radiated heat. A heated body suspended in the air has its temperatnre reduced to an equilibrium: what are the modes by which it is accomplished 1 It is done in three ways : first, by the conducting power of the air, which is very trifling; secondly, by the mobility of the air in con- tact with it; and, thirdly, by radiation. How is heat distributed in radiation ? It is emitted from the surface of a hot body equally in all directions, in right lines, like radii from the centre to the circumference of a sphere ; and when they fall upon another body are distributed in three ways : reflected, absorbed, or transmitted. In the first and third cases, the tem- perature of the body on which the rays fall is not affected, in the other it is increased. In what proportion does heat decrease as we recede from a body ? It diminishes in the ratio of the squares of the distances from the radiating body. Is the radiating power of a body influenced by the nature of the radiating surface ? It is; a polished plate of metal radiates very imperfectly ; if roughened, its radiating power is increased ; and, if covered with a thin layer of paper, isinglass, wax, or resin, it is greatly increased. The color of surfaces has been thought to have a great effect on the radiating power; black radiating the most rapidly, red less, and white still less. This has been the most prevalent view of the subject, although some recent experiments of Prof. Bache appear to prove that color alone, independent of the molecular structure, does not influence the radiating power of surfaces. Can heat be reflected when accompanied with light ? It can, and is subject to the same laws in this respect as light. Will a good radiating surface make a good reflector? No; CHEMISTRY. 193 neither will a good reflector make a good radiator, these pro- perties being inversely to each other as a general rule. When heat strikes an opaque body, and it is not reflected, what becomes of it ? It is invariably absorbed; and these rays are sup- plemental to the rays which may be reflected if any are reflected. What relation exists between the absorptive and the reflective powers of bodies ? They are in an inverse proportion to each other. So that the more rays of heat that are absorbed by a body the fewer are reflected, and vice versa. What relation exists between the radiant and absorptive power of bodies ? Those surfaces of bodies which have the absorptive power have the radiating power directly proportional in most instances. So that one class of surfaces are good absorbers and radiators, while another are good reflectors and retainers ; these qualities being in various proportions in different surfaces. What is meant by transmission of heat ? It is its passage un- changed, or nearly so, through transparent media, or through a vacuum. Is heat subject to polarization and double refraction ? It is : and also to depolarization. By what means do bodies attain and keep up an equality of temperature ? According to the theory of Prevost, all bodies are constantly radiating heat, or calorific rays, and the temperature of a body falls when it radiates more than it absorbs ; on the contrary, the cooler body becomes warmer when it absorbs more than it radiates; and the temperature is stationary when the quantities emitted and received are equal. An instance of the first case is exhibited when a hot body is surrounded by colder ones ; of the second, when a colder one is surrounded by warmer; and of the last, when the temperature of the bodies near each other is equal. According to another theory, bodies of equal temperature do not radiate at all, and when the temperature is unequal, the hotter bodies alone radiate. Wrhat are some of the effects of heat on matter ? It is essentia. to vital actions, both animal and vegetable. It influences the form of bodies, as regards their condition of solidity, fluidity, or 17 N 194 CHEMISTRY. vapor. It also powerfully influences chemical action and com- bination. Does heat invariably expand all bodies ? It does, with the exception of some fluids, which are expanded also at high tempe- ratures, and are contracted as the temperature falls, until at a certain temperature they again expand, forming an exception to the general law. Upon what principle is a thermometer founded ? The expan- sibility of fluids, and mercury is the one generally used. Upon what principle is the pyrometer of Wedgewood formed? If we heat a mixture of aluminous earth and water or clay, it con- tracts from the expulsion of the water, and this contraction is an indication of the amount of heat to which it has been subjected. The temperature indicated by this instrument, however, is not reliable. What is understood by specific heat? It is the quantity of heat which one body contains compared with other bodies of the same weight or bulk, and at the same temperature, as indicated by a thermometer. Thus, if A takes four times as long to heat to the same temperature as B does, then its specific heat is four compared to B's, which is one ; so that differences in time of bodies in heat- ing or cooling, similarly exposed, express their specific heat. If we take a pint of mercury at 100°, and a pint of water at 40°, and mix them, the resulting temperature is only 60°, and not the mean between them ; the mercury has lost 40°, and the water has gained 20°. If equal weights are taken, it is still more evident:— 1 pound of mercury at 162°) . . , n._0 , , „ , „„„ y gives a mixture at 102°. 1 pound of water at 100° j & The water has gained only 2° while the mercury has lost 60°. Water has, therefore, a specific caloric compared with mercury of 30, while mercury is 1, or in the proportion of 30 to 1, This dif- ference in bodies is sometimes termed capacity for heat. What is understood by sensible and insensible heat? Sensible heat is that heat of which we can take cognizance by our senses; and insensible or latent heat is that which is proved to exist in a body, but does not affect our sensations, or our means of measuring temperature. Latent or insensible heat may be illustrated by a simple experi- CHEMISTRY. 195 ment: Mix a pound of water at 174°, with a pound of water at 32° ; the resulting temperature will be the mean of the two, or 103°; if, instead of the water at 32°, a pound of snow or ice of the same temperature be substituted, the resulting temperature will be only 32° after the melting of the ice. Hence, as much heat will have been rendered latent in the melting of the ice as would have raised an equal weight of water one hundred and forty-two degrees. It is found also that one pound of steam will raise ten pounds of water 100°, or if concentrated in one pound, the rise of tempera- ture would be 1000°, or to about a red heat, if prevented from assuming the aeriform state. This heat imparted to the water exists in it in a latent state, or at least all above what can be ac- counted for by a temperature of 212°, which is the sensible tempe- rature both of boiling water and steam. Has every substance a specific heat peculiar to itself? It has ; and a change of composition will produce a change of capacity for heat. When has a substance the greatest capacity for heat, in a solid, or liquid state ? In a liquid condition. Does the specific heat of a gas vary with the density and elasti- city ? It does. A diminution of density increases the capacity, and vice versa. Is the specific heat of solids and liquids the same at all tempera- tures, when there is no change of composition ? As the temperature increases, the capacity increases, but it is owing to their dilatation, as in the case of gases. Does a change in specific heat produce a change in temperature ? Always; an increase of capacity, therefore, of the specific heat diminishes the temperature ; and a decrease of capacity is attended with an increase of temperature. What determines the condition of bodies as to their condition of solidity, liquidity, or gaseous state ? The relative intensity of cohesion and repulsion. To what is the property of repulsion owing? To heat; and the form of bodies may be made to vary as this is increased or dimin- ished. Every solid may be converted into a fluid, and every fluid into a vapor, provided our means for the production of heat are sufficiently powerful. 196 CHEMISTRY. Is heat absorbed and rendered insensible, or cold produced, when solid bodies assume the liquid form ? It is. This heat is some- times called the heat of fluidity, and seems necessary to the change. On this principle the cold produced by frigorific mixtures is explained. When snow and salt are mixed, a temperature of zero is produced, and arises from the attraction between the salt and water, producing liquefaction, and thereby heat is rendered latent, and cold is the result. Is heat evolved, or made sensible during the passage of a liquid into a solid? It is ; and a familiar instance exists in the formation of ice, which never gets below 32° while changing from a liquid to a solid state, let the surrounding temperature be what it may. And also in the slaking of lime by water; which produces an elevation of temperature from the water passing into a solid state. Is there any essential distinction between vapors and gases? No : what are commonly called gases are merely vapors that are difficult to condense : some never have been condensed at all, but no doubt could be by sufficient pressure and reduction of tempera- ture. Gases are more expansible than either liquids or solids, and the rate of expansion is uniform, and the same in all gases, being about the 480th of their whole volume for every degree of-Fahrenheit. What is meant by a fixed body ? It is a body which resists the strongest heat we are capable of producing without vaporizing. What is meant by a volatile body ? It is a body which is con- verted into vapor by our means of producing heat. W7hat is ebullition ? It is where vapor is formed below the sur- face, giving rise to a commotion in the liquid ; and the temperature at which this takes place is called the boiling point. What is meant by evaporation? It is where vapor is formed below the surface and occurs at common temperatures. Is the boiling point of all liquids the same at the common pres- sure of the atmosphere? No; sulphuric ether boils at 96° F., alcohol at 176°, and pure water at 212°, oil of turpentine at 316°, and mercury at 662°. What circumstances modify the boiling point of liquids ? Varia- tion in the pressure of the atmosphere is the principal one. The material of which the vessel containing the liquid is composed has CHEMISTRY. 197 an influence ; also the presence of angular bodies. Liquids boil in vacuo at 140° lower than in the open air, and if subjected to suffi- cient pressure, may be heated to any extent without boiling. The difference in the boiling point of water from difference in atmospheric pressure furnishes one of the best modes of ascertain- ing the height of mountains ; a depression of one degree being equal to 548 feet of elevation, from the amount of pressure of the atmosphere being diminished in that proportion as we ascend. A cubic inch of water, in becoming steam at the ordinary pres- sure of the atmosphere, expands nearly to a cubic foot in bulk ; and a large amount of heat is rendered latent in the process. What circumstances influence the process of evaporation? Extent of surface, and the state of the air, as to temperature, dry- ness, stillness, and density. A diminution of temperature always results when evaporation takes place, and ice may under certain circumstances be produced by this means. What are the sources of heat ? The sun, combustion, electricity, the bodies of animals during life, chemical and mechanical action.' Light. What is meant by the science of Optics ? It is that science which treats of light and vision. What is the nature of light ? According to Newton, it is an emanation of inconceivably minute particles from luminous bodies; very subtle, and travels in straight lines with immense velocity! being 195,000 miles in a second. According to the other theory,' it is simply vibrations, or undulations, of a subtle ethereal medium' which give rise to vision in a manner similar to what the undula- lations of the air impress the nerves of hearing. What is meant by a ray of light ? It is the smallest portion which can be separated from contiguous portions. In what proportion does light decrease as we proceed from a luminous object ? As the square of the distance from the luminous object increases. When light falls on a body, in what manner is it disposed of? [t is either reflected, refracted, or absorbed Is solar light simple or compound ? It is a compound of sevea 17* 198 CHEMISTRY. simple or primary colors, viz : red, orange, yellow, green, blue, indigo, and violet. This has for a long time been the received opinion, but at present the views of Brewster prevail generally, which is, that, there are but three primary colors, red, yellow, and blue ; and that the orange, green, indigo, and violet are compound ones : each color extends over the whole spectrum, but has its greatest intensity at one part (indicated by the height of the curve Fig. 1. in the diagram). There are also rays of the spectrum termed calorific, and chemical, and to which some have added the mag- netizing. The greatest illuminating power of the spectrum is about its middle, or between the yellow and green ; the greatest calorific power is the red space, or beyond it, varying with the prism used; the greatest chemical power is in the most refrangible part of the spectrum. Light is necessary to vegetable and animal existence, and many of the phenomena of the natural world are due to its influence. What is understood by terrestrial light? It is artificial light; and the common method of obtaining it is by combustion. What are instruments called that are designed for measuring intensities of light ? Photometers. Electricity. What is understood by electricity ? It is a principle called into action by rubbing substances called electrics, such as amber, glass, Ac, with dry silk or cloth, and which causes contiguous light bodies to move towards them or be attracted ; and the substance possessing this property of attraction is said to be electrified. CHEMISTRY. 199 What is this attraction called ? Electric attraction. What takes place when these light substances come in contact with an electrified body ? They recede or are repelled, and this property is called electric repulsion. Can this property or electricity be conducted from one body to another ? It can by some substances, but not by others ; hence bodies are divided into conductors and non-conductors. What are the conductors? Metals, charcoal, plumbago, water, and substances which contain water in its liquid state. Are electrics conductors ? No ; they may be handled without losing their electricity, except at the parts touched; on the other hand, conductors are non-electrics, because the electricity is at once carried off. Can a conductor be electrified or excited ? It can, by being insulated or cut off from contact with the earth, either directly or indirectly, by means of a non-conductor. TABLE OF CONDUCTORS AND INSULATORS. Conductors. Insulators. Metals, Spermaceti, Charcoal, Glass, Fused salts, Sulphur, Strong acids, Fixed oils, Alkaline solutions, Spirits of turpentine, Water, Resins, Alcohol, Ice, Damp air, Diamond, Vegetable and animal bodies. Shellac, Dry gases. Why do electric experiments usually fail in damp weather ? Because the atmosphere then acts as a conductor, and conducts the electricity off. What are the different conditions of electricity ? There is one called vitreous, because developed on glass, and another callea resinous, because developed on resinous substances. They are also termed positive and negative, the terms vitreous and positive being used synonymously, as are resinous and negative. What relation do substances bear to each other, similarly elec- trified ? They repel each other. 200 CHEMISTRY. When dissimilarly electrified ? They attract each other. How is electricity excited ? By friction, change of temperature, chemical action, contact, changes of form of a body by variations of temperature, and proximity to an electrified body, or by induc- tion ; when excited by chemical means, it is called galvanism. By friction is the most usual mode of obtaining electricity, aud the ordinary electric machine is formed on this principle. That change of temperature is a source of electricity, may be proved by heating metallic rods to different temperatures at their extremities ; this is thermo-electricity. Proximity to an electrified body, or induction, is another mode of exciting it that is often resorted to. Electricity may be forced through space at appreciable distances, even should a non-con- ducting substance be interposed ; it arises from the attractive and repulsive powers ascribed to electric fluids. If an insulated con- ductor be placed with its end towards a prime conductor, the end towards the conductor will assume a negative condition, while its other end will be positive, and any series of conductors will assume the same condition, but with constantly decreasing intensity. It is an important principle in electricity. Electrified bodies attract light objects to them, because an oppo- site state of electricity is induced. When we move the hand to- wards the prime conductor of an excited machine, a spark is given out on account of the hand being made negative by induction, and the spark restores the equilibrium. A cloud charged with electri- city passing near the earth induces an opposite state, and lightning is the result, which is an electric spark on a large scale. On what principle is the Leyden jar formed ? That of induc- tion. They consist of jars with wide mouths, coated internally and externally with tin foil. The month is closed by cork, through which a metallic conductor is conveyed to the inside coating, which is brought in contact with the prime conductor of an electric ma- chine ; it becomes charged positively, while the outside will be negative by induction. If a communication be established by a conductor between the two -oats, a spark is produced, and the equilibrium established. The coating merely serves as a conductor to spread the electricity over the surface of the glass. A series of two or more of these jars may be arranged so as to constitute a battery, by connecting their internal surfaces together, and also C HEMISTRY. 201 their external surfaces with each other. In this way the effects may be increased by discharging them all at once, imitating the lightning, which is the same thing on a large scale. The object of lightning rods is to establish or preserve the equilibrium between the cloud and the earth ; they are pointed, so that this may be done silently ; if they presented a blunt extremity, it would produce a spark and shock which might produce unpleasant effects. This is owing to the fact that electricity will flow rapidly from points, while on a large surface it must accumulate in large quantities be- fore a discharge will occur, or a high degree of intensity must take place, which is measured by the length of the spark. Electrometers and electroscopes measure intensity; pith balls suspended, and repelling each other when electrified, and the gold leaf electrometer, are instances of these instruments. The quadrant measures inten- sity by divergence of the pith ball from the perpendicular. The balance electrometer measures amount of excitation by the weights lifted by the attractive force. Galvanism. When and by whom discovered ? In 1790, by Galvini. He accidentally noticed, in dissecting frogs, that, when the scalpel was in contact with the nerves, and touched another metal in contact with the muscle, contraction took place. He supposed that there was a discharge of electricity as in a Leyden jar, and that the nerves acted as one coating of the jar, the muscles as the other, and that muscular motion was always dependent upon such dis- charges. Volta denied this, and alleged that the muscle was only an electroscope, indicating the presence of electricity. For the generation of this kind of electricity, two metals or conductors are necessary, and a fluid that acts on, or corrodes one more than another. It is identical with ordinary electricity excited by a machine ; this latter, from being insulated, has great intensity, but the quantity is small.- In galvanic development, the quantity is large, but the tension is not great. What is a simple voltaic or galvanic circle ? It may be formed by a plate of zinc and a plate of copper, or other metals, placed in a vessel of water with sulphuric acid, and the two metals brought 202 CHEMISTRY. in contact at their edges, directly, or by means of a wire, and a galvanic current will be excited ; hydrogen escaping at the copper plate, while the zinc one will become oxidized. The current sets out from the most to the least oxidizable metal in the water, and to the former out of the water. The following exhibits a connection of three simple circles, and the direction of the current: — Fig. 2. If ammonia be used in this battery instead of the dilute sulphuric acid, the current will be reversed, on account of the copper being more readily acted upon by the ammonia than the zinc is. Chemi- cal decomposition is necessary to the galvanic excitation, and any two conductors will answer the purpose, so that one is acted upon more easily than the other. Two liquids and a metal also may form a circle, provided one liquid operates more strongly on one side than the other on the other side of the plate. A battery consists of a great many voltaic circles, or compound galvanic circles. Quantity is produced by the extent of surface of the plates, while tension depends upon the number of the plates ; either may be increased to a great extent by augmenting the condition for its production. The first is measured by its chemical effect, and particularly by its power of decomposition ; the latter by its power of passing through imperfect conductors. The magnetic needle is deflected from its meridian by a galvanic current, and is a true measure of its energy; in fact, it is a gal- vanometer, which is constructed in the same way; the direction of the current is also indicated. Can heat be produced by galvanism ? It can, by increasing the CHEMISTRY. 203 surface ; platinum has been fused by it with great rapidity ; char- coal has also been heated to whiteness in vacuo, and it cannot, therefore, be dependent upon combustion. Electrolization, or electrolysis, is the decomposition of a fluid by galvanic action ; electrodes, or poles, of a battery are the points of the circuit where electrical phenomena are manifested, and are usually the extremities. Electrolytes are substances which are capable of decomposition in this manner ; and two conditions are necessary. The substance to undergo decomposition must be a conductor; and it must also be in a liquid form. Water acidulated with sulphuric acid is one substance that may be thus decomposed; and is, therefore, an electrolyte. When decomposed, the oxygen is found at the posi- tive pole, and is, therefore, electro-negative, because opposite states attract each other ; while the hydrogen is given off at the negative pole, and on the same principle must be electro positive. If these gases should be collected, it will be found that the oxygen is only one-half the bulk of the hydrogen, thus proving by analysis that two volumes of hydrogen and one of oxygen are combined in the formation of water. The manner of this decomposition is illus- trated by the diagram. P and Z are the plates immersed ; W W the wires leading into a vessel of water; and H and 0 are the gases given off. The water is supposed to arrange itself in a molecular condition between the poles or electrodes, a particle of oxygen is evolved at the anode, and its particle of hydrogen, instead of being transferred at once to the opposite electrode, unites with the next particle of oxygen, and displaces the particle of hydrogen with which it was previously united, which, on being displaced, unites with the next 204 CHEMISTRY. particle of oxygen, and so on to the last, where a particle of hydrogen is thrown off. There is, then, a propagation of a polar force throughout the molecules of the water, and all other electrolytes, and a series of consecutive decompositions and recompositions produced. Can magnetism be produced by galvanism ? It can ; and has given rise to the science of electro-magnetism. If a current of electricity be passed at right angles to a piece of iron or steel, magnetic polarity is developed, the direction of the current deter- mining the position of the poles. If this current circulate a number of times around the bar, the effect is increased, and an extraordinary magnetic power is soon acquired. By taking a piece of soft iron, surrounded by a coil of copper wire, bent into a horse-shoe form, and sur- Fig- 4. rounded previously with silk, so as to insulate it, and connecting the two ends of the wire with a battery, it will be found that the two ends of the iron have powerful magnetic properties, capable of sustaining a great weight while the current is closed. The magnetism produced in this way will exhibit the same properties as that of a common magnet, of attraction and repulsion. Magnetism may also be made to call into activity electric currents. Take the two extremities of the coil of the electro-magnet above shown, and connect them with a galvanometer ; apply a steel horse- shoe magnet to the ends of the bar, and a cur- rent of electricity will be developed, as indicated by the deflection of the needle. When the magnet is removed, the polarity being destroyed in the iron, a second current is produced opposite to the first. In both cases the current is but momentary — a mere wave. By using a powerful magnet, and making an arrangement by which a bar wrapped with the coil can be applied and removed with rapidity, or so that its polarity may be induced and destroyed quickly, magneto-electric currents of great intensity may be pro- duced. This principle has been applied to the construction of machines for medical purposes. CHEMISTRY. 205 Specific Gravity. What is specific gravity ? It is the relative weight of equal bulks of different bodies. How is it ascertained ? By dividing the weight of the body by the weight of the same bulk of water, which is assumed as unity. How is the weight of a like bulk of water found ? By weighing the substance out of water, and in water, the differences will be the weight of the water displaced. Suppose the body is lighter than water. Then add the weight necessary to sink it to the weight of the body, and you have the weight of an equal bulk of water, which will enable you to find the specific gravity in the usual manner. What are the instruments used to ascertain the specific gravity of liquids. Hydrometers. What is assumed as unity in ascertaining the specific gravity of gases ? The atmospheric air; and their specific gravity is ascer- tained on the same principles as liquids and solids. Nomenclature. What are the compounds of oxygen called, that do not possess acidity ? Oxides. What are they called when they possess acidity ? Acids; and are named from the substance acidified by the addition of ic. For instance, sulphuric and carbonic acids are acid compounds of sul- phur and carbon with oxygen. Suppose a base should form two acids with oxygen, what is the one called containing the least quantity of oxygen ? It takes the name of the base with the addition of ous, as sulphurous acid. By what name do we denote the simple non-metallic combustibles when united witn one another, with a metal, or a metallic oxide ? They are known by the addition of uret or ide, as sulphuret, carbu- ret, and phosphuret of iron, or sulphide, carbide, and phosphide of iron, denoting compounds of sulphur, carbon, and phosphorus with iron. How are the oxides distinguished from each other ? Protoxide is the first degree of oxidation; binoxide the second; teroxide the 18 206 CHEMISTRY. third ; and the term peroxide is often applied to the highest degree of oxidation. Sesqui, one and a half, is used to an oxide, the oxy- gen in which is to that in the first oxide as one and a half to one, or as three to two. What is usually understood by the term salt? A compound resulting from the union of an acid with a base. The definition of a salt, as given by Dr. Hare, is, that it is a soluble compound, con- taining one or more acids, or corrosive ingredients, the qualities of the ingredients being either neutralized or modified; the name is indicative of the composition. If the name of the acid terminates in ic, the name of the salt terminates in ate; if the acid terminates in ous, the salt terminates in ite. Thus the sulphate, carbonate, and arseniate of potassa are salts of sulphuric, carbonic, and arsenic acids with potassa. The terms sulphite and arsenite of potassa, denote combinations of sul- phurous and arsenious acids with potassa. What is understood by neutral, super, and sub salts ? Salts are termed neutral, if the acid and base neutralize each other; super, if the acid is in excess; and sub, if the base is in excess. Another manner of expressing the relation between acids and bases relates to the atomic constitution of the salt. If there is an equivalent of the acid and alkali, the generic name of the salt is employed without any other addition. If two or more equivalents of the acid are attached to one of the base, a numeral is prefixed indicating its composition, as the sul- phate and bisulphate of potassa; the oxalate, binoxalate, and quadroxalate of potassa. When the base is in excess, or the acid deficient, it is proposed to use the Greek numerals, dis, tris, tetrakis, to indicate the equivalent of an alkali in a subsalt. In other com- pounds, where two or more equivalents of a negative element enter, they are distinguished by the Latin numeral, and the Greek nume rals are applied to that element regarded as positive. For instance, a bichloride contains two equivalents of the negative element chlo- rine ; on the other hand, a dichloride signifies that one equivalent of chlorine is combined with two of a positive body. What is an amphigen element ? One which has the power of combining with others and forming both acids and bases, as oxygen ; thus, it will combine with iron, forming a base FeO, and nitrogen, to form an acid NO.s C HEMI STRY. 207 What is meant by a halogen salt ? It is a substance having the properties of a salt that is composed only of two simple substances. Iodine, chlorine, bromine, fluorine, and cyanogen are the only simple substances that have the property of combining with other simple substances, and forming this class of compounds. What is meant by katalysis? It is the action of presence^ in producing decomposition ; as when a body, which possesses what has been termed catalytic force, resolves other bodies into new compounds by mere contact or presence, without itself experiencing any modification. What is meant by isomorphous ? It is a term applied to differ- ent bodies which have the same crystalline form. Affinity. What is understood by chemical affinity, or attraction? It is that affinity or attraction which is exerted between the minutest particles of different kinds of matter, causing them to combine, and form new bodies, with new properties. Does it act at sensible or insensible distances ? It acts only at insensible distances, or when in apparent contact. What is an instance of chemical attraction ? Oxygen and iron forming rust, or an oxide; oxide of iron and sulphuric acid form- ing a green colored salt, the sulphate of iron. What is understood by single elective affinity ? Suppose we have a compound formed by the union of ammonia and oil, and to this we add sulphuric acid, the greater attraction of the ammonia for the sulphuric acid than exists between it and the oil, will cause it to leave the oil, and unite with the acid; this is an instance of single elective affinity, so termed because there appears to be an election, or choice exercised. What is meant by double elective affinity ? Suppose two salts having different acids and bases, say carbonate of ammonia and hydrochlorate of lime, be mixed together, the carbonic acid will quit the ammonia, and unite with the lime; the hydrochloric acid will also leave the lime, and unite with the ammonia ; so that both original salts will be decomposed, and two new ones formed; 'his is an instance of double elective affinity. What leading circumstances characterize chemical action ? The 208 chemistry. loss of properties of the combining substances, and the acquisition of new ones in the new compound ; changes of density, temperature, form, and color. What circumstances modify the operation of affinity ? Cohesion, elasticity, quantity of matter, gravity, pressure of the atmosphere, and the agency of the imponderables. Do bodies unite in definite or indefinite proportions ? Sub- stances unite in definite proportions, and form but few different compounds with each other; some of them but one, some two, others again unite in three, four, five, and even six, which is the highest number of compounds that any two substances are known to produce. They are governed by three remarkable laws : — First Law. — The composition of bodies is fixed and invariable. Second Law. — The relative quantities in which bodies unite may be expressed by proportional numbers. Third Law.—When one body, A, unites with another body, B, in two or more proportions, the quantities of the latter, united with the same quantity of the former,'bear to each other a very simple ratio. All substances containing only two atoms are called binary compounds; those of two binary compounds are called ternary; of four, quarternary ; and so on. Substances also unite in definite volumes, so that the laws of combination may equally well be deduced from the volumes or from the weights of combining substances, and the composition of gaseous bodies may be as well expressed by measure as weights. What is understood by chemical equivalent? It is a number representing the least combining proportions of a body, which is equivalent to another body, and may be substituted for it in com- binations. These combining proportions may be expressed by numbers, in which hydrogen is represented as 1, and they represent relative, and not absolute weights. What is meant by isomeric or metameric bodies ? Bodies are termed isomeric or metameric which contain the same chemical elements, and in the same ratio, and yet have chemical properties different from each other, as the oil of lemons (C]0H*), and the oil of copaiba (C'°HS). What is the difference between polymeric and metameric bodies 1 A body is said to be polymeric of another when the relative pro- chemistry. 209 portion of its elements is the same, but which has twice or thrice the equivalent number of the one below it. Thus, oil of turpentine (C20H'6) is polymeric of the oil of calamus (C'°Hf). How may the equivalent of compounds be determined ? By adding together the numbers representing the equivalents entering into the combination. These numbers are sometimes termed atomic weights. Symbols. What is a symbol ? The first letter of the Latin name of an element, or, if two elements begin with the same letter, a second smaller one is added. Thus, N stands for nitrogen, and Ni for nickel. A symbol itself indicates one equivalent of an element, as CI, which implies one atom of chlorine. What are the symbols for the three physical forms of matter ? A solid is represented in Roman type, as Zn for zinc ; a liquid is represented in italics, as HO for water; and a gas by a small hair letter, O for oxygen How are the symbols of organic bodies distinguished from the inorganic? By having a line drawn over them, as O. Pt, which stand for oxalic acid and protein, respectively. What rule is observed in writing formulas ? If it be an amphigen salt, the base is placed before the acid, as in sulphate of soda (NaOSO3). If a halogen salt, the metallic radical is placed before the salt radical, as in the chloride of zinc (ZnCl). In all other cases the body most resembling oxygen is placed on the right of the other element. When a compound consists of several equivalents of the same elements, how are they multiplied ? By placing small figures to the right of the symbols, as C4H30, which is the formula for ether. How is an uncombined element multiplied ? By placing a large figure to the left of the symbol, as 40, which signifies four equiva- lents of free oxygen. When a large figure is placed before a compound, how far does it multiply? To the first comma or plus sign, as 3NaO,P05, which is tribasic phosphate of soda ; or, if the symbols are enclosed in a parenthesis, it multiplies all within it, as 4(FeOS03), which indicates equivalents of sulphate of iron 18* o 210 CHEMISTRY. Is the entire formula of a compound body always expressed ? No ; it is frequently abbreviated, as Gy for cyanogen, instead of C2N, which expresses its ultimate composition. How is the symbol for constitutional water distinguished from that of water of crystallization ? Constitutional water is printed in the symbols of its elements, thus, HO, as NaOC02HOC02, which is bicarbonate of soda, the water in it being necessary to its exist- ence. On the other hand, Aq is the symbol for the water of crystallization, as in Al2033S03,KOS03 + 24 Aq, the formula for common alum, the crystalline form of which is destroyed by driving off the 24 equivalents of water. Oxygen. When was oxygen discovered? By Priestly in 1774, and by Scheele a year or two after, without a knowledge of its prior discovery. It was termed dephlogisticated air, empyreal air, and vital air. How is oxygen obtained ? It may be obtained from the perox- ides of manganese, lead, and mercury, nitre, and chlorate of potash, by exposure to a red heat. It may be obtained from the former by heating it to redness in a gun-barrel, or heating it in a flask with an equal weight of concentrated sulphuric acid, by means of a lamp. What is the rationale of these last two processes ? On applying a red heat to the peroxide of manganese it loses one-third of its oxygen, and is converted into the proto and sesqui oxides: thus, 3Mn02= Mn'O3 + MnO + 20 When mixed with sulphuric acid, the peroxide loses a whole i-quivalent of oxygen, and is converted into the protoxide, which unites with the acid, leaving a sulphate of the protoxide in the retort, thus : HOSO3 + MnO2 = MnOSO3 + HO + O. What is the rationale when procured from the chlorate of potash? A retort of glass containing no lead in its composition should be used. The chlorate first becomes liquid, and on an increase of heat is wholly resolved into pure oxygen gas, which escapes, and into a white compound, which is the chloride of potassium, and remains in the retort thus : KOC105 = KC1 + 60. Or, thus : — CHEMISTRY. 211 J Chloric acid f 0*---------- -- 60. 6 equiv. oi oxygen. C10« ( Q,X~~^x^~^"^ potassa \ Oxide of potassium J 0 —"><^-^^^ ( KO \K-------- ---C1K. Chloride of potassium. The oxygen is, therefore, derived partly from the potassa, and partly from the chloric acid. Procured in this way, it is very pure. By the addition of the black oxide of manganese to the chlorate of potash, it may be obtained at a much lower temperature, and with very simple apparatus; the oxide of manganese, in this case, operates simply by its presence, without undergoing chemical change itself, so that decomposition is effected by katalysis. What are the properties of oxygen gas ? It is colorless, insipid, inodorous, refracts light feebly, a non-conductor of electricity, the most perfect electro-negative substance we possess, heavier than atmospheric air, unites with some substances which are said to be oxidized, and are divided into oxides and acids ; supports combus- tion in a high degree, and is necessary in a diluted state to the respiration of animals ; pure, it is deleterious. Its specific gravity is 1-102 ; equivalent 8 ; and symbol O. What is understood by combustion ? In its common accepfation, it means the rapid union of oxygen with a combustible material, attended with the emission of light and heat. But the union of many other substances is also characterized by similar phenomena. When oxygen unites with another substance in the proportion of one equivalent of each, the compound is called a protoxide ; if in the proportion of two equivalents of oxygen to one of the other elements, the compound is called a deut or fo'noxide ; three, ter or tritoxide, &c. When the ratio of 1 to 1£, or 2 to 3 exists, the term sesqui is employed. Thus : — FeO, protoxide of iron : FeO2, the binoxide ; FeO3, tritoxide ; Fe203, the sesquioxide. Hydrogen. When was hydrogen discovered? It was first described by Cavendish, in 1766, under the name of inflammable air. How is hydrogen procured ? It may be procured tolerably pure by passing the vapor of water over metallic iron, heated to redness. and by putting pieces of iron or zinc into dilute sulphuric acid What is the rationale of these processes ? In the former case, 212 CHEMISTRY. the oxygen of the water unites with the red-hot iron, and the hy- drogen is set at liberty, thus: 3Fe + 4ifO = F203 + FeO + 4K. In the latter, the oxygen of the water unites with the metal, and forms an oxide, which unites with the acid, and forms a sulphate, while the hydrogen of the water is set at liberty, thus : HOSO3 + Zn = ZnOSO3 + H. Or thus : — Water..................{ £-----------H' Hydr0Sen Sulphuric acid......j S-^~^^-~~^ Zinc.................... [Zn __ "^==5*—^ZnQSO3. Sulphate of zinc. What are the properties of hydrogen gas ? It is colorless, has neither odor nor taste, is a powerful refractor of light, the lightest body known, will not support respiration, a non-supporter of com- bustion, highly inflammable, but, like other combustibles, requires the aid of a supporter of combustion, electro-positive, and produces a remarkable alteration in the voice when breathed. If a jet be thrown upon spongy platinum, it is ignited. Its equivalent is 1; symbol H ; sp. gr. 0-0689. What is the product in the combustion of hydrogen? Water; which will be exactly equal in weight to the gases disappearing; it gives off very little light in burning. When in contact with oxygen it may be set on fire by flame, a solid body heated to redness the electric spark, and spongy platinum, if thrown on it in a jet. The amount of heat evolved is very great, as is best exhibited by Hare's compound blowpipe, which is arranged so that the oxy- gen and hydrogen, emitted from gasometers, are mixed at the point of ignition, and produce the greatest heat known. The Drum- mond light is formed by a jet of this, ignited and thrown on lime. What are the chemical relations of water ? It has solvent pro- perties exceeding any other liquid. It exhibits feeble acid proper- ties by uniting with bases and neutralizing them in some degree, as in its union with potash. It also sometimes acts the part of a base, and is necessary to the existence of acidity ; as an instance of this, dry sulphuric acid exerts no acid properties until united with water. It exists in some salts as constitutional water, in which case it is necessary to their existence, and if driven off by heat, the salt is decomposed. Epsom salts is an instance of this. It is found also in crystals, and necessary to their existence, in the form of what is termed water of crystallization. CHEMISTRY. 213 What is the proportion existing between the oxygen and hydro- gen in the formation of water ? By measure there is two volumes of hydrogen to one of oxygen: by weight 88-9 oxygen to 111 hydrogen, or nearly as 8 parts oxygen to 1 of hydrogen. Its symbol is HO. How many combinations are there of oxygen and hydrogen ? Two ; one in the proportion to form water, and another, which is the peroxide of hydrogen, HO2, and contains twice as much oxygen as is contained in water. The peroxide of hydrogen is a colorless, inodorous, transparent liquid, and has strong bleeching properties. At a temperature above 55° it effervesces with the escape of oxygen gas, and explodes violently at 212° ; has a metallic taste, and becomes thick by evaporation. Metals and their oxides decompose it. Ozone has been supposed to be a new form of peroxide of hydro- gen, although it has never been isolated. Nitrogen, or Azote. How is nitrogen procured ? By burning a piece of phosphorus in a jar full of air, inverted over water; the oxygen of the atmo- sphere unites with the phosphorus, forming meta-phosphoric acid, which is absorbed by the water. Nitrogen remains in the jar, in combination with a small quantity of carbonic acid, which may be removed by agitating it with a solution of pure potassa. Or it may be procured by any other substance which will take the oxygen from the atmosphere, and leave the nitrogen. It was first noticed by B/itherford, in 1772. What are the properties of nitrogen ? It is colorless, devoid of taste or smell, more distinguished by negative characters than by any striking properties ; non-supporter of combustion and res- piration, and not combustible. Its equivalent is 14-06 ; sp. gr. 0-972; symbol N. How many compounds does nitrogen form with oxygen ? Five, oesides its combination in the atmosphere, which is considered as i mechanical mixture. 214 CHEMISTRY COMPOUNDS OF NITROGEN WITH OXYGEN. By Tolume. N. 0. By weight. Equiv. Symbols. Nitrous Oxide, 100 50 14-06+8 =2204 NO Nitric Oxide 100 100 14 06+16=30-04 NO* Hyponitrous Acid, 100 150 14-06+24 = 38-04 NO3 Nitrous Acid, 100 200 14-06+32 = 4604 NO4 Nitric Acid, 100 250 1406+40=54-04 NO5 What is understood by the air or atmosphere ? It is that mass of gaseous matter by which the earth is surrounded on all sides, and adheres to it by the force of gravity. Its pressure on the sur- face of the earth is equal to about 15 pounds to the square inch of surface, which renders it capable of supporting a column of water 34 feet high, and one of mercury 30 inches. Is the pressure of the atmosphere invariably the same ? No; it varies at different times, and according to the elevation above the level of the sea, as indicated by a barometer. What are the component parts, of the atmosphere? It is com- posed of oxygen 20 or 21 parts ; and nitrogen 79 or 80 by volume; it also contains a little carbonic acid. By weight, it is oxygen 23; nitrogen 76 ; carbonic acid, ammonia, and watery vapor 1. The principal chemical properties are owing to the presence of oxygen. How is the protoxide of nitrogen or nitrous oxide procured ? By subjecting the nitrate of ammonia to heat, which is decomposed, and the products are protoxide of nitrogen and water. What is the rationale of this process ? The nitrate of ammonia is composed of nitric acid and ammonia. The nitric acid is com- posed of one equivalent of nitrogen, and five of oxygen ; and the ammonia of one of nitrogen and three of hydrogen ; making in all two equivalents of nitrogen, five of oxygen, and three of hydrogen. By the addition of heat their relations are changed, so that the three equivalents of hydrogen unite with three of the oxygen, and form water, leaving two equivalents of oxygen and two of nitrogen which unite and form the nitrous oxide, thus : NIPNO'' = BHO + 2NO ; or, considering the nitrate of ammonia to contain one.equi talent of water, thus : — CHEMISTRY. 215 t^Q i Nitrous oxide. Nitrate of ammonia < . \Ammoma J NH3 [ Water V HO What are the properties of nitrous oxide ? It is a colorless gas, absorbable by pure water, a supporter of combustion, produces exhilaration when breathed, without being followed by depression or languor. It is what is termed exhilarating or laughing gas. How is the binoxide procured ? By the action of nitric acid on metallic copper; the gas escapes and may be collected over water or mercury. What is the rationale of this process ? One portion of nitric acid is decomposed; part of its oxygen oxidizes the copper, while another part is retained by the nitrogen, forming the binoxide or nitric oxide thus : 4N05 + 3Cu = 3CuON05 + NO2. Or thus: Nitric acid Copper, 8 equiv Nitric acid, 3 equiv, NOa. Binoxide of nitrogen. CuO^ CuO V3CuO + 3NO*. Nitrate of copper. CuOJ . Equivalent 30-04; formula NO2; sp. gr. 1-039. What are the properties of the binoxide of nitrogen ? It is a colorless gas; when mixed with any gaseous mixture containing oxygen, dense suffocating acid vapors of a red or orange color are produced, which are nitrous acid, and are copiously absorbable by water. This peculiarity is a distinguishing test for nitric oxide, and is also a test for the presence of free oxygen. It is not possessed of acid properties, and is irrespirable. How is hyponitrous acid produced ? By adding binoxide of nitrogen to oxygen in excess, pure potash being present, 100 mea- sures of oxygen combine with 400 of the binoxide, and hyponitrous acid is formed, which unites with the potash. What are its properties? At 0° F., anhydrous liquid, hyponi- 216 CHEMISTRY. trous acid is colorless, and green at common temperatures, very volatile, passing off in the form of an orange vapor ; on admixture with water, it is converted into nitric acid and binoxide of nitrogen, thus : 3N03 and HO = NO5 and 2N02. Formula NO3; equivalent 38-04; sp. gr. (of gas) 172. How is nitrous acid obtained ? By introducing 200 measures of binoxide of nitrogen into a dry exhausted glass vessel, with 100 of oxygen; also by subjecting the nitrate of lead, carefully dried, to a red heat, thus : PbONO5 = PO + O + N(A What are its properties ? Its vapor is of an orange-red color, irrespirable, has acid properties, is absorbed by water, the binoxide of nitrogen being disengaged, and nitric acid remains in the water, thus: 3N04 yield 2N05 and NO2. Formula NO4; equivalent 46-04; sp. gr. (of gas) 3-18; of liquid 1 45. Its vapor maybe condensed by a freezing mixture, into a liquid, in which state it is anhydrous acid, and pungent to the taste, gives a yellow stain to the skin, and is very corrosive. At 0° it is nearly colorless, and at 32° it is yellow. When mixed with a considerable quantity of water, it is instantly resolved into binoxide of nitrogen, which es- capes with effervescence, and into nitric acid, which unites with the water. How may nitric acid be procured ? By adding binoxide of nitrogen slowly over water, to an excess of oxygen gas. It is composed of 100 measures of nitrogen, and 250 of oxygen. For commerce it is procured by decomposing some salt of nitric acid with oil of vitriol; and common nitre or saltpetre is generally em- ployed, thus : — NO* ------------—==-H0,N06. Liquid nitric acid. KO ^^___^^—""^ H ) ""^^^^ s0*—~~~ ^^^^^^KO.SOa + HO.S03. Bisulphate of Potassa Can nitric acid exist in an insulated state ? Yes; but it is difficult to obtain it pure; it exists in a dry crystalline form, and exerts no acid reactions unless developed by water. In commerce it is generally known by the name of aqua for(is. What are its properties ? It is highly acid, largely diluted it reddens litmus paper permanently, unites with alkalies forming salts, which are called nitrates. In its purest concentrated form it is colorless, and has a specific gravity of 1-5 or 1-51 At 1'5 it 2 equivalents sulphu- ric acid................. CHEMISTRY. 217 contains 20 per cent, of water, for which it has a great affinity, acts powerfully on substances disposed to unite with oxygen de- composes vegetables, the oxygen of the acid uniting with their hydrogen, forming water, and also with the carbon, forming car- bonic acid. All the salts of nitric acid are soluble in water. TABLE OF DIFFERENT KINDS OF N1TEIC ACID. Nitric acid of sp. gr. 1-52—N06+HO, 14 per cent, ol water. 1-50—NOg+3HO, 20 " 1-42—N06+4HO, 40 " What are the tests for nitric acid and the nitrates ? When un- combined, it is readily detected by its strong action on copper and mercury, emitting ruddy fumes of nitrous acid. Another, is to mix the supposed nitric acid, or nitrate, with dilute sulphuric acid, add to this some pure zinc, and set fire to the hydrogen as it is evolved ; if nitric acid is present the flame will have a greenish white tint, which is owing to the presence of the binoxide of nitrogen. Another, is to add to the supposed nitrate a drop of sulphuric acid heated in a test tube, and then add a crystal of morphia, which, if nitric acid be present, will become of an orange red fol- lowed by a yellow color. The sulphuric acid in this case should also be tested previously. Carbon. In what form is carbon usually presented to us ? In the form of charcoal and the diamond. How is it procured? By heating wood to redness in a close vessel. The volatile parts are expelled, and the carbonaceous part remains, which is called charcoal. If bones are used instead of wood, we have animal charcoal or ivory black. The diamond is found in a pure state. What are the properties of charcoal ? It is highly combustible, hard, and brittle, conducts heat slowly, a good conductor of elec- tricity, very refractory in the fire if the air is excluded, absorbs air, or other gases, largely, and yields them again on the application of heat; the proportion, however, varying in different gases, and absorbs the odoriferous and coloring particles of animal and vege- table substances. 19 218 CHEMISTRY. Animal charcoal is mostly used when we wish to decolorize fluids, by being finely pulverized, and having the fluid filtered through it. The equivalent of carbon is 6, symbol C. What are the compounds of carbon and oxygen ? There are three; carbonic oxide, CO, oxalic acid, C203, and carbonic acid, CO2. How is carbonic acid, or fixed air, procured? It may be expelled from common limestone or magnesia (which are carbon- ates), by the action of heat or acids, thus: CaOC02+S03= CaOSO + CO2. Or thus: — CCO"1-------------CO". Carbonic acid. Carbonate of lime.........-Ma--------^—-^CaCl. Chloride of calcium. Chlorohydric acid...........j H______^--—.—_ ttq Water. It is also formed during respiration, fermentation, and combustion. When it accumulates in wells, &c., it is called choke damp. What are the properties of carbonic acid ? It is colorless, in- odorous, elastic, condensible into a liquid under a pressure of 36 atmospheres, may be frozen into a white solid, will not support respiration or combustion, incombustible, renders lime-water turbid by the formation of carbonate of lime, absorbable by water, the quantity absorbed being very much increased by pressure; and, when the pressure is removed, it escapes with an effervescence. The agreeable, lively taste of beer, porter, ale, mineral water, &c, is owing to its presence. It unites with alkaline substances, and the salts so formed are termed carbonates. It is easily displaced from all its combinations by the hydrochloric and the stronger acids, when it escapes with effervescence. Formula CO2; equivalent 22; sp. gr. 1-52. How is carbonic oxide procured? By exposing two parts of well dried chalk and one of pure iron filings to a red heat, and washing the gas evolved with lime water, or an alkaline solution, which absorbs the carbonic acid and leaves the carbonic oxide. Another mode is to mix binoxal-ate of potash with five or six times its weight of sulphuric acid, and heat it in a retort; an effer- vescence soon ensues, which is a mixture of carbonic acid and car- bonic oxide, and may be separated in the same manner as in the preceding process. What is the rationale of this last process ? Oxalic acid is a CHEMISTRY. 219 compound of equal parts of the elements of carbonic acid and car- bonic oxide, and they cannot exist in the form of oxalic acid, unless in combination with water, or some other substance. The sulphuric acid then unites with both the potassa and water of the binoxalate, and the oxalic acid being thus set free is decomposed, thus:__ HOC O3 + SO3 = HOSO3 + CO + CO2. Is -CO. Carbonic oxide. Oxalic acid. 0- _. . L<>----- -^COa. Carbonic acid. Water............... HO—--_____ Sulphuric acid.... SO'— S03H0. Sulphate of water. What are the properties of carbonic oxide ? It is colorless, insipid, has no acid properties, inflammable, burning with a lambent blue flame, and irrespirable. Formula CO; equivalent 14; sp. gr. -973. CARBONIC OXIDE SERIES. Carbonic oxide................................................. CQ Carbonic acid................................................... qq i q Oxalic acid...................................................... 2C0 4- 0 Chlorocarbonic acid (phosphene gas)..................... CO + CI. Croconic acid....................................,.............. 5Q0 i jj Mellitic acid.................................................... 4Q0 i jj &c, &c. Sulphur. In what form do we generally find sulphur ? It is found in the region of volcanoes, generally in a massive state, sometimes crys- tallized ; it is also found combined with the metals, such as silver, copper, antimony, lead, and iron. From its combination with iron, which is called iron pyrites, it may be procured in large quantities by exposure to a red heat in a close vessel, when it is sublimed. What are the properties of sulphur ? It is solid, brittle, of a greenish-yellow color, has a peculiar odor when rubbed, tasteless, crystallizable, a non-conductor of electricity, negatively electrified by friction, fused at 216° F. ; if the temperature is raised to 320° it thickens and acquires a reddish tint, 428° to 482° it is so tena- cious that the vessel may be inverted without causing it to change its place; if raised still higher, to its boiling point, it again becomes 220 CHEMISTRY. liquid ; at the temperature of 428°, if poured into water, it becomes ductile. It is volatile at 550° to 600°, and is condensed unchanged at lower temperatures. Its equivalent is 16; symbol S; sp. gr. 1-99. What are the compounds of sulphur and oxygen ? There are seven. COMPOUNDS OF SULPHUR AND OXYGEN. Sulphur. Oxygen. Eiiuiv. Formula Sulphurous acid........................ 16 + 16 = 32 SO2 Sulphuric acid........................... 16 + 24 = 40 SO'orSO^O. Hyposulphurous acid ................. 32 + 16 =• 48 S202 or S02+S. Hyposulphuric acid.................... 32 + 40 = 72 S2©5 or 2(S02) + O &c, &c. What are the properties of sulphurous acid? It is gaseous, colorless, transparent, has a pungent suffocating odor, an acid taste, and bleaching properties ; it reddens litmus at first, and then bleaches it. It has a strong affinity for oxygen, and will precipitate metals which have a weak affinity for oxygen from their solutions. It combines with metallic oxides, and forms salts called sulphites. Formula SO2; equivalent 32 ; sp. gr. 2'21. How is it procured? It is formed by the combustion of sulphur in the atmosphere, or dry oxygen gas ; it is also evolved mixed with carbonic acid when combustible substances, containing carbon, are heated with strong sulphuric acid ; and by heating sulphuric acid with most of the metals, with copper and mercury particularly, it yields a very pure gas, thus : 2S03 + Ca=CaOS03+SO2. It may be obtained liquid, by transmitting dry, pure gas through a glass tube surrounded by a freezing mixture. When exposed to cold, in a moist state, a crystalline solid is formed. How is sulphuric acid procured? One method is to subject to a strong heat the sulphate of iron (copperas or green vitriol); the sulphuric acid of the salt passes over in combination with the water which it contains, thus: 4(FeOS03) HO = HO3 2S03 + 2S03 + 2Fe'03. Procured in this way, it is called the fuming sulphuric acid of Nordhausen, on account of the white vapors which it emits on exposure to the air, and from the place in (rermany where it is manufactured. CHEMISTRY. 221 Anhydrous sulphuric acid may be procured from this by heat- ing it gently in a retort, and surrounding the receiver adapted to it with a mixture of snow and salt, in which it is condensed into a white crystalline solid. The most common process for procuring sulphuric acid, is to burn sulphur, mixed with one-eighth its weight of nitrate of potash, in a furnace arranged so that the current of air supporting com- bustion will conduct the products into a leaden chamber containing water, which becomes saturated with the sulphuric acid formed in the process. What is the rationale of this process ? The nitric acid of the nitre yields oxygen to a portion of sulphur, and converts it into sulphuric acid, which combines with the potassa of the nitre ; at the same time the greater part of the sulphur forms sulphurous acid by uniting with the oxygen of the air. - The nitric acid, by yielding a portion of its oxygen to the sul- phur, is converted into binoxide of nitrogen ; which, coming in contact with the air at the moment of its separation, is converted into red nitrous acid vapors. The gaseous product in the leaden chamber, therefore, is sulphurous and nitrous acids, atmospheric air, and watery vapor. From these elements a crystalline com- pound is formed, consisting of sulphuric acid, hyponitrous acid, and water; and, when this solid comes in contact with the water of the chamber, it is decomposed, the sulphuric acid is absorbed by the water, and nitrons acid and binoxide of nitrogen escape ; the latter of which, coming in contact with the air, is converted into nitrous acid. This nitrous acid is again intermixed with sulphurous acid and aqueous vapor, and gives rise to a second portion of the crystalline compound, which undergoes the same changes as the first. The following diagram represents the forma- t/on of the crystalline compound : — fS-------____S0*. Sulphuric acid bnlphurous acid<( 0 lo: p'_^-<—^^rNO". Hyponitrous acid .... O^ —-~Z0^ (. Crystalline compound. Nitrous acid......\0^-^>^ > S0»+N0»4-H0. 0 Water...............JH f So»+NO*+HO. ~H0. Vlatcr. 19* 222 CHEMISTRY. TABLE OF HYDRATES OF SULPHURIC ACID. Nordhausen..........................2S03+ HO Specific gravity 1-95 Purest oil of vitriol................S03 + HO " " 1-85 S03+3HO " " 1-76 S03+4HO " " 1-68 &c. &c. What are the properties of sulphuric acid ? As usually obtained, it is a dense, colorless, oily fluid ; boils at 620° ; specific gravity 1-847; very corrosive; sour, reddens litmus, and separates all other acids from their union with the alkalies. Chloride of barium, or any salt of baryta, is a test for it and its soluble combinations, and will form a white precipitate, the sulphate of baryta. Phosphorus. How is phosphorus procured? By igniting bones in an open fire until all the animal matter is destroyed, leaving only a white substance, which is principally the phosphate of lime ; reduce this to a fine powder, and digest with strong sulphuric acid and water, sufficient to give the consistence of a thin paste. The phosphate of lime is decomposed ; a sulphate and a soluble superphosphate of lime is formed. The superphosphate of lime is to be dissolved in warm water, and separated from the sulphate by filtration, and evaporated to the consistence of syrup, then mixed with one-fourth its weight of powdered charcoal, and heated in an earthen retort, with the beak of the retort put into water, in which the vapor of the phosphorus is condensed, of a reddish-brown color, owing to the presence of the phosphuret of carbon. It may be purified by a second distillation. What is the rationale of this process ? When the superphosphate of lime and charcoal are mixed, and heat applied, the oxygen of that part of the phosphoric acid, which constitutes the superphos- phate, unites with the charcoal, and forms carbonic acid and car- bonic oxide gases ; phosphorus is distilled over, and phosphate of lime with redundant charcoal, remains in the retort. What are the properties of phosphorus ? It is colorless and transparent when pure ; a soft solid at ordinary temperatures, has a waxy lustre when cut with a knife, distils at 550°, very iuflam mable, undergoes slow combustion at common temperatures when CHEMISTRY. 223 exposed to the air, and emits a white vapor of an alliaceous odor. Its equivalent is 32; symbol P; and sp. gr. 1-77. What are the compounds of phosphorus and oxygen ? The oxide of phosphorus, consisting of two equivalents of phosphorus, and one of oxygen, P20 ; the hypophosphorous acid, 1 eq. of phosphorus to 1 of oxygen, PO ; the phosphorous acid 1 eq. of phosphorus to 3 of oxygen, P03; and the phosphoric, pyrophos- phoric, or metaphosphoric acid, which is 1 eq. of phosphorus and 5 eqs. of oxygen, P05. There are several varieties- of this acid which differ very much in their reaction with other substances, but whose composition is the same as to the amount of water existing in each. TABLE OF ACIDS. Phosphoric acid (dry) PO5 Phosphoric acid (common) P05+3HO. Tribasic. Pyrophosphoric acid P05+2HO. Bibasic. Metaphosphoric acid P05+ HO. Monobasic. How is phosphoric icid procured ? By decomposing phosphate of baryta with sulphuric acid. What are its properties? It is viscid, inodorous, colorless, liquid, reddens vegetable blues, and, when heated to redness, cor- rodes glass or porcelain. How many classes of salts does phosphoric acid form, and what are they ? The monobasic, NaOP205; the bibasic, 2NaO,P'05; and the tribasic, 3NaO,P205; corresponding with the equivalents of water held by each, as is shown in the above table. Which class is the most common ? The tribasic ; which gives a yellow precipitate with nitrate of silver. What class of phosphates exists in plants and animals? The tribasic. How many series of salts does the tribasic acid form, and. how are they expressed ? Thus, in the soda series we have one with arid reaction, NAO,2HO,P03; another neutral, 2NAO,HO,P05; the third alkaline, 3NAO,P05. Of the above, the subsalt is the common phosphate of soda of the shops. In all fluids of the bodies of animals having an acid reaction, the first of these salts is found, and in those possessing an alkaline reaction the last is found. 224 CHEMISTRY. Boron. How is boron procured? It was first obtained by subjecting boracic acid to the action of a powerful galvanic battery. But it may be procured in larger quantities by heating boracic acid with potassium, by which the boracic acid is deprived of its oxygen, and the boron liberated, thus : BO3 -+■ 3K = 3KO + B. What are the properties of boron ? It is of a dark olive color, has neither taste nor smell, and is a non-conductor of electricity. It is not soluble in water, alcohol, ether, or oils, does not decom- pose water, bears a strong heat in close vessels without fusing, or being changed, except that its density is increased. If heated to 600"J it takes fire, oxygen disappears, and boracic acid is formed. Its equivalent is 10-9 ; symbol B ; sp. gr. about 2. What are the compounds of boron and oxygen ? Boracic acid, BO3, is the only compound of boron and oxygen. Where is it found, and how is it procured ? It is found, as a natural product, in some of the hot springs, and is a constituent of datolite, boracite, and borax, which is a compound of boracic acid and soda, and is a biborate. It is procured by adding sul- phuric acid to a solution of purified borax in four times its weight of boiling water. The sulphuric acid unites with the soda, and the boracic acid is deposited, on cooling, in crystals, which may be purified by washing, dissolving them in boiling water, and by recrystallization, thus: Na02B03+ £03=NaOS03+ 2B03. What are the properties of boracic acid ? In crystals, it is a hydrate, slightly soluble in water, very soluble in alcohol, and the solution, when set on fire, burns with a green flame, which is a sure test for the presence of boracic acid; sp. gr. 1-479, inodorous, bitter taste, reddens litmus, and, with alkaline carbonates, produces effervescence. In its hydrous state, if gradually exposed to a high heat, its water of crystallization is expelled, and a fused mass remains, which will bear a white heat without sublimation, and on cooling, forms a hard, transparent glass, which is anhydrous boracic acid. It absorbs water, and loses its transparency if exposed to the air. It is sometimes used as a flux, from its being rery fusible and communicating this property to other substances. CHE M1STRY. 225 Silicon. How is silicon procured? It was first procured by Berzelius, by the action of potassium on fluo-silicic acid gas; but a more convenient process is from the double fluoride of silicon and potas- sium, or sodium, previously dried, and placed in a glass tube with potassium, to which a spirit lamp is applied. The potassium unites with the fluorine and the silicon is set at liberty, thus : 2SiF3,3KF + 6 K = 9KF + 2Si. To render it perfectly pure, it should then be heated to redness, and digested in dilute hydrofluoric acid. What are the properties of silicon ? It is of a dark nut-brown color, without metallic lustre, non-conductor of electricity, incom- bustible, not dissolved or oxidized by sulphuric, nitric, hydrochlo- ric, or hydrofluoric acids ; but nitric and hydrofluoric acids mixed dissolve it readily. Its equivalent is 21 3 ; symbol Si. What is the composition of silicic acid? In 100 parts there are 484 of silicon, and 51 "6 oxygen, by weight. Where is the silicic acid found, and how is it procured ? It exists in great profusion in nature, under the names of silica and siliceous earths. It forms a part of many minerals, and, under the name of quartz, forms mountainous masses. It is the principal ingredient in sand-stones, flint, chalcedony, &c. &c. It may be procured by igniting pure rock crystal, throwing it, while red hot, into water, and reducing it to a fine powder. What are the properties of silicic acid ? As procured above, it is a light white powder, feels rough and dry when rubbed between the fingers, insipid and inodorous; sp. gr. 269. It is very fixed in the fire, but may be fused by the hydro-oxygen blowpipe, insolu- ble in water, does not affect tests for acids, but, in its chemical combinations, acts the part of an acid and displaces carbonic acid from the alkalies by the aid of heat. The nature of its combina- tions with the alkalies depends upon the proportions in which they are united. One of these combinations, which is one part silicic acid and three of carbonate potassa, is deliquescect and easily dissolved in water, in this condition it has been called the liquor of flints or liquor silicum. By reversing the proportions the result is the well-known article p 226 C II E M I S T n V . glass. Every kind of glass is a compound of silicic acid with a base or bases ; therefore, a silicate. The quality generally depend- ing upon the purity of the materials, and in flint glass, besides the pure silicic acid and alkali, there is added some of the oxides of lead; it is, therefore, a double salt, composed of bisilicate of po- tassa, and bisilicate of oxides of lead. Its equivalent is 45-3. Selenium. How is selenium formed and how is it procured ? It generally occurs in combination with iron pyrites, also in some volcanic pro- ducts, as a sulphuret, and it is sometimes found combined with several of the metals. It may be obtained from the sulphuret by mixing it with eight times its weight of peroxide of manganese, and exposing the mixture to a low red heat in a glass retort, the beak of which extends into water. The sulphur is oxidized by the oxide of manganese, and the selenium is sublimed. What are its properties ? It is a brittle opaque solid, having neither taste nor odor, of a metallic lustre when in mass, and when in powder of a deep red color. It softens at 212°, and may be drawn into fine threads; conducts heat and electricity imperfectly, and is insoluble in water. Exposed to the flame of a blowpipe it colors the flame of a light blue color, and exhales a strong odor of decayed horseradish ; which may be considered as characteristic of the presence of selenium, whether alone or in combination. Its equivalent is 39-6; symbol Se ; sp. gr. 4*3. What are the compounds of selenium and oxygen ? There are three: the oxide of selenium, ScO; selenious acid, SO2; and selenic acid, SeO . The selenic acid is analogous in composition, and many of its properties, to sulphuric acid, and that similarity extends also to their compounds with alkaline substances. Chlorine. How is chlorine gas obtained? By the action of hydrochloric or muriatic acid, and the peroxide of manganese, in the proportion of two parts of the former to one of the latter; the chlorine escapes with effervescence, without the application of heat; but much more rapidly when heat is applied. CHEMISTRY. 227 What is the rationale of this process ? The hydrochloric acid consists of chlorine 2 eqs., and hydrogen 2 eqs. ; the oxide of man- ganese consists of manganese 1 eq., and oxygen 2 eqs. In the reaction which takes place, 1 eq. of chlorine unites with the 1 eq. of manganese, forms the chloride of manganese, and 1 eq. of chlo- rine is set at liberty ; and the 2 eqs. of oxygen and 2 eqs. of hydro- gen unite and form water. So that the result is chloride of man- ganese, water, and chlorine, which is set at liberty, thus : 2HCI + MnO2 = 2HO + MnCl + CI. Or : — 1 equiv. of binoxide of fg,- =^2H0- Water * "" " ( Mn ■ , ^""T^^-* MnCl. Chloride of manganese. fH. " 2 equiv. of chlorohy- J Cl- dric acid................. ', IL- [Cl--------------CI. Chlorine. What are the properties of chlorine gas? It has a yellowish- green color, astringent taste, and disagreeable smell. It is irrespi- rable, even when largely diluted with air, and emits heat and light when strongly compressed. By the application of about four at- mospheres of pressure, it becomes a limpid liquid of a bright yel- low color. It is absorbable by water, which yields it when heated. It presents the phenomena of combustion when brought in contact with some substances, and the result is a chloride, or an acid con- taining chlorine. It has a very strong affinity for hydrogen, is negatively electric, has no acid properties, has a great affinity for metals, and a powerful bleaching property. In its application to bleaching the presence of water is necessary, and hydrochloric acid is generated during the process ; from which we infer that the water is decomposed, the hydrogen uniting with the chlorine, and the oxygen is liberated, which occasions the bleaching. The com- pounds of chlorine which are not acid are termed chlorides. The test for chlorine is nitrate of the oxide of silver, which produces a white precipitate. Its equivalent is 35-42 ; symbol CI; sp. gr. 2-47. What compound does chlorine form with hydrogen ? It forms the hydrochloric or muriatic acid, which is 1 eq. of chlorine to 1 of hydrogen, HCl. How may this acid be prepared? In a gaseous state, it may be procured by putting a strong liquid solution of the acid into a glass, and heating it until it boils, when the gas is evolved, and may be 228 CHEMISTRY. collected over mercury. Another method is to mix equal weights of liquid sulphuric acid and sea salt, and apply heat. What is the rationale of these processes ? In the former, the acid dissolved in water is simply expelled by heat. In the latter the water is decomposed, its oxygen unites with the sodium of the chloride of sodium, or sea salt, and forms soda, the hydrogen unites with the chlorine and forms the hydrochloric acid, which escapes, and the sulphuric acid unites with the soda. The water in this process is supplied by the sulphuric acid. The result, therefore, is sulphate of soda and hydrochloric acid, thus: NaCl + HOS03=NaOS03 + HCl. Or: — NaOSO3. Sulphate of soda. C1H. Chlorohydric acid. Under what circumstances will the elements of hydrochloric acid. when brought into contact, unite ? When an electric spark is passed through the mixture, by the presence of flame, a red hot body, or spongy platinum. By exposure to diffused light they unite slowly, but the direct solar rays, like electricity, flame, &c, produce a sudden inflammation accompanied with an explosion. In what manner is the acid procured in a liquid state ? By passing a current of gas into water as long as any of it will be absorbed, we procure a concentrated aqueous solution. What are the properties of hydrochloric acid ? In a gaseous state it is colorless, has a pungent odor, and an acid taste. In a temperature of 50°, and under a pressure of 40 atmospheres, it is liquid. It is irrespirable, incombustible, and a non-supporter of combustion. Heat will not alter it chemically, but galvanism will decompose it; hydrogen will be found at the negative pole, and chlorine at the positive. It has a powerful attraction for water, which causes a white cloud to appear, where it is liberated into the atmosphere, owing to its combination with the aqueous vapor; ice also liquefies instantly, if introduced into a jar containing it, and the gas is rapidly absorbed. On introducing a jar containing the gas into water, the absorption takes place so rapidly, that the water is forced up with the same rapidity as if it were a vacuum. During the absorption, heat is given out. How can we determine the quantity of this acid contained in its Sulphuric acid...............SO Water.....................j HO Chloride of sodium .. 1 CHEMISTRY. 229 solutions ? By ascertaining the quantity of pure marble dissolved by a given weight of each. Every 50-6 grains of marble corres- pond to 36-42 of real acid. What are the properties of the hydrochloric acid of commerce ? It has a yellow color, and contains impurities, which are usually nitric and sulphuric acid, and the oxide of iron. If pure, it is a colorless liquid, emits white vapors if exposed to the air, very sour, reddens litmus, and neutralizes alkalies. It freezes at 60°, and boils at 110°, giving off the pure hydrochloric acid gas freely. It is decomposed by substances yielding oxygen easily. What combination of hydrochloric acid is used in dissolving gold and platinum? It is a mixture of two parts of the hydrochloric and one of the nitric acids, and is commonly termed aqua regia. What chemical action takes place in forming a solution of gold by this mixture ? The nitric and hydrochloric acids decompose each other, and produce water, nitrous acid, and chlorine: the solvent power is dependent on the chlorine, which is liberated. What are the compounds of chlorine and oxygen ? They are the hypochlorous acid, CIO ; the chlorous acid, C103; hypochloric acid, C104; chloric acid, C105; and the perchloric acid, C107. How is hypochlorous acid procured ? Hypochlorous acid, or euchlorine, may be best procured by pouring peroxide of mercury, in fine powder, and mixed with twice its weight of distilled water, into bottles filled with chlorine gas. By agitation, the chlorine is completely absorbed. The oxide of mercury is decomposed, both its constituents combining with chlorine, the mercury forming cor- rosive sublimate, and the oxygen hypochlorous acid, thus , HgO-f 2Cl=HgCl+ CIO. The acid may then be separated by distilla- tion, which should be done at a temperature below 212°, as it is decomposed at that heat; or it may be best performed under re- duced pressure. The acid thus procured may be concentrated by a second distillation. What are the properties of hypochlorous acid ? It is a trans- parent liquid of a slightly yellow color when concentrated; has a strong penetrating odor, an exceedingly active action on the skin, similar but greater than that of nitric acid ; high bleaching pro perties, when concentrated very liable to be decomposed, chlorine being evolved, and chloric acid produced ; this effect is promoted by light, and produced instantly by the direct rays of the sun ; 20 230 CHEMISTRY. also, by agitation with angular bodies; a portion of pounded glass produces brisk decomposition, when thrown into this acid, It is a powerful oxidizing agent, particularly of the non-metallic elements, which are readily brought to their highest degree of oxidation. How is chlorous acid procured ? By heating in a flask a mix- ture of four parts chlorate potassa, three of arsenious acid, and twelve of nitric acid, previously diluted with four parts of water. The heat must be applied cautiously, by means of a water bath. The acid comes over in the form of a greenish yellow gas, having strong bleaching properties ; combines slowly with bases forming crystallizable salts ; water absorbs five or six times its own volume of the gas. How is hypochloric acid procured ? By making 50 or 60 grains of chlorate of potassa into a paste with strong sulphuric acid, putting it into a glass retort, and applying heat by means of warm water kept below 212°, when a gas of a bright yellowish- green color is disengaged, which has an aromatic odor without the smell of chlorine, and is rapidly absorbed by water, to which it imparts its tint, What is the rationale of this process ? The sulphuric acid de- composes a part of the chlorate of potassa, and liberates chloric acid, which, at the moment of separation, resolves itself into hypo- chloric acid and oxygen ; the last of which passes over to the acid of the undecomposed chlorate of potassa, and is converted into perchloric acid. The resulting compounds are bisulphate and per- chlorate of potassa, and hypochloric acid, thus: 3KOC10"'+4S03= 2K02S03+KOC107 + 2C104. What are the properties of hypochloric acid ? It has bleaching properties, and exerts violent action on combustibles. Phosphorus takes fire with an explosion when introduced into this gas. A temperature of 212° causes a violent explosion. It may be liquefied by cold. No compound of it with a base has yet been discovered. How is chloric acid procured ? To a dilute solution of chlorate of baryta add weak sulphuric acid, precisely sufficient for combining with the baryta; an insoluble sulphate of baryta is formed and precipitated ; and pure chloric acid remains in the liquid, thus: BaOC105+/S'03=-BaOS03+ CIO'. C HEMISTRY. 231 What are the properties of chloric acid ? It reddens vegetable blue colors, has a tour taste, and forms neutral salts with alkaline bases called chlorates. It has no bleaching properties, a circum- stance which distinguishes it from chlorine, hypochlorous acids, and chlorous acids. It does not give a precipitate with a solution of the nitrate of silver. It may be concentrated by a gentle heat to an oily consistence. In this highly concentrated state it has a yellowish tint, an odor of nitric acid, sets fire to dry organic matter, and converts alcohol into acetic acid. It is easily decomposed by deoxidizing agents. It may be distinguished by forming a salt with potassa, which crystallizes in tables, has a pearly lustre, deflagrates like nitre when thrown on burning charcoal, and yields chloric acid by the action of concentrated sulphuric acid. How is perchloric acid procured ? By adding dilute sulphuric r.cid to perchlorate of potassa, and applying heat to the mixture; white vapors arise that condense as a colorless liquid in the receiver, which is a solution of perchloric acid, thus : KOCIO7 + SO3 = KOSO3 + CIO1. It may be obtained in a solid form, by mixing it with strong sulphuric acid and distilling. It hisses when thrown into water, similar to red-hot iron ; forms a compound with potassa very slightly soluble in water, which is the perchlorate of potassa, and may be distinguished from the chlorate by not becoming yellowish on the application of hydrochloric acid. The primary form of its crystal is a right rhomboidal prism. How is the quadrochloride of nitrogen procured ? Dissolve an ounce of hydrochlorate of ammonia in 12 or 16 ounces of hot^water. when it has cooled to 90° invert a wide-mouthed glass bottle, full of chlorine, into it. The chlorine is absorbed, it acquires a yellow color, and in a few minutes globules of a yellow fluid float like oil upon its surface ; when they acquire the size of a small pea, they sink to the bottom of the liquid, and should be collected in a leaden saucer placed under the mouth of the bottle. What is the rationale of this process ? The ammonia is decom- posed by the chlorine, hydrochloric acid is generated by the hydro- gen of the ammonia uniting with a part of the chlorine, while the nitrogen of the ammonia unites with another part of the chlorine, thus: NH4C1 + 7C1 = iHCl + NCI.' What are the properties of the quadrochloride of nitrogen ? It 232 CHEMISTRY. is one of the most explosive compounds known. It is not congealed by a mixture of snow and salt, may be distilled at 160°, explodes between 210° and 212°, contact with some combustibles causes detonation at common temperatures, particularly oils, both volatile and fixed. The products of the explosion are chlorine and nitro- gen. This compound is 4 eqs. of chlorine to 1 of nitrogen, or, as stated by Berzelius, 3 eqs. of chlorine to 1 of nitrogen. What are the compounds of chlorine with carbon ? The ses- quichloride of carbon, C2C13; the protochloride, CC1; and the dichloride, C2C1. How is sesquichloride of carbon procured ? By exposing ole- fiant gas to chlorine ; a combination takes place between them, and an oily liquid is generated, which is a compound of carbon, hydro- gen, and chlorine. Put this into a vessel containing chlorine gas, and expose it to the direct rays of the sun; the chlorine decom- poses the liquid, hydrochloric acid is liberated, and the carbon unites with the chlorine at the moment of separation. What are the properties of the sesquichloride of carbon ? It is solid at common temperatures, has an aromatic odor, a non-con- ductor of electricity, and a powerful refractor of light; sp. gr. 2; fuses at 320° ; it may be distilled without change, and assumes a crystalline form when it condenses. How is the protochloride of carbon procured ? By passing the vapor of perchloride through a red hot glass tube filled with pieces of rock crystal, it is partially decomposed ; chlorine and proto- chloride of carbon being the result. What are the properties of protochloride of carbon? It is a limpid colorless liquid, has a density of 1-55, does not congeal at 0°, and is converted into vapor at 160° or 170°. It may be dis- tilled, but exposure to a red heat resolves it into its elements. What are the characteristics of the dichloride of carbon? It is of a white color, in the shape of small, soft, adhesive fibres, and has a peculiar odor resembling spermaceti. What are the compounds of chlorine and sulphur ? The dichlo- ride, S2Cl; and the protochloride, SCI. What are the compounds of chlorine and phosphorus ? The pentachloride of phosphorus, PC15; and the terchloride, PC13. How is the pentachloride of phosphorus procured ? By in- flaming phosphorus in dry chlorine, the perchloride collects inside CHEMISTRY. 233 of the vessel. It is white and very volatile. By heating it under oressure and cooling, it yields transparent prismatic crystals. How is the terchloride of phosphorus procured? By heating the perchloride with .phosphorus ; also by passing the vapor of phosphorus over corrosive sublimate contained in a glass tube. What are the properties of the terchloride of phosphorus ? It Is a clear liquid, like water, of sp. gr. 1-45, emits acid fumes when exposed to the air, owing to the decomposition of aqueous vapor. On mixing with water, a mutual decomposition takes place, heat is evolved, and a solution of hydrochloric and phosphorous acids is obtained. How is chlorocarbonic acid, or phosgene gas procured ? By exposing equal parts, by measure, of chlorine and carbonic oxide gases to sunshine, a combination ensues, and a contraction to half the volume takes place. What are the properties of chlorocarbonic acid gas ? It is colorless, has a strong odor, and reddens dry litmus paper, com- bines with gaseous ammonia, and forms a white solid salt, therefore, has acid properties. Water decomposes it, and the result is hydro- chloric and carbonic acids. What compound does chlorine form with boron ? It forms the terchloride ; and it is procured by putting recently prepared boron into chlorine, when it takes fire spontaneously, and a colorless gas, the chloride of boron, is formed, which is absorbable by water, and undergoes double decomposition at the same moment, the result of which is hydrochloric and boracic acids. What compound does chlorine form with silicon? The te" chloride, which may be procured by heating silicon in a current of chlorine gas. The product is condensed into a colorless liquid, which, by the addition of water, is converted into hydrochloric and silicic acids. Is chlorine a simple or compound substance ? It is a simple body, because it cannot be decomposed by any known means. Iodine, Where is iodine found ? It is found in many mineral springs, in combination with sodium and potassium ; it is also found in the water of the Mediterranean, in the oyster, and some other marina 20* 234 CHEMISTRY. molluscous animals, in sponges, and in most kinds of sea weed. It has also been found in the mineral kingdom in combination with silver. How is it procured? It is procured from kelp, an impure car- bonate of soda, obtained by incinerating sea weeds. Carbonate of soda is prepared from the kelp ; and the residual liquor contains iodine in combination with potassium or sodium, which may be separated by the addition of sulphuric acid and binoxide of man- ganese ; by the application of heat the iodine is then sublimed, and may be collected in cool glass receivers ; thus : \\ ith iodide of sodium, 2S03 + Mn02NaI = MnOSO3 + NaOSO3 + 1. Or: Iodine. Sulphate of soda. Peroxide of man-f Oxygen _______7 Sulphate of manganese. ganese............(_ Protoxide of manganese What are the properties of iodine ? It is soft, friable, solid, has a bluish color, metallic lustre, and crystalline appearance, resem- bling micaceous iron ore. It is fused at 225°, and ebullition takes place at 347°. If moisture is present, it is sublimed rapidly at a temperature below boiling water. Its vapor is of a rich violet color, from which it derives its name. It is a non-conductor of electricity, and negatively electric. It is very sparingly soluble in water, but very soluble in alcohol and ether. It has a strong affinity for the metals and most of the non- metallic combustibles, producing compounds, termed iodides. The test for iodine is starch; but the iodine must be in a free condition, and the solution cold. Its equivalent is 126-3 ; symbol I; sp. gr. 4-94. What compound does iodine form with hydrogen ? It forms the hydriodic acid, which is 1 eq. of iodine to 1 eq. of hydrogen. How is hydriodic acid procured ? It may be formed by the direct union of hydrogen with the vapor of iodine transmitted through a porcelain tube at a red heat. It may also be procured by the action of water on the iodide of phosphorus, which gives the hypophosphoric and hydriodic acids, the latter of which passes over as a colorless gas, thus : PF + 2HO = 2HI + PO2. What are the properties of hydriodic acid gas ? It has a sour CHEMISTRY. 235 taste, reddens vegetable blue colors, and produces white fumes when mixed with the air. What is its action on the metallic oxides ? Water and an iodide of the metal is formed, thus : KO + HI = KI + HO. Its salts are called iodides. What are the compounds of iodine with oxygen ? The oxide of iodine, iodous acid, iodic and periodic acid. How is the oxide of iodine and iodous acid procured ? By mixing the vapor of iodine and oxygen gas considerably heated, a yellow matter of the consistence of solid oil is produced, which is regarded as the oxide of iodine; and, if the supply of oxygen be continued, it is converted into a yellow liquid, which is the iodous acid. How is the iodic acid procured ? By decomposing iodate of barytes by means of "sulphuric acid. The following is the rationale: BaOIO5 + SO3 + BaOSO3 + IO5. What are the properties of iodic acid ? It is a white, semi- transparent solid, has a strong, astringent, sour taste, inodorous, and is anhydrous. Its compounds are called iodates. Bromine. How is bromine procured ? From bittern, by the action of chlo- rine, which, by its superior affinity for the metallic radicals, liberates the bromine. The bromine is then taken up by ether, and acted on by potash, which is converted into the bromide and bromate, the bromate being converted into bromide by means of heat. The potassium is acted on by sulphuric acid and peroxide of manga- nese; the following change occurring: 2S03 + MnO2 + KBr = MnOSO3 + KOSO1 + Br. What are the properties of bromine ? At common temperatures it is a blackish-red liquid. Its odor is very disagreeable, and re- sembles chlorine. It is congealed at 4°, and is brittle. It emits at common temperatures red-colored vapors, resembling nitrous acid, and boils at 116-5°. It resembles oxygen, chlorine, and iodine, in being negatively electric. It is soluble in water, alcohol, and ether, supports combustion under some circumstances, and is very destructive to life. It has not been decomposed, and is very analogous in its chemical relations to iodine and chlorine. It can 236 CHEMISTRY. generally be detected by means of chlorine, which displaces bro- mine from its compounds. Its equivalent is 78-4 ; sp. gr. 2'9; symbol Br. What compound does bromine form with hydrogen ? The hydro-bromic acid, and may be produced by mixing the vapor of bromine with hydriodic acid, hydrosulphuric acid, or phosphuretted hydrogen gas, when decomposition takes place, and hydrobromic acid is formed. What are the properties of hydrobromic acid? It is a colorless gas, of an acid taste and pungent odor, irritates the glottis, and when mixed with moist air yields white vapors. It is decomposed by chlorine ; hydrochloric acid gas is produced, and bromine is deposited. The salts of bromine are called bromides. What compounds are formed with bromine and oxygen ? The bromic acid is the only known compound. How is it procured? By decomposing a dilute solution of the bromate of baryta with sulphuric acid. The sulphate of baryta is precipitated, the bromic acid remains in solution, and may be con- centrated by slow evaporation, but cannot be entirely deprived of water without being decomposed. The following is the rationale: BaOBO' + SO3 = BaOSO3 + BrO\ What are the properties of bromic acid? It has an acid taste, but not corrosive, very little odor, reddens litmus at first, and then destroys its color. It is analogous to iodic, chloric, and nitric acids. Its composition is 1 eq. of bromine to 5 eqs. of oxygen. How is the chloride of bromine procured ? By passing a cur- rent of chlorine through bromine, and condensing the resulting vapors by a freezing mixture. What are the properties of chloride of bromine ? It is a volatile fluid of a reddish-yellow color, disagreeable taste, penetrating odor, and causes a discharge of tears from the eyes. Metals burn in its vapor, and chlorides and bromides are formed. What other compounds does bromine form ? It forms twc compounds with iodine, two with phosphorus, one with carbon, and one with silicon. Fluorine. How is fluorine procured ? By passing fluoride of boron ovei minium heated to redness, and collecting the gas in a dry vessel j CHEMISTRY. 237 another mode is to mix fluoride of calcium and peroxide of manga- nese with sulphuric acid. What are the properties of fluorine ? It is a yellowish-brown gas, resembles chlorine in odor, bleaches, is negatively electric, and has a powerful affinity for the metals and hydrogen. Its equivalent is 18-68 ; sp. gr. 12 ; symbol F. What compound does fluorine form with hydrogen ? The hydro- fluoric acid, which is 1 eq. of fluorine to 1 of hydrogen. How is it procured? By adding concentrated sulphuric acid to fluor spar (which is a fluoride of calcium), reduced to a fine powder. The acid distils over on applying heat, and must be collected in a leaden receiver surrounded with ice. The result is hydrofluoric acid, which comes over, and the sulphate of lime remains in the retort, thus: HOSO3 + CaF = CaOSO3 + HF. What are the properties of hydrofluoric acid ? It is a colorless liquid at 32° ; if exposed to the air, it flies off in dense white fumes, produced by its combination with the atmosphere; has a powerful affinity for water, and a very pungent vapor. It is the most destructive to animal matter of all known substances, its application being followed by a malignant ulcer; it corrodes glass, and fluosilicic acid gas is produced. When diluted with three or four times its weight of water, it is suitable for etching on glass. It has the properties of a powerful acid, reddens litmus, has a strong sour taste, neutralizes alkalies, and unites with metals forming compounds, called fluorides. How is fluoboric acid gas obtained ? By heating a mixture of 12 parts of sulphuric acid with 2 of fluor spar and 1 of vitrified boracic acid, in a flask. It may also be obtained by heating hydro-fluoric and boracic acids in a metallic retort. What the the properties of fluoboric acid gas ? It is colorless, has a penetrating pungent odor, reddens litmus, and forms salts with alkalies, called fluoborates. It has a very strong affinity for water, which it will take from any gas containing aqueous vapor, thus affording a delicate test for it in gases. Water absorbs it, and forms a strong caustic solution. How is fluosilicic acid procured ? By mixing 2 parts of strong sulphuric acid, 1 of fluor spar, and 1 of sand, or pounded glass; on the application of heat, it is disengaged, and may be collected 238 CHEMISTRY. over mercury. The following are the changes : 3S03 + SiO3 + 3CaF = 3CaOS03+SiF3. What are the properties of fluosilicic acid ? It is a colorless gas, does not support combustion, destroys animal life, and unites with the watery vapor of the atmosphere, forming a white cloud. Ammonia. What is the composition of ammoniacal gas ? It is a compound of nitrogen ; 1 equivalent to 3 of hydrogen. How is it procured ? It may be procured from any salt of ammonia by the action of a pure alkali, or alkaline earth. Equal parts of the hydrochlorate of ammonia and caustic lime are gene- rally employed ; heat is applied, the ammonia is given off, and the residue is chloride of calcium and lime, the lime being added in excess. Thus : NH4C1 + CaO = CaCl + HONH3. Or : — Sal ammoniac, or chloride f NH«------—^=^HO, NH'. Ammonia. of ammonia....................\ Cl~-—^^--" r- S °-^^^~-—-^ Llme................................ \ Ca--------^~~~~- CaCl. Chloride of Calcium. A highly concentrated solution of ammonia is obtained by trans- mitting a current of the gas into water, as long as it will absorb it. To exhibit the gas pure, it must be collected over mercury. What are the properties of ammonia ? In a gaseous form it is colorless, powerfully pungent, irritates the eyes and nose, irrespi- rable when pure, a non-supporter of combustion, slightly combus- tible in oxygen gas, and a mixture with oxygen detonates by the electric spark, water being formed, and nitrogen set free. The gas may be liquefied at a temperature of 50°, and under a pressure of 6-5 atmospheres, forming a transparent colorless liquid. It is highly alkaline, forms salts decomposable by being heated with the fixed alkalies or alkaline earths, or by a red heat. If combined with a volatile acid, the compound may be sublimed unchanged. It has a powerful affinity for water, which absorbs 780 times its bulk, the sp. gr. of which is diminished to 0-936. The liquid solution is clear, colorless, and possesses the peculiarities of the gas itself. How may free ammonia be detected ? By the odor, its tempo- rary action on turmeric paper, which it stains brown, and the coloi CHEMISTRY. 239 Boon reappears, owing to its volatility; and by its forming dense fumes when a glass rod, moistened with hydrochloric acid, is brought near it; these white fumes are the hydrochlorate of am- monia. How many compounds of nitrogen and hydrogen are there ? Three : as follows : Nitrogen. Hydrogen. Amidogen...................N+ 2H or NH2. Symbol Ad. Ammonia*...................N + 3H or NH3. Formula Ad + H. Ammonium..................N + 4H or NH. " Ad + 2H. What is ammonium ? It is a hypothetical metal, the base of ammonia. It has never been isolated, but has been inferred to exist, because an amalgam is formed with mercury, by a galvanic current, which resembles an amalgam formed with a metal. The base of the salts formed of ammonia is supposed to be an oxide of this radical, because oxy-acids do not unite with bases which contain no oxygen, while oxy-acids do unite with ammonia and form ammoniacal salts. Its formula would be NH4, and that of its oxide NH4 + 0 ; eq. 18 + 8 = 26. Compounds op Hydrogen and Carbon. What are the known compounds of hydrogen and carbon ? Light carburetted hydrogen, olefiant gas, etherine, paraffine, eupione, rose, oil stearine, wax oil, benzoin, naphtha, oil of turpentine, citrine, camphene, oil of copaiva, juniper oil, lemon oil, savin tree oil, black pepper oil, naphthaline, paranaphthaline, and idrialine. What is the proper chemical name for light carburetted hydro- gen? The dicarburet of hydrogen. Other names, frequently used, are heavy inflammable air, the inflammable air of marshes, and hydro-carburet. Where is it found, and how is it obtained ? It is formed in stagnant pools, from the decomposition of vegetable matter, and may be procured by stirring the mud at the bottom, and collecting it in inverted vessels as it rises. Obtained in this way, it contains a small quantity of carbonic acid gas. It may also be obtained by heating acetate of potash with hydrate of baryta. The following 240 CHEMISTRY. is the rationale; KOC4H303 + BaOHO = KOCO2 + BaOCO' + 20 H2. What are its properties ? It is colorless, tasteless, has very little smell, gaseous, a non-supporter of combustion or respiration, in- flammable, and burns with a yellow flame. With a sufficient por- tion of atmospheric air, or oxygen, it forms a detonating compound, water and carbonic acid being formed when it is detonated. The fire damp, so destructive in coal mines when ignited, is composed of this gas. Upon what principle is Sir Humphrey Davy's safety-lamp con- structed to prevent the explosion of this gas ? It is found that the flame cannot pass through a narrow tube, however short, provided its diameter is sufficiently reduced. Now a piece of wire gauze may be regarded as an assemblage of these tubes, and flame will not penetrate it; therefore, if a common oil lamp is surrounded with a piece of this gauze, it will burn in the explosive mixture, without communicating combustion to the gas externally. What is the composition of olefiant gas, and why is it so called ? It is composed of 2 eqs. of carbon and 2 eqs. of hydrogen, united to form 1 eq. of the gas ; and is called olefiant gas, because it forms an oil-like liquid with chlorine. Formula C2H2; equivalent 14; sp. gr. -980. How is it procured? By heating a mixture of alcohol and sul- phuric acid, in the proportion of one part of the former to four of the latter; effervescence ensues, and olefiant gas passes over. What are the properties of olefiant gas? It is colorless, taste- less, and inodorous, a non-supporter of combustion and respiration, inflammable, burning with a dense white light, and forms an explo- sive mixture with oxygen, or atmospheric air. It is decomposed by a succession of electric sparks, and by being transmitted through red-hot porcelain tubes. A mixture of two parts of chlorine, and one of olefiant gas, takes fire on the application of flame, the re- sult of which is hydrochloric acid, and the deposition of charcoal; but if they are allowed to remain at rest, they enter into direct combination, and a yellowish oil is produced. Upon what does the flame of candles, lamps, gas lights, culinary fires, &c, depend ? The compounds of carbon and hydrogen. How may they be procured for the purpose of gas lights ? By CHEMISTRY. 241 the destructive distillation of bituminous coal, wood, oil, tar. or other inflammable substances. Upon what does the illuminating power of these compounds principally depend ? This power is in proportion to the quantity of carbon condensed into a volume, provided there is a sufficient supply of oxygen to consume it; otherwise, the excess of carbon renders the flame smoky. Hydrogen and Sulphur. What are the compounds formed by hydrogen and sulphur ? There are two ; hydrosulphuric acid, HS; and the persulphuret of hydrogen, HS2. How is hydrosulphuric acid, or sulphuretted hydrogen, as it is generally called, procured ? By heating sesquisulphuret of anti- mony with four or five times its weight of hydrochloric acid. What is the rationale of this process ? The chlorine of the hydrochloric acid unites with the antimony of the sesquisulphuret, forming a sesquichloride, and the hydrogen of the hydrochloric acid unites with the sulphur of the sesquisulphuret, and forms hydrosul- phuric acid, thus : Sb'S' + SHCl = S CI3 + 3!3t. It may also be obtained by the action of an acid with water on the sulphuret of iron (iron pyrites). When chlorohydric acid is used, the following is the reaction : — Chlorohydric acid j f,1" ~^^FeCl. Chloride of iron. Sulphuret of iron J Be -" ——^^ „„ c . . .. , , . (O -----------^^HS. Sulphuretted hydrogen. When sulphuric acid is used, it is as follows : — Sulphuric acid....... O3 — _______-j.Fe0,S0». Sulphate of iron. Sulphuret of iron j |e Water. ^ i O^ ""==*"HS. Sulphuretted hydrogen. Formula, HS ; equivalent, 17; sp. gr. 1-18. What are the properties of hydrosulphuric acid ? It is a color- less gas, reddens moist litmus, has a very offensive taste and odor, similar to putrid eggs, a non-supporter of respiration and combus- tion, combustible, water and sulphuric acid being the products, and sulphur is deposited. It may be readily distinguished by its 21 Q 242 CHEMISTRY. odor, tarnishing silver, and the character of its precipitate with solutions of arsenious acid, tartar emetic, or salts of lead. Its salts are called hydrosulphates. Hydrogen and Phosphorus How is phosphuretted hydrogen procured ? By the action of strong hydrochloric acid on phosphuret of calcium. The following is the reaction when water, lime, and phosphorus are heated to- gether : — f jj--------_—^>»y PH8. Phosphuretted hydrogen. H" Water, 3 eqs............\ q' ! 0~ 1 -n1' ^\^\^^\ Hypophosphorous acid. Phosphorus, 4 cqp.... { ,,----- v^^^PO ) v. Lime' 8 e Hg'CX 1 eq. sulphate of mercury^ \ ^; °*f_geI\ L phuric acid f 1 eq. metallic mercury-------------- 1 eq. common salt............\\ «!• chl,orine \ 1 eq. sodium SulRhate of Mia. What are its properties? It is white, crystalline, compact, tasteless, inodorous, and not altered by exposure to the atmosphere if light is excluded; but by this it is rendered black and partially CHEMISTRY. 273 reduced to the metallic state ; alkaline solutions render it black by the formation of the suboxide. It sometimes contains portions of the chloride, which would be a dangerous combination when employed in medicine ; and may be detected by boiling with wrater, and adding caustic potash to the filtered liquid, which will give i yellow precipitate if corrosive sublimate be present). How is the chloride, or corrosive sublimate procured ? Bj heating mercury in chlorine gas, and by subliming a mixture of 1 eq. of the sulphate of the red oxide of mercury with 1 eq. of tin- chloride of sodium. The products of this last process are 1 eq of the chloride of mercury, and 1 eq. of the sulphate of soda. Th' action may be explained as follows : — f 1 eq. mercury------------~~7 Corrosive sublimate. 1 eq. sulphate) 1 eq. oxygen ^^ s/ of mercury j 1 eq. ?ul- 1 ^^^/"^ phuric acid J " ~><^^^^_ 1 eq. common i 1 eq. chlorine ' ' C^\^ salt............\ I e4- sodium ______________^».Sulphate of soda. What are its properties ? It is white, semitransparent, crystal- line, and poisonous ; has an acid, burning taste, and leaves a nau- seous metallic one. It is slightly soluble in cold water, and highly soluble in hot water and alcohol. By the addition of ammonia to its solution, the white precipitate is formed. What are the tests for corrosive sublimate ? Hydrosulphuric acid precipitates the black sulphuret of mercury; lime-water and the pure fixed alkalies a yellow peroxide of mercury; hydriodate of potassa precipitates the iodide of mercury, which is of a scarlet color, and resembles no other iodide; protochloride of tin causes u black precipitate with the salts of mercury, which is perhaps the most delicate test we possess for them. Another is to place a drop of the suspected liquid on polished gold, and touch it through the liquid with a piece of iron wire or point of a knife, when the part touched instantly becomes white, which is caused by an amalgam of gold. Albumen or white of eggs produces a white flocculent precipitate, which is a compound of calomel and albumen, and is inert; therefore, white of eggs is an antidote for poisoning by cor- rosive sublimate. What are the iodides of mercury ? They are the subiodide, which is mercury 2 eqs. and iodine 1 eq., HgT; and is obtained s 274 CHEMISTRY. by mixing the nitrate of the suboxide of mercury with the iodide of potassium. It is a greenish-yellow powder, insoluble in water. The iodide, which is 1 eq. of mercury and 1 eq. of iodine, Hgl; and is obtained by adding the iodide of potassium in solution to the nitrate of the protoxide ; or to the chloride of mercury. It is precipitated as a rich red-colored powder, vieing in beauty with vermilion. What are the compounds of mercury and sulphur ? The sub- sulphuret, which is 2 eqs. of mercury to 1 eq. of sulphur, Hg2S; and may be formed by passing hydrosulphuric acid gas through a solution of the nitrate of the suboxide of mercury, or through water with calomel suspended in it. The sulphuret, which is 1 eq. of mercury to 1 eq. of sulphur, HgS ; and is formed by fusing sulphur with six times its weight of mercury, and subliming in close vessels. This is fictitious cin- nabar, and, when powdered, it forms the beautiful pigment ver- milion. What is ethiops mineral ? It is a mixture of sulphur and the sulphuret of mercury, and is formed by triturating together equal parts of mercury and sulphur. It is the subsulphuret, Hg2S. What compound does mercury form with cyanogen ? A cyanide, HgCy, obtained by heating the red oxide of mercury with Prus- sian blue. The salts of mercury are all volatilized or decomposed by a tem- perature of ignition ; those that do not yield the metal by simply heating, may be caused to do so by the addition of dry carbonate of soda. The metal is displaced from its soluble combinations by a plate of copper, and also by a solution of protochloride of tin in excess. Sulphuretted hydrogen gives a black precipitate. Lime-water and the alkalies give a black precipitate with the salts of the suboxide, and yellow with those of the oxide. Alloys of mercury are called amalgams ; it unites with many of the metals and forms a solution, some of which afterwards become solid. Silver. How is silver found in nature, and where ? It is found native, and in combination with sulphur in galena, also combined with gold. «»timony, copper, &c. Nearly all the lead of commerce contains CHEMISTRY. 275 traces of silver. It is found in Mexico, Peru, Hungary, and in the United States. How is it procured? By amalgamation and cupellation, de- pending upon the form of ore used. It may be obtained pure from coin by dissolving it in nitric acid, and decomposing the nitrate. What are its properties ? It is the clearest white of the metals, receives a beautiful polish, is very malleable, ductile, quite tena- cious, soft when pure, and, when fused in open vessels, it absorbs oxygen. It is blackened by sulphur and chlorine. Its equivalent is 108; sp. gr. 10-51 ; symbol Ag; melts at 1873°. What are the compounds of silver and oxygen? They are the suboxide, Ag20 ; the protoxide, AgO. The last is obtained by decomposing the nitrate by potash or soda. It is of a deep-olive color, soluble slightly in water, and forms a fulminating compound with ammonia. It is precipitated in the metallic state by most of the metals; when mercury is employed it assumes an arborescent appearance, called arbor Dianas. And the peroxide, which is unimportant in its chemical relations. How is the nitrate of silver, AgO,NO5, procured? By the action of nitric acid on silver; when it has been fused it is called lunar caustic. What is the best test for silver ? Chlorine, and the muriates, which form an insoluble chloride. How is the chloride of silver, AgCl, prepared ? It sometimes occurs native, and is called horn silver ; it is generated when silver is heated in chlorine gas, and may be precipitated by adding hy- drochloric acid, or a soluble chloride to the nitrate of silver. What are its properties ? It is white, insoluble in water, slightly soluble in acids, but very soluble in ammonia, and is decomposed by hydrogen. How is the iodide of silver procured ? By adding the iodide of potassium to a solution of the nitrate of silver. It is greenish yellow, and is soluble in water and ammonia. How is the sulphuret of silver procured ? Silver unites with sulphur on exposure to hydrosulphuric acid, and by transmitting this gas through a solution of the nitrate, when it subsides as a dark-brown precipitate, the sulphuret of silver. Fulminating silver is prepared by dissolving the precipitated oxide in ammonia ; and possesses exceedingly dangerous explosive 276 CHEMISTRY. properties ; when dry, the touch of a feather being sufficient to cause it to explode. The reason of this explosive property is that the silver has a feeble affinity for oxygen, while the hydrogen of the ammonia has a powerful affinity for it, so that a slight disturb- ing cause is sufficient to cause the oxygen and hydrogen to unite. The products of this action are water, nitrogen, and metallic silver. Solutions of silver are reduced to the metallic state by iron, copper, mercury, &c. Gold. How is gold found in nature, and where ? It is found pure and in combination with other metals, in North and South America, Hungary, and Liberia. How is gold obtained pure ? By amalgamation with mercury, and then distilling off the mercury ; by making a solution in nitro- hydrochloric acid and precipitating it by the sulphate of iron. What are the properties of gold ? It has a yellow color which. distinguishes it from all other simple metals, is very malleable and ductile, but inferior to several in brilliancy and tenacity. It has but little affinity for oxygen or sulphur. Its equivalent is 994 ; sp. gr. 19-257 ; symbol Au. Its solvent is chlorine, to which the nitrohydrochloric acid owes its solvent powers. What are the oxides of gold ? The protoxide, AuO ; the bin- oxide, AuO2; and the teroxide, AuO3. What is the test for gold in solution ? The protochloride of tin, which throws down the purple of Cassius. Platinum. How is platinum found in nature, and where? In the metallic state, associated or combined with other metals. It is found in South America, and in the Uralian mountains. How is it obtained ? By dissolving the native grains of platinum in aqua regia, or nitro-hydrochloric acid, and adding to it a solu- tion of sal ammoniac, which affords an orange-yellow precipitate. This is to be washed, dried, and exposed to a red heat, which isolates the metal in a porous state, called platina sponge; which may be consolidated by mechanical pressure, heat, and hammering. What are the properties of platinum ? It has a white color, with a lustre inferior to silver, is malleable, ductile, may be welded CHEMISTRY. 277 at high temperatures, and is difficult of oxidation or fusion. Chlo- rine, or solutions which afford it is its proper solvent. It is the heaviest of known metals, equivalent 98-8 ; sp. gr, 21-5 ; symbol PI. What are the compounds of platinum ? There are three oxides, two chlorides, two iodides and two sulphurets. What is the test for platinum ? Protochloride of tin, which throws down a claret-colored precipitate. Alloys and Amalgams. What is meant by alloys and amalgams? Alloys are combina- tions of the metals with each other, and, when mercury is a con- stituent, they are called amalgams. Under what circumstances do metals combine with each other ? [t is necessary that at least one of them should be liquid, when they will unite if the attraction is energetic. Do they combine in definite proportions only ? They unite in all proportions ; yet there appears to be a tendency to unite in definite proportions, as some compounds of this kind occur native. What are the general properties of alloys ? They resemble the metals, are opaque, possess metallic lustre, and are good conductors of heat and electricity. The color is sometimes changed from that of its constituents ; the hardness is generally increased, conse- quently the sonorousness is in general increased; the malleability and ductility are usually impaired; the density is sometimes greater, sometimes less ; the fusibility is greatly increased, and the tendency to unite with oxygen augmented. Salts. How is the class of salts divided ? Into amphigen and halogen salts. What are the halogen salts ? They are those salts formed by the union of a salt-radical with a metallic-radical, as common salt (NaCl) ; and are binary in constitution, and included under the compounds of chlorine, iodine, bromine, fluorine, and cyanogen. What are the amphigen salts ? They are those formed of ele- ments which have the power of generating both acids and bases, 24 278 CHEMISTRY. as sulphate of soda (NaOSO3). In this instance oxygen confers acid properties on the sulphur and basic on the soda. The amphigen salts are divided into sub or basic salts, where there is an excess of base over the acid; neutral, when there is one equivalent of base and one equivalent of acid, whether they be acid or alkaline. The general rule in the formation of a neutral amphigen salt is : that there are as many equivalents of acid as there are equivalents of oxygen in the base to which, it is attached. Thus one equivalent of acid is sufficient to neutralize a protoxide; but two equivalents of acid are necesssary to form a neutral salt with one equivalent of a deutoxide. Super, or acid salts, are those in which the acid is in excess ; that is, there may be two equivalents of acid to one of base. Double salts; these may belong to either of the above classes; thus chloride of sodium will unite with the chloride of mercury, and a double haloidal salt is formed ; and sulphate of alumina, united with sulphate of potassa (alum), is a double amphigen salt. All of the salts are characterized by their taste, and form of their crystals, which are simple or compound. Cleavage is the tendency of crystals to split in particular direc- tions, and is an indication of a regular structure within. They are isomorphous when they have the same crystalline structure, but differ in chemical composition ; and dimorphous when the same substance may have two crystalline forms. Goni- ometer is the name given to an instrument for measuring the angles of crystals. What is meant by deliquescent salt ? It is where a salt attracts moisture from the atmosphere, and becomes liquid. What by an efflorescent salt ? It is where a salt loses its water of crystallization by exposure to the atmosphere, and falls down into a white powder. What is the water of crystallization ? It is water which unites with a salt in crystallization, and forms a part of the crystal, but is not an essential ingredient to the existence of the salt. What is meant by oxysalts ? Those of which both the acids and bases contain oxygen. What are the characteristics of the sulphates? They form white precipitates with the salts of baryta, strontia, and lead, which are CHEMISTRY 279 insoluble in nitric acids. Of these tests baryta is considered the best for sulphuric acid, either free or combined. They are soluble, with the exception of the sulphates of baryta, of the oxides of tin, antimony, bismuth, lead, and mercury. Those sparingly soluble, are the sulphates of strontia, lime, zirconia, yttria, and of the oxides of cerium and silver. The other sulphates are quite soluble in water. What are the characteristics of the sulphites ? The sulphuric, hydrochloric, phosphoric, and arsenic acids decompose the sulphites with effervescence, owing to the liberation of sulphurous acid gas; they are converted by nitric acid into sulphates. What is the prominent characteristic of the nitrates ? They are decomposed invariably at a high temperature. What is the prominent characteristic of the nitrites ? By the addition of a strong acid the red fumes of nitrous acid are disen- gaged. What is the characteristic of the chlorates ? They are decom- posed at a red heat, oxygen gas is evolved, and a chloride is formed. What characterizes the chlorites ? They are soluble in water, and possess high bleaching and oxidizing properties. What characterizes the iodates ? They are similar to the chlo- rates, iodides being formed of course, instead of chlorides, wheD heated. What characterizes the arseniates ? When, heated to redness with charcoal they are decomposed, and metallic arsenic is set at liberty. What characterizes the chromates ? They are generally either of a red or yellow color, are decomposed by heat, and the acid is resolved into green oxide of chromium and oxygen gas. What characterizes the carbonates ? Their decomposition with effervescence by nearly all the acids, and most of them are decom- posed by heat. How may the salts of ammonia be distinguished ? By the ad- dition of pure potassa, when the odor of ammonia is given off. How may the hydrosulphates be distinguished ? By hydrosul- phuric acid being expelled with effervescence by other acids. What is understood by sulphur-salts ? They are double sul- phurets, as the oxysalts are double oxides; the sulphuret of one 280 CHEMISTRY. metal acting as an acid, while the sulphuret of another metal actH as a base. Kcrincs mineral, for instance, is an example of a sulphur salt, being sulphuret of antimony united with sulphuret of potassium. ORGANIC CHEMISTRY. What is understood by organic chemistry ? It comprehends the history of those compounds which are of animal or vegetable origin. What are the simple elements coming under notice in organic chemistry ? They are carbon, hydrogen, oxygen, and nitrogen, with traces of phosphorus, sulphur, iron, silicic acid, potassa, lime, &c. The mode of union differs from that in the inorganic kingdom. In that, union takes place by pairs of elements ; thus—copper and oxygen combine to form oxide of copper; potassium and oxygen to potash ; sulphur and oxygen to sulphuric acid ; sulphuric acid then combines with oxide of copper and of potassium ; by which a pair of salts is formed, that are again capable of uniting to form a double compound, CuO,SO3 + KO,S03. The most complicated products may be formed in this way. In organic chemistry it is different; the union of the elements, no matter how complex, seems to be simultaneous. In sugar, C24H2i022, or morphia, C35H'°N06, and numerous other similar cases, the elements are bound up'to- gether, as a single whole, which may enter into combination with other substances, and be disengaged with properties unchanged. Are organic substances liable to decomposition ? Yes ; they are very prone to decomposition, the tendency of carbon and hydrogen being to appropriate to themselves as much oxygen as will form carbonic acid and water; and, when the oxygen is insufficient, car- bonic oxide and carburetted hydrogen are formed. When the organic substance contains nitrogen it is very prone to decomposi- tion, and water, carbonic acid, hydrocyanic acid, and ammonia are formed. They are all decomposed at a red heat, and nearly all below this temperature. What are the particular characteristics of organic products ? Th°v are composed of the same elements, undergo spontaneous CHEMISTRY. 281 decomposition with facility, cannot be formed by the direct union of their elements, and are decomposed at a red heat. The more complex the constitution, the greater the liability to decomposition ; this disposition is less where the elements saturate each other. Animal matter is generally quaternary, and more liable to decomposition than vegetable, which is usually ternary. Isomeric bodies are .numerous, and this condition is supposed to depend upon a different arrangement in the constituent atoms, the number being the same. What is understood by the term compound radicles ? They are combinations that perform the functions of elementary bodies. The following are the most important examples of this class : — Formula. Carbonic oxide, or protoxide of carbon........................... CO Cyanogen, or bicarburet of nitrogen............................. C2N Mellon, or sesquicarburet of nitrogen........................... C6N* Benzoile, benzule, or benzyle.................................. CuH502 Cinnamyl, or cinnamule........................................ C18H802 Salycyle, or salicule.............................................. C14H504 Acetyl, or acetule................................................... C4HS Formyl, or formule ................................................... C2H Amide.................................................................... NH2 Etbyl, or ethule....................................................... C*H5 Methyl, or metbule................................................... C2H3 Cetyl, or cetule...................................................... C32H33 Glyceryl, or glycerule................................................ C6H' Amyl, or amule...................................................... C10Hn Mesety], or mesetule................................................ C6H* Kacodyl, or kacodule........................................... C4H6As. Vegetable Chemistry. What are the simple elements of vegetable substances ? Oxygen, hydrogen, carbon, and a few contain nitrogen. What is meant by the proximate or immediate principle of vegetables ? They are compounds which exist ready formed in plants, such as sugar, starch and gum. What is meant by the proximate analysis of vegetables ? It is the process of separating the proximate principles from each other, and the reduction of the proximate principles into their simplest parts constitutes their ultimate analysis. 24* 282 CHEMISTRY. How may vegetable substances be arranged ? Into the vegetable acids, the vegetable alkalies ; neidral substances, the oxygen and hydrogen of which are in the ratio to form water; the oleagi- nous, resinous, and bituminous principles; the spirituous and ethereal principles; coloring matter; and compounds which can- not be classed under the preceding heads. Vegetable Acids. What are the vegetable acids ? They are compounds possessing acid properties, which are products of vegetation. What are the general properties of vegetable acids ? They are decomposed at a red heat, less liable to spontaneous decomposition than other vegetable substances, decomposed by hot nitric acid, by which they are converted into carbonic acid and water, and nearly all are polybasic. Is oxygen always in a proportion above that for forming water in vegetable acids ? Generally, but not always ; sometimes it is even in a less proportion, as in benzoic acid ; but when there is more oxygen than suffices to form water with hydrogen, the vege- table substances are always acid. Where is Oxalic acid, C203,HO, or 2CO +0 + HO, found? In several plants ready formed, as in the rumex acetosa, or common sorrel; the oxalis acetosella, or wood sorrel; and it may be pre- pared by digesting sugar with nitric acid. What are the properties of oxalic acid ? It crystallizes in slen- der, flattened, four and six-sided prisms, terminated by six-sided summits, but the primary form is an oblique rhombic prism ; it has a sour taste, reddens litmus, and forms neutral salts with alkalies, and is very soluble in water. It is powerfully poisonous, and is frequently taken by mistake for epsom salts, which it resembles. Chalk is its antidote, with which it forms an insoluble oxalate of lime. It is distinguished from all other acids by the form of its crystals, and by its solution giving, with lime-water, a white insolu- ble precipitate. It contains the elements of carbonic acid and car- bonic oxide, into which it is decomposed by the action of a strong acid. It is monobasic, but will unite in more than one proportion to a single equivalent of base. The salts of oxalic acid are neutral oxalate of potassa, KO,C?03, HO ; binoxalate of potassa, called salt of sorrel, and exists in chemistry. 283 oxalis acetosella, or sorrel, and in garden rhubarb. Formula KO,2(C'03) + 3HO. Quadoxalate of potassa, KO,4(C303) + 7HO. Oxalate of ammonia, NHJ0,C203 + HO. This last is used as a test for lime. Where is Acetic acid, C4H303 + HO, found ? It exists in the sap of many plants, either free or combined; it is generated bv the destructive distillation of vegetable matter, and is produced by the acetous fermentation. It is best obtained pure and concentrated by decomposing the acetates by sulphuric acid. For chemical pur- poses it is obtained by the destructive distillation of wood, and sold under the name of pyroligneous acid. How is acetic acid distinguished? By its flavor, odor, and volatility. Its salts are called acetates, and are all soluble in hot, and most of them in cold water; formula, HO,C4H303. Where is Lactic acid found ? In sour milk, and in the beet root; formula, HO,CeHO\ Where is Kinic acid found ? In cinchona bark, in combination with lime, quinia, and cinchona ; formula, C"H"0"HO. Where is Malic acid found ? In the acidulous fruits, such as grapes, oranges, currants, apples, &c. ; formula, 2HO,C8H408. Where is Citric acid found ? In the juice of the lime and lemon; formula, 3HO,C,2H50". From what is Tartaric acid procured ? It exists in the juice of some of the acidulous fruits, but generally in combination with lime or potassa. It is prepared by mixing chalk with cream of tartar, from which the tartrate of lime is thrown down, and the tartrate of potassa remains in solution ; to the tartrate of lime sulphuric acid is added, and the tartaric acid is set at liberty. What are the properties of tartaric acid ? It has an agreeable sour taste, reddens litmus, and forms with alkalies neutral salts, called tartrates. It is distinguished by forming a white precipitate, the bitartrate of potassa, when mixed with any of the salts of po- tassa ; it, therefore, separates potassa from the other acids, and produces a precipitate with lime, which is soluble in an excess of the acid. It is remarkable in forming double salts, the most im- portant of which are those of potassa and soda, or the Rochelle salt, and of oxide of antimony and potassa, or tartar emetic; for- mula, 2HO,C8H40'°. 284 CHEMISTRY. What is the cream of tartar of the shops ? It is the bitartrate of potassa; in an impure state known by the name of tartar, or argot, it is found encrusted on the sides and bottom of wine casks; being insoluble in alcohol, it is deposited as alcohol is formed du- ring the vinous fermentation ; formula, KO,HO,C8H O10. Tartrate of potassa, 2KO,C^H40'° ; or soluble tartar. Tar- trate of potassa and soda, or Rochelle salt, KO,NaO,C8H40'° + 10HO. Where is Benzoic acid found ? In gum benzoin, storax, balsam of Peru, Tolu, &c. ; also in the urine of the cow and of children. It is generally procured from gum benzoin ; formula, HO,C"ir03. Where is Meconic acid found ? It is found only in opium com- bined with morphia. It is known by forming with the sesquisalts of iron a blood-red color, which renders it valuable as a test for opium; formula, 3HO,Ci4HO,,. Where is tannic acid, or Tannin, found ? In the excrescences of the oak, called gall nuts, in the bark of most trees, in kino, catechu, the tea plant, sumach, uva ursi, and in astringent plants generally; it is the principal cause of astringency in vegetables. What are the properties of tannic acid ? It is colorless, inodor- ous, has an astringent taste, no bitterness, and may be kept in the solid state. It is soluble, reddens litmus, and decomposes the car- bonates. It strikes a deep-blue precipitate with the sesqui-salts of iron, but not with the proto-salts, which distinguishes it from all other substances except gallic acid, and from this it may be distin- guished by yielding, with a solution of gelatin, a white, flaky pre- cipitate, soluble in a solution of gelatin, but insoluble in water and gallic acid. This compound of tannic acid and gelatin, called tanno-gelatin, is the basis of leather; formula, 3HO,C|sH509. Where is Gallic acid found ? In most substances which contain tannic acid, and is probably developed by the oxidation of that acid. It does not precipitate gelatin or the salts of the vegetable alkalies; formula, 2HO,C7H03. How is the Succinic acid obtained ? By heating powdered amber in a retort; formula, 2HO,C8H406. chemistry. 285 Organic Salt Bases, or Vegetable Alkalies. What is understood by vegetable alkalies ? They are those proximate vegetable principles which possess alkaline properties. They all contain nitrogen, are decomposed by a moderate heat, and are but slightly soluble in water. 'What is their composition? Carbon, hydrogen (in greater pro- portion than to form water), nitrogen, and oxygen; and they always exist in combination with an acid. How are they generally procured ? The substance containing the alkaline principle is digested or macerated in a large quantity of water to dissolve the salt, of which the alkali is the base. Then idd a powerful salifiable base, which unites with the acid, the alka- line base is set at liberty, may be collected on a filter, purified I y solution in boiling alcohol, and evaporated to dryness. What are some of the most prominent vegetable alkalies ? — Morphia................................................................ C35H20NO6 Codeia................................................................... C^H^NO5 Thebaia "1 ... . , k \ composition not known. Narceia > Narcotina............................................................... C^H^NO1 Coneia................................................................... C^tPN Nicotia.................................................................. C10rJ8N Quinia................................................................... C20H12NO2 Cinchonia............................................................... C^H^NO Arlcina................................................................. C^H^NO3 Strychnia............................................................... C"H N20 Brucia................................................................... C"H N20' Veratria................................................................. C31H22NO« Aconitina Caffein \ C8H5N203 Thein f " Theobromin............................................................ CH95N302 Where is Morphia, C25H30NO6, found in nature ? It is the medi- cinal agent of opium, in which it is combined with meconic and sulphuric acids, and other foreign matters. What are the properties of morphia? Colorless crystals of a brilliant lustre, and in irregular, six-sided prisms, may be obtained from the alcoholic solution. It is insoluble in cold, and slightly 286 CHEMISTRY. in hot water, tasteless when pure, but very bitter when dis*vNsd in alcohol, or rendered soluble by means of an acid. Strong n.tric acid converts it into oxalic acid, and, with a sesquisalt of iron, it strikes a blue tint. It is almost inert when pure, from its insolu- bility, but when in solution it acts with great energy. By decom- posing a salt of morphia by ammonia, when taken into the stomach, the effects of an over-dose may be prevented. It decomposes iodic acid, and sets iodine free, which may be recognised by starch, its appropriate test; one grain of pure morphia in 7000 grains of water may be recognised by this test. It forms a sulphate, an acetate, a phosphate, a chloride, &c. Where are Cinchonia and Quinia found ? In the ciuchonia bark, in union with kinic acid. How are they procured? By taking up the soluble parts of the bark by hot water, acidulated with hydrochloric acid; concentrate the solution, and digest with successively added portions of slaked lime until the liquid becomes alkaline. The precipitate is carefully collected, and the vegetable alkali separated by boiling alcohol. What are the properties of cinchonia, C20HI2NO ? When pure it crystallizes in colorless, quadrilateral prisms, insoluble in cold, slightly soluble in hot water, and very soluble in boiling alcohol. It has a very bitter taste when dissolved by alcohol, or an acid; and forms salts with acids. What are the properties of quinia, or quinine, C20Hl2NO2 ? It is precipitated from its solutions by alkalies in white flocks, which do not crystallize; very soluble in alcohol and ether, but very slightly so in water. Its medicinal virtues are more powerful than those of cinchonia. It forms salts with acids, the most important of which is the disulphate, and is prepared in large quantities for medicinal purposes, crystallizing in delicate white, needle-shaped crystals. The sulphate of quinia is frequently adulterated; and the sub- stances generally employed are water, sugar, starch, gum, ammo- niacal and earthy salts. When pure it should only lose 8 or 10 per cent, of water of crystallization by heat. The other impurities may be detected by the appropriate means. Where is Strychnia, C44H23N20\ found ? In the fruit of the strychnos ignatia, and the strychnos nux vomica, and has alsc been extracted from the Upas. CHEMISTRY. 287 What are the properties of strychnia ? It is soluble in boiling alcohol, and by evaporation it is procured in four-sided prisms. It is a virulent poison, producing death in a very short time if taken in sufficient quantity. It action is accompanied by tetanic symptoms. Caffein, or Thein, C8H5N202, found in tea, coffee, and mate, may be prepared by adding subacetate of lead to a decoction of tea, coffee, or mate; then removing the lead by sulphuretted hydrogen, and adding ammonia. The caffein crystallizes out in tufts of white, silky needles, which have a bitter taste, and sublime without decomposition. Neutral Substances, the Oxygen and Hydrogen or which ARE IN THE SAME RATIO AS IN WATER : OR THE AMYLUM SERIES. What substances are included in this class ? Lignin............................................................ . C12H808 Gum Arabic 1 .................................................... Ci2H»0" Cane sugar J Sugar of milk.................................................... C12H12012 Sugar of ergot................................................... C12H13013 Glucose, or sugar of grapes ^ Sugar of starch I................................ C12HuO" Diabetic sugar J Starch -. Cellulose Tragacanthus .................................................. C12H1°°10 Dextrine. J Mannite............................................................ C6H706 Oleaginous, Resinous, and Bituminous Substances. What is remarkable in this class of bodies ? Their combustibility, besides other properties common to each. They generally contain hydrogen in a larger proportion than is necessary to form water with their oxygen, and they exert a feeble affinity for other bodies. W hat are tbe characteristics of Oils ? They are inflammable, have a peculia* unctuous feel, and are insoluble in water. They are divided into fixed and volatile; the former gives a permanent, 288 CHEMISTRY. greasy stain to paper; and the latter produces one which disap- pears by a gentle heat. Where are fixed oils usua'ly found ? In animals and in the seeds of plants, but olive oil is procured from the pulp which sur- rounds the stone. These oils are obtained by roasting the seeds, and subjecting the pulpy matter to pressure and a gentle heat. They absorb oxygen, and become rancid when exposed to the atmosphere, or to oxygen gas; they also unite with alkalies and form soap. What are their component parts ? Stearine and margarine, or the hard portion; and elaine or oleine. TABLE OF FATS, FATTY ACIDS, AND BASE. Fals. Stearine............................................................ C71H'°080 Margarine. Oleine. Fatty Acids. Stearic acid............................................. C68H6605+2HO Margaric acid........................................... C68HM06+ 2HO Oleic acid................................................ C"H40O*+ 2H0 Base. Glycerine..................................... C6H806, or C6H'05+ HO Stearine, C7,H70Of0, the solid constituent of fat, may be obtained by melting mutton suet in ether, and allowing the whole to cool, when the stearine will crystallize. It is white, friable, insoluble iu water and alcohol, but soluble in boiling ether; melts at 130° F. Chemically it is a stearate of glycerine. Stearic acid, C6SH6605 + 2HO, may be obtained by saponifying stearine, and then adding an acid, which separates it from the gly- cerine. Margarine may be obtained from the ethereal solution of mutton suet after the removal of the stearine. It resembles stearine, but is more fusible ; melts at 116°. It is a margarite of glycerine. Margaric acid, C68H6606 + 2HO, resembles the stearic, but is more soluble in alcohol. Melts at 140°, and has one more equiva- lent of oxygen. It is obtained from margarine by saponification. CHEMISTRY. 289 Oleine may be obtained from paper, by which it has been ab sorbed in preparing margarine; also by filtering the fixed oils at the freezing temperature. Resembles oil in appearance, colorless when pure, and congeals at 20° F.; soluble in boiling alcohol an ether; insoluble in water. It is an oleate of glycerine. Oleic acid, C44H40O4 + 2HO, is procured also by the saponifica tion of olein, which it resembles very much. It is void of color, lighter than water, has acid properties, and is soluble in alcohol. Glycerine, C6Hf06, or C6H705 + HO, the base common to all fats; obtained by forming an insoluble soap with olive oil, oxide of lead, and water. The oleo-margarate of the oxide of lead is formed (lead-plaster), and is precipitated, while the glycerine re- mains in solution, from which it may be obtained by evaporation in vacuo; void of color when pure, viscid, sp. gr. 1-27, sweetish taste, soluble in water, and is converted by nitric acid into oxalic acid. It is said to be a hydrated oxide of a hypothetical base called glycerile. Thus : — Glycerile, C6H7; oxide of glycerile, C6H705; glycerine, the hydrated oxide of glycerile, C6H703+HO. Acroline, C6H02, may be obtained by the destructive distillation of fats, in a gaseous form, which, when condensed, forms a volatile poisonous liquid. Butyric, capric, and caproic acids are found in butter, in addi- tion to the other ingredients found in fats. Wax is analogous to fats; it is composed of cerine, which is soluble in alcohol and water, and will form soap ; and of myricene, which is insoluble in water and alcohol, and will form a soap. Where are volatile or essential oils found ? In aromatic plants, from which they are obtained by distillation. They will not leave a greasy spot or stain, are converted into vapor at slight elevations of the temperature, colorless when pure, powerful odor, pungent burning taste, do not saponify, when ex- posed to the air absorb oxygen, and are converted into resins, and they also deposit a crystalline matter called stearopten, when standing some time. They have been divided into those which contain oxygen, and those having sulphur and nitrogen in their composition. 25 T 290 CHEMISTRY. TABLE OF SOME VOLATILE OILS WHICH ARE PURE CARBO-HYDROGEN8 Oil of Lemons...................................................... C10H8 Copaiba....................................................... C10H8 Calamus.........,............................................ C10rTJ> Turpentine................................................. C20H18 Savin.......................................................... C^H1* Cloves......................................................... C20Hi« Black pepper, &c, ........................................ C20Hi« Cubebs........................................................ C^His Juniper....................................................... C15H" Roses ......................................................... CH &c, &c. OILS CONTAINING CARBON, HYDROGEN, AND OXYGEN. Oil of Pennyroyal.......................................... C10H8O " Rosemary ............................................ C10H8+2HO " Bergamot ............................................. C10H8+2HO " Peppermint........................................... C2ttH2»+ 2HO " Camphor.............................................. C20H160 Artificial camphor........................................... C20H12C1* SULPHURIZED OILS. Oil of Black Mustard..................................... C^H^N^O5 Unions i Qontajn su]phur and nitrogen, but have not " " Assafcetida V yet been analyzed. " " Horseradish ) What oil is procured from bitter almonds ? When bruised and subjected to compression, they yield a pure fixed oil; but when distilled with water a poisonous volatile oil passes over, which con- tains hydrocyanic acid. What are Resins ? The inspissated juices of plants, either pure or in combination with essential oils. They are solid, brittle, inodorous, insipid, and generally of a yellow color; semi-trans- parent, non-conductors of electricity, and negatively electric when rubbed. The most important of the resins are common resin, copal, lac, sandarach, mastich, elemi, and dragons-blood. Resin, or colophony, is the best representative of this class. It is the residue after distilling oil of turpentine, and is composed of two acids, the pinic and silvic, the composition being the same, CHEMISTRY. 291 Q2ojji5Q2. tbe pm|c is more soiy^ie jn a]coaoi. thus affording a means of separating them. Caoutchouc is the product of several trees of tropical countries, which exude a milky juice that hardens by exposure to the air. When pure it is nearly white : the usual dark color is owing to smoke and impurities. Naphtha, ether, essential oils, and sulphide of carbon dissolve it perfectly, and are its proper solvents. It melts at a temperature above boiling water, but does not resume its former elasticity. Gutta percha resembles caoutchouc, and is the concrete juice of a tree growing in Borneo. It softens at a high temperature, and may be moulded into any shape, resuming its solidity on cooling. Dissolves in ether, volatile oils, and chloroform. It promises to afford many useful applications. What are Balsams ? They are compounds of resin, volatile oil, and benzoic acid. What are Gum-resins ? They are the concrete juice of plants which contain resin, essential oil, gum, and extractive matter. Their proper solvent is proof spirit. Under this head are aloes, ammoniacum, assafcetida, euphorbium, galbanum, gamboge, myrrh, scammony, and guaiacum. How are Bituminous substances divided ? Into bitumen and pit coal; under the first head are naphtha, petroleum, mineral tar, asphaltum, mineral pitch, and retina-sphaltum; and under the latter head are brown coal, common or black coal, and glance coal, or anthracite. Spirituous and Ethereal Substances. Alcohol. Is alcohol the intoxicating ingredient in all spirituous and vinous liquors ? It is ; and is always a product of the vinous fermenta- tion ; therefore, does not exist ready formed in plants. How is the alcohol procured pure ? By the addition of heated carbonate of potash (or any other substance having a strong affinity for water) to spirit of wine; the potash unites with the water, sub- Bides, and the alcohol may be decanted pure. The chemical term for alcohol is the hydrated oxide of ethyle, C4HsO + HO. 292 CHEMISTRY. Ether. How is ether procured ? By heating the stronger acids with alcohol; the different kinds are distinguished by the name of the acids used in their preparation. Ether contains C4H,0 ; in reference to acids, it resembles a base, which has been supposed to be the oxide of a metalloid or hypo- thetical radical, called ethyle, analogous to cyanogen and kakodyle. Ethyle, symbol Ae, C4H5. Oxide of ethyle; ether, C'H'O. Hydrate of the oxide of ethyle; alcohol, C'H 0 + HO. Con- sidering ether to be an oxide of ethyle, it is found to be capable of uniting with oxy-acids, and forming with them salts ; while the halogen bodies unite directly with the radical as they do with me- tallic bodies. Chloroform. How is chloroform obtained ? By distilling alcohol with chlo- ride of lime, or bleaching powders. What are its properties? It is a colorless, transparent liquid ; sp. gr. 148, of the vapor 4-199. It is not combustible; its vapor is decomposed at red heat; it is insoluble in water, but is readily in alcohol and ether. Formula, C2HCl3, or FoCl3. Coloring Matters. What are the prevailing colors of vegetables? Red, yellow, blue, and green, or their mixtures. Does vegetable coloring vmatter occur in an insulated state ? No ; it is always attached to some proximate principle, such as mucilaginous, extractive, or resinous substances, by which its pro- perties are influenced. It is generally decomposed by the combined agency of the sun's rays, and a moist atmosphere ; and all of them are destroyed by chlorine. What is meant by lakes? They are insoluble compounds formed by coloring matter with some of the metallic oxides. What is meant by the term mordant, or basis ? It is a substance having an affinity both for the coloring matter, and the articJ* to CHEMISTRY. 293 be colored; which, by combining with each at the same time, causes the dye to be permanent. Those coloring substances which adhere to the cloth without a basis, are called substantive colors, and those which require a basis, adjective colors. » What substances produce the blue dyes ? Indigo. What the red? Cochineal, lac, archil, madder, brazil-wood, logwood, and saffiower. The yellow? Quercitron bark, turmeric, wild American hickory, fustic, and saffron; *all of which are adjective colors. The black? The same ingredients as writing ink; and is, therefore, essentially oxide of iron with gallic acid and tannin. Substances which do not belong to either op the preceding sections. What are the articles belonging to this class ? Vegetable albu- men, gluten, yeast, asparagin, bassorin, cathartin, fungin, suberin, ulmin, lupulin, inulin, medullin, piperin, olivile, sar- cocoll, rhubarbarin, rhaponticin, colocyntin, berberin, bryonin, gentianin, zanthopicrin, scillitin, senegin, saponin^ arthanatin, plumbagin, chlorophyle, amygdalin, salicin, populin, meconin, columbin, elatin, sinapisin, &c. Spontaneous changes of Vegetable Matter. What is Fermentation? It is certain spontaneous changes which vegetable substances undergo when the vital principle is extinct. It is divided into four distinct kinds, viz : the saccharine, vinous, acetous, and putrefactive. What substances undergo the saccharine fermentation ? Starch is the only one known to be subject to this fermentation, which takes place when it is kept in a moist state for some time; and sugar equal to half the weight of the starch employed is formed. What circumstances are necessary to the vinous fermentation ? The presence of sugar, water, yeast, or some ferment, and a certain temperature. The changes which take place are the dis- appearance of sugar, the formation of alcohol, and the escape of carbonic acid gas. 25* 294 CHEMISTRY. Under what circumstances does the acetous fermentation take place ? When a liquid which has undergone the vinous fermenta- tion is mixed with yeast, and exposed to the open air. In this process oxygen is absorbed, and carbonic acid gas is disengaged. What circumstances are necessary to the putrefactive fermenta- tion? The accompanying circumstances which enable this proceaa to take place, are moisture, air, and a certain temperature; the most favorable temperature is between 60 and 100 degrees. The principal products are water, light carburetted hydrogen, carbonic acid, and, when nitrogen is present, ammonia. The solid remains are charcoal, combined with oxygen and hydrogen. Germination. What conditions are necessary to germination ? Moisture, a certain temperature, and oxygen gas ? Light, which is favorable to the subsequent stages of vegetation, is injurious to germination. Animal Chemistry. What is meant by proximate animal principles ? They are dis- tinct compounds derived-from the bodies of animals. How are they distinguished from vegetable matter ? By the presence of nitrogen, their strong tendency to putrefy, and the offensive products of putrefaction. Some vegetable principles contain nitrogen, but they do not putrefy readily. What are the essential constituents of animal compounds? Carbon, oxygen, hydrogen, and nitrogen; besides, some of them contain pjhosphorus, sulphur, iron, earthy, and saline matters. What effect has heat upon them when applied in a close vessel ? They yield water, carbonic oxide, carburetted hydrogen, carbon- ate and hydrocyanate of ammonia, a fetid, thick oil, and carbon- aceous matter, which is a powerful decolorizing agent. What is the principle of the mode of analyzing animal and vegetable substances ? It is to convert the whole of the carbon contained into carbonic acid, and the hydrogen into water. What is understood by protein compounds ? Substances which contain protein ; the principal ones are albumen, Pt'°+ ST ; fibrin. Pt'° + SP ; and casein, Pt'° + S. chemistry. 295 Protein, C48H36N6012 + P + S, symbol Pt. It maybe obtained by dissolving bodies in which it is contained, in caustic alkali, and then adding an excess of acid (the acetic usually) ; a snow-white precipitate is thrown down, which is protein. It is tasteless, insoluble in water and alcohol, but soluble in acetic acid, and in solutions of the alkalies. It acts both as an acid and a base. How are animal products divided ? 1st. Into those which are neither acid nor oleaginous ; 2d, the acids; and, 3d, the oils and fats. What substances are included in the first division ? Fibrin, albumen, casein, gelatin, urea, sugar of milk, and sugar of diabetes. In what does Fibrin, Pt'°+SP, exist? In muscle, chyle, and blood. It is solid, white, insipid, and inodorous. Where is Albumen, Pt'° + S2P, found? In the white of eggs, and in the serum of the blood. What are the properties of albumen ? It is precipitated by corrosive sublimate, which is its best test; and it is coagulated by heat, alcohol, and the stronger acids. Where is Gelatin found ? In the skin, cartilages, membranes, and bones. What are its properties? It is readily soluble in water, and forms a jelly when cool; it is known in commerce by the name of glue ; tannic acid is its appropriate test. Where is Urea found ? It is procured from fresh urine. Where is Pepsin found ? Called also gasterase, and exists in the epithelial cells of the mucous membrane of the stomach. It is found in the gastric juice, held in solution by the acids of the stomach. It may be obtained by dissolving the mucous membrane of the stomach in acidulated water, and adding a subacetate of lead ; the pepsin is precipitated with lead and albumen ; the lead may be removed by sulphuretted hydrogen, and the albumen by .leaf, leaving the pepsin. What are the proximate principles of animal oils ? The same as are formed in the vegetable. What circumstances are necessary to the putrefaction of animal substances ? Water, air, and a certain temperature. What are the products of putrefaction ? Water, ammonia, carbonic and acetic acids, carburetted and sulphuretted hydrogen, and phosphuretted hydrogen in some cases. 296 CHEMISTRY. ANALYTICAL CHEMISTRY. By what process do you analyze a gaseous mixture containing oxygen ? Introduce into the mixture a quantity of hydrogen, more than sufficient to saturate the oxygen present, carefully mea- sure the whole, pass an electric spark through it, or introduce into it a piece of spongy platinum, and note the diminution ; divide the diminution by three, and you have the quantity of oxygen origi- nally in the mixture. What is the process when the quantity of nitrogen is to be de- termined ? The method is to withdraw all other gaseous substances with which it is mixed. What is the mode of determining the quantity of carbonic acid in gaseous mixtures ? By agitating the mixture with lime-water, or a solution of caustic potassa, and noting the deficiency. What is the mode of determining the quantity of hydrogen ? By causing it to combine with oxygen by the electric spark, or plati- num. The principle is the same for the inflammable gases, chlorine being used for some of them instead of oxygen. What is the general mode pursued in the analysis of organic bodies ? It is to present oxygen to the organic body and apply heat; the carbon is thus converted into carbonic acid, and its hy- drogen into water; when nitrogen is present ammonia is formed. The best means of supplying the oxygen is by means of the black oxide of copper. TABLE OF SYMBOLS ANI) CHEMICAL EQUIVALENTS OF ELEMENTARY SUBSTANCES. Ele. Eq. Sy Ele. Eq. Sy. Aluminum 13-7 Al Carbon 6 C Antimony Cerium 46 Ce (Stibium) 129-4 Sb Chlorine 35-50 CI Arsenic 75 As Chromium 28 Cr Barium 68-7 Ba Cobalt 29-5 Co Bismuth 71 Bi Columbium Boron 10-9 B (Tantalum) 185 Ta Bromine 78-4 Br Copper Cadmium 55-8 Cd (Cuprum) 31-6 Cn Calcium 20 Ca Fluorine 18-68 F CHEMISTRY. Ele. Glucinium Gold (Aurum) Hydrogen Iodine Iridium Iron (Ferrum) Lantnnum Lead (Plumbum) Lithium Magnesium Manganese Mercury (Hydrargyrum) Molybdenum Nickel Nitrogen Osmium Oxygen Palladium Phosphorus Platinum Eq. Sy. Eh. 26-50 G Potassium (Kalium) 199-2 Au Rhodium 1 H Selenium 126-3 I Silver 98-8 Ir (Argentum) 28 103-6 6-44 12-7 27-7 101 47-7 29-5 14 99.7 8 53-3 3> Fe Ln Pb L Mg Mn Hg Mo Ni N Os 0 Pd P PI Silicium Sodium (Natrium) Strontium Sulphur Tellurium Thorium Tin (Stannum) Titanium Tungsten (Wolfram) Uranium Vanadium Yttrium Zinc Zircon tbj Eq. 3915 52-2 39-6 108 21-35 23-3 43-8 16 64-2 59-6 58-9 24-3 94-8 60 68-5 32-2 32-3 33-7 297 Sy. K R Se A? Si Na Sr S Te Th Sn Ti W U V Y Zn 7* PART IV. POISONS. (299) PART IV.— POISONS. What are Poisons ? They are substances, which, when intro- duced into the animal economy by any means, act in a noxious manner on the vital properties or texture of organs. Are poisons similar in their action ? No ; each one produces symptoms somewhat peculiar to itself; although poisons of a par- ticular class may resemble each other very much in their effects. How many kinds of antidotes are there ? Two ; one destroys the deleterious qualities of poisons, by a chauge of composition, before its injurious action is developed ; and the other controls the poisonous action after it has been established. The former is of great consequence; the latter of but very little, if considered as a specific antidote, independent of the general condition of the system. What other means are resorted to ? Evacuation of the stomach, either by an emetic, or stomach-pump, when taken internally; and by excision, or the application of a cupping-glass, if applied exter- nally. Acids. What are the poisonous acids ? The Acetic, Citric, Muriatic, Nitric, Sulphuric, Tartaric, Oxalic, and Prussic. What are the symptoms produced by them ? With the excep- tion of the prussic, they are generally strong corrosive poisons; producing a burning heat in the mouth, throat, oesophagus, and stomach; acute pain, eructations, nausea, hiccough, vomiting, tenderness of the abdomen, coldness of the surface and extremities, depressed pulse, horrible contortions, excessive thirst; and, when taken in large quantities, a fatal termination. 26 (301) 302 POISONS. What is the treatment ? The alkalies, alkaline earths, and their carbonates, as antidotes for all the acids except the nitric and oxalic; and for these magnesia and lime only, or their carbonates, are to be used. Lime in some form or other, as in chalk, or in plastering on the wall, is generally the nearest at hand, and should be used in an emergency. To obviate the effects of the poison use mucilaginous drinks, olive or almond oil in large quantitities, emollient fomentations, and clysters. In what forms does prussic acid exist, in which it may be taken into the system ? That of prussic or hydrocyanic acid, oil of bitter almonds, and laurel water. What are the symptoms? It is a sedative poison, and is so rapid in its action that it is seldom treated by a physician. When it is not at once fatal, the symptoms are sudden loss of sense, trismus, difficult, and rattling respiration, coldness of the extremi- ties, a smell of bitter almonds proceeding from the mouth, small pulse, swelling of the neck, immobility of the pupils, sometimes contracted, and at others dilated, convulsions, &c. What is the treatment? The antidotes are ammonia, cold affu- sion, artificial respiration, and Smith's antidote, which consists in administering a solution of carbonate of potash, followed by a dilute solution of old sulphate of iron, by which Prussian blue is formed, a compound not poisonous. What are the tests for the acids ? Sulphuric acid is precipi- tated by any salt of baryta, and the precipitate is insoluble in nitric acid. Muriatic gives a white precipitate with the nitrate of silver, which turns black by exposure to light. Nitric gives orange-colored fumes when put on copper, and dis- solves gold when mixed with muriatic acid. Acetic gives the odor of vinegar. Citric blackens when heated. Tartaric precipitates crystals with a solution of potassa Oxalic gives a white precipitate with lime-water. Alkalies and their Salts. What articles are included under this head ? Ammonia, and Muriate of Ammonia ; Potassa, caustic and the liquor potassa?; POISONS. 303 the carbonate, the nitrate, or saltpetre; and the sulphuret, or liver of sulphur ; and Soda. What are the symptoms produced by a poisonous dose of these articles ? Great heat in the throat, difficult and painful degluti- tion, vomiting of bloody.matter, acute pain in the stomach, cold sweats, weakness, hiccough, colic pains, bloody stools, convulsions, and death : when nitrate of potash has been taken, there are also internal rigors. The carbonates will effervesce with acids, and the liver of sulphur will cause eructations of sulphuretted hydrogen. What is the treatment? Vegetable acids, as vinegar, lemon- juice, &c, neutralize the alkalies and their carbonates: the fixed oils will form soaps with them, and destroy their caustic effects. When nitrate of potash has been taken, an emetic should be given, and the effects should be combated by antiphlogistics. Com- mon salt and liquid chloride of soda will decompose the liver of sulphur. What are the tests ? The alkalies are known by their action on turmeric paper; and by restoring the color of litmus, which has been reddened by an acid. Carbonates by their effervescence with an acid; the muriate of ammonia by giving out fumes of ammonia when mixed with quick- lime. Nitrate of potassa decrepitates, and deflagrates when thrown on hot coals. Liver of sulphur emits sulphuretted hydrogen when dissolved with an acid. EARTHS AND THEIR COMPOUNDS. Baryta. Carbonate, Muriate, and Nitrate. What are the symptoms? Violent vomiting, burning in the stomach, purging, exhaustion, convulsions, and death. What is the treatment ? Dilute sulphuric acid and the soluble sulphates are antidotes, converting them into an insoluble sulphate of baryta. Emetics should also be given. What are the tests ? A soluble sulphate gives a white precipi- tate, insoluble in any of the acids. 304 POISON S. Lime. What are the symptoms ? It is a pure irritant. What is the proper treatment ? Dilute acids or oils. It gives a precipitate with oxalic and carbonic acids. Alcohol in all its Preparations. What are the symptoms ? Intoxication, complete insensibility, apoplexy, paralysis, swollen face, and a smqll of liquor in the breath. What is the treatment? Emetics, the stomach-pump, if the patient cannot swallow ; the cold dash will answer a good purpose; and bloodletting, if necessary, should be resorted to. Acetate of ammonia (spiritus Mindereri) will relieve intoxication ; and the inhalation of gaseous ammonia answers the same purpose. Volatile Oils. Creasote, Dippel's Animal Oil, Oil of Tar, Oil of Tobacco, Oil of Turpentine, Fusel Oil, &c. What are the symptoms ? Burning pain, vomiting, pungent taste, purging, &c. Turpentine and tobacco affect the nervous system : the peculiar odor of each will serve to detect them in the matter vomited. What is the treatment ? Albumen for the creasote ; dilute acids and fixed oils will counteract Dippel's animal oil: the others have no particular antidotes, but must be treated on general principles. The odors of these substances afford the best tests. Chlorine. Gaseous. ■** What are the symptoms when inhaled ? Violent irritation of the organs of respiration, bloody expectoration, inflammation, and permanent pulmonary disease. What is the treatment ? We have no antidotes. The effects to be treated on general principles. It is recognised by its bleaching property, and peculiar odor. POISONS. 305 Iodine. Iodide of Potassium. What are the symptoms? Burning pain in the throat, lacerating pain in the stomach, fruitless efforts to vomit, suffusion of the eyes, and pain and tenderness of the epigastrium. What is the treatment? Starch, or anything containing it, is the antidote for iodine. Iodide of potassium has no antidote, and our only reliance is in prompt emesis. Inflammation should be subdued by general treatment. What are the tests for iodine ? Starch forms a blue precipitate. Iodide of potassium gives a crystalline precipitate with tartaric acid, and the remaining liquid a blue color with starch. Bromine. What are the symptoms? Most violent burning pain in the fauces and stomach, with difficulty of breathing; which are soon followed by collapse and death. When applied externally, it has a corrosive action. What is the treatment? Acetate of lead is the antidote ; albu- men or starch should be freely administered; and the inflammation is to be treated on general principles. What are the tests ? It is displaced from its compounds by chlo- rine, and is known by its color and odor. METALS. Antimony. Tartar Emetic, Muriate or Butter of Antimony. What are the effects as a poison ? A severe metallic taste, nausea, copious vomiting, hiccough, burning pain in the stomach, colic, frequent stools and tenesmus, difficult respiration, fainting, small quick pulse, cold skin, loss of sense, cramps, prostration, and death. What is the treatment ? If emesis does not take place, it should be promoted by tickling the throat, and diluent drinks ; antidotes 26 * u 30G POISONS. should be administered ; among which are decoction of galls, Peru- vian bark, common tea, &c. If the vomiting is excessive, give laudanum and warm brandy ; and apply revulsives freely; the con- secutive treatment should be adapted to the condition of the dis- ease existing. What are the tests ? Sulphureted hydrogen forms an orange- colored precipitate with the solutions of antimony. Free alkalies produce white precipitates. In its solid forms there are white fumes when heated, which redden litmus. Arsenic. Arsenious Acid, or White Arsenic. Orpiment, or Yellow Sul phuret of Arsenic. King's Yellow. Red Sulphuret. Fly Powder. Fowler's Solution. Arsenical Paste. Arsenica] Soap. Arsenite of Copper, or Scheele's Green. What are the symptoms? The different preparations are all violently poisonous, whether applied internally or externally. The symptoms are an austere taste, hawking, constriction of the throat, hiccough, nausea, anxiety, frequent sinkings, pain at the precordia, vomiting, black fetid stools, frequent irregular pulse, insatiable thirst, delirium, convulsions, loss of feeling, especially of the feet and hands, and death. What are the usual morbid appearances after death ? Inflam- mation of the mouth, stomach, and intestines; spots resembling eschars on the stomach and duodenum ; perforations of their coats; and the villous coat of the stomach is reduced to the consistence of a reddish-brown pulp. What is the treatment? Before the antidote can usually be procured, the poison should be dislodged by an emetic of sulphate of zinc or copper, tickling the throat, &c, or by the stomach-pump. Demulcents should be freely given, both before and after vomiting. As an antidote in all cases for the poisonous compounds of arsenic, the hydrated sesquioxide of iron, in a moist or pulpy state, should be given as soon as possible, in doses of a tablespoonful to an adult, of a dessertspoonful to children, every five or ten minutes, until urgent symptoms are relieved. The after symptoms should be combated on general principles. The hydrated sesquioxide of iron is the antidote most commonlj POISONS. 301 relied on in cases of poisoning by arsenic; and the formula for its preparation is given below. Every apothecary and country phy- sician should keep it always on hand. HYDRATED PEROXIDE OF IRON. R. — Sulphuric acid (67° BaumS), 8 oz. 16 parts. Iron wire, 8 oz. 16 " Nitric acid (49° Baume"), 5| oz. 11 « Water of ammonia, q. s. Water, 11 gal. 384 « Mix the sulphuric acid with the water in a glass vessel; then add the iron ; and after the effervescence has ceased, filter. Add the nitric acid in divided portions, and apply heat so long as orange-colored fumes are given off. To the heated solution, pour in the water of ammonia until a decided excess has been added ; then wash the precipitate by decantation until the washings give no precipitate with nitrate of baryta. The water is then to be drawn off until just enough remains to give the consistence of thick cream. It should then be kept in bottles of convenient size for use, and given as above when required. If the hydrate is not at hand, use the precipitated hydrate of magnesia or carbonate of iron, diffused through water in the same manner. Calcined magnesia has also recently been used as an antidote with good effect. The hydrate of magnesia may be prepared bv adding potassa to a solution of Epsom salts and washing the pre- cipitate with water. For the tests of arsenic, see Chemistry, article "Arsenic." Copper. Sulphate of Copper. Acetate of Copper. Carbonate of Copper, Arsenite of Copper; and from Cooking Utensils, Soda Foun- tains, &c. What are the symptoms of poisoning by the salts of copper ? A coppery taste, pain in the head, nausea, vomiting, cathaisis, colic, cramp, convulsions, insensibility, and death. What is the treatment? Albumen, in the form of white of eggs, copious draughts of warm milk, and brown sugar, or molasses, are the best antidotes. 308 poisons. What are the tests? Ammonia gives a light blue precipitate, redissolved by an excess, forming a deep blue solution ; ferrocyan- ate of potash, a rich claret red ; sulphuretted hydrogen, a chocolate brown; and a polished needle causes a precipitate of pure copper on its surface. Gold. Chloride of Gold. Fulminating Gold. What are the symptoms ? Similar to other irritant poisons. What are the antidotes ? Magnesia and albumen ; mucilaginous drinks should also be freely used. What are the tests ? The chloride is readily decomposed by the protosulphate of iron, and the nitrate of silver, and the gold sepa- rated in a metallic state. Iron. Sulphate and Chloride of Iron. What are the symptoms ? Irritating, colic pains, vomiting, purging, pain in the throat, tension of the epigastrium, coldness of skin, and feebleness of pulse. What is the treatment ? Carbonate of soda is a good antidote; and the particular symptoms should be relieved by their appropriate treatment. Albumen may be freely used. Lead. Acetate. Carbonate. Red Oxide. Litharge. Wines sweetened by Lead. From Cooking Utensils, &c. What are the symptoms ? Irritation of the alimentary canal, spasm, nervous symptoms, paralysis, either partial or complete, convulsions, and death. The most common effect is colica pictonum. What is the treatment ? The soluble sulphates, as magnesia, or soda; dilute sulphuric acid, which is also said to act as a preven- tive ; and the phosphate of soda. Emetics of sulphate of zinc should also be used. What are the tests ? The soluble salts yield a white precipitate POISONS. 309 with sulphates and carbonates in solution. The chromates and iodide of potassium give a yellow precipitate. Sulphuretted hy- drogen a black. Mercury. Corrosive Sublimate. Cyanuret of Mercury. Nitrate. Red Oxide. Sulphate. Red Sulphuret, and the White Precipitate. What are the symptoms ? An irritant; harsh, metallic, as- tringent taste ; burning pain in the stomach ; vomiting and purg- ing of bloody matter; irritation of the urinary organs; tightness and burning in the throat; countenance pale or flushed ; dozing, stupor, convulsions, and death. What is the treatment? Albumen in some form or other, as eggs beaten up with water; milk; wheat flour beaten up with water. Carbonate of soda has been used with success in poisoning with corrosive sublimate. The inflammatory symptoms should receive their appropriate treatment. What are the tests ? Potash gives with corrosive sublimate a yellowish precipitate; ammonia a white ; lime-water an orange; and sulphuretted hydrogen a black. A solution placed on gold, and touched with a knife, produces an amalgam of mercury and gold at the point touched. The nitrate gives a black precipitate with the free alkalies. All the solid forms of mercury are volatile, and they may also be reduced by heating them with charcoal and carbonate of soda, and the mercury will be sublimed. Silver. Nitrate or Lunar Caustic. What are the symptoms? The usual effects of the corrosive poisons. What is the treatment? Common salt is the proper antidote. Mucilaginous drinks should be freely given, so as to produce vomit- ing. Consecutive inflammations should be treated according to the indications What are the tests? Chloride of sodium gives a white precipi- tate, insoluble in nitric acid ; ammonia, a gray precipitate, which 310 POISONS. is redissolved by an excess of ammonia; and a yellow precipitate with phosphate of soda; the precipitates may also be reduced. Tin. Chloride of Tin. Solution used by Dyers. Oxide of Tin. What are the proper antidotes for the salts of tin ? Eggs or milk, in large quantities. Zinc. Oxide. Sulphate and Acetate of Zinc. What are the symptoms ? Violent vomiting ; astringent taste; burning pain in the stomach ; pale countenance ; cold extremities; dull eyes ; fluttering pulse. Death is a rare result. What is the treatment ? Warm water, carbonate of soda, milk, and albumen. Phosphorus. What are the symptoms of poisoning by phosphorus ? The principal one is violent pain and irritation of the stomach. What is the treatment? The stomach should be evacuated, and demulcents freely employed ; but we have no antidote. Glass, or Enamel. What are the symptoms ? When taken in coarse powder they produce irritation and inflammation of the bowels. What is the treatment ? A sulphate of zinc emetic, and demul- cent drinks. VEGETABLE POISONS. How are the vegetable poisons divided ? Into the Irritant, Acro-narcotic, and Narcotic. Name some of the Irritant vegetable poisons. Jalap, Scammony, Croton Tiglium, Spurge, Savin Oil, Red Cedar Oil, Elaterium, Poke, Cubebs, Ranunculi, Oleander, Castor Oil Plant, Gamboge, and Tansy. poisons. 311 What are the poisonous effects of these ? An acrid pungent taste, with more or less bitterness, excessive heat, great dryness of the mouth and throat, with a sense of tightness ; violent and continued vomiting ; purging, with great pain in the stomach and bowels; pulse strong, frequent, and regular; breathing often quick and difficult; appearances of intoxication ; dilatation of the pupil; insensibility resembling death; the pulse becomes slow and loses its force, and is followed by death. If applied externally, many of them vesicate and inflame the skin. What is the treatment ? If there is vomiting, use large draughts ■)f warm water or thin gruel; but if other urgent symptoms come on without vomiting, it should be excited by sulphate of zinc, or some other prompt emetic; purging should also be excited when it does not exist. After the poison has been got rid of, give a strong infusion of coffee or dilute vinegar, camphor, or ether, and apply frictions ; blisters may also be often used properly. The other treatment should be upon general principles. Acro-Narcotic Poisons. Name some of them. Aconite, Mushrooms, Truffles, Dogsbane, Arnica, Belladonna, Buckeye, Wormseed, Cicuta Maculata and Virosa, Cocculus In- dicus, Colchicum, Conium, Stramonium, Digitalis, Ergot, Black Hellebore, Ipecacuanha, Camphor, Lobelia inflata, Oleander, Tobacco, Poison Vine or Rhus Rhadicans, Sumach or Poison Oak, Rue, Sanguinaria Canadensis, Squill, Pinkroot, Nux Vomica, Upas, Diseased Wheat, White Hellebore, Diseased Maize. The inhalation of chloroform allays the spasms produced by nux vomica, or its active principle, strychnia. Narcotic Poisons. Name some of them. Bitter Almonds and Peach Kernels, Hyoscyamus Niger and Albus, Lactuca Virosa, Opium and its proximate principles, Poppy, Cherry Laurel, Black Cherry, Wild Cherry, and Dul- camara. What are the general symptoms of these poisons ? Stupor, 312 POISONS. numbness, heaviness of the head, desire to vomit, slight at first, but increasing ; a sort of intoxication ; stupid air ; pupils dilated ; furious delirium, sometimes pain; convulsions or palsy; pulse is variable, but at first generally strong and full; breathing quick, great anxiety and dejection, clammy skin, cold extremities, inter- rupted gasping respiration, and death unless relieved. What is the treatment ? Evacuation of the stomach by the pump, or an active emetic, of which sulphate of zinc is the best, and its action should be promoted by the usual means. After the stomach has been evacuated, dilute vinegar, stimulants, sinapisms, and fric- tions may be called for. The patient should be bled if necessary; kept roused as much as possible by cold to the head, cold douche to the face and chest, and by the action of an electric or electro-magnetic machine, or flagellation ; and artificial respiration should also be kept up, until the system can rally. If opium produces difficulty of breathing, the inhalation of the vapor of water is attended with benefit; and spiritus Mindereri is said to prevent the stupor. Poisonous Mushrooms. There are five poisonous species. What are the symptoms? Nausea, heat, pain in the stomach and bowels, with vomiting and purging; thirst; convulsions and faintings ; pulse small and frequent; delirium; dilated pupils and stupor; cold sweats, and death. What is the treatment? The stomach and bowels should be evacuated by an emetic, followed by a cathartic and stimulating clyster. After the poison is evacuated, ether may be administered with small quantities of brandy and water; but if inflammatory symptoms occur, they should be combated with appropriate reme- dies. Animal Charcoal as an Antidote for Poisons. This substance has recently been brought forward with consider able confidence, as an antidote for poisons, and particularly foi the whole class of vegetable poisons. The conclusions, which it is stated we are justified in admitting, are the following:__ POI SONS. 313 1st. That animal charcoal has the power of withdrawing, when used at a proper temperature and in sufficient quantity, most, if not all, known vegetable and animal poisonous principles, and certain mineral poisons from their solutions. 2d. That, given at the same time with, or shortly after these poisons have been swallowed, it prevents their deleterious action, or acts an antidote. 3d. That, given in cases of poisoning, it can exert no injurious influence; but, on the other hand, promotes vomiting, entangles the poison, and protects the coats of the stomach against it. 4th. That, although it cannot be substituted for the usual anti- dotes for poisoning by mineral substances, yet it may be usefully employed in conjunction with them, or in their absence. When given, it should be mixed with water as hot as can be swallowed, as its action is aided by an elevated temperature. Large quantities with warm water promote emesis. Animal charcoal may be prepared by removing the earthy matter from ivory black by dilute chlorohydric acid, and afterwards wash- ing and heating to redness in a covered crucible. This, however, is a tedious process, and only ten per cent, of pure charcoal is obtained. A better mode is to calcine leather scraps or blood with pearlash, washing and reheating in a close crucible. It is particu- larly necessary that a pure article should be used, and, as it may be kept for a long time without deteriorating, it should be prepared so as to be ready for use by apothecaries and country physicians. See Banking's Abstract, No. 13, p. 302. ANIMAL POISONS. Poisonous Fish. There are twenty or more species. What are the symptoms ? After eating, a weight at the stomach comes on, with slight vertigo, and headache, sense of heat about the head and eyes, thirst, often an eruption of the skin (urticaria), and in many cases death. What is the treatment? An emetic, quickly followed by a pur- gative, should be given. Vinegar diluted may be drunk after their operation, and the body also sponged with it: sweetened water 27 314 poisons and also alkaline water have been recommended to obviate the effects of the poison. If spasms occur after the evacuations, give laudanum ; and if inflammation, adopt the appropriate treatment. Poisonous Serpents. Of these there are a number of species. What are the symptoms? A sharp pain at the part bitten, which soon spreads over the limb or body ; great swelling, at first hard and pale, then reddish, livid, and gangrenous in appearance; faintings, vomitings, convulsions, jaundice sometimes ; pulse small, frequent, and irregular; breathing difficult, cold sweats; the sight fails, and the intellectual faculties are disordered. Inflammation, suppuration, and gangrene, followed by death. What is the treatment ? Excision of the part, if it can be done early ; or destroyed by the application of caustic ; apply a ligature, and cup the wound : aq. ammoniae has been recommended as a local application to the wounded part, and also to be taken internally. The treatment should then be regulated by general principles. Keeping the patient intoxicated is sometimes attended with benefit. Cantharis Vesicatoria. Spanish or Blistering Fly ; and Lytta Vittata, or Potato Fly. What are the symptoms ? A nauseous odor of the breath; acrid taste; burning heat in the throat, stomach, and abdomen; vomiting, often bloody, with copious bloody stools; severe pain in the stomach ; painful and obstinate priapism, with heat in the bladder, and strangury or retention of urine; convulsions, delirium, and death. What is the treatment? Vomiting should be excited by large draughts of sweet oil, sugar and water, milk or linseed tea, to which may be added ipecac, or sulphate of zinc. Emollient clys- ters ; and if inflammation of the organs occurs, we use the appro- priate remedies for such a condition. Camphor dissolved in oil may li e rubbed over the belly and on the thighs. POISONS. 315 Venomous Insects. What are the symptoms ? Usually there is not much swelling or pain ; but at other times there are violent symptoms, intense pain, high fever and sickness. What is the treatment? Hartshorn and oil rubbed on the part; salt and water is also a good application ; they should be kept on until pain and swelling are reduced. Bathing the part with chloro- form allays the pain. Hartshorn or other diffusible stimulants internally are often necessary. Saliva of the Rabid Dog. What are the symptoms ? At an uncertain period, pain occurs in the bitten part, although the wound may have healed. Anxiety, uneasiness, languor, spasms, great disturbance, and difficult respi- ration succeed; saliva flows from the mouth ; there is a horror of drinks, and an inability to take them. These symptoms are all aggravated until death closes the scene What is the treatment? No treatment can be relied on after the disease has occurred. As a preventive of the fatal symptoms, the part should be completely excised, even after it has healed, if not done before; the part should then be washed with warm water, caustic applied to it, followed by a poultice, and the wound healed by granulations. PART V. MATERIA MEDICA AND PHARMACY", 27* (317) PART V. —MATERIA MEDICA AND PHARMACY. What is Materia Medica ? It is that science which treats of medicines. What is Pharmacy ? It is the art of preparing them for use. What is Therapeutics ? Therapeutics comprises the principles of medicinal administration, and the indications which articles of the materia medica are calculated to fulfil. What are Medicines! They are substances capable of pro- ducing as an ordinary result, and by their own inherent power, certain modifications of the vital functions, which render them applicable to the cure of disease. — Wood. What are the objects of attention in the study of medicines ? Their origin; modes of collection and preparation ; commercial history; sensible properties ; chemical composition and relations ; physiological action and toxological history; effects in diseases and the indications they are calculated to answer in their treat- ment; particular applications in cases not falling under any general rule; and doses, mode of administration, and the extem- poraneous or officinal preparations to which they may be sub- jected. How may theii operation be divided ? Into their primary and secondary operation. In what way may the primary or immediate influence of medi- cines be exerted ? 1st. By nervous communication. 2d. By entering the bloodvessels, and acting through the medium of the circulation. (319) 320 materia medica and pharmacy. 3d. By acting exclusively in the neighborhood of their appli- cation. What are the methods of primary operation? Mechanical or Physical; Chemical; and Physiological, Vital, or Dynamic. Have medicines in their operation an affinity for one part more than another ? They have. Some substances act on the circula- tory, nervous, or the absorbent system, and from the general dis- tribution of these systems their action appears to be general. Others act upon the stomach, bowels, skin, kidneys, lungs, &c.; the primary action of which is considered to be local. This differ- ence in their mode of action furnishes a basis for their division. What influences affecting the system may modify the action of medicines ? They are disease, climate, mode of life, habit, age, sex, temperament, idiosyncrasies, and mental operations, which should all be attended to in making prescriptions. What general rule is applicable in the doses of medicines accord- ing to age ? For children under twelve years of age the doses of most medicines should be diminished in the proportion of the age to the age increased by 12. Thus, at 2 4 2 years to 1-1; viz : n , .n = 1-7 : at 4 years, to 1-4, viz:-—— J 2 + 12 j > > 4_j_12 = 1-4 A full dose to be given at 21 years of age.—Paris' Phar- macologia. Some medicines, such as castor oil, calomel, &c, may require larger proportional doses, and opiates smaller. Disease, by modifying the susceptibility, often requires us to modify the quantity of medicine administered, to produce a given effect. The instances of this are numerous, and should be attended to in each particular case that may arise. Climate, and also summer and winter in different climates, cause medicines to act differently. Narcotics act more powerfully in hot than in cold climates ; therefore, smaller doses should be given ; it is the reverse in regard to some other medicines. Sex. Women require smaller doses than men ; they are more rapidly affected by purgatives than men, and the condition of the uterine system should always be taken into account. Temperament. Stimulants and purgatives more readily affect the sanguine than the phlegmatic; and, consequently, the dose should be modified. materia medica and pharmacy. 321 Habits. A knowledge of these is important; persons habituated \o the use of stimulants and narcotics, require larger doses to affect them when diseased ; while persons in the habit of using saline purgatives require smaller doses of this class to operate on the bowels. When opium is habitually used it requires larger doses of this article, but not of other narcotics. Idiosyncrasies. These, of course, can only be known by expe- rience with each particular individual and article of medicine; but, when known, it should govern us accordingly. What is meant by the secondary effects of medicines ? They are changes which follow the immediate operation of medicines, and depend upon certain physiological laws of the system, which modify the effects of primary actions and conditions, and are very important in the treatment of disease. Purgation is the primary operation of a cathartic, and derivation of blood from the head by depletion and revulsion is a secondary effect What are the methods by which their effects are produced ? By the depression following excitement; by the reaction following dipression; through the dependence of function ; the principle of sympathy or nervous transmission ; the principle of revulsion or derivation ; the efforts of Nature to repair injuries ; and the removal of the cause. What are the methods by which the effects of medicines can be ascertained ? Through their sensible properties ; their chemical relations; their botanical affinities ; by experiment or observation on inferior animals ; and by observation of their effects on man. What are the methods by which medicines operate in the cure of disease ? By depletion, repletion, dilution, elimination, stimula- tion, sedation, revulsion, supersession, alteration, anti-causation, chemical action, and mechanical action.—Wood. In what forms are medicines used ? In powders, pills, troches, extracts, electuaries, confections, mixtures, solutions, decoctions, infusions, wines, tinctures, vinegars, syrups, honeys, oxymels, liniments, cerates, ointments, plasters, cataplasms, and in the state of gas and vapor. Powders should be formed by drying the substance, bruising it in an iron mortar, and passing it through a sieve; and should be V 322 materia medica and pharmacy kept in well-closed vessels. Medicines that are not very bulky or disagreeable, and that are not corrosive, are given in this way. Pill is one of the most convenient forms of medicines, both for preservation and administration. In their preparation, the mass should be of a consistence to cohere properly, and yet firm enough to retain the globular form. Its composition should not permit it to mould, contract moisture, or harden too quickly and firmly. The excipients, or substances with which they are mixed, vary in some measure with the composition. Bread crumb, hard soap, extract of liquorice, mucilage, syrup, treacle, conserve of roses, &c, are the substances usually employed. If pills are to be kept some time, treacle and conserve of roses are best; if used early the others do well. When resins are used, the addition of alcohol prevents hardening. To prevent pills from adhering, use liquorice powder, flour, starch, or lycopodium. To cover them, gelatin auswers well. Pills are best preserved in close bottles or tin boxes. The efficiency of small pills is greater than large ones, the same quantity of mate- rial being used. Boluses are preparations similar to pills, but larger. Troches, or Lozenges, are often used ; the basis consists of sugar, gum, or liquorice extract, which are combined with such articles of activity as may be desired. Care should be taken to avoid too great heat in preparing them. Electuaries, Confections, and Conserves, are all essentially the same, and are in use as a vehicle or form for the administration of remedies which are bulky and insoluble, and can be disguised in taste by sweet substances. Extracts consist of the active ingredients of complex medicinal substances, extracted by water, alcohol, or acetic acid, or by ex- pressing the juice of plants and then evaporating to the solid con- sistence. Mixtures, or Emulsions, are convenient modes of administration of remedies. They are generally composed of one or more sub- stances which are insoluble, and suspended in water by the inter' vention of gum, sugar, or yolk of egg. Much care is necessary in forming a good mixture or emulsion, so as to be of a uniform character. Decoction: this is a form much in vogue, but is improper when the substance contains a volatile oil, starch, or gum, unless these materia medica and pharmacy. 323 latter are necessary for the purposes designed by the preparation. In some cases chemical changes also occur at the boiling point, by which the composition is entirely changed. The vessels used for decoctions should be covered, so as to prevent the escape of steam, and the process should be continued as short a time as suffices for extracting the desired material. Care should be taken that the vessel should be composed of a material not acted upon by the sub- stance to be boiled. Infusions are prepared either with cold or hot water, but are not boiled ; and is a convenient mode of administering remedies of the vegetable kingdom. They are usually prepared as wanted, but may be kept some time, provided they be put into a bottle filled to the top and well corked. Many substances yield their active principles to cold water by percolation or displacement, which is becoming a favorite mode of obtaining them at the present time. Tinctures are formed by macerating substances in alcohol or proof spirit for seven days or more, and then straining or filtering; or by displacement of the active ingredients by percolation, a method now generally preferred. This form is favorable to the preservation of the active constituents of drugs without alteration. Syrups: where medicinal substances are preserved in a solution of sugar. Sometimes resorted to for the purpose of covering dis- agreeable taste, but more generally to preserve them in a conve- nient shape for making mixtures. They are simple or radical; the former consists of white sugar, 2\ pounds to a pint of water; the latter are prepared by dissolving the sugar in a watery solution of the drugs, or by adding the tincture to simple syrup, and driving off the heat by a sand-bath. Heat should, however, be employed in all cases. Vinegars is where vinegar is used as a solvent, and is often an eligible preparation. Honeys are not now much in use. Oxymels are where honey and vinegar is combined in prepa- ration. Liniments are oily compounds intended for external applica- tions ; they are softer than either cerates or ointments. Ointments melt at the temperature of the surface of the body, but are harder than liniments and softer than cerates. Cerates are harder than either liniments or ointments. Simple 324 materia medica and pharmacy. cerate is composed of fresh lard and white wax. Some of these last preparations are made by simply mixing or triturating; others require the aid of a moderate heat, and agitation while cooling. Plasters are solid at ordinary temperatures, and require the aid of heat to render them in a condition to be spread. Cataplasms, or Poultices: these are preparations having pro- perties of softness, or emollient properties, moisture, and heat or elevation of temperature in some cases. They are mostly prepared from bread and milk, flaxseed, slippery elm, &c. Gas and Vapor: many articles may be applied to the surface of the body and lungs, or bronchial tubes, in this way, and affords a means of active medication in some cases. To what part of the body are medicines applied ? To the sto- mach, rectum, skin, bronchial tubes and pulmonary air-cells, nostrils, inside of the mouth, and by injections into the blood- vessels. What are the objects in the application of medicines to the rec- tum ? - 1st. To produce alvine evacuations. 2d. To obtain their peculiar effects on the system, or on the rectum itself. In the latter case it should be given in small bulk, so that it may remain in the bowels. The relative dose administered in this way should be three times the ordinary quantity, as a general rule. Medicines applied to the rectum are called suppositories, when solid ; and, when liquid, clysters, injections, or enemata. What are the modes of application to the skin ? They are va- rious. The skin may be retained or removed ; the medicine may- be used in the form of gas, vapor, liquid, or a soft solid, and may be applied to the whole surface of the body, or a part. How are medicines applied to the bronchial tubes, &c. ? In the state of gas and vapor. What objects are to be gained by their application to the nos- trils ? A powerful excitement of the brain, and a strong revulsion from neighboring parts. CLASSIFICATION. Upon what principle is the preferable mode of classification founded ? On the relations which medicines bear to the human system in a healthy state, or upon their physiological effects. MATERIA MEDICA AND PHARMACY. 32ft What is the first grand division in classification ? Into medicines which act on the living body, and those which act upon foreign matters contained in the body. How is the first grand division divided? Into those substances which act generally, and those which act locally. How are the general remedies divided ? Into stimulants or excitants and sedatives. How are stimulants divided ? Into permanent and diffusible. How are the permanent stimulants divided ? Into astringents and tonics. How are the diffusible stimulants divided ? Into arterial stimu- lants and cerebro-nervous stimulants. The latter may be again divided into cerebral stimulants or stimulant narcotics, and into nervous stimulants or antispas- modics. How are sedatives divided ? Into arterial sedatives or refri gerants, and nervous sedatives or sedative narcotics. How are the local remedies divided ? Into those which affect the functions, those which affect the organization, and those which are mechanical in their action. Those affecting the fuuction of a part are : 1st. Emetics; 2d. Cathartics; 3d. Diuretics; 4th. Diaphoretics; 5th. Expecto- rants; 6th. Emmenagogues; 7th. Sialagogues ; and, 8th. Errhines. Those affecting the organization of a part are ; 1st. Rubefacients ; 2d. Epispastics ; and 3d. Escharotics. Those operating mechanically are : 1st. Demulcents ; 2d. Emol- lients; and 3d. Diluents. Then there are mercury, iodine, ar- senic, nux vomica, and ergot, which cannot be conveniently classi- fied. How is the second grand division divided ? Into, 1st. Antacids; and, 2d. Anthelmintics. TABULAR VIEW OF THE CLASSIFICATION, AS ADOPTED BY PROFESSOR WOOD, OP THE UNIVERSITY OP PENNSYLVANIA. I. Substances which act on the living body. General Remedies. Stimulants. Permanent stimulants. 28 326 MATERIA MEDICA AND PHARMACY. Astringents. Tonics. Diffusible stimulants. Arterial stimulants. Cerebro-nervous stimulants. Cerebral stimulants, or stimulant narcotics. Nervous stimulants, commonly called antispasmodiea. Sedatives. Arterial sedatives, or refrigerants. Nervous sedatives, or sedative narcotics. Local Remedies. Affecting the functions. Emetics. Cathartics. Diuretics. Diaphoretics. Expectorants. Emmenagogues. Sialagogues. Affecting the organization. Rubefacients. Epispastics. Escharotics. Operating mechanically. Demulcents. Emollients. Diluents. Medicines insusceptible of accurate classification. Ergot. Nux vomica. Arsenic. Mercury. Iodine. II. Substances which act on foreign matters contained within the body. Antacids, Anthelmintics. MATERIA MEDICA AND PHARMACY. 32 Astringents. What is an astringent ? A medicine which produces contraction of the living fibre. What are the general effects of astringents ? They produce greater firmness of muscle, diminished calibre, greater rigidity of the bloodvessels and absorbents, and a diminution or closure of secreting orifices and secretions generally. They produce moderate and permanent excitement of the organic life, but do not influence the nervous system much, or the functions of animal life When are astringents indicated ? In unhealthy discharges from the bloodvessels, or secreting orifices ; in cases generally which depend upon relaxation of the tissues ; and in inflammation in its earliest stage. When are they contra-indicated? By the existence of any mor bid condition of which the discharge is a mere effect, and which it is calculated to relieve ; and by the existence of any considerable local or general excitement. In cases of excitement, if it be desira- ble to suppress a discharge, they should be preceded by bleeding, or other depleting measures. Their external use is governed with some modifications by the same rules, but may be admissible locally, when their internal use would not be justifiable. In what particular diseases, attended with unhealthy discharges, are astringents applicable ? Diarrhoea, chronic dysentery, diabetes, catarrh of the bladder, excessive sweating, and all the hemorrhages, always subject to the contra-indicating circumstances. Under what circumstances may astringents be used locally in cases of inflammation ? In the commencement of inflammation, before the excitability is much increased, or in the latter stages after it has become in some measure exhausted ; and are applicable in increased mucous secretion, after the subsidence of inflammation, as from the urethra, vagina, rectum, and nostrils, in excessive per- spiration, in hemorrhages from parts within reach ; and in cases of local relaxation, as in venous distensions, prolapsed anus, uterus, and uvula, and in flabby ulcers. How are astringents divided ? Into the vegetable and mineral. The former have an identity of character depending upon a 328 MATERIA medica and PHARMACY. similarity of composition, the latter agreeing only in the property of astringency. VEGETABLE ASTRINGENTS. To what proximate principle do vegetable astringents owe their peculiar property ? Tannin, or tannic acid, and gallic acid; and they differ only in the proportion of this principle, and in the character of the other ingredients associated with it. What are the sensible properties of tannin ? It is solid, uncrys- tallizable, white or slightly yellowish, strongly astringent without bitterness, and it precipitates many of the metallic salts, with iron forms a black compound, and is incompatible with gelatin, with which it forms a precipitate. It is soluble in water, alcohol, and ether; reddens litmus, and forms salts with bases. What is its dose ? From 2 to 10 grs. every hour, 2, 3, or 4 hours. Gallic acid is produced by an alteration of tannic acid by the addition of oxygen. It has been preferred to tannin by some as an astringent. The dose is the same as tannin. Quercus, U. S. What are the officinal species of Quercus in the United States, from which oak bark is derived ? The Quercus alba, or white oak, and the Quercus tinctoria, or black oak, are the only ones officinal in the United States; but this genus contains about eighty species, thirty or forty of which are found in the United States. They contain tannin and gallic acid; are powerfully astringent, and well adapted to cases requiring astringents, both internally and externally; although not used much internally. The black oak contains a coloring principle, called quercitrine, which renders it valuable as a dye. How is the oak bark used ? In powder, decoction, and extract. What is the dose ? Of the powder, 30 grains; the decoctioD, f |ij ; extract, 20 grains. MATERIA MEDICA AND PHARMACY 329 Galla, Galls. U. S What are Galls, and where are they procured. Excrescences on the young branches of the Quercus infectoria and other species, produced by the puncture of the Cynips quercusfolii; the best are gathered early, and are called blue, green, or black galls; the inferior are gathered later, and are called the white galls. Active principles, tannic and gallic acids. They are brought from Asia Minor and neighboring countries. How are galls generally used ? As a local application exter- nally, but may be used in powder, infusion or decoction, and tincture. Dose of the powder 10 to 20 grains ; of the infusion (made ^ss to Oj) f^ij ; of the tincture f^ss to f ^iij. What are incompatibles ? Sulphuric and muriatic acids, ge- latin, preparations of iron, &c. Kino, U. S. What are the varieties of Kino ? They are the African, Ja- maica, Botany Bay, and East India or Amboyna kino. The East India is the kind most used, and is the inspissated juice of Pterocarpus Marsupium. What are its general characteristics ? As found in the shops, it is in small, irregular, angular, shining fragments, of a dark reddish- brown or black color, and easily pulverizable ; contains tannin and extractive matter. What are its medical properties and uses ? It is powerfully astringent, and is one of the best articles of this class where as- tringents are indicated. It may be given in powder, infusion, or dissolved in diluted alcohol. Dose of powder from 5 to 30 grains; of infusion (made by ^ij extract, and boiling water R>^) f^j. The amount of alcohol in the tincture renders it objectionable. Incom- patibles same as galls. Catechu, U. S. From what is the Catechu procured ? It is an extract of the wood of the Acacia Catechu, and comes from Hindostan. 28* 330 materia medica and pharmacy. What are the general oharacters of catechu ? It comes to us in musses of different shapes, of a rusty brown, varying from a reddish or yellowish-brown to a dark-liver color; contains tannin, ex- tractive, and mucilage. What are its medical properties and wses ? It is tonic, power- fully astringent, and may be given where astringents are indicated Dose from 10 grains to 3ss, and repeated frequently. Ineompati- bles same as galls. Rhatany, Krameria. U. S. From what is Rhatany obtained? From the root of the Kra- meria triandria. It is a native of Peru. What are the general characters of rhatany ? It comes to us in pieces of various shapes and dimensions, often cylindrical, and two or three feet in length. The mineral acids, and most of the mineral salts, are incompatible. Cold water, by displacement, extracts all the astringency from it. What are its medicinal properties and uses? It is a gentle tonic, powerful astringent, and may be given where astringents are indicated. Dose of powder from 20 to 30 grains; of infusion op decoction (made by gj of bruised root to Oj of water) f 3j ; of ex- tract 15, or 20 grains;, tincture f^j to fgiij -t and syrup f|ss. Log WOOD; Hcemaioxylon. U. S. From' what is the Logwood procured ? From the Haematoxylon Campeehianum, and is brought from Campeaeby, the shores of Honduras Bay, and other parts- of tropical America. What are the general characteristics of logwood ? It is hard, compact, heavy, of a deep-red color; becomes dark by exposure, and has a sweetish astringent taste. Its peculiar principles are tannic acid and hcematoxylin. What are its medical properties and uses ? It Is a mild astrin- gent, well adapted to relaxed and enfeebled conditions of the bowels. It is given in. decoction and extract, both of which are officinal Dose of the decoctiouf gij ; of the extraet 10 to>20 grains. materia medica and pharmacy. 331 Cranesbill, Geranium. U. S. From what is the Cranesbill derived ? From the Geranium maculatum, an indigenous, perennial, herbaceous plant, growing in Fig. l. woods. The root is the part used, and should be collected in autumn ; active principle, tannin. What are its medical properties and uses? It is a powerful 332 materia medica and pharmacy. astringent, and may be employed where they are indicated; it is very free from unpleasant qualities, which renders it serviceable for infants, and may be given in substance, decoction, tincture, or ex- tract. Dose of powder 20 or 30 grains; decoction Xmade §j to Ojss boiled to Oj) from fgj to f gij. It is frequently given to children, boiled in milk. Blackberry Root, Rubus Villosus. U. S. Dewberry Root, Rubus Trivialis. U. S. What is the officinal name of the plant furnishing the Blackberry Root and the Dewberry Root ? The Rubus Villosus and Rubus Trivialis, the virtues of which reside in the bark of the root. What are their medicinal properties and uses? Tonic and strongly astringent. The decoction is prepared the same as the preceding article, and given in the same dose. Dose of powder 20 to 30 grains. Uva Ursi, Arctostaphylos Uva Ursi. U. S. What is the plant furnishing the Uva Ursi ? The Arbutus Uva Fig. 2. MATERIA MEDICA AND PHARMACY. 333 Ursi, or Arctostaphylos Uva Ursi, a small, trailing, evergreen shrub, growing plentifully in the United States as far south as New Jersey. The leaves are the part used. What are the general properties of the leaves ? They are in- odorous when fresh, smell like hay when dried, have a bitterish taste, strongly astringent, and afterwards sweetisn. The active ingredients are tannin, bitter extractive, resin, gum, and gallic acid. What are its medical properties and uses ? It is astringent, Fig. 3. 334 MATERIA MEDICA AND PHARMACY. tonic, and thought by some to have a specific direction to the uri- nary organs. Dose of powder is from 3j to 3j ; decoction, £ij, 3 or 4 times a day. Pipsissewa, Chimaphila Umbellata. U. S. What portion of the Pipsissewa, or Chimaphila umbellata (Fig. 3), is used in medicine ? The leaves and stem. It is a small, in- digenous evergreen plant, growing in the north of Europe, Asia, and America; inhabiting the woods. What are their general properties ? The taste is pleasantly bit- ter, astringent, and sweetish. Boiling water and alcohol extract the native properties of the plant, which are tannin and bitter ex- tractive. What are its medical properties and uses ? Diuretic, alterative, tonic, and astringent. It has been used with good effect in cases of scrofula. It is generally used in decoction (§j to Ojss of water boiled to Oj), and taken in 24 hours. Red Roses, Rosa Gallica. U. S. What portion is used ? The petals. It is a native of the south of Europe, but is introduced into the United States, and is exten- sively cultivated. The active principles are tannin, gallic acid, and coloring matter; not much used except in its preparations, as a vehicle for other articles. Compound infusion is sometimes used when an astringent is re quired, but more frequently as a vehicle for sulphate of magnesia. Conserve, formed with the petals, sugar, honey, and water; which is mostly used in the formation of pills. Persimmon, Diospyros Virginiana. U. S. What portion is used ? The unripe fruit, in infusion, syrup, and vinous tincture ; and the bark. Creasote. In what diseases has creasote been used as an astringent ? In haemoptysis and haematemesis; also in leucorrhoea and bronchor- materia medica and pharmacy. 335 rhcea. It has also been used as a local application in haemorrhage, and in a diluted state to relaxed inflamed surfaces ; and to check vomiting in cholera, pregnancy, &c. Dose, as an astringent, one or two drops, several times a day, well diffused in mucilage. A fluidrachm contains 150 drops of creasote. Pill is said to be a good form of exhibition. One part to 80 of water is a good strength to begin with as a local application. Several articles, as wood-soot, pyroligneous acid, tar-water, &c, owe their principle virtues to the presence of creasote in them. MINERAL ASTRINGENTS. Alum, Alumen. U. S. What is the chemical composition of Alum ? It is a sulphate of alumina and potassa. What are the incompatibles ? The alkalies, lime, magnesia, and their carbonates ; tartrate of potassa and acetate of lead. What are its medical properties and uses ? Astringent in ordi- nary medicinal doses, but emetic and purgative in large doses. It is used internally and locally. It forms an excellent local applica- tion to chronic congestive inflammations, and particularly in leucor- rhcea. The ordinary dose js from 10 to 20 grains, repeated every two or three hours. Alum curd is made by rubbing up alum with the white of an egg- Alum whey; prepared by £ij of alum in a pint of milk, and then straining. Dose |ij. Lead, Plumbum. U. S. What are the preparations of Lead used medicinally ? They are the Litharge, or Plumbi Oxidum Semivitrium, the Carbonate, the Acetate and Subacetate. What are the effects of the combinations of lead ? They are sedative and astringent, and produce poisonous effects, if taken in large doses, or long repeated. The sulphate, and probably the acetate, are exceptions to this. Sulphuric acid, sulphate of soda, and sulphate of magnesia are antidotes, 336 MATERIA MEDICA AND PHARMACY. What are the general properties of the Acetate of Lead? It is a white salt, crystallized in brilliant needles. Its taste is sweet and astringent. It is liable to be decomposed by water containing car- bonic acid, but is redissolved by acetic acid. What are its ineompatibles ? It is decomposed by all acids, soluble salts, the acids of which produce insoluble or sparingly soluble compounds with the protoxide of lead, lime-water, ammo- nia, potassa, and soda Sulphuretted hydrogen gives a black pre- cipitate, and iodide of potassium a yellow one. What are its medical properties and uses ? In medicinal doses, it is powerfully astringent, sedative, and in large ones an irritant poison. It is administered in hemorrhages of the lungs, intestines, and uterus. By giving acetic acid combined with it, the formation of a carbonate is prevented, upon which its poisonous qualities are sup- posed to depend. Dose is from 1 to 3 grains, repeated as required. What is the white lead ? It is the carbonate ; and is only em- ployed externally, being used as an application to ulcers and exco- riated surfaces. It is the most poisonous of the preparations of lead, producing the disease called colica pictonum. What is Goulard's extract of lead? It is a solution of the sub- acetate of lead (Liquor Plumbi Subacetatis) formed by the acetate of lead |xvj, semivitrified oxide of lead sixss, distilled water four pints, boiled and filtered; if diluted in the proportion of gij to a pint of water, it forms the liquor plumbi subacetatis dilutus, or Goulard's vegeto-mineral water. Goulard's cerate is formed by heating together the extract with white wax, olive oil, and camphor. The nitrate of silver, sulphate of copper, tincture of chloride of iron, perchloride of iron, per nitrate of iron, sulphate of iron, sulphate of zinc, and some other articles, are used for their local astringent effects, but they will be found under other heads, as they have other properties also besides that of astringency. TONICS. What are meant by Tonics ? They are medicines which produce gentle apd permanent excitement of the vital actions. MATERIA MEDICA AND PHARMACY. 337 When are tonics injurious ? In the healthy state, and in diseases of excitement. They may diminish excitability, or natural healthy power ; or, produce an irritation which may be followed by inflammation. They should never be given in a state of sound health, with the riew of increasing strength, or of rendering the system less accessi- ole to disease. Under what circumstances are tonics indicated? In cases in which the vital actions are depressed below the standard of health. They invigorate the system in a twofold manner : 1st, by increasing the energy of the stomach ; and, 2d, by a direct influence over the whole frame, producing an elevation of all the vital actions. They are also given for the purpose of making a decided impres- sion on the nervous system, so as to break up diseases which occur in paroxysms with regularity. There are several influences which may act as tonic remedies which are not medicines. These are diet, exercise, pure air, men- tal influences, travelling, cold, and transfusion of blood. How may tonics be divided? Into the pure bitters; bitters peculiar in their properties ; aromatics ; and mineral tonics. What are the effects of the Pure Bitters ? They increase the appetite, invigorate digestion, have little influence over the circula- tion, unless in large doses, and exhibit but little evidence of action on the nervous system. What are the effects of Bitters peculiar in their properties ? They are generally more stimulating than the pure bitters. What are the effects of the Aromatics? They depend upon the presence of volatile oil, are more stimulating than the bitters, and approach nearer to the diffusible stimulants. What are the peculiarities of the Mineral Tonics ? They have no common peculiarity except the tonic property, each having pecu- liarities which serve to distinguish it from the others. PURE BITTERS. Quassia, U. S. From what is Quassia derived? It is the wood of the Quassia excelsa and Quassia amara, trees of the west Indies. 29 w 338 MATERIA MEDICA AND PHARMACY. What are the general characteristics of quassia ; The wood is whitish, and yellowish by exposure ; has a purely bitter taste; the active principle is quassin. What are its medical properties and uses ? It has the proper- ties of the simple bitters in their highest degree. It is particularly useful in dyspepsia from debility of the stomach. It is given in infusion in the proportion of gij to Oj cold watei Dose f ,5ij, 3 or 4 times a day ; of extract, from 2 to 5 grains; of tincture, f^j to f^ij ; of powder, 20 to 30 grains. Goldthread, Coptis. U. S. From what is the Goldthread procured ? It is the root of the Coptis trifolia. What are its medical properties and uses ? It is a simple tonic Fig. 4. bitter, closely analogous to quassia. Dose of powder 10 to 30 grains; tincture f^j. f materia medica and pharmacy 339 • Gentian, Gentiana. U. S. From what is Gentian procured? It is the root of the Gentiana lutea, which grows on the Alps, and other mountains; the active principle of which is gentianin. What are the general properties of the root ? The taste is slightly sweetish, and intensely bitter. Water and alcohol extract the taste and medical virtues from it. What are its medical properties and uses ? It possesses in a high degree the tonic power of the simple pig 5 bitters, excites the appetite, invigorates the power of digestion, increases the temperature of the body and the force of the circulation. It is given in powder, dose 10 to 40 grains; in infusion (^ss to Oj), f5i to fgij; of tincture, fjj to f^ij; of extract, 5 to 30 grains. Sabbatia Angularis, U. S. What portion of the Sabbatia angu- laris, or American Centaury, is used ? The whole plant. It grows in the Middle and Southern States, in low meadows, and should be collected when in flower. It is prescribed in the same cases as gen- tian, and is generally given in infusion (3jto Oj) ; in powder, the dose is 3ss to 3j. What are its medical properties and uses ? It has the tonic properties of the simple bitters. Dose of the infusion (gj to Oj) f5 ij. Columbo, Colomba. U. S. From what plant is the Columbo derived ? The Cocculus pal- matus. The root is the part used, and is brought from Africa. 340 MATERIA MEDICA AND PHARMACY. What are its general properties? As it comes to us, it is in flat, circular, or oval pieces, of a bitter taste, and slightly aromatic odor. Active principle, Columbia. What are its medical properties and uses? It is a useful mild tonic, no astringency, and but slightly stimulant. Used in powder, infusion, and tincture. Dose of the powder, 10 to 30 grains; of infusion (made in the proportion of gss to Oj), from fgj to fjij; of tincture, f3ss to f^j. BITTERS OF PECULIAR, OR MODIFIED PROPERTIES. Peruvian Bark, Cinchona. U. S. From what is the Peruvian Bark obtained? Different species of the Cinchona, brought from the western coast of South America. There are three officinal varieties: 1, pale bark; 2, yellow bark; and, 3, red bark. The pale embraces the varieties called Loxa and Lima; the yellow is called in commerce Calisaya bark, and of which there are two varieties, the quilled and flat. The red is divided into the quilled and the flat also. What are the important principles of bark ? Quinia, Cinchonia, Quinidia, and Quinoidia, combined with kinic acid. What preparations of bark are generally used ? The sulphate of quinia and cinchonia. What are the medical properties and uses of cinchona ? It ia one of the most valuable tonics we possess, as well as anti-inter- mittent. The best mode of giving the bark is in substance; dose of the powder 3j. What is the comparative power of sulphate of quinine compared with the bark ? 10 to 14 grains is equivalent to 3j of good bark. The different varieties of bark differ in the relative proportions of the active principles which they contain. The pale bark contains a much larger proportion of cinchonia than of quinia. The yellow bark contains a large proportion of quinia, with very little cinchonia. The red bark contains considerable quantities both of quinia and cinchonia. It is given as an antiperiodic in intermittents in doses of 12 to 18 grains, divided into two or three parts, in the interval of the paroxysm. As a mere tonic, \ to ^ a grain 3 or 4 times a day. The sulphate of cinchonia requires to be given in somewhat larger quantity to produce the same results as the quinia. MATERIA MEDICA AND PHARMACY. 343 The Peruvian bark or its preparations may meet several distinct therapeutical indications: 1, as a simple tonic; 2, as an antipe- riodic ; 3, as a superseded; and 4, in reference to its secondary sedative properties. Dogwood, Cornus Florida. U. S. From what do we procure the Dogwood bark? From the Fig. 5. Cornus Florida, an indigenous tree. The dose and mode of using similar to the Peruvian bark Wild Cherry Bark, Prunus Virginiana. U. S. What is the officinal name of the tree from which the Wild Cherry bark is procured ? Prunus Virginiana — indigenous to this country. What are the active principles ? Hydrocyanic arid, tannin, and bitter extractive. <>q * 342 MATERIA MEDICA AND PHARMACY. What are its medical properties and uses ? It is tonic and sedative ; lessens the action of the heart and arteries ; and is use- ful in the hectic fever of scrofula and consumption. Dose of pow- der, 3ss to 3j ; of the infusion, f^ij 3 or 4 times a day. Chamomile, Anthemis Nobilis. U. S. What is the officinal name of the Chamomile ? Anthemis nobilis; the flowers are the parts used, although all parts of the plant are active. The active principle is bitter extractive and volatile oil. In small doses it is tonic, and in large ones emetic. The cold infusion is best when used as a tonic in doses of fjij ; dose if the powder, gss to 3j. Boneset, Eupatorium. U. S. What are the medical properties and uses of the Eupatorium MATERIA MEDICA AND PHARMACY. 343 perfoliatum, or Thoroughwort? It is tonic, diaphoretic, and taken in large doses it acts as an emetic and aperient. As a tonic it should be administered in substance or cold infusion. Dose of the powder, 20 or 30 grains; and of the infusion, f^i frequently repeated. As a diaphoretic, it should be given warm. As an emetic and cathartic, in doses of one or two gills of the strong decoction. Virginia Snakeroot, Serpentaria. U. S. What are the medical properties and uses of the Aristolochia Serpentaria, or Virginia Snakeroot ? It is indigenous ; the root is the part used, and its active ingredients are a bitter principle. Fig. 8. 344 MATERIA MEDICA AND PHARMACY. and volatile oil. It is a stimulant tonic, acting also as a diapho- retic or diuretic, according as it is administered. Dose of the powder, 10 to 30 grains; infusion, fgj to fjij every 2 or 3 hours ; officinal tincture, f 3i to f 313. Myrrha, Myrrha. U. S. From what is Myrrh procured ? It is an exudation from the Amyris Myrrha. There are two varieties, the India and Turkey. What are its medical properties and uses? Its active principle is a resin and volatile oil. It is a stimulant tonic, with a tendency to the lungs, and also to the uterus. Employed in diseases of these organs where there is no febrile excitement or acute inflain- - mation. Used in powder and pill in dose of 10 to 30 grains; of the tincture, f 3ss to f 3j. Angustura. U. S.. What are the medical properties and uses of the bark of the Galipea officinalis, or Angustura? Its active parts are bitter extractive and volatile oil. It is a stimulant tonic, but little employed in the United States. Dose of the powder, 10 to 20 grains; infusion, f^ij; tincture, f3j to f^ij. False Angustura bark has poisonous properties; its active ingredient is brucia. Cascarilla Bark, Cascarilla. U. S. What are the medical properties and uses of the bark of the Croton Eleutheria, or Cascarilla? Its active ingredients are extractive and volatile oil. It is an aromatic tonic, and is now only employed where a gentle stimulant tonic is desired. Dose of the powder, 20 to 30 grains ; of the infusion, fgij. AROMATICS. What are the general properties of aromatic tonics ? They owe their characteristics to volatile oils, are .more stimulant than tonics generally, and more local in their action than diffusible stimulants: MATERIA MEDICA AND PHARMACY. 345 relieve pains in the stomach and bowels, expel flatulence, &c. Decoctions and extracts objectionable. What are the medical properties and uses of Orange Peel, or rind of the fruit of the Citrus Aurantium ? It is a mild tonic, stomachic, and carminative ; given in infusion. What are the properties of the prepared bark of the Laurus Cinnamomum, or Cinnamon ? There are two varieties, the Ceylon cinnamon and China cinnamon, or cassia. Its active principles are volatile oil and tannin; its medical use the same as aromatics in general, applicable in cases requiring astringents. Dose of powder, 10 to 20 grains ; tincture, f^j. What are the properties of the bark of the Canella Alba ? Its active ingredients are volatile oil and bitter extractive; used generally combined with other articles. It is an ingredient in the powder of Aloes and Canella, or hiera picra. From what are Cloves derived? They are the unexpanded flower buds of the Eugenia Caryophyllata, or Caryophyllus aro- maticus; brought from the West Indies and the European colonies of Guiana. What are their medical properties ? Their active principle is a volatile oil. They are used where a stimulant aromatic is indi- cated. Dose of the powder, 5 to 10 grains; infusion made with (3ij to Oj) f gij ; oil, 2 to 5 drops. Used in several officinal pre- parations. From what is the Nutmeg procured? It is the kernel of the fruit of the Myristica Moschata, growing in the Moluccas. What are its medical properties and uses ? The active principle is a volatile oil; it also yields a fixed oil, called the Oil of Mace. It combines narcotic with aromatic properties. Dose of powder, 5 to 10 grains ; of volatile oil, 2 or 3 drops. From what is the Black Pepper obtained? It is the dried berries of the Piper Nigrum. What are its properties and uses? It contains a volatile oil an acid concrete oil, and piperin. Its activity depends upon its oils, and not the piperin, which is inert when pure. It is a warm carminative stimulant, and used where such properties are indicated. From what are Ccbebs obtained? It is the dried fruit of the Piper Cubeba, a vine growing in the East Indies. 346 MATERIA MEDICA AND PHARMACY. What are its properties and uses ? Its active ingredient is a volatile oil. It is aromatic and diuretic. Dose of the powder, 3ss to 3iss 3 or 4 times a day; of the volatile oil, 10 to 20 drops. From what is the Pimento obtained? The Myrtus Pimento. The active properties reside in a volatile and fixed oil. Dose of the oil, 3 to 6 drops. What are the properties and uses of Cardamom, or the fruit of the Alpinia Cardamomum ? It is a warm aromatic, less heating and stimulating than some others. It enters into a number of officinal preparations. Dose of the compound tincture, f 3j. What other aromatic seeds are used in medicine ? Fennel, Caraway, Coriander, Anise. What is the dose of the compound spirit of Lavender? The dose is f^ss to f3j. What is the officinal name of the Peppermint ? Mentha Pipe- rita. , Dose of the oil, 1 to 3 drops ; of the essence, 10 to 20 drops. What is the officinal name of the Spearmint ? Mentha Viridis, and possesses properties similar to the last. Fig. 9. MATERIA MEDICA AND PHAR MACS'. 341 What other herbaceous aromatics are used in medicine ? The Hedeoma pulegioides, or Pennyroyal ; Melissa officinalis, or Balm; Origanum vulgare, or Origanum; and the Gaultheria procumbens, or Partridge Berry (Fig. 9). From what is Ginger procured ? It is the root of the Zingiber officinale, an herbaceous plant, native of the East Indies, and cul tivated in the West Indies. What are its properties and uses ? It is aromatic, spicy, pun- (Fig. 10.) 348 MATERIA MEDICA AND PHARMACY. gent, hot, and biting. Its virtues are extracted by water and alcohol. It is a grateful stimulant, and carminative ; and may be given in powder, in doses of 10 to 30 grains ; in infusion, f 3 ij; in tincture, f3j or f3ij. In what doses is the Acorus Calamus, or sweet flag (Fig. 10) used ? Its uses, modes of administration, and doses are similar to those of the ginger. MINERAL TONICS. Iron, Ferrum. U. S. What are the properties of the preparations of iron ? They are highly tonic, raise the pulse, promote the secretions, and increase the coloring matter of the blood. The diseases in which they are most used are chlorosis, hysteria, fluor albus, gleet, scrofula, rickets, &c. The preparations of iron may be considered in reference to their local effects upon parts with which they come in contact, and their effects on the system generally. In their therapeutic application they may be considered as a mere tonic, or excitant of the func- tions, and as a reconstructive agent, by affording material and influ- ence for the production of blood corpuscles. What are the doses of the different preparations of Iron ? The Filings — Ramenta ferri—in doses of 5 to 10 grains. Scales— Squamae ferri—5 to 20 grains. Prepared Carbonate — Fern Carbonas Prceparatus; Precipitated Carbonate—Ferri Carbonas Prcecipitatus. Dose of the last two, 5 to 20 grains ; in neuralgic cases, from £ss to 3j, 3 times a day, and increased Sulphate—Ferri sulphas—Green vitriol—Copperas—in doses of from 1 to 5 grains; of the dried, from ^ to 3 grains, 3 or 4 times a day. What are the incompatibles of the sulphate ? The alkalies and alkaline carbonates, muriate of lime and baryta; nitrate of silver; acetate of lead, tannin, &c. Tincture of the Muriate — Tinctura Ferri Muriatus — dose 10 io 30 minims, 3 or 4 times a day. Tartrate of Iron and Potassa .— Ferri et Potassce Tartras—dose 10 to 30 grains. Phosphate, 5 to 10 grains. MATERIA MEDICA AND PHARMACY. 34H Ammoniated Iron — Ferrum Ammoniacum — dose 10 or 12 grains. Iodide of Iron — Ferri lodidum — dose 2 or 3 grains, three times a day. Syrup of Iodide of Iron, or Solution of Iodide of Iron — dose 20 to 50 drops, three times a day, diluted with water at the moment of exhibition. Ferrocyanuret of Iron —Ferri Ferrocyanuretum—Ferrocyanide of Iron—Pure Prus- sian Blue—dose 4 to 6 grains, several times a day. Copper, Cuprum. U. S. What is the effect of the preparations of Copper on the system ? In its pure state it is inert, but in combination highly poisonous ; in small quantities but little sensible effect is produced, except a slightly tonic and astringent influence. When taken in poisonous doses, they produce a coppery taste in the mouth, nausea, vomiting, violent pain in the stomach and bowels, black and bloody stools, irregular pulse, faintings, thirst, difficulty of breathing, cramps, convulsions, and death. The best treatment in these cases is to administer white of eggs in water in large quantities. What are the doses of the different officinal preparations of Copper as a tonic? Sulphate—Cupri Sulphas — Blue vitriol. Dose £ of a grain, 2, 3, or 4 times a day, given in pill, and omitted if the stomach becomes irritated. Anvmoniated Copper—Cuprum Ammoniatum. Dose \ a grain, three or four times a day. Zinc, Zincum. U. S. What are the preparations of Zinc used medicinally ? The Sui phate, Oxide, impure Oxide, and Carbonate. What are the medical properties and uses of the Sulphate of Zinc ? It is tonic, astringent, and, in large doses, a prompt emetic Dose as a tonic, ^ a grain to 2 grains, two or three times a day; as an emetic, 10 to 30 grains. What are the incompatibles ? Alkalies and their carbonates, hydrosulphates, lime-water, and astringent vegetable infusions. The Acetate and Valerianate of Zinc are used for the same pur- poses as the sulphate, but are rather milder and less astringent. The dose is the same. 30 350 materia medica and pharmacy The Oxide may be given in doses of 2 to 8 grains, which may gradually be increased to 20. It has been used externally in pow der and ointment, as an absorbent, desiccant, and alterant. Bismuth, U. S. What preparations of Bismuth are used medicinally ? The Sub- nitrate or White Oxide; it is tonic and antispasmodic. Dose 3 to 30 grains, in powder or pill. Silver, Argentum. U. S. What preparations of Silver are used medicinally ? The Nitrate, Oxide, and Chloride. What are the medical properties of the Nitrate of Silver ? As an internal remedy, it is tonic, astringent and antispasmodic. It has been employed in epilepsy, chorea, angina pectoris, &c. Ex- ternally, it is a vesicant, stimulant, and escharotic. Dose ^th of a grain, increased gradually to 4 or 5, three times a day, in pills. The proper antidote for a large dose is common salt. What are its incompatibles ? Its incompatibles are common salt, alkalies and their carbonates, lime-water, mineral acids, as- tringent vegetable infusions, &c. What preparation of Sulphuric Acid is used medicinally ? The Diluted and the Aromatic. Dose of each, 10 to 30 drops. They increase the appetite and promote digestion. What are its incompatibles ? Its incompatibles are the alkalies, alkaline earths, their carbonates, &c. What are the effects and dose of Nitric Acid ? It is tonic and refrigerant when diluted; concentrated, it is a corrosive poison. Dose 2 to 5 drops, in water. What are its incompatibles ? Its incompatibles are the alkalies, alkaline earths, their carbonates, sulphate of iron, the salts of lead, Ac. What is the dose of the Nitromuriatic Acid ? From 2 to 10 drops, 3 or 4 times a day. materia medica and pharmacy. 351 ARTERIAL STIMULANTS. What is understood by Arterial stimulants ? They are medicines which excite the circulation, with but little influence on the nervous system. Under what conditions of system are they applicable ? In cases of great prostration, when sufficient energy of the system remains to sustain it at the point to which it may be elevated. Great care is often necessary in their use, even in some cases where they are indicated ; or too great reaction may occur. Cayenne, or Red Pepper, Capsicum. U. S. What are the medical properties and uses of the Cayenne Pep- per, or Capsicum Annuum ? It is a powerful stimulant, without being narcotic ; useful in enfeebled and languid stomachs; active principle capsicin. Dose of powder, 5 to 10 grains; of infusion (3ij to Oss), f^ss ; of tincture, f£j to f 3ij ; used also as a gargle. What are the medical properties and uses of Spirits of Tur- pentine, or Oil of Turpentine ? It is stimulant, diuretic, anthelmintic, and, in large doses, cathartic. Dose 5 to 20 drops, repeated. What is the dose of Phosphorus ? It is y^th of a grain, in an oleaginous, or ethereal solution. What are the properties and dose of Carbonate of Ammonia ? It is stimulant, diaphoretic, and antispasmodic. The dose as a stimulant is from 5 to 10 grains, in pills or emulsion, and repeated. It is one of our best stimulants in low fevers, &c. NERVOUS STIMULANTS, OR ANTISPASMODICS. What is understood by Nervous Stimulants ? They are medi- cines that not only affect the heart and arteries, but also superadd an excitant influence over the nervous system. Under what conditions of the system are they applicable ? In deranged conditions of the nervous system, not connected with inflammation or arterial excitement, and particularly if associated with general debility. They are termed antispasmodics from their 352 MATERIA MEDICA AND PHARMACY. power of relieving spasm, when it is the result of irregular distri- bution of nervous influence depeudent upon debility, or other cause not connected with inflammation. They are useful in morbid vigi- lance, restlessness, dejection of mind, hypochondriasis, and some- times in mental derangement. From what is Musk obtained? It is obtained from the Moschus Moschiferus, an animal resembling the deer, found in Asia. What are its- medical properties and uses ? It is stimulant and antispasmodic, and used in cases where these qualities are indicated, particularly in low states of the system. Given in pill and emul- sion. Dose 10 grains, and increased. How is artificial musk prepared ? By the action of nitric acid on amber. From what is Castor obtained ? It is a peculiar product of the Castor fiber, or Beaver. It is not much used. Dose in sub- stance, 10 to 20 grains ; in tincture, f 3j to f^ij. ASSAF03TIDA. U. S. From what is Assafcetida procured ? It is the inspissated juice of the root of the Narthex Assafcetida. W7hat are its medical properties and uses ? Its active part is a resin and volatile oil. It is a moderate stimulant, powerful antispasmodic, an expectorant, and feebly laxative. Dose 5 to 20 grains, in pill; emulsion (Lac assafcetida), f^ss to f3j ; of the tincture, f£j. Valerian, Valeriana. U. S. From what is Valerian obtained? It is the root of the Valeriana officinalis, a native of Europe. What are its medical properties and uses? It is a gentle stimulant, with a narcotic effect. It is used in hysteria, hypochon- driasis, &c. Active principles a volatile oil and volatile acid, called valerianic. Dose of the powder, 30 to 90 grains; of the infusion (3j to Oj), foij; of the tincture, f^j to f^iv ; of the oil, 4 to 6 drops; of the fluid extract, 3j to'^iij. What are the properties and uses of the Oil of Amber ? It is MATERIA MEDICA AND PHARMACY. 353 stimulant and antispasmodic, and used as a liniment. Dose 5 to 10 drops, in emulsion. What other nervous stimulants do we possess ? Garlic, Tea. Coffee, Skunk Cabbage, &c. CEREBRAL STIMULANTS. CALLED ALSO NARCOTICS, FROM THE STUPOR WHICH THEY PRO- DUCE IN LARGE DOSES. What is understood by Cerebral Stimulants ? They are medi- cines which not only stimulate the circulation, but also conjoin a peculiar determination to the brain. They are also called narcotics, from the stupor they occasion in large doses. When taken in sufficient doses to destroy life, it is occasioned by the suspension of respiration, consequent upon impaired cerebral influence. Their influence is rapidly diminished by habit, and must, therefore, be rapidly increased in dose to keep up any required effect, provided their long-continued use becomes necessary. Caution is always necessary in their use. These are called narcotics, from the stupor they occasion ; anodynes, from their influence in relieving pain; and soporifics, or hypnotics, from their effect in iuducing sleep. Alcohol. How is Alcohol produced ? By the vinous fermentation. What are its medical properties and uses ? It is a powerful stimulant, and is the intoxicating ingredient in all spirituous and vinous liquors. It is not used in medicine in a pure state; diluted, it is extensively used as a menstruum. When a decided stimulus is required, brandy is preferred ; but, when a more moderate one, malt liquors or wine is used. What Wines are used medicinally ? Madeira, Teneriffe, and Sherry ; Port when an astringent is indicated. Wine-whey is a convenient and good form of giving wine ; it may be made by adding to a pint of boiling milk half a pint of whatever wine may be preferred ; separate the curd from the whey, and flavor to suit the taste if wished. Malt liquors possess tonic, alterative, and nutritious properties, 30* x 354 MATERIA MEDICA AND PHARMACY. and may be used more freely than wine. Porter and Ale are said to be the best. When the pulse becomes fuller and slower, the skin moist, and delirium abates under the use of alcoholic remedies, the influence is favorable. How is Sulphuric Ether procured ? By the distillation of alcohol and sulphuric acid. What are its medical properties and uses? It is a transient, powerful diffusible stimulant; and given where such medicines are indicated. Dose f£ss to f3j. Opium. U. S. From what is Opium obtained? It is the concrete juice of the Papaver somniferum, or Poppy. Of what is it composed ? Morphia, narcotina, codeia, meconic, acid, gum, extractive, resin, &c. What are its incompatibles ? All vegetable infusions containing tannin and the alkalies. What are its medical properties and uses ? It is a stimulant narcotic. It diminishes the peristaltic action of the bowels, and all the secretions except of the skin ; allays inordinate muscular contractions, and general nervous irritation. Medium dose in substance is 1 grain ; of the tincture, 25 drops; of the camphor- ated tincture, f3i; f 3j of which contains 2 grains of opium; of the acetated tincture, 20 drops, which is equal to one grain of opium ; of the sulphate, acetate, and muriate of morphia, £th of a grain is equal to 1 grain of opium. The best tests for the presence of morphia are the sesquichloride of iron, which causes a blue color; and nitric acid, which pro- duces a blood-red color. From what is Lactucarium procured ? It is the inspissated milky juice of the Lactuca sativa. Dose 2 to 3 grains. Cannabis Indica, Hemp of India. From what is Extractum Cannabis, or Extract of Hemp, ob- tained ? It is an alcoholic extract of the dried flowering tops of the Cannabis sativa, grown in the East Indies. The active prin- ciples of this plant are a volatile oil, and a peculiar resin called Cannabin. MATERIA MEDICA AND PHARMACY. 355 What are its medical properties and uses? It slightly increases the force of the pulse, acts with energy upon the brain, exalting, deranging, and finally diminishing the functions of the cerebral centres, and produces mental confusion. The indications for its use are to allay pain, relieve spasm and other nervous disorders, and to promote sleep. It is said also to have the property of pro- ducing uterine contractions. It is used in extract and tincture. The dose of the former, when of best quality, is £ grain, repeated every two or three hours until its effects are produced. In tetanus it is given in ten grain doses, and repeated every hour until its effects are manifest. Forty drops of the tincture are equal to 1 grain of extract. Henbane, Hyoscyamus. U. S. From what is Henbane procured? From the Hyoscyamus Niger. Leaves and seeds officinal. Fig. 11. 356 MATERIA MEDICA AND PHARMACY. What are its properties and uses ? Its active principle is hyos- cyamin, or hyoscyamia. It is narcotic in large doses ; in small ones it gently accelerates the circulation, and increases the general warmth ; it does not constipate. Dose, of leaves, 5 to 10 grains ; of extract, which is mostly used, 2 or 3 grains; of tincture, f 3j. Hops, Humulus. U. S. From what are Hops procured ? They are the strobiles of the Humulus Lupulus. The active principles are a volatile oil and a peculiar bitter principle. What is Lupulin ? It is a yellowish powder, obtained separate by rubbing and sifting the strobiles. Its bitter principle is called lupulite, or lupuline. W7hat are their medical properties and uses ? Tonic, moderately narcotic, and used in diseases of debility where morbid vigilance exists. Dose of the infusion of hops (made with |ss to Oj of water) is f Jij ; of the tincture, f^i to f^ss ; of the lupulin, 6 to 12 grains, in pill; of the tincture, f 3j to f 3ij. Camphor, Camphora. U. S. From what is Camphor derived ? From the Laurus Camphora, an evergreen, growing in China and Japan ? It is procured by sublimation from the roots and smaller branches. What are its properties and uses ? It is very volatile, and may be sublimed unchanged. The medium dose is 1 to 10 grains in emulsion. In each ounce of the aq. camphora, when well made, there is 3 grains of camphor. It enters into the composition of several liniments. Deadly Nightshade, Belladonna. U. S. What is the active principle of Atropa Belladonna, or Deadly Nightshade ? An alkaline principle called atropia. The leaves of the plant are the part used. Dose of the powdered MATERIA MEDICA AND PHARMACY. 357 leaves 1 grain, night and morning; of the infusion 0j to gx of water) fgj to f,$ij ; of the extract, which is the inspissated juice, £ to £ a grain, twice a clay, and increased if necessary. It is used in the form of plaster, and as an application to the eye and the os uteri. Thornapple, Stramonium. U. S. What part of the Datura Stramonium, or Thornapple, is used Fig. 12. medicinally ? The leaves and the seeds. The active alkaline prin- ciple is daluria. What are its medical properties and uses ? It is a powerful narcotic, and sometimes used in epilepsy. Dose, of the seeds, 1 grain ; of the extract from seeds, £ to ^ a grain ; of the powdered leaves, 2 to 3 grains ; of the tincture, 10 to 30 drops; of the ex- tract of the leaves, 1 grain. Used also as an ointment. Bittersweet, Dulcamara. U. S. What is the dose of the Dulcamara, or Bittersweet ? Of the officinal decoction, f^ij, 4 times a day; of extract, 5 to 10 grains. Active principle, solania. 358 materia medica and pharmacy. Hemlock, Conium. U. S. What is the dose of the Conium maculatum, or Hemlock ? Of Fig. 13. the powdered leaves, 3 or 4 grains ; of the extract, or inspissated juice of the leaves, 3 grains; tincture 3ss to 3j. ARTERIAL SEDATIVES. What is meant by Sedatives ? Medicines which, by their imme- diate influence produce a reduction of the vital actions. Arterial sedatives are those that operate more particularly upon the heart and arteries, independent of depletion. Those that re- duce both arterial and nervous power are called nervous sedatives. Under what circumstances are arterial sedatives indicated ? In increased vascular action, arising from an increased display of the vital energies. Refrigerant remedies belong to this class. materia medica and pharmacy. 35y Antimony. What preparations of Antimony are employed medicinally 7 The tartar emetic, precipitated sulphuret, and antimonial powder. What are the properties and uses of Tartar Emetic, or the Tar- trate of Antimony and Potassa ? It is the most important of the antimonials. Its general action is sedative on the circulation, while it excites many of the secretions. It may produce an altera- tive, diaphoretic, diuretic, expectorant, purgative, and emetic effect, according as it is administered. Applied externally it acts as a counter-irritant. Its dose, as an alterative, is from ^d to T]3th of a grain ; as a diaphoretic, or expectorant, from T]-2-th to ^-th of a grain ; as a nau- seating sudorific, from ^- to -g- a grain, repeated as occasion re- quires ; as a purgative, ^-th of a grain combined with Epsom salts 3j, and repeated every two or three hours ; as an emetic, from 2 to 4 grains given in divided portions, at intervals of 10 or 15 minutes. The antimonial wine contains 2 grains of tartar emetic to f 3j. What are its incompatibles ? Mineral acids, the alkalies and their carbonates, sulphurets, lime-water, and vegetable astringents. What is the dose of the Precipitated Sulphuret ? As an altera- tive 1 to 2 grains; as an emeto-cathartic 5 to 20 grains. What is the dose of the Antimonial Powder, used in imitation of James' powder? From 3 to 8 grains. What other medicines are used as arterial sedatives ? Nearly all the neutral alkaline salts, and those in which the acid predomi- nates ; they are usually called refrigerants, the most prominent of which is nitrate of potassa. Dose 5 to 10 grains every hour or two, in powder or solution. It is frequently combined with tartar emetic. The Vegetable acids are also refrigerant or arterial sedatives. NERVOUS SEDATIVES. What is understood by Nervous Sedatives ? They are remedies that reduce the nervous powers as well as the force of the circula- tion. They all affect the functions of the brain, and rank with those medicines usually called narcotics. 360 MATERIA MEDICA AND PHARMACY. To what class of diseases are nervous sedatives applicable ? To complaints attended with nervous disorder, and unhealthy excite- ment of the heart and arteries. Foxglove, Digitalis. U. S. What are the medicinal properties and uses of the leaves of the Digitalis purpurea, or Foxglove ? They are narcotic, sedative, and diuretic. Active principle digitalin, the dose of which is g^th of a grain. It is best given in substance. Dose 1 grain twice or three times a day; of the officinal infusion (3J to Oss), f^ss ; of the tincture, 10 drops, which is equivalent to 1 grain of the substance. It re- quires caution in its exhibition. Lobelia. U. S. Furnished by the lobelia inflata, which grows abundantly in the United States. The whole herb is officinal, but the seeds are the strongest portion, and should be gathered in August and Septem- ber. Active principle, Lobelina. The dose, as a nervous sedative and nauseant, is 5 grains in powder, repeated every hour or two; tincture, for the same object, f 3j. Aconite. The officinal article is the Aconitum Napellus, growing in the mountainous districts of Central Europe. The leaves and root are the parts used. Active principle, aconitin or aconitia. It is locally irritant, followed by numbness, and generally sedative to the nervous system and the circulation. It is a powerful poison in large doses. It has been used to fulfil the indications of re- ducing morbid excitement of the nervous or circulatory systems. It is used in powder of the leaves in doses of 1 or 2 grains; alcoholic extract of the leaves, ^ grain to 1 grain ; of the extract of 1he root, % of a grain ; tincture of the leaves 20 drops ; tincture of the root 3 to 5 drops, three times a day, and increased gradually It may be applied locally freely for the purpose of relieving local pains ; caution should be observed in applying it to mucous mem- branes and to abraded surfaces. The aconitia may be made into an ointment, and applied locally also. MATERIA MEDICA AND PHARMACY. 361 American Hellebore, Veratrum Viride. U. S. The rhizome of the veratrum viride, which grows in the United States from Maine to Georgia. It is locally irritant, and in its general action it is powerfully sedative to the nervous system and circulation, and stimulates the secretions. It is also emetic in its effects. Its excessive action may be controlled by opiates and alcoholic stimulants. It has been used chiefly in inflammations, fevers and nervous diseases. It is used in powder, dose 1 or 2 grains, every three or four hours; extract (made by drying the expressed juice of the root at a low temperature), ^ to ^ grain ; tincture (.Iviij of dried root to a pint of officinal alcohol, by Dr. Norwood, macerated two weeks), 4 to 8 drops, repeated every three or four hours, if necessary, to produce the desired effects. In what preparations is the Hydrocyanic or Prussic Acid found ? Iu the Cherry Laurel water, and in the Oil of Bitter Almonds. What are its properties and uses ? It is a deadly poison ; one or two drops of the pure acid is sufficient to prove fatal. The medicinal article is diluted, and may be given in does of from 1 to 6, or 8 drops in distilled water, gum water, or syrup. It should be administered with caution, commencing with the smallest dose. The antidotes are chlorine, ammonia, cold affusion, and artificial respiration. What is the active principle of the Nicoliana tabacum,, or Tobacco ? Nicotia, or Nicotin. What is the quantity given as an injection ? Infusion, made of 3ss to Oss at a time. EMETICS. What are Emetics ? Medicines capable of producing vomiting in certain doses, and as an ordinary result. What are the therapeutical effects of emetics ? Evacuation of the stomach, mechanical pressure on the abdominal viscera, reduc- tion of arterial action during the period of nausea, muscular relax- ation, promotion of the secretory functions of the skin, liver, and lungs, powerful agitation of the whole frame, purgation frequently, 31 362 MATERIA MEDICA AND PHARMACY. revulsion to the stomach, depletion, promotion of absorption, shock on the system, and irritation of the stomach. What are the circumstances contraindicaling the use of emetics ? Acute inflammation of the stomach, bowels, or neighboring viscera ; strong sanguineous determination to the brain ; and pregnancy in the advanced stages. Caution should also be observed in cases of hernia. How are emetics usually administered ? Diffused in water, in doses repeated every 15 or 20 minutes until vomiting occurs. When the object is merely to evacuate the stomach, warm diluent drinks should be freely given, chamomile tea is very good ; if we wish a powerful impression made on the system but little drink should be allowed. If vomiting should be excessive, apply a sina- pism over the epigastrium, and laudanum internally, which will generally relieve it: a laudanum injection is also beneficial. Ipecacuanha, U. S. From what is Ipecacuanha obtained? It is the root of the Cephcelis Ipecacuanha, growing in South America. What are its properties and uses? In large doses it is emetic; in smaller, diaphoretic and expectorant; in still smaller, stimulant to the stomach, promoting its healthy actions. Its active principle is emetia. It is mild, and certain in its operation. Dose as an emetic, 15 to 30 grains; as a nauseant, 2 to 3 grains; as a dia- phoretic, | to 2 grains ; as an alterative, \ grain, repeated 2, 3, or 4 times a day. The Wine of Ipecacuanha is emetic in doses of f^j to an adult, and f3j to an infant. Emetic, \ grain ; syrup, about double the quantity of the wine. What is the dose of the root of the Gillenia trifoliata, Indian physic, or American Ipecacuanha ? From 20 to 30 grains. Lobelia, U. S. (Fig. 14.) What are the properties and uses of the Lobelia inflata, or In- dian Tobacco ? Besides emetic, diaphoretic, and expectorant properties, it has sedative properties. The whole plant is active. It bears a close resemblance in its effects to tobacco. It-is tap MATERIA MEDICA AND PHARMACY. 3G3 powerful and distressing, as well as hazardous in its operation for ordinary use. Dose of the powder from 5 to 20 grains, as an emetic; of the tincture, f3j to f 3ij every two or three hours until it acts. Milk-Weed, Euphorbia Corollata. U. S. (Fig. lb.) WThere does the Euphorbia grow? In various parts of the United States. The dried root is emetic in doses of from 10 to 15 grains. What other vegetable substances possess the property of pro- 364 MATERIA MEDICA AND PHARMACY. ducing vomiting, and are occasionally used for that purpose? The root of the Euphorbia Ipecacuanha, in doses of from 10 to 20 grains. Fig. 15. Bloodroot, Sanguinaria. U. S. (Fig. 16.) The root or rhizome of the Sanguinaria Canadensis; active ingredient, sanguinaria. Dose of the powder, from 10 to 20 grains ; of the tincture, f3iij to gss. An acrid emetic. The Squill ; in dose of 6 or 8 grains. Tobacco ; dose of the powder, 5 or 6 grains. Mustard in powder; dose 3j. What is the character of Tartar Emetic as an emetic ? It is characterized by certainty, strength, and permanency of operation. It remains in the stomach longer than ipecacuanha, and exerts a more powerful impression on the system generally. MATERIA MEDICA AND PHARMACY. 365 Dose, 2 to 4 grains, given in divided portions; 1 grain with 10 of ipecacuanha, repeated if necessary, makes a good emetic ; of the Fig. 16. wine f J.ss to f |i, repeated if necessary ; for a child of 1 or 2 years old, 20 to 40 drops. What, are the characteristics of the Sulphate of Zinc as an emetic ? It is characterized by promptness and comparatively little naasea. Used chiefly as a mere evacuant of the stomach in cases re [uiring a prompt and energetic emetic; as in narcotic 31* 366 materia medica and pharmacy. poisons, when it should be combined with ipecacuanha. Dose, 10 grains to 3ss. What are the characteristics of the Sulphate of Copper as an emetic ? It is characterized by promptness and slight nausea, more prompt and powerful than the last article. Seldom used except in narcotic poisoning, where it is given in doses of 5 to 15 grains Alum has been used as a very certain emetic in membranous croup, in doses of one teaspoonful of the powder every fifteen minutes, until it operates. CATHARTICS. What are Cathartics ? They are medicines which produce evacuations from the bowels. They operate : 1. By irritating the mucous membrane of the bowels; 2. By stimulating the exhalant vessels and mucous follicles; 3. By stimulating the liver; and, 4. By absorption. Some act one way and some another, and some by a combined action. Do they operate on all parts of the alimentary canal alike ? No ; some operate on one portion, and some on another, and others on the whole. What is meant by a hydragogue cathartic ? A cathartic which produces large watery evacuations. How are cathartics divided ? Into laxatives, purges, and dras- tics or drastic purges. In what way are cathartics useful in disease ? They evacuate the bowels and relieve constipation ; they directly deplete from the bloodvessels; promote absorption ; act as revulsives; and some by increasing the secretions from the liver, and thereby relieving congestion. Is the action of cathartics modified by combination ? It is ; by mixing several drastics together they become milder without loss of purgative power. Small doses of emetic substances promote their operation ; the same effect is also produced by bitters. Their tendency to gripe may be lessened by aromatics. What circumstances affect the operation of cathartics ? They operate more favorably and speedily when given on an empty stomach. Susceptibility to their action is diminished during sleep and increased by exercise. Mild diluent beverages, such as molassei MATERIA MEDICA AND PHARMACY. 367 and water, barley or rice-water, oatmeal gruel, &c, form proper drinks to be taken before and during the operation of a cathartic. Excessive or hypercath arsis may be checked by a few drops of laudanum. VEGETABLE CATHARTICS. Manna, U. S. From what is Manna procured ? It is the concrete juice of the Ornus Europea and rotundifolia, growing in the south of Europe. There are three varieties : flake, common, and fat manna. The first, or flake, is the result of spontaneous exudation; the common is produced when the season is more advanced, by inci- sions ; the fat is obtained still later in the season ; they are to be preferred in the order named. What are its medical properties and uses ? It is a gentle laxative. Dose sj to Jij. Active principle, mannite. Purging Cassia, Cassia Fistula. U. S. What are the properties and uses of the Cassia Fistula or Purging Cassia? The pulp of the pods is the medicinal portion. It is gently laxative, and given in cases of habitual costiveness. It is au ingredient in the confection of senna. Dose Jss to §j. Castor Oil, Oleum Ricini. U. S. What plant produces the Castor Oil ? The Ricinus Communis, a native of Africa, but cultivated in Europe and in this country. The oil is obtained from the seeds b^ expression. What are its medical properties and uses ? It is a mild cathartic, speedy in its action, and good to remove accumulation of feces in the bowels. Dose for an adult f 3J ; children requiring more in proportion than adults. Rhubarb, Rheum. U. S. Prom what is Rhubarb obtained? It is the root of different 368 MATERIA MEDICA AND PHARMACY. species of Rheum; of which we get three varieties : the Russian, Chinese, and European. The Chinese is the most used, but the Russian is the best. The active principles are rhubarbarin and tannin. What are its medical properties and uses? It combines a cathartic and astringent power ; it is tonic and stomachic in small doses ; roasting increases its astringent, and decreases its purgative effects. Dose as a stomachic and laxative 5 to 10 grains, as a purgative 20 to 30 grains ; of the European variety the dose should be double. There are numerous officinal preparations of rhubarb. Infusum Rhei (3i to Oss), dose fgi to f^ij ; Pilules Rhei (Rhei 3ij, sapon. 3ij, div. in pil.) ; Pilules Rhei Comp. (Rhei gi, Aloes 3vi, Myrrh 3ss, 01. Menth. Pip. f3ss, Syrup. Aurant. q. s. div. in pil.) ; Syrup. Rhei Arom. (Rhei giss, Caryophyll., Cinnam., aa gss, Myristic. 3ij, Alcohol, diluted, Oij, Syrup Ovi), or Spiced Syrup of Rhubarb ; Tinctura Rhei (Rhei §iij, Cardam. §ss, Alcohol, diluted, Oij); Tinctura Rhei et Aloes (Rhei 3x, Aloes 3vi, Cardam. gss, Alcohol Oij), or Elixir Sacrum; Tinctura Rhei et Sennce, or Warner's Gout Cordial; Fluid Extract of Rhubarb (Rhubarb ^viij, Sugar §v, Tinct. Ginger fgss, 01. Fen- nel, 01. Anise, aa., T^piv, Diluted Alcohol q. s). Dose f3j to f^ss. Senna, U. S. From what is Senna obtained? It is the leaves of several species of Cassia. There are three commercial varieties — Alex- andria, Tripoli, and India Senna. What are its properties and uses ? It is a prompt, efficient, and safe purgative. Its active principle is cathartin. Dose of the powder 3j; gene- rally given in infusion, which is officinal 3j to Oj, and given in doses f3ii every 4 or 5 hours. The elixir salutis is a tincture of Senna and Jalap. Dose f3y to f^ss. Its tendency to gripe may be obviated by aromatics. Fluid Extract of Senna (Senna Ibiiss, Sugar %xx, 01. Fennel f3i, Comp. Spt. Ether f 31J, Diluted Alcohol Oiv.) Dose gssto |i. Dose of Confection of Senna 3J to 5ss. materia medica and pharmacy. 369 American Senna, Cassia Marilandica. U. S. What are the properties and dose of the Cassia Marilandica, or Fig. 17. American Senna ? It is similar in properties to senna, but weaker ; dose one-third greater. Butternut, Juglans. U. S. What are the properties and uses of the extract of the Juglan? 370 MATERIA MEDICA AND PHARMACY. cinerea ? It is a mild cathartic, operating without pain, and evacuating the alimentary canal without debilitating. Dose 20 to 30 grains as a purgative, and 10 or 12 grains as a laxative. Aloes, U. S. From what is Aloes procured ? It is the inspissated juice of different species of Aloe. There are three commercial varieties — Cape, Socotrine, and Hepatic Aloes. What are its properties and uses? It is cathartic, operating slowly, but certainly, and has a peculiar affinity for the large intes- tines. It also has a tendency to the uterine system. Dose as a laxative from 2 to 6 grains ; as a purgative 10 to 15 grains. It is usually given in pill. There is a large number of officinal preparations of aloes. Pilulce Aloes et Assafcetida (Aloes, Assafcetida, Saponis, aa). Pilules Aloes (Aloes, Saponis, aa). Pilulce Aloes et Myrrha (Aloes §ij, Myrrh |j, Croci gss, Syrup q. s.), or Rufus' Pills. Pulv. Aloes et Canella (Aloes Ibj, Canella, liij), or Hiera Picra, or Holy Bitter. Tinctura Aloes et Myrrhcs (Aloes ,3iij, Tr Myrrh Oij), or Elix. Proprietatis. Jalap, Jalapa. U. S. (Fig. 18.) From what is Jalap obtained ? It is the root of the Ipomosa Jalapa, or Ipomosa purga, a vine, native of Mexico. What are its properties and uses ? It is an active cathartic, operating briskly, and sometimes with pain, producing copious watery stools. Pulv. Jalapce Comp. (Jalap %i, Potassa Bitart. 5lj-) Dose of the powder, 15 to 30 grains; of the resin of jalap, 8 to 10 grains; of the extract, 10 to 20 grains. May-Apple, Podophyllum Peltatum. U. S. (Fig. 19.) What are the properties and uses of the Podophyllum peltatum? It is an active, certain cathartic, produces copious liquid discharges MATERIA MEDICA AND PHARMACY. 371 Fig. 18, without much griping, or other unpleasant effect. It resembles jalap in its operation, and is applicable whenever a brisk cathartic is required. The dose of the powdered root is about 20 grains. It contains a resinous principle, obtained by Mr. Hodgson, of Philadelphia, called podophyllin, which gives the peculiar property to the root, mainly, the dose of which is about 2 grains. Scammony, Scammonium. U. S. From what is Scammony obtained ? It is the inspissated juice of the Convolvulus Scammonia, growing in Siberia and Asia Minor. There are two varieties in commerce, the Aleppo and Smyrna Scammony. W hat are the medical properties and uses of scammony ? It is an energetic cathartic, apt to occasion griping, and may be used in cases where a powerful impression is desired. It is seldom given alone. Dose, 5 to 10 grains. 372 MATERIA MEDICA AND PHARMACY Fig. 19. Black Hellebore, Helleborus. U. S. What are the properties and uses of the root of the Helleborus niger, or Black Hellebore ? It is a drastic hydragogue cathartic, with emmenagogue powers ; the fresh root applied to the skin will inflame and vesicate. Dose, 10 to 20 grains. It is seldom given alone. It is sometimes called Melampodium. Colocynth, Colocynthis. U. S. From what is Colocynth procured? It is the fruit of the Cucu- mis Colocynthis, deprived of its rind. It is an annual plant, bear MATERIA MEDICA AND PHARMACY. ing considerable resemblance to the common cucumber • native of Turkey. Fig. 20. What are its medical properties and uses ? The pulp is a power- ful, drastic, hydragogue cathartic, producing all the effects of ca- thartics of this class. The dose is 5 to 10 grains. The active principle is colocynthin. It is seldom given alone. The most common form of its exhibition is the compound extract (Colocynth §vi, Aloes |xii, Cardamom gi, Saponis giij, Alcohol, dilut., cong.), which is offioinal. Dose, 10 to 15 grains. Gamboge, Gambogia. U. S. What is Gamboge ? It is the inspissated juice of a tree sup- posed to be Stalagmitis Cambogioides, or Garcinea Cambogia, natives of Asia. What are its properties and uses ? It is a powerful, drastic, hydragogue cathartic ; apt to nauseate and vomit, and used in cases 32 37 h and is a 374 MATERIA MEDICA AND PHARMACY. where such properties are indicated. Dose, 3 to 6 grains in pill or emulsion. It is a constituent in the compound cathartic pill (Ext Colocynth. Comp. gss, Ext. Jalap., Hydrarg. Chlor. Mit., aa 3iij, Gamboge Bij), the dose of which is 3 pills. Elaterium, U. S. What is Elaterium produced from ? The Momordica Elate- Fig. 21. rium, or Squirting Cucumber, a native of Europe. The fruit has the shape of a small oval cucumber, about 1^ inches long, covered with stiff hair or prickles. The elaterium is the substance spon- taneously deposited by the juice of the fruit, rssides in that part which surrounds the seeds, and may be obtained without expression. What are its properties and uses ? It is a powerful hydragogue cathartic, and, in large doses, will excite vomiting. The dose of ordinary commercial elaterium is from 1 to 2 grains, given in £ grain portions, repeated every half hour or hour until it operates. Of the purest (Clutterbuck's) ^ of a grain is a dose The active principle is elateri^. Dose, Jff of a grain. MATERIA MEDICA AND PHARMACY. 375 Croton Oil, Oleum Tiglii. U. S. From what is the Croton Oil procured ? It is the oil of the Fig. 22. Beeds of the Croton Tiglium, a native of the East Indies ; obtained by expression of the seeds after having been deprived of their shell. What are its properties and uses? It is a powerful hydragogue purgative, producing violent effects if given in an overdose. Dose, 1 or 2 drops, administered in pill with a crumb of bread. Ap- 376 materia medica and pharmacy. plied externally, it inflames the skin, and produces a pustular eruption. mineral cathartics. Sulphur. What are the properties and uses of Flowers of Sulphur? It is laxative, diaphoretic, and alterative, is evidently absorbed, and passes off by the skin. Dose, as a laxative, 3j to 31'j. It is used externally as an ointment, and in vapor. How is Lac Sulphuris prepared ? By boiling sulphur and lime in water, filtering, precipitating by muriatic acid, and washing the precipitate. Magnesia, U. S. What are the properties and uses of the Carbonate of Magnesia? It is antacid, and by combining with acid in the stomach becomes cathartic. Dose, 3ss to gij. What are the properties of Calcined Magnesia, or Magnesia usta? It is antacid and laxative ; used very much among children. Dose for an adult, 3J ; for a child two years old, from 10 to 20 grains. saline cathartics. What is the general character of Saline Cathartics ? They are intermediate in power between laxatives and purgatives, produce watery evacuations, operate as arterial sedatives, and do not act harshly. These properties adapt them to inflammatory and active febrile complaints. They closely resemble each other in properties. What are their doses ? Sulphate of Soda, or Glauber's salt; of the crystallized salt, gj to gij ; effloresced, half the quantity. Sulphate of Magnesia, or Epsom salts; dose, gj to gjss. Sulphate of Potassa; dose, gss to gjss. Supertartrate of Potassa, called also cream of tartar; dose, gss to gj. It is frequently combined with jalap as a hydragogue. Tartrate of POtassa, or, soluble tartar; dose, gss to 3j. Tartrate of Potassa and Soda, or Rochelle salt; dose, gj to gjss. It enters into the composition of the Seidlitz Powders, which are tartrate of potassa and soda gij, and bicarbonate of soda MATERIA MEDICA AND PHARMACY. 377 By, in a white paper; and tartaric acid, grs. xxxv, in a blue paper. Phosphate of Soda; dose, |j to gij. Citrate of Magnesia, magnesian lemonade (Acid. Citric. 3ss, Magnes. Carb. Bj, Syrup. Aurant. f 3ij, Aq. destil. fgij)- Effer- vescing solution of Citrate of Magnesia (Acid. Citric. 3ss, Aq. destil. fgj, Syrup. Aurant. f3ij); to be taken with f3x of Dinne- ford's solution of bicarbonate of magnesia in effervescence. What is the officinal name of Calomel ? Mild Chloride of Mercury—Hydrargyri Chloridum Mite—Hydrargyri Chloridum —Protochloride of Mercury — Subchlo?ide of Mercury — some- times improperly called Submuriate of Mercury. What are the tests of purity ? It sublimes freely on the appli- cation of heat, and strikes a black color, free from reddish tinge, by the action of fixed alkalies. The presence of corrosive sublimate may be tested by ammonia. What are its incompatibles ? The alkalies, alkaline earths and their carbonates, soluble hydrosulphates, &c. Nitromuriatic acid probably converts it into corrosive sublimate, and may thus render it very poisonous, also the alkaline chloride, and should, therefore, never be given with it. Howard's calomel is prepared by bringing steam in contact with it while in a state of vapor, which converts it into an impalpable powder, and washes it from corrosive sublimate. What are the medical properties and uses of calomel ? In addition to the general properties of mercurials, it unites those of a purgative and anthelmintic. It is employed to a great extent, and is the most valuable of the mercurial preparations. As a cathartic, its tendency to increase the secretory functions of the liver is its chief value. As an alterative, the dose is ^ a grain every other night, or every night, keeping the bowels at the same time gently open. To pro- duce salivation, the dose is ^ to 1 grain, 3 or 4 times a day, increased if necessary. If it purges, it should be combined with opium; as a,purgative, the dose is 5 to 15 or 20 grains. Larger doses are required in proportion for children than adults. Calomel is frequently combined with other purgatives. It is also frequently employed topically in powder, ointment, and fumigation, 32* 378 MATERIA MEDICA AND PHARMACY. ENEMATA. For what purposes are Enemata employed ? To hasten, facili- tate, or increase the action of cathartics, to operate on the bowels where medicines cannot be propel ly used or retained by the stomach where there is too great a debility to sustain the action of a purga- tive, or there is great feculant accumulation in the lower bowels, and in habitual constipation ; also to obtain the peculiar local or general effects of medicinal articles on the body. A solution of common salt, molasses, and lard, combined, is in common use; warm water alone, or soap and water, also form very good injec- tions. If a more powerful remedy is required, castor oil and oil of turpentine, common salt, or senna tea, are very proper. An emulsion of spirits of turpentine and also of assafoetida are often used in tympanitic conditions of the bowels. When the peculiar effects of remedies are wished, articles adapted to the case should be selected, and administered in some convenient vehicle, such as starch-water or flaxseed tea ; and the bulk should be small, so that they may be retained. They are a valuable class of remedies. DIURETICS. What are Diuretics ? They are medicines which increase the secretion of urine. How do they operate? In one or more of three ways — by entering the circulation, by a sympathetic impression, or by pro- moting absorption. What therapeutic effects may be accomplished by the use of diuretics ? They diminish the quantity of liquid in the circulation ; produce absorption ; purify the blood of excrementitious material; impart to the urine the power of dissolving a larger quantity of saline matter thrown off by the kidneys, and rendering it less irri- tant ; and the lining membrane of the kidneys may also be stirau- tated when debilitated or paralyzed. They are, therefore, used in dropsy, febrile and inflammatory diseases, and in diseases of the kidneys and urinary organs. Squill, Scilla U. S. From what is the Squill obtained ? It is the bulb of the Scilla MATERIA MEDICA AND PHARMACY. 379 maritima, growing on the borders of the Mediterranean. Its active principles are called scillitin, and an acrid substance. What are its medical properties and uses? It is diuretic, expectorant, and, in large doses, emetic and purgative. As a diuretic, it is generally combined with calomel, and used when there is not much inflammatory action existing. Dose as a diuretic or expectorant, 1 to 2 grains, repeated every 2 or 3 hours, and increased in quantity until its action is evinced. As an emetic, from 6 to 12 grains. Meadow Saffron, Colchicum. U. S. What are the properties and uses of the bulb and seeds of the Colchicum autumnale, or Meadow Saffron ? They produce seda- tive effects upon the nervous system as well as stimulate the secre- tions. Given in sufficient doses, they produce disorder of the stomach and bowels, vomiting and purging severely, and should, therefore, be given with some caution. When not carried off by the bowels, diuresis and diaphoresis are produced. They are used in rheumatism and gout Dose of the bulb, or seeds, from 2 to 8 grains ; but it is usually administered in the form of wine. Active principle, colchicia. There are two officinal vinous tinctures. The Vinum Colchici Radicis, the dose of which is from 10 drops to f 3j. The Vinum Colchici Seminis. Dose, f 3ss to f 3j. Dandelion, Taraxacum. U. S. What are the properties and uses of the Leontodon Taraxacum, or Dandelion ? It is slightly diuretic, tonic and aperient; and is thought to have a specific action on the liver. Its properties adapt it to diseases of the digestive organs, and dropsical affections de- pending upon them. An irritable condition of the stomach and bowels, and acute inflammation, contra-indicate its use. Dose, of the officinal decoction, f gij 2 or 3 times a day; of the extract, 20 or 30 grains. 380 MATERIA MEDICA AND PHARMACY. Fig. 23. Juniper Berries, Juniperus. U. S. What are the properties and uses of the fruit of the Juniperus communis, or Juniper Berries ? The active ingredient is a vola- tile oil. The berries are stimulant and diuretic, and, in large doses, pro- duce irritation of the urinary passages ; they are generally used as an adjuvant to more powerful diuretics. It is a native of Europe. Dose, of the infusion (Jj to Oj), one pint during the day, often combined with cream of tartar; of the oil, 5 to 15 drops. Wild Carrot, Carota. U. S. What are the properties and uses of the seeds of the Daucuf Carota, or Wild Carrot? They are gently stimulant and diuretic, and may be used in nephritic affections where the stomach is en- feebled. The active ingredient is a volatile oil. Dose, 3ss to 3j of the bruised seeds ; or one pint of the infusion, made with 3jss to Oj of water, in the 24 hours. Parsley Root, Petroselinum. U. S. What are the properties and uses of the root of the Apium Petroselinum, or Parsley? It is diuretic and aperient; used in strangury. Dose of the infusion indefinite. materia medica and pharmacy. 381 Turpentine, Terebinthina. U. S. From what is turpentine obtained ? It is the juice of different species of the genera Pinus Abies and Larix, and consists of a resin and volatile oil. There are two kinds used in the United States. The common white turpentine, derived principally from the Pinus palustris ; and the Canada turpentine, derived from the Abies balsamifera, or Balsam of fir. Their virtues reside in the volatile oil. What are their medical properties and uses? They are stimu- lant, diuretic, anthelmintic, and laxative. If long continued, they produce irritation of the mucous membrane of the urinary organs. Dose, 10 grains to 3j, in pill or emulsion. The volatile oil, or spirit of turpentine, is generally used, the dose of which is 10 to 20 drops, and repeated It is also used ex ternally as a rubefacient. Buchu. U.S. This consists of the leaves of several small shrubs of Southern Africa, of the genus Barosma. Their virtues depend principally upon a volatile oil, and partly on a bitter principle. It is stimu- lant, tonic, and diuretic. It is used in cases of debility with chronic inflammation of the pelvis, of the kidney, ureters, bladder, and urethra, attended with profuse discharges of mucous or muco- purulent matter. The dose of the powder is 20 or 30 grains, two or three times a day; infusion (Jj to Oj of water), f Jj to f Jij ; tincture, f 3j to f3iv ; fluid extract, f 3j. Copaiva, Copaiba. U. S. From what is the Balsam of Copaiva derived ? It is the juice of the Copaifera officinalis, and other species of the Copaifera, growing in Brazil and Guiana. What are its properties and uses ? Its constituents are a resin and a volatile oil. It is gently stimulant, diuretic, and laxative. It is used in gonorrhoea, leucorrhoea, gleet, chronic dysentery, and in chronic bronchitis. Dose, 10 to 30 drops, 3 times a day ; of the volatile oil, 5 to 15 drops. 382 MATERIA MEDICA AND PHARMACY. Tar, Pix Liquida. U. S. What is tar ? It is an empyreumatic product, and consists of resin held in solution by acetic acid and an empyreumatic oil; colored by carbonaceous matter ; slightly soluble in water. Used in aqueous sohdion (tar water), wine, and vapor. In ointment, it is useful in many cutaneous affections. Creasote is an active ingredient in it. Cantharides, Cantharis. U. S. What are the medical properties and uses of Cantharis vesica- toria, Cantharides, or Spanish flies ? Administered internally, they are powerfully stimulant, and exercise a peculiar influence over the urinary organs. In moderate doses, diuretic. Externally ap- plied, they inflame and vesicate. Dose, 1 or 2 grains of the powder 2 or 3 times daily ; of the tincture, 10 drops as often. What are the doses of the Carbonates of Potassa ? The car- bonate is used in doses of 10 to 30 grains 3 or 4 times a day. The bicarbonate is used in doses of from 3ss to 3j. What are the medical properties and uses of the Acetate of Potassa, or Sal Diureticus ? It is diuretic in doses of from Bj to 3j, every 2 or 3 hours. In large doses, it is cathartic. What are the properties of Bitartrate of Potassa, or Cream of Tartar ? It is diuretic, cathartic, and refrigerant. In small doses, it is a cooling aperient; in large ones, it is a hydragogue cathartic, which renders it useful in dropsies, as well as on account of its diuretic properties. The dose is from 3j to 3ij as an aperient; and from Jss to Jj as a hydragogue cathartic. What are the medical properties and uses of the Nitrate ot Potassa, or Saltpetre ? It is diuretic, refrigerant, and diaphoretic. Dose, as a diuretic, from 10 to 20 grains, repeated. What are the medical properties and uses of Spirit of Nitric Ether, or Sweet Spirit of Nitre ? It is diuretic, diaphoretic, and antispasmodic. Dose, in febrile diseases as a diaphoretic, about 1 teaspoonful. When given as a diuretic, it should be given in larger doses. MATERIA MEDICA AND PHARMACY. 383 DIAPHORETICS. What are Diaphoretics ? They are medicines which promote perspiration. How do they exert a beneficial effect in disease ? By removing constriction of the cutaneous capillaries; by depleting from the bloodvessels ; by revulsion to the surface ; by promoting absorp- tion ; and by eliminating noxious matter from the blood. What circumstances should a patient be subjected to if free per- spiration be required ? He should be confined in bed, well covered, clothed with flannel next the skin, and warm diluent drinks freely given. If there is high inflammatory excitement, the lancet or other depleting remedies should be premised. How are diaphoretics divided ? Into nauseating, refrigerant, and alterative diaphoretics. NAUSEATING DIAPHORETICS What are some of the Nauseating Diaphoretics ? Ipecacuanha, and Tartrate of Antimony and Potassa. With what is ipecacuanha usually combined ? With opium in the form of Dover's Powder, which consists of ipecacuanha 1 grain, opium 1 grain, and sulphate of potassa 8 grains. Dose 10 grains, repeated every 4 or 6 hours. What is the dose of tartar emetic as a diaphoretic ? From y^th to ^th of a grain. REFRIGERANT DIAPHORETICS. What are some of the Refrigerant Diaphoretics ? Citrate of Potassa, Acetate of Ammonia, Nitrate of Potassa, and Spirit op Nitric Ether. How is the Citrate of Potassa used ? In two forms ; the neutral mixture or saline draught, and the effervescing draught. Dose of the former, fjss every hour or two ; of the latter, f Jss of the alka- liue solution, with f Jss of the lemon-juice or the acid solution. They are sometimes combined with tartar enetic, and also with spirits of nitre. 384 materia medica and pharmacy. How is the Acetate of Ammonia used ? In the form of the officinal solution called liquor ammonia acetatis, or Spiritus Min- dereri. Dose, f Jss to f Jj, repeated every 2 or 3 hours. How is Nitrate of Potassa used ? It is usually combined with tartar emetic, ^th of a grain to 10 or 15 grains of the nitrate. How is the Spirit of Nitre used ? It is used in fevers where there is nervous derangement, or a typhoid tendency, and in chil- dren. Dose, 20 drops to f3j, repeated. ALTERATIVE DIAPHORETICS. What are some of the Alterative Diaphoretics ? The products of the Guaiacum officinale, Mezereon, Sassafras, and Sarsaparilla. Guaiac. U. S. What are the products of the Guaiacum- officinale ? The Guai- cum wood, or lignum vitce, and the Guaiac, a concrete juice. The medicinal properties of the wood are owing to the guaic which it contains. It grows in the West Indies and South America. What are the properties and uses of guaic ? It is stimulant, alterative, and promotes the secretions, particularly of the skin. Dose of powder, 10 to 30 grains, with sweetened water or mucilage. There are two officinal tinctures. Dose of either, f3j. The wood is used in decoction, and is an ingredient in the Compound De- coction of Sarsaparilla. Mezereon, Mezereum. U. S. From what is Mezereon obtained ? It is the bark of the root of different species of Daphne; a native of Europe. What are its properties and uses? The recent bark, applied to the skin, inflames and vesicates. Given internally, it is stimu- lant, which may be directed to the skin or kidneys. Dose of the bark, in substance, 10 grains. Generally given in decoction with liquorice root, which is officinal. Dose, a teacupful four times a day. Sassafras. U. S. What are the officinal portions of the Laurus Sassafras? The materia medica and pharmacy. 885 bark of the root (Sassafras Radicis Cortex), and the pith of the twigs (Sassafras Medulla). What are the medical properties and uses of the bark ? It is stimulant and diaphoretic. Its active principle is a volatile oil. Dose, from 2 to 10 drops. The infusion may be given ad libitum. Sarsaparilla. U. S. What are the properties and uses of Sarsaparilla ? It is the root of different species of the Smilax, growing in Mexico, West Indies, and South America. Its active principle is sarsaparillin. It acts upon the secretions, and thereby produces alterative effects. There are numerous officinal preparations. Dose of the powder, 3ss to 3j; of the compound decoction (Sarsap. Jvj : Sassaf., Guaiac, Glycyrrhiz., aa Jj ; Mezer. 3iij ; Aquae Oiv), f Jiv ; of the compound syrup (Sarsap. Itij ; Guaiac. Jiij ; Ros. centifol., Sennas, Glycyrrhiz., aa Jij ; 01. Sassafras, 01. Anisi, aa TJPv; 01. Gaultheria IJpiij ; Alcohol dibit. Ox ; Sacchr. Ibviij), Jiiss ; of the alcoholic extract, 10 to 20 grains; of the fluid extract (Sarsap Jxvj; Rad. Glycyrrhiz., Rad. Sassaf., aa Jij; Mezereon 3vj ; Sacchr. Jxij ; Alcohol dilut. Oviij), f 3j. EXPECTORANTS. What are Expectorants ? They are medicines which increase the secretion from the mucous membrane of the air-cells and air- passages of the lungs ; or facilitate its discharge. How do expectorants act ? 1. By directly stimulating the bronchial secretion through the medium of the circulation. 2. By reduction of irritation and active congestion of the bronchial mucous membrane. 3. By moderate excitation of the circulation in the lungs. 4. By diminishing the amount of matter thrown out into the air-passages, in relaxed states of the tissues, thus enabling the organs to expel it with more facility. This is effected by what are called stimulating expectorants. 5. By stimulating the muscular power by stimulants when it is deficient. 6. By local applications to the bronchial mucous membranes by inhalation. As the thera- peutic indications differ in different cases requiring expectorants, 33 i- 386 MATERIA MEDICA AND PHARMACY. the remedies calculated to effect one or the other of the above objects must be selected according to circumstances. What circumstances should a patient be subjected to while using expectorants ? The surface should be kept warm, and flannel worn next to the skin. Are emetic substances usually expectorant in small doses ? Yes; ipecacuanha in doses of 1 to 2 grains; tartar emetic in dose of Jth of a grain; and their preparations also in this proportion. What are the properties and uses of Squill as an expectorant ? It stimulates the vessels of the lungs; and where there is much inflammation it should be preceded by blood-letting. The officinal preparations are the vinegar, syrup, oxymel, and tincture. Dose of vinegar, f3ss to f3j; of syrup and oxymel, from f3j to f3ij; of tincture, from 20 to 40 drops. What are the properties and uses of the bulb of the Allium Sativum, or Garlic? It is a general stimulant, and promotes expectoration in debilitated states of the lungs. The expressed juice is often given to children with sugar. Dose, f3ss to f3j. Fig. 24. materia medica and pharmacy. 387 Senega. U. S. (Fig. 24.) What are the properties and uses of the root of the Polygala Senega, or Seneka ? It active principle is senegin. It is a stimulating expectorant, and diuretic; it also acts more or less on all the secretions. Dose of powder, from 10 to 20 grains ; of decoction, made by boiling Jj of the root with Jj of liquorice root in Ojss of water to Oj, given in doses of f Ji to f Jij, 3 or 4 times a day. It is an ingredient in Coxe's Hive Syrup. Fig. 25. 388 MATERIA MEDICA AND PHARMACY. Black Snakeroot, Cimicifuga. U. S. (Fig. 25.) What are the properties and uses of the root of the Cimicifuga racemosa, or black snakeroot, or cohosh ? It stimulates the secre- tions, and particularly those of the skin, kidneys, and bronchial mucous membrane. Dose of powder, 10 to 30 grains; decoction, f Jj to f Jij, re- peated frequently. Ammoniac, Ammoniacum. U. S. From what is Ammoniac obtained? It is the inspissated juice of the Dorema Ammoniacum, an umbelliferous plant, growing in Persia. It comes in tears and masses. What are its properties and uses ? It is a stimulant and expec- torant gum resin ; mostly used in chronic catarrh, asthma, and other pectoral diseases. Dose, 10 to 30 grains in emulsion or pill. Lac Ammoniaci (Ammoniac 3ij ; Aquae Oss) Jss to Jj, when given alone; it is, however, more frequently giveu in combination, or forms a vehicle for other remedies. Assafcetida. U. S. What is the character of Assafcetida as an expectorant? It is an efficient expectorant and moderate stimulant. Dose, 5 to 15 or 20 grains, in pill or emulsion. Mistura Assafcetida, Lac Assafcetida (Assafcetida 3ij ; Aquae Oss), Jss to Jij for an adult. Balsam of Tolu, Tolutanum. U. S. From what is the Balsam of Tolu obtained ? The Myroxylon Toluiferum, a tree growing in tropical America. Its essential constituents are a resin, volatile oil, and benzoic acid. It is pro- cured by incising the trunk of the tree, and collecting the juice. What are its medical properties and uses? It is a gently stimulating expectorant. Dose, 10 to 30 grains in emulsion, of the tincture, f3j to f3ij. materia medica and pharmacy. 389 Balsam of Peru, Myroxylon. U. S. What are the properties and uses of the balsam of the Myroxy- lon Peruiferum, or Peruvian Balsam ? Its constituents are a resin, volatile oil, and benzoic acid. It is a warm, stimulating tonic, and expectorant. . Dose, f 3ss. Storax. Dose, 10 t<5 30 grains. Benzoin. Dose, 10 to 30 grains. Copaiba. Dose, 20 to 30 drops, in emulsion. Myrrh. Stimulating expectorant. Dose, 10 to 30 grains. Galbanum. Dose, 10 to 30 grains. Elecampane, or Inula. Dose of decoction (Jss to Oj), f Jj to Wood Naphtha. Dose, 10 to 40 drops, three times a day, when an excitant expectorant is needed. The Demulcent Expectorants are : Gum Arabic, Marshmallow, Almonds, Olive Oil, Spermaceti, Sugar, Liquorice, Flaxseed, Tragacanth, Benne, Sassafras, Slippery Elm Bark, Iceland Moss, &c. CHOLAGOGUES. What is meant by the term Cholagogues ? Medicines which increase the flow of bile, either by increasing the secretion or facili- tating its discharge from the gall-bladder. Remedies may effect this object by relieving irritation and congestion of the liver; by exciting the portal circulation, mechanically or otherwise; heat may excite the hepatic function, and also irritant substances applied to the mucous coat of the duodenum. The medicinal substances having cholagogue properties are mercurials, nitromuriatic acid, chlorine water, aloes, and dandelion. EMMENAGOGUES. What are Emmenagogues ? They are medicines which promote the menstrual discharge. How do emmenagogues act ? They may act either through the medium of the circulation ; or by an impression being made else- where, and extended sympathetically to the uterine vessels. 33* 390 materia medica and pharmacy. How should they be given so as to produce their full effect ? A short time before the regular period of menstruation. The state of the uterine and general system should be carefully considered; if plethoric, their use should be preceded by depletion, and the milder ones of the class should be used. If debility exist, those of a tonic or stimulant character should be used ; and if constipation attend, the cathartic emmenagogues are indicated. What are the properties of the Chalybeates as regards their emmenagogue power ? They are considered to be inferior to no other remedies in this respect, and are applicable where there is no local inflammation or general excitement. They are often combined with aloes and myrrh. What are the properties of Aloes as an emmenagogue? It is very effective, and believed to exert a specific influence on the uterine vessels, independent of its cathartic property. Dose, 1 or 2 grains, 2 or 3 times a day. It may also be given in enema, about the period when menstruation should come on. What is the dose of Black Hellebore as an emmenagogue ? From f3ss to fji of the tincture, 2 or 3 times a day. What are the properties of Guaiac as an emmenagogue ? It is applicable in cases associated with rheumatism, particularly in its neuralgic forms. Used in dysmenorrhcea either in the simple or ammoniated tincture. Dose, f^j, 3 or 4 times a day. What are the properties of the leaves of the Juniperus Sabina, or Savine? They are highly stimulant, increase most of the secre- tions, and particularly those of the uterus. The active principle is a volatile oil, called oil of savine. It should be avoided in pregnancy. Dose of the powder, from 5 to 20 grains, 2 or 3 times a day ; of the oil, from 2 to 5 drops. The plant is a native of Europe. What are the properties of Cantharides as an emmenagogue ? They exert a powerful stimulant effect over the urinary and genital organs. Dose of the tincture, 10 to 30 drops three times a day. EPISPASTICS. What are Epispastics ? Medicines that produce a blister when applied to the skin. They are called also vesicatories. MATERIA MEDICA AND PHARMACY. 391 How do they exert a remedial influence ? By acting indirectly as general stimulants; by their revulsive action ; by substituting their own action for a diseased one in the part to which they are applied; by their local stimulus ; by producing local depletion ; by the pain they occasion, which may be useful in hypochondriacal cases; and they are employed to separate the cuticle for the pur- pose of applying medicines. Spanish Fly, Cantharis. U. S. What are the officinal preparations of the Cantharis vesicatoria, or Spanish Fly, as an epispastic ? The Cerate of Spanish Flies, commonly called Blistering Plaster. Used for blistering. The Ointment, used for maintaining a discharge. The Plaster of Pitch with Spanish flies. Used as a rubefacient plaster. The Liniment of Spanish flies, generally called Decoction of Flies in Oil of Turpentine. Used as an external stimulant. W7hat are the remedies for strangury produced by cantharides ? The milder diuretics, such as uva ursi, sweet spirit of nitre, muci- lages, &c. Where are cantharides procured ? In Spain and Italy. Active principle, canlharidin. What are the properties of the indigenous insect, the Cantharis Vittata, or Potato fly ? They are similar to the Spanish flies ; the chemical composition and uses the same. RUBEFACIENTS. What are Rubefacients ? They are medicines which inflame the skin, and produce redness without ordinarily vesicating. What are the indications for the use of this class in preference to blisters ? In cases where a sudden and powerful action is neces- sary ; and in cases where a slight but long-continued action is desired — in which case the milder articles should be employed. Will you enumerate the rubefacients commonly employed ? The seeds of the Sinapis alba and S. Nigra, distinguished as white and black mustard ; Cayenne Pepper; Oil of Turpentine ; Burgundy Pitch, which is the product of the Abies Communis, growing in 392 MATERIA MEDICA AND PHARMACY. the north of Europe; Hemlock Pitch, or Pix Canadensis, "ery analogous to the Burgundy Pitch ; and Aqua Ammonice, which ia much used in combination with sweet oil as volatile liniment. ESCHAROTICS. What are Escharotics ? They are substances which destroy the life of the part to which they are applied, and produce sloughiug. They operate by chemical agency, or by influencing the vitality of the part directly. What substances are used for this purpose ? The Actual cautery; Moxa ; Potassa, or common caustic; Nitrate of Silver, or Lunar caustic; Arsenious Acid, or the white oxide; Sulphate of Cop- per; Chloride of Mercury, or Corrosive sublimate; Burnt Alum ; and the Mineral Acids. DEMULCENTS ? What are Demulcents ? They are bland substances which form a viscid solution with water. How do demulcents act ? When applied to an inflamed surface, they protect it against irritating matters. Mixed with acrid sub- stances, they blunt their acrimony, which are thereby rendered less irritating to parts with which they come in contact. Wrhat medicines are used as demulcents ? Gum Arabic, the product of several species of the Acacia; Tragacanth; Slippery Elm Bark, or the inner bark of the Ulmus fulva; Flaxseed, or the seeds of the Linum usitatissimum; Liquorice Root, or the root of the Glycyrrhiza glabra ; Iceland Moss, or Lichen Islandi- cus; Irish Moss, or Carrageen ; Sago, the product of the Sagus Rumphii; Tapioca, the product of the Jatropha Manihot of tropical America ; Arrow-Root, the product of the Maranta arun- dinacea of the West Indies ; and the Barley, called commonly pearl barley, or hordeum perlatum. EMOLLIENTS. What are Emollients ? They are substances which retain moisture, and form a soft mass, without irritating properties. MATERIA MEDICA AND PHARMACY. 393 DILUENTS. What are Diluents ? They are liquids which dilute the contents of the stomach and bowels, fill the bloodvessels, and increase and dilute the secretions. Water is the great diluent, to which addi- tions are made to give it flavor. MEDICINES UNCLASSIFIED. Ergot. U. S. From what is Ergot obtained ? It is a product of the Secale cereale, or common rye, What are its properties and uses ? It yields its virtues to water and alcohol. Its active principle is ergotin. It exhibits a strong tendency to the uterus, and operates with energy upon its contract- ile property; and reduces the frequency of the pulse. Bread made from rye contaminated with it, and long used, will, it is supposed, produce dry gangrene, typhus fever, diseases of the nervous system &c. It is adapted to lingering cases of labor, where the os uteri is dilated, the external parts relaxed, and no mechanical impediment exists ; the delay being ascribable solely to a want of energy in the uterus. Dose of the powder, 20 to 30 grains ; of the infusion, Jj, made with 3j of the ergot to f Jiv of water, to be repeated every 20 minutes until its peculiar effects are produced, or 3ij are given; of ergotin 5 to 10 grains. Nux Vomica. U. S. From what is the Nux Vomica obtained ? It is the seed of the Strychnos Nux Vomica, a tree growing in the East Indies. The active ingredients are strychnia and brucia. What are its properties and uses ? In very small doses, it is tonic, and operates upon the secretions. In larger doses, so as to produce a decided effect, its action is chiefly directed to the nerves of motion, producing a tendency to permanent, involuntary, mus- 394 MATERIA MEDICA AND PHARMACY. cular contraction. It is sometimes used in paralytic affections, and its action appears to be particularly directed to the parts affected. It has also been recommended as an antiperiodic; supposed by some to possess more permanency of action than quinine in the cure of intermittents. Dose of the powder, 5 grains ; of the alco- holic extract, from ^ to 2 grains; of strychnia, from -J2th to £th of a grain. Arsenic, Arsenicum. U. S. What are the properties and uses of Arsenious Acid ? Inter- nally, it is alterative, febrifuge, and tonic, and peculiarly applicable in diseases of a periodical character. The effects should be care- fully noted, and when there is any disposition to oedema produced, especially of the face and eyelids, or a feeling of stiffness, tender- ness of the mouth, prickling in the eyelids, &c, it should be dis- continued immediately. It has been used in scirrhus, anomalous ulcers, intermittent fever, diseases of the bones, and in cutaneous diseases. It is an ingredient in nearly all empirical, external remedies for cancer. Dose, Jgth of a grain in pill, and taken 3 times a day; of Fowler's solution, 10 drops, 2 or 3 times a day. Mercury, Hydrargyrum. U. S. What are the preparations of Mercury that are used medicinally, and their doses as alteratives or sialagogues ? Mercurial Oint- ment, or Unguentum Hydrargyri; Mercurial Plaster, or Em- plastrum Hydrargyri ; Mercurial Pills, or Pilules Hydrargyri, commonly called blue pills. Dose, 1 pill 3 times a day as a sia- lagogue; 1 every night, or every other night as alterative. Tho officinal pill weighs 3 grains, and contains 1 grain of mercury; Mercury with chalk, or Hydrargyrum cum Cretd, dose, 5 to 20 grains twice daily; Black Oxide of Mercury, or Hydrargyri Oxidum Nigrum, dose 1 to 3 grains 2 or 3 times a day; Red Oxide of Mercury, or Hydrargyri Oxidum Rubrum, commonly called red precipitate, used externally as an escharotic and stimu- lant—the officinal ointment called Unguentum Hydrargyri Oxidi Rubri; Mild Chloride of Mercury, or Hydrargyri Chloridum Mite, commonly called calomel, dose, from ^ a grain to 1 grain 3 MATERIA MEDICA AND PHARMACY. 395 times daily; Corrosive Chloride of Mercury, Hydrargyri Chlo- ridum Corrosivum, commonly called corrosive sublimate, dose from £th to |th of a grain 3 or 4 times a day ; Yellow Sulphate of Mercury, or Hydrargyri Sulphas Flavus, commonly called Turpeth mineral, dose, as an alterative, from ^ a grain to 1 grain, and from 2 to 5 grains as an emetic—seldom used — sometimes as an errhine, diluted with five parts of starch; Ammoniated Mer- cury, or Hydrargyrum Ammoniatum, commonly called white precipitate, used externally ; Nitrate of Mercury, used only as an ointment, called the Ointment of Nitrate of Mercury, or Ungu- entum Hydrargyri Nitratis, commonly called citrine ointment; Red Sulphuret of Mercury, Hydrargyri Sulphuretum Rubrum, commonly called cinnabar, used only for fumigation ; Black Sul- phuret of Mercury, or Hydrargyri Sulphuretum Nigrum, for- merly called Ethiops mineral, scarcely ever used at present. Iodine. U. S. What are the properties and uses of Iodine ? It operates as a general excitant, but particularly of the glandular and absorbent systems. If long continued, or given in very large doses, it gives rise to derangement of the nervous system, restlessness, palpitation, a sense of burning along the gullet, excessive thirst, acute pain in the stomach, violent cramps, rapid and great emaciation, and frequent pulse. The condition of the system in which any of these poisonous effects are exhibited is called iodism. It is used in glandular enlargements and morbid growths. Dose £ to ^ of a grain 3 times a day. It is never used in powder, but dissolved in alcohol or a watery solution of the iodide of potassium. Dose of the officinal tincture, 10 to 20 drops. The Iodide of Potassium is officinal. Dose, 1 to 2 grains. Lugol's solution is iodine Bj\ iodide of potassium Bij, and water 3vii. Dose, 6 drops, repeated. Iodine ointment, J j of lard, and 9j of iodine. Also iodine gr. v, hydriod. potassa? Bj, ung, hydrarg. Jj, rubbed well together. 396 MATERIA MEDICA AND PHARMACY ANTACIDS. What are Antacids ? Substances capable of combining with and neutralizing acids. What substances are used as antacids ? The carbonates of potassa and soda, ammonia, lime, and magnesia. ANTHELMINTICS. What are Anthelmintics ? Substances which operate on Trorms in the alimentary canal, and render them easy of expulsion. Pinkroot, Spigelia. U. S. (Fig. 26.) From what is Pinkroot obtained ? It is the root of the Spigelia Marilandica, and is tne only part of the plant which is officinal. What are its properties and uses ? It is considered to be one of the most powerful of the anthelmintics. In over doses, it deter- mines to the brain, giving rise to vertigo, dimness of vision, spasms, &c. Dose of the powder for a child from 2 to 4 years old, 10 to 20 grains, repeated twice a day, and followed by a cathartic ; sometimes it is combined with calomel; of the infusion, for a child, f Jss to f Jj, 3 or 4 times a day, made with Jss of the root to Oj of water; often given with Jss of senna added, in the same dose. Pride of China, Azedarach. U. S. What are the properties of the bark of the root of the Melia Azedarach, or Pride of China ? Used in decoction, made by boiling Oij of water with Jiv of the fresh root to Oj. Dose for a child, Jss every 2 or 3 hours, and followed by a cathartic. Wormseed, Chenopodium. U. S. From what is Wormseed obtained ? They are the seeds of the Chenopodium Anthelminticum. What is the dose ? In substance, bruised, Bj to B]j f°r a cnu^5 of the volatile oil, from 4 to 8 drops for a child, repeated twice a day. MATERIA MEDICA AND PHARMACY. 397 Fig. 26. What are the properties and uses of Cowhage ? The spiculae are vermifuge, and act mechanically on the worm. Dose of the electuary for an adult, Jss; for a child 3 or 4 years old, 3j. What is the dose of the oil of turpentine as an anthelmintic ? For an adult, from f Jss to f Jij, or even more, followed with castor oil; for children, in proportion. 34 398 MATERIA MEDICA AND PHARMACY. What is the dose of Stannum, or Tin, as an anthelmintic? From 3j to Jj. "What are the properties of Pomegranate Bark ? The bark of the root is powerfully anthelmintic ; used in the expulsion of tapeworm. Used in decoction (Jij in Oij of water boiled to Oj), one-third to be taken every half hour. SIGNS AND ABBREVIATIONS. 399 TABLE OF SIGNS AND ABBREVIATIONS. Recipe. Ana. Libra vel librae. Uncia vel unciae. Drachma vel drachmae. Scrupulus vel scrupuli. Octarius vel octarii. Fluiduncia vel fluidunciae. Fluidrachma vel fluidrachmae. Minimum vel minima. Chartula vel chartulae. Cochlear vel cochlearia. Collyrium. Congius vel congii. Decoctum. Fiat. Gargarysma. Granum vel grana. Gutta vel guttae. Haustus. Infusum. Misce. Massa. Mistura. Pilula vel pilulae. Pulvis vel pulveres. Quantum sufficit. Signa. Semis. Take. Of each. A pound or pounds. An ounce or ounces. A drachm or drachms. A scruple or scruples. A pint or pints.. A fluidounce or fluidounces. A fluidrachm or fluidrachms. A minim or minims. A small paper or papers. A spoonful or spoonfuls. An eye-water. A gallon or gallons. A decoction. Make. A gargle. A grain or grains. A drop or drops. A draught. An infusion. Mix. A mass. A mixture. A pill or pills. A powder or powders. A sufficient quantity. Write. A half. 400 EXAMPLES OF COMMON EXAMPLES OF COMMON EXTEMPORANEOUS PRESCRIPTIONS. Powders. JJ. Antimonii et Potassse Tartratis, gr. i. Pulveris Ipecacuanhae, "!)i. Fiat pulvis. S. To be taken in a wineglassful of sweetened water. An active emetic. R. Hydrargyri Chloridi Mitis, Pulveris Jalapae, aa gr. x. Misce. S. To be taken in syrup or molasses. An excellent cathartic in the com- mencement of bilious fevers, and in hepatic congestion. R. Pulveris Jalapae, gr. x. Potassee Bitartratis, 3H. Misce. S. To be taken in syrup or molasses. A hydragogue cathartic, used in dropsy and scrofulous inflam- mation of the joints. R. Sulphuris, 31. Potassae Bitartratis, 311. Misce. S. To be taken in syrup or molasses. A laxative, used in piles and cuta- neous diseases. R. Pulveris Rhei, gr. x. Magnesias, 33s. Fiat pulvis. S. To be taken in syrup or molasses. A laxative and antacid, used in diarrhoea, dyspepsia, &c. R. Pulveris Scillae, gr. xii. Potassae Nitratis, 3L Fiat pulvis, in chartulas sex divi- dendus S. One to be taken twice or three times a day in syrup or molasses. A diuretic, employed in dropsy. R. Potassae Nitratis, 3L Antimonii et Potassae Tartratis, gr. i. Hydrargyri Chlorid. Mitis, gr. vi. Fiat pulvis, in chartulas sex divi- dendus. S. One to be taken every two hours in syrup or molasses. A refrigerant, diaphoretic, and al- terative, used in bilious fevers; usually called nitrous powders. R. Pulveris Guaiaci Resinae, Potassae Nitratis, aa 3L Pulveris Ipecac, gr. iii. Opii, gr. ii. Fiat pulvis, in chartulas sex divi- dendus. S. One to be taken every three hours in syrup or molasses. A stimulant diaphoretic, used in rheumatism and gout after suffi- cient depletion. R. Ferri Subcarbonatis, Pulveris Columbae, Pulveris Zingiberis, aa 3L Fiat pulvis, in chartulas sex divi- dendus. S. One to be taken three times a day in syrup or molasses. A tonic, used in dyspepsia and general debility. Pills. R. Pulveris Aloes, Pulveris Rhei, aa 3S8. Saponis B*- EXTEMPORANEOUS PRESCRIPTIONS. 401 Misce, et cum aqua fiat massa in pilulas viginti dividenda. S. Two or three to be taken daily, at bedtime, or before a meal. An excellent laxative in habitual constipation. R. Massse Pilularum Hydrargyri, Pulveris Aloes, Pulveris Rhei, aa ^i. Misce, et cum aqua fiat massa in pilulas viginti dividenda. S. Three to be taken at bedtime. An alterative and laxative, useful in constipation, with deranged or deficient hepatic secretion. R. Pulveris Aloes, Extracti Quassiae, aa 31. Olei Anisi, IJPx. Syrupi, q. s. Misce, et fiat massa in pilulas tri- ginta dividenda. S. Two to be taken once, twice, or three times a day. A laxative, tonic, and carminative. useful in dyspepsia. R. Pulv. Rhei, Sapo Alba, Myrrhae, Assafnetida, aa 3SS. Misce, et fiat massa in pilulas tri- ginta dividenda. 8. One or two to be taken after each meal. Useful in promoting digestion, and relieving pain and uneasiness of the stomach. R Pulveris Scillae, B*- Hydrargyri Chloridi Mitis, gr. x. Pulveris Acaciae, Syrupi, aa q. s. Misce, et fiat massa in pilulas decern dividenda. S. One to be taken two or three times a day. A diuretic and alterative, much used in dropsy, especially when 34* 2 complicated with organic vis- ceral disease. R. Pulveris Opii, gr. iv. Pulveris Ipecacuanhae, gr. xvii. Pulveris Acaciae, Syrupi, aa. q. s. Misce, et fiat massa in pilulas duo- decim dividenda. S. One to be taken after each stool. An anodyne diaphoretic, useful in dysentery and diarrhoea, after the use of laxatives. R. Pulveris Opii, Pulveris Ipecacuanhae, aa gr. iii. Hydrargyri Chloridi Mitis, gr. iv. Pulveris Acaciae, Syrupi, aa q. s. Misce, et fiat massa in pilulas tres dividenda. S. One or more to be taken at bed- time, or according to circum- stances. An anodyne, diaphoretic, and al- terative, very useful in diarrhoea, dysentery, typhoid pneumonia, and various other diseases. R. Plumbi Acetatis in pulverem triti, gr. xii. Pulveris Opii, gr. i. Pulv. Acaciae, Syrupi, aa q. s. Ut fiat massa in pilulas sex divi- denda. S. One every two, three, or four hours. An astringent much employed in haemoptysis and uterine hemor- rhage. Mixtures. R. Magnesiae, 31. Syrupi, f Ji. Tere simul, et effunde Aquae Acidi Carbonici, f Jiv. Fiat haustus. S. To be taken at a draught, the mix- ture being well shaken. 402 EXAMPLES OF COMMON Au agreeable mode of administer- ing magnesia. R. Mannae, Ji. Foaniculi contusi, 31. Aquae bullientis, f Jiv. Fiat infusum et cola; dein adjice. Magnesiae carbonatis, 3ii. Ft. Mist. S. One-third to be taken every three or four hours till it operates, the mixture being shaken. An excellent carminative and mild laxative, in flatulence and pain in the bowels. R. Olei Ricini, f Ji. Pulveris Acaciae, Sacchari, aa 3H. Aquae Menthae Piperitae, f Jiii. Acaciam et saccharum cum fluid- uncia dimidia aquae menthae tere; dein oleum adjice, et con- tere; denique aquam reliquam paulatim infunde, et omnia misce. S. To be taken at a draught, the mix- ture being well shaken. R. Olei Ricini, f Ji. Vitellum ovi unius. Tere simul, et adde, Syrupi, f Jss. Aquae Menthae Piperitae, f Jii. Ft. haust. S. To be taken at a draught, the mix- ture being well shaken. This and the preceding formula afford convenient modes of ad- ministering castor oil, when the stomach is irritable. Any other Ixed oil may be given in the same way. R. Olei Ricini, f Jiss. Tinctura Opii, W xxx. Pulv. Acaciae, Sacchari, aa 3ij. Aquae Menthae Viridis, f Jiv. Acaciam et saccharum cum palulo aquae menthae tere; dein oleum adjice, et iterum tere; denique aquam reliquam paulatim in- funde, et omnia misce. S. A tablespoonful to be taken every hour, or two hours, till it ope- rates, the mixture being each time well shaken. Used as a gentle laxative in dysen- tery and diarrhoea. It is usually known by the name of oleaginous mixture. R. Elaterii, gr. i. Spiritus JDtheris Nitrici, f^ij. Tincturae Scillse, Oxymellis Colchici, aa f3ss. Syrupi, f Ji. Ft. Mist. S. A teaspoonful to be taken three or four times a day in a little water. Diuretic, used in Ferriar dropsy. R. Copaibas, Spiritus Lavandulae Comp., aa f3ii. Mucilaginis Acaciae, f 33s. Syrupi, f 3m. Simul tere; dein paulatim affunde, Aquas, f Jiv. Misce. S. A tablespoonful to be taken foul times a day, or more frequently. Given in chronic catarrhs, and chronic nephritic affections. The dose must be larger in gonor- rhoea. Neutral Mixture. R. Acidi Citrici, f ^ii. Olei Limonis, IfPi. Simul tere, et adde, Aquae, f Jiv. Liqua, et adde, Potassae Carbonatis, q. 8. ad satu rand. Misce, et per linctum cola. Or, R. Succi Limonis recentis, f Jiv. EXTEMPORANEOU Potassae Carbonatis, q. s. ad satu- randum. Misce et cola. S. A tablespoonful to be given with an equal quantity of water every hour or two hours.- An excellent diaphoretic in fever. Effervescing Draught. R. Potassae Carbonatis, 3H. Aquae, f Jiv. Liqua. Or, R. Potassae Bicarbonatis, 311J. Aquae, f Jiv. Liqua. S. Add a tablespoonful of the solution to the same quantity of lemon or lime juice, previously mixed with a tahlespoonful of water; and give the mixture, in a state of effervescence, every hour or two hours. An excellent diaphoretic and anti- emetic in fever, with nausea or vomiting. Brown Mixture. R. Pulv. Extract. Glycyrrhizae, Pulv. Acaciae, aa 3ii. Aquae ferventis, f Jiv. Liqua, et adde, Vini antimonii, f 3H. Tincturae Opii, T1PXX- Ft. Mist. S. A tablespoonful to be taken occa- sionally. Expectorant, demulcent, and ano- dyne, useful in catarrhal affec- tions. R. Antimonii et Potassae Tartratis, gr- j- Syrupi Scillae, Liquoris Morphiae Sulphatis, aa fjss. Pulveris Acaciae, 3ii. S PRESCRIPTIONS. 403 Syrupi, f Jss. Aquae fluvialis, f Jiv. Ft. Mist, S. A tablespoonful to be taken occa- sionally. An expectorant and anodyne cough mixture. R. Acidi Nitrosi, f gi. Tincturae Opii, gtt. xl. Aquae Camphorae, f Jviii. Misce. S. One-fourth to be taken every three or four hours. Hope's mixture, used in dysentery, diarrhoea, and cholera. R. Camphorae, 31. Myrrhae, 3SS. Pulv. Acaciae, Sacchari, aa 3a. Aquae, f Jvi. Camphoram cum alcoholis paululo in pulverem tere; dein cum myrrha, acacia, et saccharo con- tere; denique cum aqua paula- tim instillata misce. S. A tablespoonful to be taken for a dose, the mixture being well shaken. A convenient form for administer- ing camphor. R. Cretce preparatae, Biy- Massae Pil. Hydrarg, gr. viii. Tincturae Opii, gtt. viii. Pulveris Acaciae, Sacchari, aa 3!. Aquae Cinnamomi, Aquae, aa f 3. Solida simul tere, dein liquida pau- latim inter terendum adjice, et omnia misce. A teaspoonful to be taken for a dose, the mixture being well shaken. An antacid and alterative mixture, well adapted to infantile diar- rhoea with white stools. The 404 EXAMPLES OF COMMON dose mentioned is for a child a year or two old, and may be repeated four or six times in twenty-four hours R. Pulveris Kino, 3H. Aquae bullientis, f Jvi. Fiat infusum et cola; dein secun- dum artem admisce. R. Cretae praeparatae, 3iii. Tincturae Opii, f 3SS. Spiritus Lavandulae compositi, fjss. Pulveris Acaciae, Sacchari, aa 3ii. S. A tablespoonful to be taken for a dose, the mixture being well shaken. Astringent and antacid, useful in diarrhoea. Solutions. R. Magnesias Sulphatis, Jj. Syrupi Limonis, f Ji. Aquae Acidi Carbonici, f Jvi. Misce. S. To be taken at a draught. An agreeable mode of administer- ing sulphate of magnesia. R. Potassae Nitratis, 3L Antimonii et Potassae Tartratis, gr. i. Aquae fluvialis, f Jiv. Liqua. S. A tablespoonful to be taken every two hours. A refrigerant diaphoretic, used in fevers. R. Magnesiae,Sulphatis, Jj. Antimonii etPctassae Tartratis,gr.i. Succi Limonis recentis, f Ji. Aquae, f Jiii. Misce. S. A tablespoonful to be taken every two hours till it operates on the bowels. Useful in fevers. E£. Quinios Sulphatis, gr. xii. Acidi Sulphurici Aromatici, TTPxx. Syrupi, f Jss. Aquae Menthae Piperitae, f Ji. Misce. 3. A teaxpoonful to be taken every hour, or two hours. A good mode of administering sul- phate of quinia in solution. Infusions. R. Sennae, sjiii. Magnesiae Sulphatis, Mannae, aa Jss. Fceniculi, 31. Aquae bullientis, Oss. Macera per horam in vase leviter clauso et cola, S. Give a teacupful every three or four hours till it operates. An excellent purgative in febrile complaints. R. Columbae Contusae, Zingiberis contusii, aa Jss. Sennae, 3H. Aquae bullientis, Oi. Macera per horam in vase leviter clauso et cola. S. A wineglassful to be taken morn- ing, noon, and evening, or less frequently, if it operates too much. An excellent remedy in dyspepsia, with constipation and flatulence. R. Spigeliae, Jss. Sennae, 3ii. Mannae, Jj. Fceniculi, 3H. Aquae bullientis, Oi. Macera per horam in vase leviter clauso et cola S. A winegLissful to be given to a child from two to four years old, three or four times a day A powerful anthelmintic. EXTEMPORANEOUS PRESCRIPTIONS. 405 R. Pulveris Cinchonas. Rubrae, Ji. Acidi Sulphurici Aromatici, f Ji. Aquas, Oi. Macera per horas duodecim, sub- inde agitans. 8, A wineglassful of the clear liquid to be taken for a dose. A good method of administering Peruvian bark in cold infusion. R. Ext. Hyoscyam. gr. x. Vini antim. f ^ij. S. Eight drops four times a day to an infant a year old, in whooping- cough. (Hu/eland.) R. Aq. fceniculi, f 3iv. Vini Antimonii, f 3J. Ext, hyoscyam. gr. iij. Syrup, althaeas, f Jjss. S. A teaspoonful every two hours to an infant from six to twelve months old, as a cough mixture. (Vofft.) R. Ext. belladonnse, gr. j. Aq. destil. Jj. S. To infants, five drops four times a a day, in whooping cough. (Wendt.) R. Magnesias, BJ- Tinct. foetid, gt. Ix. -----opii, gt, xx. Aquae font, f Jj. M. Twenty drops to a child from two weeks to one month, in colic ; if not relieved in half an hour, ten drops more—increasing the dose as the child advances in age. (Dewees.) Carminatives and Antacids. R. Magn. carb. 3SS. Tinct. rhei, f 3J. Aq. menth. f Jvj. Syrup, alth. f Jj. M. Sit mistura. S. A teaspoonful every hour for an infant of six months, troubled with acidity of the stomach. (Vogt.) R. Aquae fceniculi, 3vij. Potassae bicarb. Bij. Syrupi, f Jj. M. A dessertspoonful occasionally. (Hamilton.) R. Potassae bicarb. 3SS. Aq. destil. f Jiss. Solve. S. Ten to forty drops daily in infan- tile convulsions. (Hamilton.) Antispasmodics. R. Cretae, gr. iij. Mosch. gr. ss. Croci, gr. i. Ft. pulv. dent. tal. dos. No. iv. S. One every hour for an infant. (Frankel.) R. Moschi, gr. vj. Amnion, sesquicarb. gr. iv. Sacchari albi, 3iij. Misce terendo, et adde, Aq. flor. sambuci, Jijss. M. Sit mistura. S. A teaspoonful every hour in infan- tile fits. (Wendt.) Expectorants and Demulcents. R. Pulv. Ipecacuanhae, Calomelanos. aa gr. x. Sacchar. albi, gr. xx. S. One or two grains every second or third hour, as an expectorant in bronchial irritation. (Evanson and Maunsell.) R. Decoct, polyg. seneg. f Jiijss. Oxymel. scillae, f 3ij. Vini ipecac, f^ij. Antim. tart. gr. j. S. Ten minims to a scruple, as an expectorant. (Evanson and Maunsell.) R. Mist, acaciae, f Jiss. 406 EXAMPLES OF COMMON Aquae purae, f Jiijss. Syrupi, f Jss. M. S. A teaspoonful every two or three hours, for an infant from four to six months old. R. Rad. seneg. 3ss. Infus. in s. q. aq. fervid, per J hor. colatur, f Jiv. Adde. Ammoniae hydrochl. Jss. Syrup. Althaeas, f Jj. S. A teaspoonful every two hours to an infant. (Wendt.) R. Potass, tart. 3J. Vin. antim. f3ss. Aquae anethi, f Jj. Oxymel. scillae, f Jss. Ext. glycyrrh. 3J. M. S. One or two teaspoonfuls for an infant of twelve or eighteen months, in catarrhal fever. (Frankel.) R. Pulv. ipecac, gr. iij. Pulv. acaciae, Magnes. carb. aa 3SS. Sacchari albi, 3J. M. Ft. pulvis divid. in xij aequales part. S. A powder every two hours in whooping cough. (Volger.) R. Tincturae opii camph. f Jj. Vin. antim. f Jss. Succ. glycyrrh. 3HJ. Pulv. g. acaciae, 3ij. Aquae fervent, f Jvj. S. A teaspoonful every two or three hours during the night, to a child six months old, in trouble- some cough. (Dewees.) R. Emulsio amygd. Jiv. Syrup, simpl. Jj. Gum. tragacanth. gr. vi. M. S. To be given by the teaspoonful. (H. des Enf.) Astringents. R. Hydr. c. creta, 3J. Pulv. ipecac, comp. By. Magn. carb. 3SS. Tere bene simul. S. Four to six grains, as a sedative for infants. (Copland.) R. Cretae ppt. 3iij. Tinct. thebaic, gt. xx vel xxx. 01. cinnam. gt. j. Sacchar. alb. 3ij. Aq. font. f3ij. M. S. A teaspoonful every two, three, or four hours. (Dewees.) External Applications. R. Antim. tart. 3J Aq. ferv. f Jj. Tinct. cantharid. f Jj. S. An embrocation in whooping cough. R. 01. oliv. f Jij. 01. succin., 01. caryoph., aa Jss. S. An embrocation in whooping cough. R. Sulph. cupri, 3ij. Pulv. cinchon. Jss. Aquae, f Jiv. S. To be applied twice a day to a gangrene of the cheek. (Dr. Coatu.) Baths. R. Potassae sulphur. Jij. Aquae, Ibj. This bath differs from the artificial Barege water, in containing half the quantity of sulphuret of po- tass. S. Used in psora. (H. des Enfant.) R. Sulph. sublim., Acetatis plumbi, aa 3J. Zinci sulph. ^ss. S. Used in psora. (H de la Matern.) EXTEMPORANEOU S PRESCRIPTIONS 40f Enemata. R. Syrup, papav. f^ij- Decoct, amyli, f Jviij. S. In diarrhoea of infants. (H. de la Matern.) R. Cap. papav. No. j. Decoc. lini, Ibiij. (H. de la Matern.) R. Cap. papav. 31J. Aquae, Ibj. (H. des Enfans.) R. Amyli, Jj. Aquae, Ibij. (H. des Enfans.) R. Flor. anthemidis, 3y. Aquae, Ibj. 6. Ft. enema. For infantile colic. Purgatives. R. Pulv. rad. jalap, gr. xxiv. Calomelanos, gr. iv. Sacchari alb. 31J. M. Ft. pulvis. divid. in xij partes aequales. S. A teaspoonful twice a day for a six months' infant, in obstruction of the bowels. ( Wendt.) R. Calomelanos, gr. iij. Pulv. rhei, Oleo-sacch. foenic, aa BJ- Ft. pulvis. S. One-third of the above quantity is a dose for an infant, as a laxa- tive. (Fischer.) R. 01. ricini f 3HJ —iv. Pulv. acaciae, q. s. Aq. foenic. f 31J. Mannas, Jss. Fiat emulsio. S. A dessertspoonful, repeated every hour till it operates. (Berends.) R. 01. ricini, f Jss. Syrup, rosae, f Jss. Vitel ovi un. Tinct. sennae, 31SS. 8. One or two spoonfuls for an infant. R. Mannae, Jss. Emulsio arab. f Jss Syrup, violae, f ^ij. Bene admisce, et adde, Aquae menth. f Jj. M. S. From f 3J to f 3ij every third hour, until an effect is produced. (Evanson and Maunsell.) R. Infusi sennae, Jj. Aquae menthas, Jss. Magnesias, BJ- Mannae, 3ii. Tinct. rhei, 3J. Syrup, rosae, 3ij. M. S. From 3J to 3ij every third hour. (Evanson and Maunsell.) R. Mag. calcin. 3SS. Pulv. rhei, gr. vj. Sacchar. albi, 3J. 01. menth. gt. vj. Aquae, f Jiss. S. A desertspoonful every two hours. (H. d'Amer.) Emetics. R. Vini antim. f Jss. Syrup, althaeas, f Jj. S. A teaspoonful every quarter of an hour to a child three or four months old. ( Wendt.) R. Pulv. ipecac, gr. xij. Syrup, simpl. f Jj. S. A teaspoonful every quarter of an hour to an infant five or six months old. R. Vin. antim. Jss. Oxymel. scillae, f 31J. S. A teaspoonful for an infant at the breast. (Frankel.) R. Aquas, f Jj. Vini ipecac, f Jss. Syrupi, f Jss. S. One or two drachms frequently, till vomiting ensues. {Evanson and Maunsell.) 408 EXTEMPORANEOUS PRESCRIPTIONS. Tonics and Stimulants. R Ferri tart. 3J. Syrup, simpl. q. s. M. Ft. bol., No. iij. S. As a tonic for debilitated infants. (H. des Enfans.) R. Cinchonae, Jss. Aquae, ftj. M. S. To be used as an enema when the stomach rejects cinchona. (H. des Enfans.) R. Aquae destillat. f Jiss. Quinae disulph. gr. ij. Acid, sulph. aromat. gtt. xvj. Syrupi caryoph. f Jss. M. S. From one to two drachms thrice a day. (Evanson and Maunsell.) R. Sal. martis, gr. ij. Acid, sulph. gt. x. Sacchari albi, 3J. Aquae font. M. Dose, 3J in chronic stages of cholera infantum. (Chapman.) Wine Whet. R. Lactis vac. Oss. Vin. alb. Jj vel Jij. S. Boil the milk, then add the wine. External Applications. R. Unguent, cetacei, Jj. Oxydi zinci, Pulv. lycopodii, aa Bss. S. Useful in ulceration of the eyelids. (Hufeland.) R. Croci sativ. 3J. Aquae fervent. Jiv. Vin. opii, 3J. S. Anodyne collyrium. To be used when there is great pain. (Jadelot.) R. Flores anthemidis, Acet. commun., aa Jiv. A common revulsive. (H des Enfans.) R. Cataplasm, emol. ftij. Ung. resinos. Jj. M. Useful to hasten the suppuration of a phlegmonous tumor. R. Pulv. lini. q. s. Decoc. rad. alth. q. s. M. An emollient cataplasm. R. Cataplasm, emol. Jiv. Farinae sinap. 3W. M. Used as a revulsive. (H. des Enfant.) Stimulant. R. Sp. ammon. arom. f 3SS. Syrup, althaeae. Aquae fceniculi, f 3J. M. S. A teaspoonful for an infant every hour. (Franku.) Alterative. R. Calomelanos, gr. iij. Amyli, 3SS. Sacch. albi, 3iss. M. Ft. pulvis divid. in xii partes aequales. S. One thrice a day in infantile Byphilis. (Wendt.) APOTHECARIES' WEIGHT. U. S., Lond., Ed., Dub. Pound. Ounces. Drachms. Scruples. Grains ft 1 = 12 = 96 = 288 = 5760 I 1 = 8 = 24 = 480 31 = 3 B 1 _ 60 gr. 20 DIETETIC PREPARATIONS. 409 APOTHECARIES' OR WINE MEASURE. U. S., 1Mb. Gallon. Pints. Fluidounces. Fluidrachms. Minims. Cubic Inches Cong. 1 == 8 = 128 = 1024 = 61440 = 231 0 1= 16 = 128 = 7680 = 28-875 f J 1 = 8 = 480 = 1-8047 f3 1 = TTJ? 60 = -2256 DIETETIC PREPARATIONS. BISCUIT JELLY. White biscuit, Jiv, water Oiv, boil down one half, strain, evaporate to Qj add white sugar ftj, red wine, Jiv, cinnamon water, 3J. In debility of the digestive organs. HARTSHORN JELLY. Hartshorn shavings, Jj, water, Oiv, boil to uij, strain; warm again with orange juice, Jj, white sugar, Jvj, sherry, J v. ANOTHER. Hartshorn shavings, Jviii, water, Oiv, boil, strain, add white wine and sugar, each, Jiv, or, if a very clear jelly is required, syrup of vinegar, Jvi; clarify with the white of two eggs, and strain, flavoring with cinnamon or lemon peel. SAGO JELLY. Soak sago in water for an hour, pour it off, adding more, boil till the sago is transparent, then add wine and sugar. TAPIOCA JELLY. Soak it in water for nine hours, then boil it gently till quite clear, and add lemon-juice and peel, wine, sugar, and cinnamon. GLOUCESTER JELLY. Rice, sago, pearl barley, hartshorn shavings, Rad. Eringii, each, Jj, boil in Ibiij of water to ftj, and strain; nutritive, dissolved in broth, wine, or milk. ALMOND JELLY. Sweet almonds, blanched, Ji, white sugar, 3VJ, water, Jiv. Rub into an emulsion, strain, and add melted hartshorn jelly, Jviii, orange flower water, 5), essence of lemon, gtt. iij. 35 410 DIETETIC PREPARATIONS. BRANDE'S JELLY. Ground jalap, Jii, water, Oxii, calcined magnesia, Jiii, boil to a jelly; not subject to grow mouldy. CREME DE RIS. Rice, three spoonfuls; boil in two pints of water to one, strain; add sweet almonds, No. x., bitter almonds, No. v., make an emulsion with sugar, a little cinnamon or orange-flower water, and drink it warm in the morning. ISINGLASS JELLY. Isinglass, Jii, water, two pints, boil to one, strain, and add milk one pint, white sugar candy, Ji. Nutritive. CHICKEN JELLY. Cut a chicken into small pieces, bruise the bones, and put the whole into a stone jar, with a cover that will make it water-tight. Set the jar in a large kettle of boiling water, and keep it boiling for three hours. Then strain off the liquid, and season it slightly with salt, pepper, and mace; or with loaf sugar and lemon-juice, according to the condition of the patient for whom it is intended. RICE JELLY. Mix a quarter of a pound of rice, picked and washed, with ftss of loaf sugar, and just sufficient water to cover it. Boil till it becomes a glutinous mass; then strain and season with whatever may be thought proper. BREAD JELLY. Boil a quart of water and suffer it to cool. Take one-third of a sixpenny loaf of bread, slice it, pare off the crust, and toast to a light brown. Then put it into the water, place it on hot coals in a covered pan, and boil it gently, till you find, by putting some in a spoon to cool, that the liquid has become a jelly. Strain through a cloth, and set away for use. When it is to be taken, warm a teacupful, sweeten it with sugar, and add a little grated lemon-peel. ARROWROOT JELLY. Mix three tablespoonfuls of the best Bermuda arrowroot in a teacupful of water till quite smooth; cover it, and let it stand a quarter of an hour. Put the yellow peel of a lemon into a pint of water, and boil to one-half. Then take out the lemon-peel, and pour in the dissolved arrowroot, while the water is still boiling; add sufficient white sugar to sweeten it well, and let it boil together for five or six minutes. It may be sweetened, if thought necessary, with two teaspoonfuls of wine and some grated nutmeg. It may be boiled in milk instead of water, or in wine and water, according to the condition of the patient. DIETETIC PREPARATIONS. 411 PORT WINE JELLY. Melt Jj of isinglass in a little warm water, stir it into a pint of port wine, adding Jij of sugar candy, Jj of gum Arabic, and half a nutmeg, grated. Mix all well, and boil it ten minutes, or till thoroughly dissolved. Then strain through muslin, and cool. TAPIOCA JELLY. Take of tapioca, two spoonfuls, water, one pint; boil gently for an hour, oi until it assumes a jelly-like appearance. Add sugar, wine, and nutmeg, with lemon-juice to suit the taste and the nature of the case. (This is improved by washing the tapioca well, and allowing it to steep for five or six hours, changing the water three times; then proceed as before.) SAGO. Wash in two or three waters, and let it soak for two or three hours. To a teacupful of sago, allow a quart of water, and some of the peel of a lemon. Simmer till all the grains look transparent. Then add wine and nutmeg, and boil together for a few minutes (or plain, with milk). BARLEY WATER. Wash clean some pearl barley, and to Jij of barley add one quart of water. Add a few raisins, or some lemon-peel and sugar, and boil slowly till reduced one-half. Then strain and sweeten. As nourishment in inflammatory diseases. RICE-WATER. Take of rice, Jij ; wash it well, and add two quarts of water. Boil for an hour and a half, and then add sugar and nutmeg, as much as may be required. To be taken ad libitum. Mixed with milk, this is an excellent diet for children. VEGETABLE SOUP. Take one potato, one turnip, and one onion, with a little celery, or celery seed. Slice, and boil in one quart of water for an hour; add as much salt as is agreeable, and pour the whole upon a piece of dry toast. To be used when animal food would be improper. INDIAN GRUEL. Put three large tablespoonfuls of Indian meal, sifted, into a quart of water. in a large bowl; wash with several waters, turning off the water as the meal settles; then boil for twenty minutes, stirring all the while ; add a little salt; then strain and sweeten, adding a little butter, wine, and nutmeg, if the case require. It should be taken warm. Oatmeal Gruel may be proparecttn the same way; but if made of coarse grits, it should be strained, after boiling, and then seasoned. 412 DIETETIC PREPARATIONS. PANADA. Boil some slices of soft bread in a quart of water for five minutes. Then beat the bread smooth in a deep dish, mixing with it a little of the water in which it has been boiled; mix with it a bit of fresh butter, and sugar, and nutmeg, according to circumstances. Or, it may be made by grating some bread, or grating or pounding a few crackers; pour on boiling water; beat it well, and add sugar and nutmeg, or cinnamon. BOILED FLOUR. Take ftj of fine flour, tie it up as tight as possible in a linen rag; dip it frequently in cold water, and dredge the outside with flour till a crust is formed on it. Then boil until it becomes a hard dry mass. This may be grated and prepared in the same manner as arrowroot, for which it is an excellent substitute. BEEF TEA. Cut ftj of lean beef into shreds, and boil for twenty minutes in one quart of water, taking off the scum as it rises—often cooling; strain. Very nourish- ing and palatable. ESSENCE OF BEEF. Put a pound of lean beef, thinly sliced and slightly salted, into a porter- bottle, or jar, closely corked. Place this in a vessel of cold water, and boil for an hour or more. Then decant and skim the liquid. Chicken tea may be made in the same way. CHICKEN WATER. Take half a chicken; strip off all the fat, and break the bones; add two quarts of water, boil for fifteen or twenty minutes, and season with salt. MUTTON BROTH. To one pound of lean mutton, allow one quart of water; season with a little salt, and some parsley, and put in some large pieces of the crust of bread. Boil slowly for two or three hours, skimming carefully. Beef, veal, or chicken broth may be made in the same manner. Vegetables, barley, rice, &c, can be added, if expedient. Mutton broth may be made more speedily, by taking three chops; beat the meat on both sides, and slice thin; put into a sauce pan with a pint of water, a little salt, and some crusts of bread, or some parsley, and a small onion sliced thin. Cover the sauce-pan, and boil fast; skim, and in half an hour it will be ready for use. It renders mutton broth more palatable to broil the chops before boiling. INFUSION OF MALT. Take the ground malt, Oj, hot water, Oiij. Infuse for two hours, and Btrain. Add sugar or lemon-juice if necessary. DIETETIC PREPARATIONS. 413 WINE WHEY. Boil a pint of milk, and, when boiling, add a large wineglass of Sherry or Madeira wine. Let it boil again, and then remove it from the fire and let it Btand a few minutes. Then remove the curd, pour the whey into a bowl, and sweeten it. RENNET WHEY. Wash a small bit of rennet, about two inches square, in cold water, to re- move the salt. Put it into a teacup, and pour on lukewarm water enough to cover it. Let it stand all night, and in the morning stir rennet water into a quart of warm milk. Cover it, and set it near the fire, till a firm curd is formed. Pour off the whey, and it will be found a very cooling and palatable drink. CALVES' FEET JELLY. Take two calves' feet, and add to them one gallon of water, which reduce, by boiling, to one quart. Strain, and, when cold, skim carefully. Add the whites of six or eight eggs, well beaten, a pint of wine, half a pound of loaf sugar, and the juice of four lemons, and let them be well mixed. Boil the whole for a few minutes, stirring constantly, and pass it through a flannel Btrainer. (Wine should be omitted in some cases.) RICE GRUEL. Take of ground rice, Jj, cinnamon, Jj, Water, Oij. Boil for forty minutes, adding the cinnamon near the conclusion. Strain and sweeten, and add wino if necessary. BRAN TEA. Take of fresh wheat bran, Oj, water, three quarts. Boil down one-third- Btrain, and add sugar, honey, or molasses, according to the taste of the patient. LEMONADE. ->. Take of fresh lemon-juice, Jiv, fresh lemon-peel, Jss, white sugar, Jiv, boiling water, three pints. Let them stand till cold, and then strain off for use. In fevers, a little spirits of nitre may be added. TAMARIND WATER. Put tamarinds into a pitcher or tumbler, till it is one-third full; then fi. it up with cold water, cover it, and let it infuse for a quarter of an hour or more. MOLASSES POSSET. Put into a sauce-pan a pint of best molasses, a teaspoonful of powdered white ginger, and a quarter of a pound of fresh butter. Simmer on hot coals for half an hour, stirring frequently. Then stir in the juice of two lemons, or two tablespoonfuls of vinegar; cover the pan, and let it stand by the fire five minutes longer. 35* 414 DIETETIC PREPARATIONS, COCOA. Boil two ounces of good cocoa in a quart of water, and as soon as it boils set it on coals to simmer gently for an hour or more. To be used hot. TOAST WATER. Toast some pieces of bread brown (not burnt), then put them into a pitcher, and fill it up with boiling water. Let it stand till cold, then strain it, and pul it into a decanter. Quantities of Opium contained in Different Preparations. Linimentum Opii................................ gr. Pilulae Saponis comp .......................... gr. Pilulas Styracis comp.......................... gr. Pulv. Cretae comp. c. opio................... gr. Pulv. Ipecacuanhae comp..................... gr. Pulv. Kino compositus........................ gr. Tinctura Camphorae comp................... gr. Tinctura Opii.................................... gr Vinum Opii..................................... gr. Tinctura Iodinii comp. contains........... gr. ij of Iodine. Unguentum Iodinii comp................... gr. v.............. Unguentum Hydrarg. Fortius contains 3J of mercury...... Unguentum Hydrarg. Mitius " 3J " ...... "J- j- j- j j j- j j ■ j ■ f3iv. gr. v. gr. v. By- 1 gr. x >BJ- m 1f*ix. ifpxix, f3J- >3JSS- 3*3 ALCOHOLIC STRENGTH OF WINES, 413 TABLE Of the Alcoholic Strength of Wines. By Christison. Per cent, of ab- Per cent, of solute alcohol proof spirit by by weight. volume. 14.97 30.56 16.20 33.91 17.10 37.27 14.97 31.31 13.98 30.89 15.37 33.59 16.17 35.12 14.72 32.30 16.90 37.06 14.09 30.86 16.90 36.81 13.84 30.21 16.45 33.65 16.14 34.71 12.95 28.30 12.63 27.60 7.72 16.95 7.78 17.06 7.61 16.74 8.99 18.96 9.31 22.35 12.86 28.37 8.40 18.44 6.90 15.19 7.35 16.15 5.90 12.60 6.06 13.40 5.36 11.91 Port, weakest................................................... ----mean of seven wines..................,.............. ----strongest.................................................. White Port...................................................... Sherry, weakest................................................ ------mean of 13 wines, including those very long "t kept in cask....................................j ------strongest.............................................. .----- mean of 9 wines very long kept in cask in 1 the East Indies ..............................j Madre da Xeres.............................................. Madeira, strongest "I kept long in cask in East! --------weakest / Indies........................J Teneriffe, long in cask at Calcutta........................ Cercial.............................- ............................ Dry Lisbon...................................................... Shiraz............................................................ Amontillado............................ ....................... Claret, a first growth of 1811.............................. Chateau Latour, first growth of 1825.................... Rosau, second growth of 1825............................. Ordinary Claret, a superior "vin ordinaire".......... Rives Altes...................................................... Malmsey........................................................ Rudesheimer, superior quality............................ ------------inferior " ............................. Hambacher, superior quality............................... Giles' Edinburgh ale, before bottling.................... The same ale two years in bottle.......................... Superior London Porter, four months bottled......... The results of the above table were obtained by distillation, which was applied with such contrivance for accuracy, that nearly the whole spirit and water were distilled over without a trace of empyreuma, and without the loss of more than between two and six grains in 2000. From the quantity and density of the spirit, the weight of absolute alcohol of the density 793.9, aa well as the volume of proof spirit of the density 920, was calculated from the tables of Richter, founded on those of Gilpin. Dr. Christison remarks that the alcoholic strength of various samples of the same kind of wine bears no relation whatever to their commercial value, and is often very different from what wo M be indicated by the taste even of an experienced wine-taster. 416 COMPARATIVE TABLE OF MINIMS, DROPS, AC. TABLE Showing the Difference between Minims, Drops, and Grains of various Medicinal Liquid Preparations of the Pharmacopceia of the UNiTEn States, &c. (From Edwards and Vavasseurs' "Manual of Materia Medica," edited by Drs. Togno and Durand.) No. of drops in 20 minims. Sulphuric acid........................... Sulphuric ether......................... Rectified alcohol........................ Nitric acid................................ Acetic acid (crystallizable).......... Muriatic acid............................ Oil of wormseed (Chenop. Anthel.) -----peppermint, of aniseed... ^ ----- sweet almond, olive, pal- > ma christi.................J ----- cloves............................ ----• cinnamon........................ Copaiba................................... Diluted alcohol.......................... Tincture of hydriodate of potassa,"] cantharides, kino, digitalis,assa- I fcetida, sulphuric aeid, colchi- l cum, opium, valerian, guaiacum J Tincture (volatile) of valerian, of "J guaiacum.........................../ Tincture of muriate of iron.......... Wine (Teneriffe)....................... ---- (antimonial)...................... ---- of opium (Syden. laudan.)... ---- of colchicum root............"> ---- of colchicum seeds...........J Vinegar (distilled)....................... ------of opium (black drop).."} ------of colchicum............... J- ------of squill....................J Water (distilled)....................... ----- solution of hydrocy. acid.*. —— solution of sulphuric acid "l (1 to 7)....................j -----solution of nitric acid, do... -----solutionof ammonia (strong) ■----solution of ammonia (weak) -----solution of hydriod. potas... ■---- solution of arsenite of potas. 30 50 46 28 40 18 40 40 40 40 40 40 40 40 44 26 24 26 25 19 26 15 15 17 17 18 15 18 19 No. of minims ir 20 drops. 13.3 8 8.6 14.2 10 22.2 10 10 10 10 10 10 10 10 9.1 15.3 16.6 15.3 16 21 15.3 26.6 26.6 23.5 23.5 22.2 26.6 22.2 21 No. of drops in 20 grains. 25 60 57 22.2 40 18.1 50 48.5 36 32 40 42 43 50 50 25 25 29 29 20 25 17.5 17.5 17 17 18.5 20 20 20 23.5 23.5 22 20 20 20 * Prepared according to the process of the London Apothecaries' HalL PAET VI. SURGERY. 2b (417| PART VI.— SURGERY. INFLAMMATION. What is Inflammation ? It is a condition of hyperemia, or of too much blood in a part, with its motion partly increased, and partly diminished. What are the symptoms of inflammation ? Unusual redness, heat, swelling, pain ; and the function of the p'jt is also perverted or arrested. The redness is produced by an increased quantity of blood, or a relatively increased quantity of the red corpuscles, or both to- gether. The hue and degree vary acceding to the intensity, and with the tissues affected ; and are permanent. Heat is produced by the increased quantity of blood, and the more rapid oxidation of the tissues. Swelling depends upon increased quantity of blood, and from effusion of lymph, serum, pus, &c. Pain depends upon pressure upon the nerves, and the function of sensibility is also exalted. It is increased by pressure of the hand, or otherwise ; and varies with the part affected. Sometimes these symptoms are not all present; one of them may be absent, and yet inflammation exist. How has inflammation been divided ? Into acute, chronic, healthy, and unhealthy. How many stages are there of inflammation ? Two ; the cold and the hot. In the first there are coldness, languor, nausea, and a small, quick pulse. In the second, the skin is hot, pulse full and hard ; there is thirst, and the part becomes swelled and painful. It is not, however, always accompanied by constitutional symptoms. (419) 420 SURGERY. What are the results of inflammation ? There are eight: resolution, adhesion, effusion, suppuration, ulceration, granula- tion, cicatrization, and mortification, which constitute a series of stages in some cases. What are the causes of inflammation ? They are chemical, mechanical, and vital. Among the former are excessive heat, cold, cold and moisture combined, atmospheric air, noxious gases, acids, alkalies, blisters, rubefacients, animal poisons, contagious and specific diseases. Among the mechanical are contusions, lacerations, punctures, fractures, luxations, pressure, and numerous other agents. Is every part of the body subject to inflammation ? Nearly every part, but in an unequal degree ; the liability is generally in proportion to the sensibility of the part. How are the means of arresting inflammation divided ? Into constitutional and local. Among the former, are general blood- letting, purgatives, diaphoretics, mercury, opium, antimony, and low diet; among the latter, are topical blood-letting, blistering, cold, acetate of lead, tincture of iodine, nitrate of silver, rest, counter-irritation, and position. What objects are to be obtained by constitutional treatment 1 A reduction of the quantity and quality of the blood, by which it is rendered less stimulating, and a general sedative influence is produced upon the system. Some of the means which operate constitutionally also act by derivation or revulsion. Suppurative Inflammation. What are the symptoms of suppuration ? The redness assumes a brighter hue, the swelling increases, becomes pointed and softer, pain is increased, and there is a sensation of pulsation and throb- biug. Rigors or shivering often occur, and are looked upon as a sure indication that pus is formed, or about to be. When the pus is once formed, pain and redness diminish, the swelling fluctuates, and a cavity usually exists, which encloses the matter, and is called an abscess. What are the characteristics of healthy or laudable pus ? It is of a light yellow or cream color; made up of small globules which float in a watery fluid. SURGERY. 421 Unhealthy pus is called ichor when it is thin and acrid. Sanies, when it is mixed with blood. Sordes, when it is of a leaden color, thick, and offensive. Malignant, when generated in pesti- lential diseases. Contagious, when it has the power of producing a disease of the same character. Sero-purulent, or mucopuru- lent, when mixed with serous or mucous discharge. What is the treatment of suppurative inflammation ? If the patient has been much enfeebled by evacuations, we substitute a better regimen, employ tonics, mineral acids, and opium. As local means, we use fomentations and warm poultices. Poultices should be continued after the discharge of matter, unless it is kept up too profusely, when other mild dressings should be employed. What rules should govern us in regard to opening abscesses ? Abscesses, where the matter is widely diffused, when it produces great pain, when its presence is likely to occasion additional harm in any way, such as by bursting into any cavity, laying bare a portion of bone, or of a large vessel, or by burrowing under fascia a great way before its arrival at the surface, and when situated on the face, or near joints, should be opened early. In other cases, they should be left longer. The best instrument for opening them is a narrow, sharp-pointed bistoury, which should be passed iu slowly until you find by the feel that it is in the sack; then cut forward so as to make a free incision. The part at which the opening should be made usually, is where there is the greatest fluctuation, or where pointing occurs; some times it is necessary to open at the most depending part, even if fluctuation should not be so evident in that position. If the edges after being opened, tend to unite, a tent should be introduced. Ulcerative Inflammation. What is meant by ulcerative inflammation, or ulcerative absorp tion ? It is that morbid process by which the continuity of the different textures of the body is destroyed. What parts of the body are liable to ulceration ? Every texture is liable; but the skin, mucous membranes, and cellular tissue, suffer more readily than other parts. Pain always attends this process, and is generally lancinating. 36 422 SURGERY. Mortification. What is mortification ? Gangrene is that condition which mmediately precedes the destruction of a part. Sphacelus denotes he complete death of a part; and the term mortification desig- nates both stages of the complaint. What are the different kinds of gangrene ? They are the humid and dry ; and the idiopathic and traumatic. The idiopathic is constitutional, and the traumatic results from an injury. What are the causes of mortification ? It is generally the result of inflammation. It may be caused also by poisons, a deficient supply of arterial blood, any cause which will enfeeble the circula- tion, pressure, deposits in the arteries, ergot, &c. What are the symptoms ? The part loses its sensibility, heat, and color. These changes seldom take place suddenly, but are preceded by an increase of pain and swelling; the blood circulates only in the larger vessels ; the skin becomes soft, and of a dark-red or purple color, and vesicles containing a thin serum are formed under the cuticle. When it is complete, if you press upon the part Horizontal section of a Part Mortified.—/. Slough, or mortified tissue. «. Pus. d. Grannl* tions, or reparative surface, c. Circumscribing fibrinpus septum, b. Effused serum in eellq lar tissue, a. Unaltered healthy structure. SURGERY. 423 the blood will not return. Along with these symptoms the pulse becomes quick and tremulous, of a typhoid character, tongue dry and brownish, skin hot, the patient restless, uneasy, and frequently with delirium, subsultus, nausea, and hiccup. If sufficient power exists in the system, nature makes an effort at separation. The living part in contact with the dead becomes inflamed, a line of demarcation is thus formed, at which point ulceration and suppu ration take place, and the line of suppuration is developed. What is the treatment? When there is high inflammation which is likely to terminate in gangrene, the antiphlogistic treatment should be adopted; but if gangrene has taken place, a different practice must be pursued. The bowels should be gently opened, and tonics, and nutritious food given. Opium, carbonate of am- monia, camphor, &c, will be found beneficial. Local remedies are of use only where the mortification is incomplete; when scari- fications, emollient poultices, blisters, &c, have been recommended. In senile gangrene, opium is an important remedy. To prevent sloughing or bed-sores, from long confinement, the parts, when they are first discolored, should be washed with a solution of nitrate of silver, 10 grs. to gj of water, 3 or 4 times a day, then covered with bland adhesive plaster. The hydrostatic bed is highly recommended by Dr. Mussey, as a preventive. Where the sores have formed, dress with adhesive plaster, and change the position of the patient. Amputation is seldom resorted to in cases of mortification before a line of separation is formed, although it is sometimes in traumatic gangrene; but it should never be in the idiopathic variety. What are the symptoms of dry mortification ? The toes and feet lose their heat, and become shriveled, discolored, and converted into a hard, dry, insensible mass, of a dark-blue or black color, without previous swelling, redness, pain, or fetor. What is the treatment ? Amputation. Erysipelas. What are the symptoms of erysipelas? The surface of the part affected is elevated, varies from a bright scarlet to a purplish color, has an abrupt termination, and is accompanied with a burn- 424 SURGERY. ino- or itching s'ensation. There is generally more or less rigor, fever, nausea, &c, preceding the complaint. The symptoms are sometimes slight, and sometimes very severe, particularly in the epidemic form, and when it attacks the head and face. What are the causes of erysipelas ? The causes are not always obvious; in other cases, it may be traced to the application of poisons, wounds, exposure, foul air, derangement of the digestive organs, &c. What is the treatment? In the commencement, if indicated by the general symptoms, recourse should be had to blood-letting, purgatives, diaphoretics, and low diet. Sometimes a contrary plan becomes necessary during the course of the disease, and opium, bark, camphor, &c, may be indicated. The local remedies in use' are collodion, tincture of iodine, sulphate of iron, nitrate of silver, and acetate of lead in solution; incisions, mercurial ointment, British oil, starch, flour, &c. The nitrate of silver, applied with a pencil so as to surround the inflammation, is fre- quently resorted to. Furunculus, or Boil. What are the symptoms of furunculus ? It is a hard, painful, and highly inflamed tumor, conical, base below, and apex above the level of the skin; and contains a disorganized mass, called a core. What is the treatment? Encourage suppuration with warm poultices, and as soon as the apex becomes soft, make an opening into it large enough to remove the core. Anthrax, or Carbuncle. What are the symptoms of anthrax? It is a deep-seated, circumscribed, hard, and painful swelling, of a livid hue, attended with itching and a burning heat, and terminates by sloughing. The constitutional symptoms are often very severe, particularly loss of appetite, fever, prostration, &c. When on the scalp, they nearly always prove fatal. What is the treatment ? Emollient poultices in the first stage, until vesication, or a discharge of bloody serum, appears1, it should then be freely covered with caustic vegetable alkali, as SURGERY. 425 recommended by Dr. Physick. Other surgeons recommend that it should be opened early by free incisions, and stimulating appli- cations used. Opium should be freely employed to assuage pain and procure sleep. Pernio, or Chilblain. What are the symptoms of pernio ? It is the result of cold, and is met with in the extreme parts of the body. At first the skin is pale and shrivelled, which is succeeded by redness, tumefac- tion, pain, pruritus, and oedema. In severe cases, the skin becomes purplish, the itching very violent; vesication takes place, and forms an ill-conditioned sore. The mild form frequently dis- appears in summer, and returns in the winter. What is the treatment? The application of soap liniment, spirit of turpentine, sulphate of copper, and tincture of cantharides is recommended. The best remedy is to smear the part with the balsam of copaiva. Nitrate of silver is also a useful application. Frostbite. What are the symptoms of frostbite ? The exposed part be- comes benumbed, stiff, and insensible; these symptoms are suc- ceeded by heat, swelling, pain, lividity, and by suppuration, which occurs between the sound and living parts. When the cold is long continued, so as to affect the internal organs, drowsiness, shivering, rigidity of the limbs, diminution of the circulation, and profound sleep, terminating in death. What is the treatment? Snow and ice water should first be applied, and the parts carefully handled ; when the natural tempera- ture is restored, it should be treated according to the circumstances of the case in regard to inflammation, tendency to mortification, &c. When the patient is insensible, the indications are to restore the respiration and circulation by sternutatories, volatiles, fric- tions, &c. Burns. How are burns divided, and what are their symptoms ? They are divided into superficial, ulcerated, and carbunculous. In the first, there is simple erythema ; in the second, vesication ; and the third is where the cutis and adjoining parts are disorganized, 36* 426 SURGERY. with severe constitutional disturbance in proportion to the extent of the injury. In the second variety, the constitutional disturb- ance may be great also, in proportion to the extent of surface involved. At what period may burns prove dangerous ? When the shock is first received ; from reaction or inflammation; and at the sup- purative period. What is the treatment? In superficial burns, the application of carded cotton is highly extolled ; also cooling applications, either by the direct application of cold, or by evaporating lotions. The essence of peppermint, before vesication takes place, is one of our best applications to assuage pain, and prevent the effusion of serum. In the second variety, emollient applications should be used, and a liniment of lime-water and flaxseed oil, or sweet oil, spread on cotton batting, is as good an application as we can make. In the third variety, the stimulant plan, internally and externally, should be adopted, until reaction takes place, when the antiphlo- gistic system may become necessary. Opium is generally necessary to relieve pain and constitutional disturbance. Dry flour is a good local application in all farms of burns. The after-treatment of ulcers should be governed by the circum- stances of the case, always bearing in mind the strong tendency to contraction of the cicatrices, which should be counteracted by splints, rollers, &c. The treatment of these cicatrices has been recently much improved by means of plastic operations. Wounds. How are wounds divided ? Into incised, punctured, pene trating, contused, lacerated, poisoned, and gunshot. These maj be divided into wounds of the head, face, neck, chest, belly, and extremities. Incised Wounds. What are the dangers of incised wounds ? These are the least dangerous of the wounds except from hemorrhage, which may be troublesome when a sharp instrument is used, or large bloodvessels divided. SURGERY. 421 What is the proper treatment? It is to suppress the hemor- rhage, clear the wound of all foreign matter, and retain the edges in contact. The object is to have them heal by adhesion, or union by the first intention, as it was formerly called. It is pro- duced by the effusion of coagulable lymph, or fibrin, which be- comes organized, and incorporates the cut surfaces together. Another mode of healing is by growth, reparation being made, as in the ordinary nutritive process, without inflammation or suppuration. The modelling process is similar to this; the gap being filled up with lymyh gradually. Granulation is what has been termed union by the second inten- tion. What are the means of suppressing hemorrhages ? Ligatures, compression, styptics, cold, elevated position, and the actual cau- tery. The tenaculum, needle, and forceps are the instruments employed to secure bleeding vessels. Ligatures are made of thread, silk, or leather. Compression may be performed by the tourniquet, by rollers and pledgets, or by tying a handkerchief around a limb and twisting it with a stick. The actual cautery should never be employed when the bleeding vessels can be secured. What are the means used for retaining the edges of the wound in contact ? Adhesive straps, bandages, and sutures; the object of which is to produce adhesion. There are two sutures in use ; the twisted and the interrupted. How is the interrupted suture formed ? By passing a needle and thread through the skin and subcutaneous cellular texture, from without inwards on one side, and from within outwards on the other, at about one-fourth of an inch distance from the margin, and fastening the ends of the thread with sufficient tightness to prevent the surfaces from separating. They should be placed about an inch apart; and, of course, the proper number is proportioned to the size of the wound. The intervals should be supported by adhesive straps. How is the twisted suture formed ? By passing a common sew- ing-needle through the skin and other texture from one side of the wound to the other, and twisting a thread over each end of it in the form of a figure 8, with a sufficient degree of tightness to keep <28 SURGERY. the parts together; where several are used, the thread may also be passed from one needle to another. The points should then be clipped off. Needles composed of gold, silver, &c, have been recommended, but they possess no advantage over the common sewing-needle. Punctured Wounds. How are punctured wounds produced? By sharp narrow instruments, such as needles, pins, thorns, splinters of wood, nails, &c. What are the dangers from punctured wounds ? Tetanus, and large collections of matter under the fascia. What is the treatment? A soft poultice is generally sufficient; but, if there are indications of the formation of matter, or nervous symptoms arise, the wound should be freely dilated, and kept open. The use of opium may become necessary. Penetrating Wounds. What are the characteristics of penetrating wounds ? They are more extensive than punctures, and generally produced by the small sword, bayonet, or dirk. What are the dangers from penetrating wounds ? They may be dangerous from entering large cavities ; injury to important blood- vessels, nerves, or viscera ; or they may cause extensive collections of matter in deep-seated parts. What is the treatment? The first object is to suppress hemor- rhage, which may require extensive incisions. If the bleeding vessel is in the chest or abdomen, deep-seated, the plan is to diminish the general activity of the circulation by blood-letting. In other respects, they are to be treated as the constitutional and local symptoms may demand. Contused Wounds. What are the dangers from contused wounds ? Gangrene is very liable to take place when they are extensive and severe. What is the treatment? They should be treated on common antiphlogistic principles, locally and generally. Adhesion is not to be expected. SURGERY. 429 Lacerated Wounds. What are the dangers of lacerated wounds ? They are danger- ous from their extent, and the parts involved. They bleed spa- ringly ; but are liable to secondary hemorrhage and to gangrene, and do not heal by adhesion. What is the treatment ? Bring the parts as near together as possible, and treat the constitutional effects as the condition of the patient may demand. Poisoned Wounds. How are poisoned wounds produced? Generally by cuts in dissection, insects, serpents, rabid animals, &c. What is the treatment? In the sting of bees or wasps, the local application of common salt, cold water, aqua ammonia?, &c, are useful. In the bites of serpents, olive oil, aqua ammonias, arsenic, &c, have some reputation. The application of a cup- ping-glass to the part has proved useful When called early, the part should be removed entirely. In dissecting wounds, apply lunar caustic, after washing clean, and take a mercurial purge. The effects of inflammation may require attention on general principles. Gunshot Wounds. What are included under the head of gunshot wounds ? All injuries occuring from firearms, explosion of shells, rockets, &c, and are of the nature of lacerated and contused wounds. What circumstances render gunshot wounds dangerous ? The extent of the injury, the parts involved, from their indisposition to. heal by the first intention, their disposition to slough, and secon- dary hemorrhage. What is the general treatment? It is to suppress hemorrhage, and extract the foreign body when it can be done without too much injury to surrounding parts, and attend to the general state of the system. The applications should be simple, such as water- dressings, with sugar of lead and opium. Amputation is frequently required. 430 SURGERY Abscesses. What is the treatment of Abscess of the Antrum ? It is to rc« move one or more teeth corresponding with the floor of the antrum ; if the matter is not then discharged, pass a stilet or small trocar into the cavity from where the tooth has been pulled, and push it into the antrum gradually, Use astringent injections four or five times a day, and keep a bit of bougie or tent in the opening until the discharge and inflammation subside. What is the treatment of Mammary Abscess ? The first step is to prevent them, if possible, by the repeated application of warm vinegar, topical olood-letting, and a general antiphlogistic course. If we find suppuration must take place, apply warm poultices, and open in a depending part when fluctuation is perceived. What are the symptoms of Lumbar Abscess ? Pain in the lumbar region, extending from the kidney down to the outside of the thigh, testicle of the side drawn up, and pain in the spermatic cord. These are followed by rigors, loss of appetite, and hectic. It sometimes points below the groin, sometimes it passes through the ischiatic notch, and, in other cases, passes down near the rectum. The discharge is generally thin and gleety, mixed with small flocculi resembling curds or cheese. What is the treatment ? "Very few recover. In the early stages, the antiphlogistic course should be adopted; but, when matter is formed, an opposite course should be pursued. When the abscess is opened, it should be done by a small val- vular incision, then closed for a time, and again opened, so as to draw off the matter in a gradual manner. Ulcers. How are ulcers divided ? Into healthy, unhealthy, and specific. The first comprehends but one species, the simple uloer. The second contains two species, the irritable and indolent ulcer. The third contains several species, the principal of which are ulcers from scrofula, cancer, fungus haematodes, syphilis, and syphiloid, scorbutic, herpetic, lupus, or noli me tangere, &c. SURGERY. 431 Simple Ulcer. What are the causes of the simple ulcer ? Injuries done to a sound part by wound, contusion, abscess, or burn. What are the characteristics of a simple ulcer ? It exhibits a florid appearance, owing to the small, pointed, and numerous bright-red granulations which cover it. There is a discharge of healthy pus in small quantity, and the tendency is to heal. What is the treatment? Simply keep the part in a proper posi- tion, and cover the sore with some mild, fresh ointment, spread on lint or linen rag. Dry lint is ajso a good application. Irritable Ulcer. What are the characteristics of the irritable ulcer ? The edges of the sore are ragged, undermined, and sometimes almost ser- rated. The parts beyond the ulcer are red and inflamed ; the bottom of the ulcer exhibits irregular hollows, which contain a thin, greenish, or red acrid matter; and, in place of healthy granu- lations, may be found a dark-red, spongy mass, painful, and bleed- ing on the slightest touch. What are the causes of the irritable ulcer ? It proceeds from local causes, influenced by the state of the constitution and habits of the patient. The digestive organs in particular are generally disordered. What is the treatment? The constitutional condition should be attended to; and, if the digestive organs are affected, resort should be had to steady purging and antimonials, if not contra- indicated. The proper local applications are poultices, fomentations, cream, a weak solution of the nitrate of silver, and opium mixed with poultices, or sprinkled over the sore. The limb should be elevated, and pressure and bandaging avoided. Phagedcenic ulcer is irregular in form, edges ragged and abrupt, surface uneven and brown, pain burning, and constitutional dis- turbance generally great. More or less sloughing usually occurs, and the extension is rapid. Constitutional and local treatment are both necessary. Correct '.he secretions, allay irritation, and invigorate the system with fresh air and good diet. Apply nitric acid, nitrate of mercury, 432 SURGERY. &c. ; then poultices, solutions of chloride of lime or soda, &c. Mercurials are inadmissible. Indolent Ulcer. . What are the symptoms of the indolent ulcer ? The granulating surface has a flat, shining aspect, and is partly covered with a pel- licle or crust of a whitish or dark-gray color. Sometimes the sur- face is dry, but generally there is a discharge of a viscous cohesive fluid. The edges are elevated, smooth, and rounded; beyond the ulcer the parts are swollen and indurated. The pain is trifling. What is the treatment of the indolent ulcer ? Where an ulcer shows a disposition to become indolent, resort should be had with- out delay to escharotics, adhesive straps, or the roller. If these Fig. 2. do not effect a cure, the edges should be pared away, and the whole surface pencilled with the vegetable or lunar caustic. The oak-bark poultice, followed in a few days by the adhesive strips or roller, will sometimes cure. These ulcers frequently require stimulating applications, such as lunar caustic, savine powder, cantharides, capsicum, corrosive sublimate, &c. Dr. Physick considered a combination of 3j of simple cerate, and 3ij of British oil as the best cicatrizer. The dressings should be changed re- peatedly. SURGERY. 433 Constitutional remedies also exert a powerful influence, and such remedies as blue-pill, and other mercurials, should be re- sorted to. In healing chronic ulcers, care should be taken to establish an issue in some part of the body ; otherwise, the stoppage of a long- established discharge may give rise to apoplexy, or other serious disturbance. Varicose ulcers will usually heal with adhesive straps, the roller, or laced stocking; but in many instances the enlarged veins can only be relieved by an operation. Ulcers should not be healed when they have been stationary for years, and the patient is old, gouty, or a high liver. Their con tinuance may act as a safety valve in preventing the occurrence of some serious disease. Scrofula. What are the premonitory signs of scrofula ? A delicate com- plexion of a lively-red color, mixed with a clear white, the lips red, and the upper one especially thick and protuberant. The pupils of the eyes large, and the conjunctiva free from vessels. These are some of the symptoms which denote the scrofulous constitu- tion. Children are more subject to it than adults. What are the symptoms of scrofula ? A scrofulous tumor is first a simple enlargement without pain, or unnatural heat; in a short time, it becomes tender on pressure, and the heat is aug- mented; inflammation then generally sets in, and it terminates in abscess and ulceration, but not always. The matter discharged from abscesses of this kind is thin, gleety, and mixed with flocculi. What are some of the most obvious causes of scrofula ? Cold and moisture, hereditary influence, irregularities of diet, meagre and unwholesome provisions, an impure or tainted atmosphere, deficient clothing, fevers, filth, fatigue, mental anxiety, &c. What is the proper treatment for scrofula ? Invigorate the general system by a light nourishing diet, tonics, and such other means as the general state of the health may require. Flannel should be worn next the skin, and moderate exercise persevered in. Iodine and its compounds, both generally and locally, are valuable in the treatment of most cases of scrofula. Cod-liver oil has been found of much value in this disease, 37 2 c 434 SURGERY. For the scrofulous ulcer, dry lint, the iodine cataplasm, astrin gent washes, and moderate pressure, are recommended. Gonorrhoea. What are the symptoms of gonorrhoea ? They are a slight titillation of the glans penis, tumidity of the lips of the urethera, and more or less inflammation of the glans and prepuce. These are followed by a discharge from the urethra of a thin whitish fluid, speedily changing into a yellow purulent matter, of peculiar smell, attended with pain along the course of the urethra in dis- charging the urine. It consists of an acute inflammation of the lining membrane of the urethra, caused by the application of matter from another during the sexual connection. The time of its appearance is vari- able. Chordee sometimes occurs, in which there is erection with great pain, and the penis is bent, with the concavity downwards, in consequence of the effusion of lymph into the corpus spongiosum urethras, preventing its expansion. Yarious other complications may occur, such as phymosis, para- phymosis, excoriation, bubo in the groin, abscess in the perineum, swelling of the testicles, and pains in the joints. What is the treatment? The abortive plan of treatment has been recommended by some, prior to the suppurative stage, by injecting a strong solution of the nitrate of silver, with a glass syringe, into the urethra. The constitutional treatment in severe cases is rest, blood-letting, purgatives, and low diet. Stimulating diuretics, especially balsam of copaiva and cubebs, are beneficial. When the ardor urinae and discharge diminish, we may use astrin- gent injections, which should be very mild. Syphilis. What is understood by the syphilitic virus? It is a specific morbid poison, which, applied under certain conditions to any por- tion of the human body, will there determine definite and charac- teristic local phenomena, and, if absorbed, contaminate the system. How is syphilis divided? Into primary or local, of which chancre is the exponent. And consecutive, general, or constitUt tional, which is always the consequence of chancre, SURGERY. 435 What is chancre ? It is a primary venereal sore, produced by the direct action of the syphilitic virus on the inoculated part. What are the different ways that chancres may be developed ? By pustule, ulceration, and small abscess. What are the stages ? There are two ; one of ulceration, and the other of cicatrization. What is the difference in the properties of the matter in these two stages ? In the first it is inoculable, and in the second it is not. How are chancres divided as to location ? Into external and larvated, or concealed. How are they divided in regard to their characteristics ? Into follicular, indurated, phagedcenic, and furunculous. What is the index of constitutional affection ? Induration of a chancre. Are buboes classed among the primary or secondary symptoms of syphilis ? The primary; and may occur both from sympathy and absorption. If from absorption, they are inoculable, and are included in the term furunculous chancres, or chancrous buboes. What is the treatment of chancre ? As it is at first purely a local affection, the specific sore should be converted into a simple one by the application of caustic. Nitrate of silver, protonitrate of mercury, sulphate of copper, potassa cum calce, &c., are used for this purpose, some preferring one, and some another. After the separation of the eschar, simple dressings, such as weak solu- tions of sulphate of copper, black and yellow washes, aromatic wine, &c., will be proper dressings. Larvated urethral chancres may be cauterized by Lallemand's instrument. How should buboes from absorption be treated ? By antiphlo- gistics generally; leeches, blisters, succeeded by a solution of cor- rosive sublimate, and other antiphlogistic applications locally; after ulceration, they should be treated like chancres. When sup- puration takes place, they should be opened early. What is the proper treatment for chancre when it becomes indu rated ? Induration being the index of absorption, which is fol- lowed by constitutional symptoms, constitutional remedies become necessary, and mercury, pushed to the extent of a very slight im- pression on the glands, is the best remedy. What are the constitutional, or secondary symptoms ? Cutane* 436 SU RGERY. ous eruptions, inflammation of the eye, inflammation and ulcera- tions of the palate and fauces, induration and ulcerations of the glands of the skin, inflammation of the osseous and fibrous tissues, neuralgia, &c. Are these affections capable of hereditary transmission ? _ They are ; but the primary are propagated from one to another only by inoculation. What is the treatment? By alteratives ; among which mercury stands first; iodide of potassium, sarsaparilla, arsenic, &c, are also useful. Tumors. What is understood by a Tumor ? A swelling or new produc- tion, and not a part of the original composition of the body. How are tumors divided? Into solid and encysted. The solid are generally enveloped by a dense cellular sheath of surrounding cellular substance, which divides them from surrounding parts. Others, however, have no such limit, and involve surrounding parts as they enlarge. What is understood by Adipose Tumors? They appear to be composed of fatty matter insinuated amongst extended and delicate cellular substance ; generally lobulated, and found only in the cel- lular and adipose tissues. What is understood by Fibrous Tumors? They are formed in various textures, are composed of a substance of a dirty-gray color, with considerable density, through which firm ligamentous bands ramify. They do not mingle irregularly with surrounding parts; thus differing from malignant tumors which contain fibrous matter. What is understood by Encephaloid Tumors? They are deci- dedly malignant, and called Encephaloid, or Medullary Sarcoma. They are not like brain or spinal marrow in their intimate struc- ture, as the name might indicate ; perhaps fungoid would be a better term. They consist of a homogeneous matter, resembling the substance of brain in color and consistence ; always soft, but more so in some parts than in others; general softening occurs in advanced stages. The mammas, testicle, and contents of the orbit in children, are the parts most liable to this disease. What is understood by Melanoid Tumors? They are of rare SURGERY. 431 occurrence, originate in the cellular tissue, and most frequently attack the viscera, sometimes the eyeball. The external appear- ance is generally shining and mottled ; internally, they consist of a homogeneous black matter, infiltrated into the cellular tissue. Occasionally they are firm, in other cases soft, broken down, and semifluid. What is understood by Carcinomatous Tumors ? They are the most malignant and intractable of tumors. The term scirrhus is often used synonymously with carcinoma, while cancer is a term pretty indiscriminately employed to denote their condition after ulceration. They are characterized by a preternatural density or induration of the soft parts, difficult of resolution, and prone to ulceration. Unequal in surface, uncommonly heavy, and the skin covering them puckered, and of a faint blush or leaden hue; with a vehement, peculiar, lancinating pain in the part. Their internal structure contains firm ligamentous bands, traversing in various directions, and communicate a grating feel to the knife when cut- ting them. What is understood by Fungus Hcsmatodes ? It is a term ap- plied to those fungous growths which have hemorrhage proceeding from them to a greater or less degree, and with more or less fre- quency. The term is often applied to medullary sarcoma. What is understood by Encysted Tumors? They are superfi- cial, consist of an external cyst, which is sometimes thin and delicate, in other cases dense, thick, and fibrous, or almost cartila- ginous. The internal structure varies very much in different cases. They are sometimes designated from the nature of their contents : Atheromatous, containing curdy matter; Melicerous, containing a substance like honey; and Steatomalous, containing fatty matter. It is difficult, however, to thus designate them all properly. What is the proper treatment for tumors ? Extirpation with the knife is the only remedy to be depended upon ; and even this will often fail when the tumor is malignant, although it gives the best chance for success. Fractures. How are Fractures divided? Into simple, compound, and complicated, and again into transverse, oblique, comminuted, and longitudinal. A simple fracture is a mere separation of the bony 31* 438 SURGERY. fibres, unattended with severe contusion or external wound. A compound fracture is accompanied with an external wound or pro- truded bone. It is called complicated when the bone is broken in more than one place, combined with luxation, laceration of large vessels, or rupture of ligaments, tendons, &c, or other extensive injury. A fracture is transverse when its direction is perpendicular to the axis of the bone, oblique when it deviates from the perpen- dicular direction, comminuted when the bone is broke in several places, and longitudinal when it runs parallel with the axis of the bone. What are the symptoms of fracture ? Generally there is cre- pitus, and when it exists can be relied on. There is also usually deformity, pain, swelling, and inability to use and move the limb. Bones in young subjects are sometimes bent, only a few of the bony fibres on the convexity giving away. What is the prognosis in fractures ? It will depend much upon the extent of the injury, constitution, and age of the patient, the kind of fracture, and the bone broken. Complicated and com- pound fractures are the most dangerous. An oblique fracture is more difficult to manage than a transverse one, owing to muscular contraction. What is the treatment for fractures. The general indications are to prevent or subdue inflammation, and to coaptate and retain the fragments in contact, until they are restored by callus. The former is best accomplished by the antiphlogistic course and position ; and the latter by extension, counter-extension, position, splints, compresses, and bandages. It requires from two to eight weeks to produce consolidation, and sometimes longer, before complete restoration takes place. Fracture of the Lower Jaw. What are the symptoms of fracture of the lower jaw ? Crepi- tation can generally be detected, and the teeth will be found irregu- lar, and often loosened. It generally occurs in the mental region, or middle of the horizontal ramus ; but it may occur in any part. What apparatus is necessary ? A compress, and a bandage united in the centre and divided at each end, near to the middle, so that each loose end may be lied to the one of the opposite side; one of them over the top, and the other at the back part of the SURGERY. 439 head; the united portion of the bandage covering the compress ai.u jraeture. Fig. 3. The patient mnst be nourished with broth or other thin fluid, imbibed between the teeth. Fracture of the Vertebrae. What are the symptoms of fracture of the vertebras ? It is rare, and when it does occur, must be the result of great violence. Diagnosis is sometimes difficult, as paralysis may occur from con- cussion without fracture. If it occur above the fourth cervical vertebra, death takes place at once, from injury to the phrenic nerve. If immediately below the fourth, the upper extremities are paralyzed, there is difficult respiration, and death occurs in a few days. When the dorsal vertebras are the seat of fractures, paralysis of the lower extremities, and intestinal torpor occur, with gaseous distension, and death in a few weeks or sooner. If it be the lumbar vertebras, the bladder and rectum are para- lyzed, and the urine and feces pass involuntarily, the lower ex- tremities are paralyzed, and death follows sooner or later. Fractures of the spinous processes are not serious, unless accom- panied by concussion, or some other injury. Prognosis is unfavorable. What is the treatment for fracture of the vertebrae ? If the patient should survive the immediate effect of the injury, the anti- phlogistic course should be adopted, particularly one to relieve in- flammation of the spinal marrow ; and the urine must be drawn off frequently by the catheter. 440 SURGERY. Fracture of the Ribs. What are the symptoms of fracture of the ribs ? They are not always distinct unless crepitus exists ; there is generally little dis- placement ; but usually pain on respiration (especially in the re- cumbent posture) at the seat of the injury, which is increased upon coughing. What is the treatment ? A roller 6 or 1 inches wide should be applied tightly round the breast, so as to cause the patient to breathe by the diaphragm. The general symptoms should be attended to at the same time. Fracture of the Sternum. What are the symptoms? An incessant grating of the frag- ments upon each other during respiration. The direction of the fracture is commonly transverse. What is the treatment? The indications are to prevent or sub- due inflammation, and to appease the incessant cough and difficult respiration that usually attend. A roller should be applied also, as in fracture of the ribs, and a compress if necessary. Fracture of the Clavicle. What are the symptoms? Crepitation, depression of the hume- ral beneath the sternal fragment, the shoulder falling below the level of the opposite one, and the peculiar inclination of the head and body towards the affected side. What is the treatment? The indications in fracture of the clavicle are to carry the shoulder upwards, outwards and back- wards ; and to retain it in this position by appropriate apparatus, of which there is a variety in use, some surgeons preferring one, and some another. The plan of Yelpeau is recommended by Prof. Mussey, in which the forearm is brought across the chest, with the hand resting on the shoulder of the sound side, and secured in this position by proper bandages and compresses. " The last and best apparatus is that of Dr. Fox, which consists in a sling for the elbow, made of stout linen, or other material; this should be in length about two-thirds of the forearm, and deep enough to embrace the forearm ; it can easily be made out of a piece of stuff, cut into a parallelogram twice the width of the fore- arm, and two-thirds of its length ; this is to be doubled in its SURGERY. 441 shortest diameter, and one end sewed up ; at the upper angle, and the corner of each side, a strong loop of tape is attached. A ring of linen, stuffed with carded cotton, is made to embrace the shoulder and axilla ; a wedge-shaped pad, which should be three inches thick at the base, six inches long, and four or five wide ; three strong pieces of tape or bandage complete the apparatus. The application of it is as follows : The base of the pad is placed in the axilla of the injured side, and temporarily secured by being- held, or by tapes tied around the neck ; the arm of the sound side is passed through the padded ring, which rests in the axilla and over the shoulder: the sling is applied to the forearm, the elbow placed firmly in its angle, and the arm is now brought down to the side, the fracture coaptated ; tapes having been passed through the loops attached to the sling, are now carried through the ring at the sound shoulder, the tape at the elbow carried behind the 'diest, and those at the wrist in front; these are firmly drawn so as 442 SURGERY. to place the shoulder and clavicle in proper position, the hand being put into a sling. Raw cotton should be placed under the tapes where they touch the skin, to prevent excoriation. With this apparatus I have treated a child only twenty months old with- out inconvenience or deformity, but it is necessary to avoid much pressure in such young subjects, as well as to exercise great care in protecting the skin from excoriation ; in this case, a few circular turns of a roller were passed round the chest and forearm to pre- vent motion — an addition unnecessary in the adult. This appa- ratus is easily applied ; and can be worn without inconvenience, and probably answers the indications better than any that has yet been proposed."—Hastings' Surgery. Fractures of the scapula can generally be treated by the same position and apparatus as those of the clavicle. Fig. 5. Fig. 6. Fracture of the Arm. (Figs. 5 and 6.) What are the symptoms? Crepitation, mobility of the frag* ments, and angular displacement, or a tendency to it. A fracture SURGERY. 443 of the neck of the humerus, besides the ordinary symptoms of fracture, may be distinguished from dislocation by the rotundity of the shoulder being preserved ; while in dislocation there is a hollow under the acromion, and a tumor in the axilla. What is the apparatus necessary for the treatment ? A long roller and four narrow splints, when the shaft is the seat of frac- ture. When the condyles are fractured, a roller and two angular splints are necessary. When fracture of the lower extremity of the humerus occurs just above the condyles, much care is necessary to distinguish it from dislocation of the radius and ulna backwards. In fracture, crepitation may be produced ; the deformity is easily removed by extension, and returns when discontinued, and the length of the arm is shortened, which is not the case in dislocation. Fig. 7. The roller and angular splints are also appropriate for this injury; one splint should be placed in front and the other behind the arm, with the horizontal limbs of the splints resting upon the upper and lower surfaces of the forearm, and attached to it by the roller. Fracture of the Forearm What are the symptoms? Crepitation, deformity, and the mo bility of the fragments. Both bones may be fractured upon the same level, or at different points, or one bone alone may be fractuied; the radius being more fiequently broken than the ulna. 444 SURGERY. Fig. 8. Fig. 9. Fig. 10. The olecranon process of the ulna may be fractured by direc* violence, or by the action of the triceps muscle. The coronoid process is sometimes, although rarely, fractured. When the coronoid process is broken, there is dislocation of the ulna backwards, with the characteristic projection, and difficulty of bending the elbow. Fracture of the lower end of the radius may easily be mistaken for dislocation of this bone at the wrist-joint, and great caution should be observed in making a diagnosis. In fracture, crepitus may be produced, and the deformity is easily removed by pressure, and returns when left free. What apparatus is necessary in the treatment? Two long compresses ; two splints 2\ inches wide, and long enough to ex- tend from the elbow to the points of the fingers; and a roller. SURGERY, Fig. 11. 445 The soft parts of the interosseous space should be made to serve as a splint, by the arrangements of the compresses, so as to force the fragments outwards, and keep them in apposition. If this precaution should be neglected, pronation and supination may be destroyed, as may be seen by Figure 12. Fig. 12. Fig. 13. In fracture of the olecranon, the elbow should be straightened and bandaged by circular and reversed turns of a roller from the hand to the injured joint; the fragment should be brought down and adjusted, the roller passed above it and around the joint, in the form of figure of 8, until is it firmly fixed. (Fig. 13.) A splint 446 SURGERY. is then to be placed in front of the joint, of some length, and secured by a roller. In three weeks the joint should be moved passively so as to prevent anchylosis. The union will be ligamentous. In fracture of the coronoid process, the joint must be put in proper position, bent at right angles, bandaged properly, and placed in a sling. Fractures of the carpus, metacarpus, and phalanges require no special directions; general principles in reference to fractures governing iu all cases. Fracture of the Patella. What are the symptoms ? The transverse fracture, which is the most common, is known by the Fig. 14. upper half being remove upwords on the thigh, and the patient is unable to rise or to walk. What is the treatment and ap. paratus? The limb should be placed in au extended position and flexed on the pelvis. The apparatus is a splint two inches wide, long enough to extend from the tuberosity of the ischium to near the heel; two rollers, each six yards long, and three inches wide; and compresses. Pass the roller by circular and reversed turns from the foot to the lower fragment; bring the upper one down in contact with the lower; pass the roller around the knee in the form of the figure of 8, and with circular turns in such a manner as to retain the fragments in contact. The roller should be passed so as to confine the muscles of the thigh ; a straight splint applied behind the limb, and quietude enjoined. The union is generally ligamentous. Fracture of me Thigh. At what part of the Neck do fractures occur ? Both within and external to the capsular ligament; but fracture within is more SURGERY. 447 common, although rare in persons under fifty years of age, and is mostly met with in old women ; the bone undergoes changes in advanced life, which render it more liable to this accident. There is a deficiency of earthy matter, and sponginess of the cancelli; the neck becomes atrophied, shortened, and sunk from the oblique to the horizontal position. Fig. 15. The prognosis is very unfavorable ; union takes place slowly, if at all. What are the symptoms of the fracture of the neck ? The limb is generally shortened ; its length can be restored without difficulty, and reascends as soon as the extension is removed. Upon rota- ting the thigh, and placing the hand on the trochanter, it will turn, as it were, upon a pivot; whereas, in the sound bone it describes the arch of a circle, the radius of which is formed by the neck, and crepitus may be produced. What is the proper treatment? In very old subjects, place the patient in bed, keep the limb quiet, by a splint if necessary, for a few weeks, when the patient may be allowed to use crutches. If the patient be young, it may unite by bone, and he should, there- fore, be placed in a proper apparatus for keeping it in place. 448 SURGERY. The Trochanter Major may be fractured, and is known by its being drawn upward, and by crepitus. When this occurs, the dis- placing1 muscles should be relaxed, and the recumbent position assumed. The shaft may be separated from the epiphysis in young sub- jects, and should be treated by extension, Fig- lg- counter-extension, and fixing the limb by splints. What part of the thigh is most liable to fiacture ? The middle in young subjects. What are the symptoms of fracture of the Shaft? There are the general symp- toms of fracture with shortening of the limb, unless it is transverse, in which case the ends are supported against each other. What are the indications of treatment? The principal indications are to keep up extension, counter-extension, and coapta- tion, for which there is a great variety of apparatus in use. Desault's apparatus has been very popu- lar, and consists of an outer splint, three or four inches wide, reaching from the crest of the ilium to four inches beyond the foot, each extremity having a hole in it; an inner splint reaching from the perineum to the sole of the foot, and an upper splint reaching to the knee. A counter-extending band is passed over the perineum ard through the upper hole in the splint. Extension is produced by a band or handkerchief applied to the ankle, and made fast to the lower end of the splint through the hole. Dr. Physick modified Desault's apparatus by extending the outer splint to the axilla, in which extension is made in a line more nearly parallel with the axis of the body. A block is also placed on the inner side of the same splint, below the foot, so as to pre- vent obliquity in the line of extension. Bags of bran or oat chaff to 5 00 450 SURGERY. Fig. 19. SURGERY. 451 are placed on each side of the limb, so as to prevent excoriation, and keep up steady pressure ; the whole is then to be secured by bandages. Liston's apparatus consists in using the outer splint alone, as seen in the figure applied. (Fig. 17, p. 449.) Dr. Gibson recommends Hagedorn's apparatus as modified by himself, as seen in the annexed figure. (Fig. 18, p. 449.) Physick's modification of Desault's is more popular than any other apparatus. Fracture of the Leg. What are the most common varieties ? Oblique and transverse fractures of the middle, but it is liable to every variety, and in any part. Sometimes one bone is broken, and at others both. A variety of apparatus is used in their treatment. The chief purpose of a splint being to enable a surgeon to keep, effectually, the frac- tured surfaces of a bone in the closest apposition during the time requisite for reunion, that one, of course, should be adopted, that will best answer this purpose; and it will be found that, in some Fig. 20. Fig. 21. 452 SURGERY. case, sone kind will answer best, and in others another kind; depending upon the kind of fracture, the tact of the surgeon in its application and adjustment, &c. The fracture-box and pillow has high authority to recommend it. It should have a foot-board to which the foot can be secured by bandage so as to prevent lateral inclination. Two splints, the length of the leg, applied on either side, also answer the purpose well; care being taken to support the foot by a bandage or handkerchief, as seen in the figure. (Fig. 19, p. 450.) p. 22 The fibula is often fractured near the ankle-joint, and often accompanied with dis- location of the foot. The foot is turned out- wards, as seen in Figs. 20 and 21, p. 451. Dupuytren's or Physick's apparatus is preferable to any other, and consists of a single splint, placed on the inner side of the leg, and reaching beyond the foot. A wedge-shaped pad reaching only to the ankle, with the larger end applied to the internal malleolus, should be used; and a bandage applied so as to produce inversion of the foot, and retention in that position. The internal malleolus is also sometimes fractured, including more or less of the tibia. (Fig. 22.) It is easily detected, and requires the same apparatus and treatmenl as fracture of the fibula, only the application should be on the opposite side of the limb. Compound Fracture. A compound fracture is where an external wound communicates with the fracture, and may be produced by jthe means causing the broken bone, by the protrusion of the bone itself, or by ulceration, subsequently. The dangers result from shock, hemorrhage, tetanus, suppuratiou, hectic, or typhoid fever. If the bone is much comminuted, or a large joint opened; if large arteries are torn ; if the soft parts are extensively injured; and particularly, if conjoined with age, or disease, amputation may be necessary. SURGERY. 453 When an attempt is made to save the limb, we should endeavor to convert the compound into a simple fracture, by arresting hemorrhage, clearing out the wound, and bringing the parts together properly, so that adhesion may take place. The general principles of treatment applicable for inflammation and its results in different stages, must be resorted to, and yef secondary amputation may be necessary. Luxations. What is a luxation or dislocation ? It is the removal of the head of a bone from its corresponding articulating cavity. How are the varieties of dislocation designated ? By the terms simple and compound; primitive and consecutive; recent and old; complete and incomplete. Simple luxation is where there is a mere removal of the head of the bone; compound, when an external wound communicates with the cavity of the joint; primitive, when the head of the bone continues in the unnatural position it first assumed; consecutive, when it is removed and becomes fixed in another; recent and old, relate to the duration ; complete and incomplete, denote total, and partial displacement. How may luxations be distinguished from fractures ? By want of crepitation, by the peculiar distortion and rigidity of the limb, and the shape of the joint. What are the means generally employed ? Constitutional and local means are both often necessary. Among the former are blood-letting, warm-bath, nauseating emetics, &c, The latter are extension and counter-extension. A partial removal of the head of the bone from its articulating surface is termed sub-luxation. If a dislocation is connected with a wound in the integuments, fracture, or laceration of large vessels, it is called compound dis- location, and the same general principles govern as in compound fracture. Dislocation of the Lower Jaw. In how many ways may the Lower Jaw be luxated, and what are the symptoms ? Only in one — anteriorly. The condyles are 454 SURGERY. Fig. 23. displaced, the mouth is thrown open and cannot be shut, and the coronoid process projects under the cheek bone. (Fig. 24.) What is the treatment? The surgeon places his thumbs deep in the mouth, and rests them upon the posterior molar teeth, while the fingers are carried beneath the chin and base of the jaw. Fig. 24. SURGERY 455 Pressure should be made downwards by the thumbs, and the chin elevated at the same moment; by which reduction may be effected. When it depends upon relaxation of the ligaments, Sir Astley Cooper recommends blisters before the ear, shower-bath, and the internal use of ammonia and steel. Dislocation of the Clavicle. How many ways may the Clavicle be luxated ? It may be lux-. ated at either end; and the sternal portion in three directions—. forwards, backwards, and upwards. They are all easily distin- guished by their peculiar deformity. Fig. 25. What is the treatment ? The same as for fracture of the same bone. Dislocation of the Arm. How many ways may the Arm be luxated ? Downwards, for- wards, backwards, and a consecutive dislocation upwards. How should the reduction be accomplished? The patient should be seated in a chair; a strong band, eight or ten inches wide, passed around the chest with its middle close to the injured part, and its two ends given to an assistant on the opposite side ; another cloth should encircle the arm above the elbow, be fixed and entrusted to another assistant; the surgeon should lay hold of the extremity so as to bend the elbow and rotate the humerus, while the assistants make extension and counter-extension. When 456 SURGERY sufficient force is applied, the humerus will generally pass into the glenoid cavity with a kind of snap. Fig. 26. Fig. 27. SURGERY. 451 Another mode is to place the patient on his back, place a ball in the axilla, and then let the surgeon place his heel on the ball, seize the wrist, and by a steady force effect the reduction. If necessary, a wet roller may be passed round the arm above the elbow, and an extending band applied, upon which greater tractive force can be exerted. Sometimes it is necessary to apply pulleys, as shown in Fig. 27, particularly in old cases. A dislocation of this joint should not be attempted after having existed twelve weeks. Dislocation of the Forearm. How may the Forearm be luxated ? Backwards, laterally, and forwards by a previous fracture of the olecranon. The ulna may be dislocated backwards, the radius forward and also backward. Fig. 28. What are the symptoms ? When both bones are thrown back- wards, there is a projection posteriorly; on each side of the ole- cranon there is a hollow ; the lower extremity of the humerus can be felt at the forepart of the joint; the hand and forearm are fixed in the supine position, while the joint is nearly immovable. The treatment is to seat the patient; the surgeon should place his knee in the bend of the arm, take hold of the wrist, and make extension ; this will have a tendency to separate the radius and ulna from the humerus, and bring them forwards into their proper position. The forearm should then be placed in a sling after re- duction. When the ulna is dislocated backwards, there is a contortion of 39 458 SURGERY. Fig. 29. the hand and forearm inwards, and the olecranon process projects behind the humerus. The forearm cannot be extended, neither can it be flexed beyond a right angle ; these are the distinguishing marks ; it is easily reduced by extension and counter-extension. In dislocation of the radius forwards, the head occupies the hollow above the external condyle of the humerus. (Fig. 30.) Fig. 30. Fig. 31. SURGERY. 459 The forearm is slightly bent, but cannot be flexed to a right angle, nor extended completely; the hand is pronated ; the head of the radius may be felt inside the external condyle, rotating, if the hand be rotated ; and there is a sudden check if the elbow be flexed. In reducing it, extend the wrist and supinate the hand ; at the same time, press with the thumb on the head of the radius. Dislocation of the radius backwards is known by feeling the head of the bone back of the external condyle; and there is partial loss of movement in the joint. (Fig. 31.) Reduction and treatment same as in previous injury. Fig. 32. The radius ana uina may be dislocated at the wrist, both back- wards and forwards. (Fig. 32.) Reduction is effected by extension, counter-extension, and pres- sure ; the wrist and forearm should then be placed in splints and sling. The radius at the wrist may be dislocated anteriorly, poste- riorly, and laterally. The ulna may be dislocated at the wrist, and may easily be known by the change of position of the styloid process, projection of the ulna, and twisting of the hand. It may be reduced by extension and pressure ; it should then be confined by compresses, splints, and bandages, on account of the great liability to displace- ment from rupture of the ligaments. The thumb may be dislocated backwards, and also in the oppo- site direction. Fig. 33. 460 SURGERY. Fig. 34. In reducing it, a clove-hitch should be placed upon the first phalanx, and extension made, with some forcible and steady flexion, towards the palm of the hand ; and pressure made by the thumb upon the head of the bone, which will usually succeed. Fig. 35. Dislocation of the Thigh. What are the different luxations of the Thigh ? Upwards and outwards on the dorsum of the ilium; downwards and inwards into the foramen ovale (Figs. 36 and 37) ; upwards and forwards on the pubes ; backwards into the ischiatic notch, and downwards under the tuberosity of the ischium. (Figs. 38 and 39.) The first may be known by a prominence near the superior spinous process of the ilium, formed by the great trochanter, to- gether with a shortening of the limb, and an inclination of the foot inwards. SURGERY 461 Fig. 36. Fig. 37. Fig. 38 Fig. 39. 39* 462 SURGERY. The second by the limb being lengthened two or three inches; the foot is turned outwards, and the head of the bone in thin sub jects may be felt in the foramen ovale. (Fig. 41.) The third by a hard tumor above Poupart's ligament; the limb is shortened about an inch, the foot is turned outwards, and the trochanter major is in front of the anterior superior spinous process of the ilium. (Fig. 42.) The fourth by the limb being shortened half an inch, and the foot slightly inclined inwards. (Fig. 43.) What is the treatment? Extension by pulleys, and counter- extension by a band passing over the perineum and resting against the tuber of the ischium. Bleeding, warm bath, and tartar emetic, so as to produce re- laxation, frequently have to be resorted to. The mode of acting and arranging the means of effecting reduction in the different forms, is well exhibited by Figs. 44, p. 463, 45, 46, p. 464, and 47, p. 465. SURGERY. 463 Fig. 42. Fig. 43 Fig. 44 SURGERY. Fig. 45. Fig. 46. 26 SDRQ HEY. 165 Fig. 47. Dislocation of the Knee. In what ways may the Knee be luxated ? In four directions. backwards, forwards, inwards, and outwards. (Figs. 48, 4? 50, and 51.) Fig. 48. Fig. 49. The diagnosis is easily made in these cases. Reduction is accomplished by extension and direct pressure. Inflammation is apt to be severe, and must be combated by active means, and rest enjoined for several weeks. How may the Patella be luxated ? Outwards, inwards, and upwards when the ligament of the patella is ruptured. 2e 466 bDRGERY. Fig. 50. Fig. 61. Dislocation of the Ankle. In what direction may the Ankle be luxated ? Inwards, out- wards, forwards, and backwards; all of which may be easily recognised. Reduction is accomplished by extension of the foot and flexion of the leg, so as to relax the gastrocnemius muscle. It is a very serious injury, and amputation will often be necessary. The Astragalus is sometimes dislocated, and may be either for- ward or backward. Reduction' is difficult, and cannot always be accomplished, in which case excision or amputation may be necessary. Diseases op the Bones and Joints. To what diseases are the Bones liable? Caries; necrosis; exostosis; spina ventosa; osteosarcoma; mollities and fragihlas ossium; and rachitis. Caries. What is caries ? It is an ulceration of bone. The soft or spongy bones are the most liable to caries. SURGERY. 467 What are the symptoms ? The affected part swells, there is a softening of the bone, and it crumbles away; there is also a dis- charge of fetid blackish matter, and a luxuriant growth of pale fungous granulations. What is the treatment ? When it is dependent upon a syphilitic, scrofulous, scorbutic, or any constitutional disorder, general reme- dies should be resorted to. When it proceeds from local injury, the indications are to combat inflammation, keep the parts at rest, and remove diseased portions of bone as they become loose, Mineral acids, and gastric juice have also been applied with bene- fit. Blisters, issues, setons, and steady purging are serviceable in constitutional caries. Fresh air, tonics, and alteratives are proper in advanced stages. Caries of the Spine. What are the symptoms? The patient complains of numbness or an uneasy sensation in the lower extremities, is languid, easily tired, and apt to trip or stumble in walking. There is often flatulence, sick stomach, and derangement of the digestive organs. Paralysis of the lower extremities occurs in the advanced stages of the disease. There is more or less protuber- ance at some portion of the spinal column ; the spinous processes of which project, and create considerable deformity. The most common seat is the dorsal vertebras. What is the treatment ? In the commencement benefit may be derived from leeches, blisters, and caustic issues ; the latter of which it is often necessary to continue for a long time. The con- dition of the bowels, and diet of the patient should be strictly attended to, the recumbent posture enjoined, and at the same time the benefit of fresh air should be given. Necrosis. What is necrosis ? It is where there is destruction of the vitality of bone, and differs from caries as sphacelus differs from ulceration. The term sequestra is given to dead portions of bone thrown off. Cloacae is a name for openings in the case of new bone which is thrown out. The pain is deep seated, long con< tinued, and severe. 468 SURGERY. What is the treatment? It is to remove the dead pieces of bone when formed. Constitutional remedies are often required. Exostosis. What is exostosis ? It is an enlargement of the bony structure, and is divided into laminated, circumscribed, tuberculated, and spinous exostosis. The bones generally affected are those of the cranium, lower jaw, sternum, ribs, and extremities. What is the treatment ? When it becomes troublesome, its re- moval should be attempted by general remedies, and low diet. If these fail, it should be extirpated, if necessary for the comfort or safety of the patient. Spina Ventosa. What are the symptoms of spina ventosa ? It is a tumor in- volving the whole circumference of a bone, consisting of an osse- ous shell perforated with numerous holes, containing sometimes a thin sanies mixed with portions of lymph or a cheesy substance. What is the treatment ? A cure may sometimes be produced by long-continued pressure ; .another mode of treatment is to make an opening into, the cavity, and throw in stimulating injections, or by cutting instruments excite such a degree of irritation as to cause it to fill up with granulations. If this fail, amputation must be resorted to. Osteo- Sarcoma. What is osteo-sarcoma ? It is a malignant disease of the bones. The tumor forming the diseased part is composed of thin bony plates, arranged so as to form cells, which contain a cheese-like or fleshy matter, or a thin gelatinous fluid. What is the treatment? In the early stages, constitutional remedies may avail something; of which the compound decoction of sarsaparilla with corrosive sublimate is perhaps the most efficient. Leeches and blisters have also been applied locally. Amputation, when practicable, is the only remedy likely to be permanently bene- ficial; even this often fails, and the disease returns, and attacks some of the internal organs, or another part of the osseous system / Mollities Ossium. What are the symptoms ? The bone loses its natural firmness; SURG ERY. 469 both the animal and saline parts diminish until mere shells are left, which are very soft. It is a very rare disease. What is the treatment ? Treatment is of little use ; and all that can be accomplished is to support the patient's strength by tonics, and nutritious diet. Rachitis, or Rickets. What are the symptoms? Disorder of the digestive organs, swelling of the abdomen, emaciation, dryness or discoloration of the skin, and blackness of the teeth. These symptoms are followed by distortion of different parts of the body, which in bad cases become very much deformed. What is the treatment? To strengthen the system by tonics, and keep the stomach and bowels in proper condition. Good nutritious diet, consisting of animal food, has been recommended, also frictions, and frequent bathing in salt water. Coxalgia, or Hip Disease. What are the terms used to denote this disease ? Morbus coxarius, ischias, spontaneous luxation of the os femoris, scrofu- lous caries of the hip, and abscess of the hip-joint. What are the symptoms? The first symptom is a slight pain in the knee, and emaciation of the limb ; then pain is felt about the trochanter and groin, which varies in different cases, and is in creased by pressure upon the hip-joint. In ^ome cases, anchylosis is established apparently without the formation of pus; while in others there is a large abscess formed, which discharges itself by one or more openings. —During this process, the patient is some- times worn out by hectic, and dies; at other times, anchylosis takes place ; the openings heal up, and a cure is accomplished with considerable deformity. What is the treatment? The habit of bending the thigh on the pelvis, and the leg on the thigh, should be corrected by curved splints gradually changed for straighter ones. — Before the abscess forms, blisters, cupping, and issues should be used, conjoined with steady purging, vegetable diet, and perfect rest. During the suppurative stage, the strength of the patient should be supported, and such other constitutional remedies employed as are indicated. 40 470 SURGERY. Fungus Articuli, or White Swelling. What is comprehended under these terms ? Inflammation of the synovial membrane. Morbid change of structure in the synovial membrane. Ulceration of the cartilages of joints. Scrofulous disease of the joints, having its origin in the can- cellous structure of the bones. What is the treatment of the first variety ? In the acute form bloodletting, purgatives, low diet, &c. The affected part should be kept in a state of quietude, and elevated.—As internal remedies, mercury and sarsaparilla are often indicated. What is the treatment for the second variety ? Amputation is generally the only remedy, and this does not always succeed. What is the treatment for the third variety ? Caustic issues, blisters, setons, and absolute rest: anchylosis generally takes place, and may be considered as the safeguard of the patient. What is the treatment for the fourth variety ? The remedies for scrofula should be resorted to ; also rest and adhesive strips. In all these varieties, when matter is formed in the joint, it should not be let out, but an effort made to produce absorption. Hydrarthus, or Dropsy of a Joint. What is the treatment ? Blisters and well-regulated pressure will generally be appropriate treatment. Movable Cartilage. What is the treatment? If a laced knee-cap, bandages, &c, have been tried without relief, recourse may be had to an operation for its removal. Anchylosis. How is it divided ? Into complete and incomplete. In the incomplete variety, the ligaments, tendons, and surround- ing cellular membrane are involved, and there is partial movement of the joint. In the complete form, the extremities of the bones often become perfectly united and identified. What is the treatment? Friction with stimulating articles, and judicious movement of the joint, in the incomplete variety. SURGERY. 471 Diseases of the Arteries. To what diseases are arteries subject? To inflammation, sup- puration, ulceration, sphacelus, calcareous concretions, uniform dilatation of the coats, and aneurism. Aneurism. What is aneurism ? It has been defined to be a pulsating tumor formed of arterial blood. What are- the varieties of aneurism ? True, false, circum- scribed, dissecting, diffused varicose aneurism, and aneurism by anastomosis. By true aneurism is understood a simple dilatation of all the coats of an artery, or the internal and middle ruptured, while the cellular coat remains entire; by false aneurism, a rupture or wound of the three coats, so that the blood is extravasated among the surrounding parts; the sac is formed by cellular tissue, or a new deposit of lymph, as seen in the figure. Fig. 52. The term circumscribed and diffused relate to the form of swell- ing, or extent of extravasation. In dissecting aneurism the sac is formed by the infiltration of blood between the coats of the arteries. What are the symptoms of aneurism ? The tumor is first small, free from pain, and disappears easily by pressure, but returns when the pressure is removed. As it enlarges the pulsation is lessened, and when much enlarged the integuments covering it become pain ful, livid, crack, ulcerate ; and hemorrhage, if not arrested, sooner or later destroys the patient. What is the treatment? Some benefit may accrue by frequent 472 SURGERY. and repeated bleeding; rigid abstinence; confinement to a nori zontal position ; the internal use of digitalis, astringents, and refrigerants; these remedies cannot be depended on, but should be pursued when the ligature from any cause is impracticable. The ligature may be considered as the only means upon which reliaiico can be placed, and even this often fails, and secondary hemorrhage is the consequence. Compression has sometimes succeeded. What are the rules for the application of the ligature in aneu- rism ? The surgeon should cut for a sound part of the artery above the sac ; penetrate cautiously until the pulsations of the artery are discovered ; pass an aneurismal needle round, armed with a liga- ture, detaching it as little as possible from its connections; the ligature should be firmly tied, one end cnt off, and the other left hanging from the wound, which should be brought together by adhesive straps. Aneurism by Anastomosis. What are the symptoms? It is a tumor formed by a congeries of small arteries and veins, with an intermediate cellular structure; as it enlarges, it acquires a thrilling pulsatile or jarring motion. What is the treatment? Compression, and excision are the means proposed for curing this disease ; they may also frequently be cured by exciting inflammation in the part by vaccination, caustic, needle and twisted thread, hot wire, &c. Some surgeons preferring one mode, and some another. The frequent application of collo- dion has been useful in some cases by producing gradual compres- sion. Varicose Aneurism. What is varicose aneurism ? It is that form of disease in which a communication is established between an artery and a vein. It may be produced in any part of the body where a large artery and vein are near each other, and happen to be punctured at the same time. Fig, 53. SURGERY. 114 What is the treatment? Compression and ligature are the means recommended. Diseases of the Veins. What are the diseases of the Yeins ? Inflammation, and vari- cose enlargement. Varicose Veins. What are the symptoms ? The disease is almost entirely con- fined to the veins of the lower extremities. In the commencement, numerous small circumscribed swellings may be observed; at length the whole venous trunk and branches become enlarged, run in a serpentine course, and appear knotted. As they enlarge, the sup- port afforded by the valves is diminished until they are entirely lost. The surrounding cellular membrane" becomes inflamed, and gives rise to painful ulcerations. What is the treatment? Compression with a roller or laced stocking; astringent washes; an elevated position of the limb; and obliteration of the diseased vein by an operation, of which there have been several kinds proposed and practised ; viz., the ligature, the section, and the excision of the vein — all of which are attended with more or less danger. Cirsocele and Varicocele. What are the symptoms? Cirsocele is an enlargement or vari- cose state of the veins of the spermatic cord. Varicocele is a varicose state of the veins of the scrotum. When examined, the whole cord appears like a bundle of knotted and tortuous veins; and feel like a bunch of worms wrapped round and twisted to- gether. The tumor subsides on assuming the horizontal position, and reappears on standing. What is the treatment? A bag truss should be worn that will suspend the testicles, and give them a firm support. Cold astrin- gent washes are also recommended. There are several operations, for the purpose of obliterating the vein, proposed and practised for this disease, upon which the profession is not yet very well settled. 40* 474 SURGERY. Inflammation of Veins. —Phlebitis. What form does phlebitis assume ? It may be acute or sub acute. There is not much danger in the subacute form ; it gene- rally affects varicose veins of the lower extremities. Swelling and tenderness about the veins and cedema of the limb exist. Rest, leeching, fomentations, cold lotions, elevation of the limb, and purgatives ; after wdiich, stimulating frictions and pressure are the proper course of treatment. The acute form is generally fatal. It may be caused by wounds, ligatures, bruises, erysipelas, &c. There are rigors, weak rapid pulse, anxiety of countenance, de- pression of spirits, swelling and tenderness over the vein, tongue furred, brown, dry, or black ; skin sallow, with prostration, low delirium, and bilious vomiting, and death often occurs in two or three days. Consecutive abscesses are very apt to occur in some joint, preceded by excessive pain, and followed by abscesses also in the lungs, liver, &c. Leeches, repeated and followed by fomentations to the part; bowels opened and pain allayed, are proper to be done; and the abscesses should be opened early. General depletion may be necessary in some cases ; stimulants and tonics in others, accord- ing to the condition of the patient. Mercury may be resorted to unless great depression exist. Injuries of the Head. Fractures of the Skull. What are the varieties of fracture of the skull ? There are several: fissure, counter fissure, depressed, double depressed or camerated, stellated, and punctured fracture. Fissure is a simple crack or division; counter fissure is a sepa- ration produced at a point opposite to that where the force was applied ; depressed fracture is when the bones are forced below their natural level; camerated when the sides decline towards the centre ; stellated, when it radiates from a centre resembling a star; and punctured when produced by a pointed instrument. Wlat is the treatment? In simple fracture, where the brain oi SURGERY. 415 membranes are uninjured, little or no treatment is necessary. The rule in all cases is not to interfere unless the contents of the skull are affected, and of this the symptoms must be our guide. In cases, however, where sharp points, or ragged edges of bone exist, they may be removed by appropriate instruments, to prevent them from irritating the dura matter, or other adjacent soft parts. In- flammation should be guarded against in all cases. Concussion of the Brain. What are the symptoms ? In slight cases there is vertigo, sick- ness of the stomach, trembling of the limbs, dimness of vision, &c. In severe cases there is insensibility, coldness of the skin, relaxa- tion of the limbs, feeble and irregular pulse, difficulty of breath- ing, (not, however, generally stertorous,) and dilated pupils. These symptoms may, after a time, subside gradually, when a determination of blood to the brain follows, of greater or less severity. ( What is the treatment ? If called early, be careful that the im- portunities of the bystanders do not determine you to bleed before the pulse rises and reaction is established, when it may be proper. Content yourselves with administering a little cold water, or, if the depression is very great, wine in small quantities, and with caution. Generally, external stimulants, such as mustard plasters, will be sufficient to rouse the system, and are free from the injurious effects of alcohol upon the brain. If inflammatory symptoms come on, bloodletting, purgatives, low diet, &c, with cold to the head, an elevated position of it, and blisters, become highly ne- cessary. Compression of the Brain. What are the causes and symptoms ? It may arise from de- pressed fracture, effused or extravasated blood, and fro'm suppura- tion within the brain, or its membranes. When symptoms of compression come on from extravasation, there is generally an interval between the injury and the appear- ance of the symptoms ; and when this occurs, may be considered as characteristic of compression from extravasated blood. When these symptoms are caused by matter, it is the result of inflamma- tion, and does not follow immediately an injury of the skull. £16 SURGERY. If compression arise from either of the preceding causes, it may be known by the pulse becoming slow and regular; the pupils dilated, and insensible to the strongest liirht; breathing stertorous, slow, and difficult; the limbs loose, or yielding, perhaps paralytic; sometimes flexion of one or both forearms, and insensibility. These symptoms will be sufficient to distinguish it from concussion, where the distinction is well marked ; but often the symptoms are intermixed so as to create confusion and doubt in the mind of the surgeon. What is the treatment? Blood-letting, purgatives, &c. will often, alone, relieve symptoms of compression. When the bones are depressed, they should be elevated; or, if produced by extravasation, the trephine must be resorted to, and the coagulum removed. What are the instruments required for operations on the skull? Two or three trephines, the largest about an inch in diameter, and the smallest half an inch ; a Hey's saw ; a lenticular; raspatory; trepan forceps ; two elevators, a small brush, tooth-pick, or probe; tenacula ; sponges ; crooked needles ; ligatures, and a scalpel. What are the objects to be attained in the application of the trephine ? To make an opening for the removal of coagulated blood, and for the introduction of the elevator beneath a depressed bone. For the former a large trephine should be used, and for the latter a small one. It is not, however, always necessary to use the trephine in depressed bone, as there is often sufficient space to pass the elevator between the fragments and restore them to their proper position. To what parts of the skull may the trephine be applied ? To all parts, except to the occipital bone. When it is necessary to trephine the inner table of the frontal sinus, two trephines should be employed ; a large one for the ex- ternal portion, and a small one for the inner. Inflammation of the Brain. What are the symptoms? The face becomes flushed, the eyes red, and tender to light, pupils contracted, skin hot, pulse hard and quick, and the tongue dry. The pain in the head is also severe, and the wound, if there be one,"discharges a sanious matter, Rigors follow, which are dangerous symptoms. Delirium, hemi- SURGERY 471 plegia, and convulsions may also come on in the latter stages of tho disease. What is the treatment ? The most active antiphlogistic course should be pursued ; blood-letting, generally, and locally, purgatives blisters, &c. If suppuration take place, the trephine may be used ; but the chance of the patient's recovery is very small. Fungus Cerebri, or Encephalocele. What are the symptoms ? It is a tumor having the appearance of a vascular organized growth, which sprouts from the brain after extensive fractures, or the operation of the trephine; fills up the opening of the bone, and projects beyond the scalp. What is the treatment? Light dressings, with moderate pres- sure upon the tumor. This disease is generally fatal. Diseases of the Eye. Conjunctival Ophthalmia. What are the symptoms ? A sense of uneasiness or itching an impatience of light, diffused redness of the conjunctiva, pain heat and swelling of the globe of the eye; an increased secretion of tears, and a feeling as though there was a lodgment of sand in the eye.' If the inflammation proceeds, there is violent pain in the eyeball and forehead, accompanied by fever and other general indisposition. Fig. 54. ^rm^ 478 SURGERY. Sometimes the conjunctiva throws out a fungus beyond the margin of the cornea, and at others suppuration takes place, followed by destruction of the cornea, and evacuation of the humors of the eye. There are several varieties of conjunctival ophthalmia ; the catar- rhal, purulent, gonorrhoea!, and scrofulous. Some authors, however, adopt different divisions of the disease from this. What is the treatment? In the early stage of simple inflamma- tion it may be easily removed by blood-letting, general and local, purgatives, antimonials in nauseating doses, low diet, blisters, lotions of tepid water, a solution of opium, or acetate of lead, or sulphate of zinc. If it runs into the chronic stage, cold astringent washes, and stimulating ointments may become necessary. For the catarrhal variety the proper remedies are moderate depletion at first, followed by highly stimulating collyria, and oint- ment. The purulent variety should be treated upon common antiphlo- gistic principles, and moderately astringent washes, of which the liquor of the acetate of lead is one of the best. The gonorrhceal variety may be treated upon general principles, but it is seldom cured. The scrofulous variety does not generally require much anti- phlogistic treatment, but rather a tonic course will be indicated. A blister on the nape of the neck kept open, and weak solutions of the nitrate of silver, sulphate of zinc, &c, applied to the eye, will be found beneficial. Granulations often form on the palpebral conjunctiva from long continued inflammation, which cause great pain and disturbance of the motions of the eye, and may, by continuing, render the cornea opake by friction. They can generally be cured by scarifications, lunar caustic, or sulphate of copper. Iu some cases they must be removed by the knife or scissors. Constitutional treatment, and blisters behind the ears are sometimes necessary. Sclerotic Ophthalmia. What are the symptoms ? It is an inflammation of the sclerotic coat sometimes called rheumatic ophthalmia. The pain in the commencement is generally seated in the temple, and extends to the eye-brow and cheek of the side affected, being most severe at night. There is no purulent discharge or intolerance of light; SURGERY. 479 Fig. 55 ihe sclerotic coat is of a dingy brick-dust tinge ; there is more 01 fever and derangement of the diges- tive organs. What is the treatment ? The in- dications are to restore the functions of the stomach, biliary organs, and skin, by emetics, purgatives, and antimonial diaphoretics, after which bark may be employed to advan- tage. The best local applications are a blister behind the ear, and the vinous tincture of opium as a collyrium. Iritic Ophthalmia or Iritis What are the symptoms? Severe lancinating pain, extending from the eyebrow to the orbit, and through the globe of the eye to the optic nerve; extreme impatience of light and morbid sensi- bility. The conjunctiva does not present the appearance of inflam- mation, but there are numerous red vessels on that part of the sclerotica connected with the cornea, also on the anterior part of the iris, which loses its brillancy, and changes to a reddish or greenish hue. The pupil becomes contracted, irregular, and its edge is turned backward toward the crystalline lens : lymph is deposited on the outer surface of the iris in spots, and sometimes so copiously as to obliterate the pupil. What is the treatment? The antiphlogistic course should be carried to its fullest extent. Obliteration of the pupil should be prevented by breaking up any bands of coagulable ^mph which may have formed, with the extracts of belladonna or stramonium, applied to the outer surface of4 the eyelids, or over the eyebrows, two or three times a day, and kept on for half an hour at a time. When it has a syphilitic origin, mercury, followed up with sarsa- parilla, should be used. The formation of an artificial pupil is often necessary after this disease. Psor ophthalmia. What is psorophthalmia ? It is an inflammation or ulceration oi the eyelids ; whether caused by small-pox, measles, scrofula, erysi pelas, or any other cause. 480 U R G E R Y . What are the symptoms? Children of scrofulous habit are most liable to this disease. The inflammation commences on the edges of the lids, and extends along the conjunctiva with pain and vio- lent itching; suppuration and ulceration sometimes occur, and are very troublesome. The Meibomian glands are always involved, and pour out an adhesive fluid. What is the treatment? In the early stage, purgatives and low diet, with the local application of solutions of acetate of lead, sulphate of zinc, or sulphate of copper. In the chronic stage, the unguentum hydrargyri nitrati, applied to the edges of the lids, will relieve the itching, and dispose the ulcerated surfaces to heal. If the disease resists every remedy for a long time, blisters behind the ears and a course of mercury may be tried. Pterygium. What is pterygium ? It is a thin membranous expansion, situ- ated on the conjunctiva; generally occupying the inner angle of the eye in the shape of a triangle, the apex of which looks towards the cornea, and sometimes extends to its centre. A pannus is a pterygium on each side, which meet in the centre of the cornea. There are two varieties, the membranous, and fleshy. What is the treatment? When it becomes troublesome, it should be dissected off with a pair of curved scissors. Encanthis. What is encanthis ? It is an enlargement of the lachrymal ca- runcle, and semilunar fold. It is sometimes malignant, but it is not a frequent disease. The caruncle presents a granulated and livid appearance ? If the disease continue a long time, adjoining parts become involved. What is the treatment ? Excision of the diseased parts. Opacity of the Cornea. What are the varieties of opacity of the cornea ? Nebula, albugo, and leucoma. Nebula is a superficial opacity produced by chronic ophthalmia. and does not entirely interrupt vision. Albugo occupies the lamella or substance of the cornea; it is .)f a white or pearl color, often accompanied by ophthalmia, and \a alwavs the result of an effusion of lymph. SURGERY. 481 Leucoma is a dense callous speck on the cornea, of a pure white or chalk color, and has a polished appearance. It is generally produced by a wound or ulcer. What is the treatment ? For the first variety astringent col- lyria, and such other remedies as are proper in chronic ophthal- mia. The treatment of albugo is generally difficult, and requires highly stimulating applications, of which one of the best is the unguentum hydrargyri nitrati, applied by a camel's hair pencil to the surface of the speck, once or twice a day. Washing the eye with diluted vinegar has also been recommended. Leucoma is perhaps seldom or never removed by any treatment. Ulcer of the Cornea. What are the symptoms ? It is commonly the result of the dif- ferent varieties of ophthalmia. Sometimes it occupies the whole cornea, and at others it is a simple cavity not larger than the head of a pin, on some particular part of the cornea. What is the treatment? The sore should be gently touched with nitrate of silver, until an eschar forms on its surface; and when it drops off, the caustic should be renewed. When the ulcer assumes a healthy appearance, discontinue the caustic, and use mild collyria or ointments. Staphyloma. What is staphyloma ? It is a thickening and opacity of the layers of the cornea, with a projection of its anterior surface. It may be produced by smallpox, purulent ophthalmia, wounds of the eye, &c. What is the treatment? There is no remedy; except that an operation may be performed to evacuate the humors of the eye, which will prevent the pain and inflammation caused by dust and other extraneous bodies. Blindness, of course, always exists, whether the eye is operated on or not. Hypopion. What is hypopion, and its symptoms? It is a collection of purulent matter, formed within the posterior or anterior chamber of the aqueous humor. There is redness of the conjunctive, and a yellow spot may be 41 2f 482 SURGERY. seen at the bottom of the anterior chamber, which increases in size until the whole cavity is filled. Pain, intolerance of light, &c, are very severe. In some ca.ses, the inflammation subsides, and the pus is absorbed. In others, ulceration and sloughing of the cornea may take place, followed by a destruction of the eye. What is the treatment? A prompt antiphlogistic course is the proper treatment. Hydrophthalmia. What is hydrophthalmia ? It is a dropsy of the eye, and con- sists in a gradual enlargement of the globe, without, at first, much pain or injury to vision ; but, as the disease advances, there is pain, impaired vision, &c, which may terminate in irritation, suppuration, and the loss of the eye. What is the treatment? When it is accompanied with general dropsy, digitalis, squill, volatile tincture of guaiacum, and calomel, may be proper If the accumulation is large, paracentesis should be performed. Obliterated Pupil. What are the symptoms ? The iris becomes wrinkled, and the pupil either entirely effaced or contracted to a very small compass. What is the treatment? An operation dividing a portion of the iris is the only proper course. Procidentia Iridis. What is procidentia iridis ? It is a projection of the iris through an ulcer or wound of the cornea. The pain and intoler- ance of light are excessive. What is the treatment? When it follows a wound of the cornea, it may be replaced ; but when it proceeds from an ulcer, it cannot be retained in its natural situation while the ulcer exists. The ulcer should be touched with the nitrate of silver, and healed as soon as practicable. Cataract. What is cataract, and the symptoms ? It is an opacity of the crystalline lens, or its capsule, or of the Morganian fluid, sepa< rately, or conjointly. They differ in color and consistence. Some are fluid, and called milky; others are called gelatinous, caseous, SURGERY. 483 or hard, according to their consistence. When the capsule is opake, and the lens remains transparent, or is absorbed, it is called capsular cataract. If a cataract exist from birth, it is called con- genital. Most cataracts are of a bluish, or pearl color; some are gray, or green; others white ; and in some rare instances black. There are four varieties ; the lenticular, capsular, Morganian, and the capsulo-lenticular. The symptoms are a diminution of sight; objects appear as if enveloped in mist, or smoke; and vision is very imperfect when suddenly exposed to a strong light. In a dull light the vision is improved ; and when the lens is opake, its color will generally indicate the nature of the disease. The diseases with which it is liable to be confounded are amaurosis and glaucoma. The catoptric examination gives the most certain diagnostic signs of cataract. When a lighted candle is held before a healthy or amaurotic eye, three distinct images of it may be observed. First, an erect image, which moves upwards when the candle is moved upwards; this is caused by reflection from the suiface of Fig. 57. 484 SURGERY. the cornea. Second, another erect image may be seen produced oy reflection from the anterior surface of the lens, which also moves upwards when the candle is moved in that direction. Third, a very small inverted image is seen, that moves downwards when the candle is moved upwards, and is a reflection from the posterior surface of the lens. In cataract, this inverted image is, from the first rendered indistinct, and is soon abolished ; and the deep, erect one soon disappears also. What is the treatment? An operation is the only treatment to be depended upon. What are the operations in use for cataract ? Couching, or depression ; extraction ; and the absorbent practice. The first is done with a needle, and consists in removing the crystalline lens downwards and backwards into the vitreous humor. Extraction is performed with a knife ; and the opening is made into the cornea. Fig. 58. The absorbent practice is founded upon the solvent power of the aqueous humor ; the operation is to break up the crystalline lens, and bring it in contact with the aqueous humor in the anterior chamber. It is done in two ways : one is to introduce the needle anterior, and the other posterior to the iris, so that in one case the cornea is penetrated, and in the other the sclerotica. In all in- stances, previous to the performance of any operation, the system should be prepared by purging, diet, &c. ; and stramonium, or belladonna should be applied to the parts about the eye. Congenital Cataract. What is the treatment ? An early operation. URGERY. 485 Amaurosis. What is amaurosis, and what are the symptoms ? It is an in- sensible state of the retina. The pupil is changed in color, greatly expanded and irregular in shape, has undulating edges, and the strongest light produces no perceptible contraction. The pupil is occasionally contracted, and in some instances its motions are partially retained. The natural lustre of the eye becomes diminished, or lost. It is easily distinguished from cataract by the catoptric test. What is the treatment? When it arises from any organic defect, the probability of affording relief is small. If it proceed from gastric derangement, emetics and purgatives will prove use- ful, followed by tonics. Errhines may also be found beneficial; beginning with the milder, and afterwards using the turpeth mineral combined with powdered liquorice. Fistula Lachrymalis. What is fistula lachrymalis ? It is an overflow of tears, pro- duced by an obstruction of the nasal duct, either in consequence of acute or chronic, inflammation, which may be produced by a great variety of causes. We should endeavor to remove the inflammation, and remove the obstruction in this way if possible, which can generally be done: if it fail, an operation will have to be resorted to. This: consists in passing a narrow bistoury into the duct, introducing its point just below the tendon of the orbicularis palpebrarum ; by pressing it downwards, backwards and inwards, until it enters the duct; the remaining obstruction of the duct must be overcome by passing a probe. The duct should then be kept open by a catgut or silver style, with an enlarged end, to prevent it from sinking too deep, and of sufficient length to reach from the cornea of the eye to the termination of the nasal duct. It should be removed and cleansed from time to time. Strabismus. What are the causes of strabismus ? It consists either in an over-action or paralysis of some of the muscles of the eyeballs, 41* 486 SURGERY and may be congenital, the result of imitation, or produced by gasiric, intestinal, or cerebral irritation. If caused by sympathetic disturbance, the treatment should be purgatives, alteratives, and anthelmintics. Division of the muscle will generally relieve the deformity, but not always. The opera- tion is simple, and easily performed. The head should be sup- ported, the eye turned outwards, the lids separated with an elevatoi (Pellier's answers well), or by the fingers of an assistant. Then catch the eye with a double hook, about midway between the edge Fig. 59. of the cornea and canthus ; raise the conjunctiva at the canthns by a pair of forceps, and divide it along with the subjacent cellular tissue ; pass the blunt hook under the tendon of the muscle, raise this on the hook, and divide it with the scissors. Fig. 60. Remove the double hook as soon as the blunt hook is passed. The division of the tendon terminates the operation-: Sometime? the inter-muscular fascia, or some fibres of the tendon, may prt vent the eye from becoming straight, in which case, pass the hook again and divide them, taking care not to divide too freely, or there may be reversion of the eye SURGERY. 487 The eye should be placed at rest, and inflammation combated if it arise. If any exuberant granulations appear, they should be touched with nitrate of silver, or clipped off with scissors. Hordeolum. What is hordeolum? It is a red, inflamed, painful tumor involving one or more Meibomian glands, usually seated on tho lower eyelid, near the inner, angle. What is the treatment ? Purgatives and attention to diet. If it becomes indolent, apply lunar caustic. Encysted tumors of the Eyelid. What is the treatment ? Extirpation. Entropion. What is entropion ? It is an inversion of the tarsus or its cilia What is the treatment? When there is simply an unnatural d.rection of the eyelashes, they should be removed with a pair of forceps. r When the tarsus is inverted, and the skin of the eyelid relaxed there should be an oval piece removed, and the sides of the wound brought together. Other operations are also practised. Ectropion. What is ectropion ? It is the reverse of entropion ; the eyelid being turned outwards instead of inwards. What is the treatment? A portion of the lid of the shape of the letter V should be removed from the outer angle; the thick- ened conjunctiva should then be dissected off, and the edges of the wound brought together with a fine suture. Ptosis. This is a falling of the upper eyelid from a palsy of the third nerve or from an injury of the levator palpebral superioris muscle. It is sometimes dependent upon congestion of the brain ; in which case bleeding, purgatives, mercury, and blisters are useful. Sometimes it persists, and has been treated by the removal of a fold of skin from the upper eyelid. 488 SURGERY. Diseases of the Nose and Antrum. Polypus of the Nose. Where are polypi of the nose generally attached ? They may *rise from any portion of the Schneiderian membrane; but are mostly attached to the superior, or inferior spongy bones, and are not malignant. What is the treatment ? They should be removed with the poly- pus forceps by a twisting motion rather than by pulling in a straight line. To prevent their return after removal, the application of the white precipitate ointment, softened, and applied by means of a brush, to the part from which the polypus has been removed, is highly recommended by Sir B. Brodie. Ozcena. What is ozoena ? It is an ulceration of the lining membrane of the nostrils, having a fetid discharge, and sometimes followed by destruction of the cartilages and bones of the nose. What is the treatment ? Bark, iron, mineral acids, muriate of lime, sarsaparilla, and antimony have been recommended. If there is a syphilitic taint connected with it, mercury will be proper. Locally, a solution of opium and acetate of lead may be used with advantage. Fungus, or Polypus of the Antrum. What are the symptoms? It is generally a formidable affection. The tumor sprouts from the lining membrane of the antrum, and grows until it fills the whole cavity ; pain is then experienced in the cheek and eye of the affected side, and the face becomes enlarged. These symptoms are followed by distortion of the nose, projection of the eye, enlargement of the gums, profuse discharges of sanious matter, &c. What is the treatment? As soon as the nature of the disease is ascertained, it should be completely removed. Diseases of the Mouth. Labium Leporinum, or Hare-Lip. What are the varieties of hare-lip ? The single and the double. What is the treatment ? An operation. Some surgeons recou> SURGERY. 489 mend that we should operate immediately after birth, or within a few weeks, others that we should wait until the child is two or three years old, or after the period of the first dentition. It is often combined with a deficiency in the palate and maxillary bones ; in which case their closure is more perfect with an early operation. The principal danger of an early operation is a liability to convul- sions. The operation consists in paring the edges of the fissure in the lip, and bringing them in contact by the interrupted suture, or pins, and figure of 8 bandage. Ranula. What is ranula ? It is an obstruction of one or more of the ducts of the sublingual glands, and gives rise to a tumor or cyst. What is the treatment ? Lay the cyst open freely, and remove a portion of it with scissors. Sometimes the application of caustic becomes necessary. Malformation of the Frcenum Linguae. What is the malformation of the fraenum linguas ? It is some- times too short, so as to prevent sucking. What is the treatment ? A slight division of the frsecum, which should be done carefully, so as to avoid hemorrhage, a\id also not to allow the tongue to fall backwards into the pharynx. Enlarged Tonsils. What are the symptoms? A hoarse, husky voice, snoring during sleep, excessive wheezing when laboring under cold; and upon inspection they will be found to be enlarged. What is the treatment ? Removal, either with the knife or liga- ture. What instruments are used for removing them ? Fahnestock's, Physick's instrument modified by Gibson, and Chamberlin's ex- cisor, the latter of which is to be preferred. Elongation of the Uvula. What are the symptoms ? Irritation about the tLroat, nausea, vomiting, and haemoptysis in some cases. What is the treatment ? Removal with a hook and commop scissors, or other suitable instrument. 490 SURGERY. Epulis, or Tubercle of the Gums. What are the symptoms ? It is often a malignant form of tumor which sprouts from the sockets of the incisor teeth of the upper jaw, or from the gum between teeth. What is the treatment? Extirpation in its very incipiency is the only chance for a permanent cure. Diseases of the Neck. What diseases are included under this head ? Lodgment of foreign bodies in the pjharynx, larynx, trachea, and oesophagus; stricture of the oesophagus; ulceration of the glottis; broncho- cele ; wry neck, &c. Extraneous bodies in the Oesophagus. In what manner may extraneous bodies in the oesophagus produce death ? By producing spasmodic action of the muscles of the glot- tis ; from distension of the oesophagus so as to press upon the trachea, and close it; or by producing inflammation or gangrene from the continued pressure ; or by violent attempts in removing them. What is the treatment? When the substance is large, it gene- rally sticks in the pharynx, from which it may be removed by the finger, or a pair of forceps. Articles that can be digested, pro- vided they have no hard, rough points, should be pushed into the stomach by a probang, unless they can be easily reached. Coins and sharp ragged bodies should be extracted by forceps, probang, hook, or some other contrivance, when practicable ; but when it is not, they should be pushed into the stomach. When it becomes necessary to push any of these articles into the stomach, purgatives and mucilaginous draughts should be taken. Dr. Physick prescribed boiled rice in large quantities, for the pur- pose of defending the coats of the stomach. Stricture of the Oesophagus. How are they divided? Into spasmodic and permanent, which are sometimes combined. Its most common seat is at the com- mencement of the oesophagus. SURGERY 491 What are the symptoms ? Difficulty of swallowing, pain in the Btomach, nausea, troublesome eructations, and pain in the fauces. What is the treatment? Bougies, with or without lunar caustic. In the spasmodic variety, camphor, opium, and ether are serviceable Removal of extraneous bodies from the Larynx and Trachea. What operations are performed for this purpose ? Laryngotomy and tracheotomy. The former is the one generally adopted. In performing this operation, should the incision be made al once into the larynx ? No ; the integuments should first be di- vided, and the hemorrhage entirely stopped ; then the crico-thyroid membrane may be divided. In what other cases are laryngotomy and tracheotomy resorted to ? Sometimes from substances lodged in the oesophagus, for croup, for enlargement of the tongue and tonsils, ulceration of the glottis, &c. Bronchocele, or Goitre. What is bronchocele ? It is an enlargement of the whole, or a part, of the thyroid gland. Its causes are not satisfactorily under- stood. What is the treatment? Iodine, internally and externally. Torticollis, err Wry Neck. What are the causes? Contractions of the platysma myoides, or sterno-cleido-mastoideus, cicatrices of burns, paralysis, &c. What is the treatment? When it proceeds from morbid con^ traction of the muscles, they should be divided, and the head brought into a proper position. Hernia. What is hernia ? It is a protrusion of any of the contents of the abdomen, covered by peritoneum, through the parietes of the abdomen. What are the divisions of hernia ? Hernia is divided into re- ducible, irreducible, and strangulated. It may also be termed, from its contents, enterocele, epiplocele, and entero-epiplocele. Reducible hernia is when it is easily replaced. 192 S URGERY. Irreducible hernia, when there is permanent protrusion. Strangulated hernia, when the parts are confined by stricture. Enterocele, when the profusion consists of intestine. Epiplocele, when it consists of omentum. Entero-epiplocele, when it consists of intestine and omentum together. There are also names given from the position they occupy. Bubonocele, or inguinal hernia. Oscheocele, or scrotal hernia. Merocele, crural or femoral hernia. Exomphalos, or umbilical hernia. Congenital, when it exists at birth. Ventral, when the protrusion occurs in different parts of the abdomen, without reference to natural openings. Ventro-inguinal, when there is a combination of the two va- rieties. What is the sac of a hernia ? It is the peritoneal investment which surrounds the protruded viscera. That portion communica- ting directly with the abdomen is called its mouth ; that portion most remote is its fundus; and the part surrounded by the aperture in the tendinous parietes, the neck, What are the causes of hernia ? The exciting causes are severe exercise, lifting heavy weights, playing on wind instruments, vomiting, costiveness, coughing, jumping, &c. The predisposing are hereditary conformation, and preternatural laxity of the abdominal parietes. What are the symptoms of reducible hernia ? The tumor de- scends in the erect position, and retires by gentle pressure, or a recumbent posture. If the sac contains intestine, its reduction is accompanied by gurgling ; the tumor will also have a tense, elastic feel. Omentum, on the contrary, communicates a doughy sensation, and is restored to the abdomen with greater difficulty. Reducible hernia is larger after a meal, and an impulse is communicated to the finger when the patient is directed to cough. There is generally more or less disorder of the digestive organs. What are the causes of a hernia becoming irreducible ? It may arise from adhesion between the sac and its contents; from mem- branous bands; and from extraordinary enlargements of the ome."- SURGERY. 493 turn or increase in the volume of intestines. Slow inflammation is the most frequent cause of hernia being changed from the reducible to the irreducible condition. What are the symptoms of strangulated hernia ? In addition to the other symptoms of hernia, there is obstinate costiveuess, general soreness of the abdomen, pain around the navel, sickness of the stomach, and severe pain in the tumor. These symptoms may be followed by bilious or steicoraceous vomiting, hiccup, quick, hard pulse, cold sweats, and great anxiety of countenance If relief is not obtained, the pulse becomes thready, the patient easy, the tumor crackles when pressed upon, and assumes a leaden color; enormous distension of the abdomen takes place, the pulse becomes fluttering, and death ensues. What is the general treatment of hernia ? For reducible hernia, an appropriate truss is the proper treatment; and the patient should never be without one capable of retaining the tumor. For irreducible hernia, a suspension of the tumor by a bag truss, and strict attention to diet, are all that can be done. For strangulated hernia, the proper remedies are blood-letting, purging, cold, and warm baths, opium, fomentations, poultices, cold, the taxis, tartarized antimony, tobacco injections, and an operation. Inguinal Hernia Through what openings do the contents of an inguinal hernia pass ? Through the internal abdominal ring, inguinal canal, and the external abdominal ring. It may be oblique, as when it follows the course of the spermatic cord; or direct^ when it does not follow the course of the cord, and is not therefore covered by the cremaster mus- cle, but bursts through the conjoined tendon of the internal oblique and transversalis mus- cles, opposite the external ring. Suppose a dissection is made of the cover- ings and contents of an inguinal hernia com- mencing at the skin, what will we find ? The integuments, superficial fascia, cremaster muscle, hernial sac, omentum, or intestine, or both. 42 494 SURGERY. How is the operation for inguinal hernia performed ? The pa- tient should lie on his back, knees and shoulders elevated ; the surgeon standing in a convenient position, should make an incision through the skin over the neck and body of the tumor, its upper extremity being near midway between the anterior superior spinous process of the ilium and the tuberosity of the pubes, and its lower about midway of the scrotum ; next, divide the cellular membrane, &c , so as to lay bare the sac, in which make a small aperture Fig. 62. 46 SURGERY. 495 Fig. 64. cautiously; and then lay it open freely with a probe-pointed bis- toury ; pass the apex of the forefinger of the left hand to the neck of the sac, and the bistoury laid flat upon it; the latter should be insinuated cautiously beneath the stricture, which must be divided Fig. 65. by turning the edge and pushing it upwards and forwards, so as to cut the anterior part of the sac and other structures assisting in the formation of the stricture : the knife being withdrawn, the bowel should be pushed gently upwards until it reaches the abdomen ; then stitch the wound and cover with a thick broad compress, which should be retained by means of a roller. How is inguinal hernia distinguished from hydrocele? The tumor of hernia commences above or at the external abdominal ring, and descends towards the scrotum ; whereas, hydrocele com- mences below, and gradually ascends. How is it distinguished from cirsocele ? Place the patient in a horizontal position, press firmly on the upper part of the ring, then direct him to rise ; when, if it be cirsocele, the tumor will reappear, with an increase of size ; on the contrary, hernia will not show itself until the finger be removed. What is meant by concealed inguinal herna ? It is a hernia 496 SURGERY. contained within the canal leading from the internal to the external ring. In operating for inguinal hernia, what parts are divided? The integuments, superficial fascia, cremaster muscle, and the sac. Where is the seat of stricture in inguinal hernia ? In very old and large ones the external ring, but in recent cases the internal ring ; these strictures should be divided upwards in all cases so aa to avoid wounding the epigastric artery. Femoral Hernia Through what opening are the contents of a fermoral hernia protruded ? Beneath Poupart's ligament, through the crural ring. How is the ring bounded? On the outer or iliac side by the femoral vein ; on the inner or pubic side by Gimbernat's ligament; anteriorly by Poupart's ligament, and posteriorly by the pubes. In dissecting a femoral hernia commencing at the bend of the thigh, what parts will be presented ? The integuments, superficial fascia, fascia propria, which was originally loose cellular mem- brane, occupying the orifice of the crural ring, and the hernial sac What is the treatment? For reducible, an appropriate truss. For strangulated, the treatment must accord with the general principles proper in hernia. Where are the points of stricture of femoral hernia ? At Hey's ligament, in the crural sheath, at Gimbernat's ligament, or at the mouth of the sac. In dividing these strictures, the knife should be turned upwards, and slightly inwards in making the incision. If turned outward, the crural vein and epigastric artery might be injured, or, if too far inwards, the obturator artery may be endan- gered. How is the operation for femoral hernia performed ? The patient should bend the thigh upwards on the pelvis, lie in a hori- zontal position with the chest elevated. An incision should be made three inches long over the tumor, the dissection should be done cautiously, and, whatever may be the thickness of the cover- ings, they must be divided ; when the sac is opened, the finger should be passed to the stricture with the probe-pointed bistoury advancing beyond it, and turned towards the stricture in such a manner as to make an incision sufficient to admit of the reduction of the contents of the sac SURGERY. 497 Umbilical Hernia. Through what opening do the contents of umbilical hernia pro trude ? The umbilical ring, either at its centre or edges. What forms the outer covering of congenital umbilical hernia? The cellular membrane that connects the vessels of the cord; the inner, or sac, is a portion of peritoneum. What forms the covering of the protruded viscera of young subjects and adults in umbilical hernia? The common integu- ments, superficial fascia, and peritoneal coat. What is the treatment? The congenital variety, unless there is some considerable deficiency of parts or morbid complications, may be often cured by a bandage ; or by reducing the intestines, and surrounding the sac with a firmly drawn ligature, so as to produce sloughing, and cause the edges of the ring to cicatrize. For umbilical hernia of young subjects and adults, a properly contrived truss is the proper treatment; or a small compress, re- tained in its proper place by a bandage or adhesive straps. For strangulated umbilical hernia, the usual remedies should be used, and, if they fail, an operation must be resorted to. Congenital Inguinal Hernia. In what respect does congenital hernia differ from common inguinal? It is destitute of a distinct peritoneal sac, in being lodged in the tunica vaginalis in contact with the testicle, and the spermatic cord and artery lie behind the hernia. What is the treatment? A w^ell-eontrived truss, and, when strangulated, an operation may be required unless relieved by the usual remedies. Artificial Anus. From what does it proceed ? A mortified intestine in strangu- lated hernia ; in which case the sound portion adheres to the neck of the sac, the portion protruded sloughs, is thrown off, and the feces are discharged externally ; it may also be caused by a pene- trating wound, or an abscess or ulceration of the intestines. What is the treatment ? Nature often effects a cure; it is not best therefore to be too officious in the early stages, but simply apply a truss with a broad pad to the opening, which will retain 42 * 2g 498 SURGERY. the feces. In this disease, the upper and lower portion of intes- tine lie side by side ; and a very ingenious operation was suggested and practised successfully by Dr. Physick ; the principle of which is, to produce adhesion between these two portions, then divide the barrier between them, and by that means establish a communi- cation between the upper and lower portions, and suffer the ex- ternal opening to close. This adhesion was produced by passing a crooked needle armed with a ligature within the orifice of one gut, and bringing it out at the other, traversing in its passage the coats of each ; the ends of the ligature were then tied in a loose loop. Diseases of the Rectum. Prolapsus Ani. What are the causes of prolapsus ani, or inversion of the lining membrane of the rectum ? Habitual costiveness, straining at stool, diarrhoea, dysentery, hemorrhoids, strictures, stone, drastic purga- tives, &c. What is the treatment? The parts should be returned as soon as possible by gentle pressure. If there is much inflammation, blood-letting, general and local, mild cathartics, cold poultices, astringent washes, &c, should first be resorted to. Where the parts become indurated, and incapable of reduction, it may become necessary to remove them, either with the ligature or knife. Hemorrhoids What are hemorrhoids ? They are tumors situated about the rectum, sometimes distinguished as internal and external, from their situation ; blind and bleeding, according as they are attended or not with hemorrhage. They may consist of varicose enlargements of veins, or from blood poured into cysts formed by cellular membrane, or from a more organized growth. What is the treatment ? To palliate urgent or present symptoms, recourse may be had to leeches, cold astringent washes, astringent ointments, rest, &o. They may, by becoming large and trouble- some, or irreducible, require an operation, either by the knife or ligature. When they consist of varicose enlargements, the ligature SURGERY. 499 should always be used; on the contrary, in the other kinds, the knife may be proper. Fistula in Ano. What is fistula in ano ? It is an abscess about the verge of the anus, with one or more small openings. If the opening communi- cates with the rectum, and not with the integuments, it is called internal fistula; if it opens upon the surface of the integuments, it is an external fistula; and if there is an opening both internal and external, it is called a complete fistula. What is the treatment? Absolute rest, moderate diet, and mild laxatives. When the disease is long established, an operation becomes necessary, unless consumption exists, in which case the fistula ought not to be healed. "A better and easier mode of performing the operation is by passing a grooved director through the stricture, against or into the intestine; then pass into the rectum a smooth rounded stick, like a rectum bougie, the size of the thumb, the stick having a groove upon one side as wide as the finger; this being passed up and held firmly by an assistant, the surgeon takes the director and impinges it firmly against the groove in the stick ; he now takes a sharp-pointed knife, and runs it forcibly down the groove of the director; the moment it comes in contact with the rectum stick, he makes a strong incision outwards against this, and thus divides the fistula at one sweep. This operation is performed in half the time that the other is, and with much less pain to the patient, and greater convenience to the surgeon. Any one who performs the operation once this way will not be likely to employ the other mode. The French surgeons, many of them, after dividing the fistula, dissect out its walls ; thus cutting out a tube of the indurated soft parts." — Hastings' Surgery. Diseases of the Testicle and Penis. Hydrocele What is hydrocele ? It is a collection of water in the tunica vaginalis; and forms an elastic pyriform tumor, which at first occupies the lower part of the scrotum, and gradua5Iy extends upwards. 500 SURGERY. What is the treatment? An operation is generally required; and is either palliative or radical. The palliative operation is simply the evacuation of the fluid by a lancet or small trocar. The operation for radical cure may be performed by laying open the tunica vaginalis ; by passing a seton through it; by applying caustic; by extirpating a part of the tunica vaginalis; by the introduction of a tent; and by injection, after the water has been evacuated. The last operation is the one usually performed, and generally wkh success when properly done. There are several different arti- cle,- made use of for the purpose of injection. Fig. 66. How is the operation for tapping in hydrocele performed ? The scrotum should be seized in the left hand, raised and squeezed, so as to render the skin tense in front; the point of the trocar, held in the right hand with the forefinger close upon it, should be thrust into the front of the swelling midway between the ends. When entered, the finger must be raised ; and as the trocar is withdrawn the canula should be pushed farther in, where it should be allowed SURGERY. 501 to remain until the fluid has-run off. When injections are used, they may be introduced through the canula. Hematocele. What is hematocele ? It is a collection of blood, either in the tunica vaginalis testis, within the tunica albuginea, or in the cellu- lar membrane of the scrotum. It may proceed from injury of one or more of the bloodvessels of the scrotum. What is the treatment? If the extravasation is small, it will probably be absorbed in a short time. If it is not, an incision should be made, and the blood evacuated. Phymosis. What is phymosis ? It is where the prepuce is contracted in front, and cannot be drawn over the glans penis. There are two varieties : the natural, when it exists at birth ; and the preternatural, when it occurs at any other period of life.' What is the treatment ? An operation ; either by slitting up the prepuce, or removing a small portion by circumcision. In preternatural, when attended with high inflammation, the best remedies are local bleeding, emollient poultices, fomentations, &c. Paraphymosis. What is paraphymosis ? It is where the prepuce is firmly re- tracted behind the corona, leaving the glans penis uncovered, and sometimes producing great constriction and swelling. It may be congenital or acquired. What is the treatment? Cold, the antiphlogistic course, and steady pressure, kept up for several minutes. In extreme circum- stances, the stricture must be divided. Diseases of the Urethra and Bladder. Stricture of the Urethra. How are they divided? Into permanent, spasmodic, and a combination of the two. What part is the common seat of stricture ? Usually behina the bulb, about seven inches from the extremity of the glans; also, 502 SURGERY. at the distance of four or five inches7and three and a half inches; sometimes the orifice itself is the seat of stricture. What are the symptoms ? The constitutional symptoms are dis- order of the digestive functions, general irritability, severe chills, followed by high fever, and profuse perspiration; the febrile parox- ysm is not, however, an invariable attendant. The local symptoms are a slight discharge of matter from the urethra ; a frequent desire to urinate ; the urine issues in drops, or in a forked, twisted, wiry, or thread-like stream ; nocturnal emissions ; scalding of the urine, &c. Excess in eating, drinking, and cold, aggravate all these symptoms. What is the treatment? The first object is to ascertain the position and extent of the stricture ; which may be done by a bougie, catheter, or urethra sound. There are three methods of cure. Dilatation by bougies, de- struction by caustics, and division by a stilet. Fistula in Perineo. What is fistula in perineo ? It is an abscess communicating ex- ternally, and with the urethra internally. It may proceed from strictures of the urethra, or from blows or other injuries. What is the treatment? If it depend upon stricture, the first indication is to get rid of that; if the canal anterior to the fistula becomes obliterated, it can only be accomplished by an operation. When the fistula is pervious, it should be dilated with bougies, or such other means as the case may require. Retention and Incontinence of Urine. What are the causes of retention of urine ? Severe gonorrhoea, strictures of the urethra, enlarged prostate, spasm of the neck of the bladder, stone, hemorrhoids, fistula in ano, stimulating diure- tics, blisters, &c. What are the remedies for retention of urine ? The warm bath, blood-letting, purgatives, opiate enemata, the catheter, forced injections to overcome obstructions, and puncture of the bladder. The following plan is recommended by M. Cazenave, and pub- lished in Ranking's Abstract, No. 10, December, 1849. "When called to a patient laboring under complete or incom- plete retention of urine, I immediately cause the large bowel to be SURGERY. 503 emptied by an oily clyster, or prescribe a purgative one, if there has been no motion, for fifteen or eighteen hours. When the first clyster has been returned, I make use of another, less in bulk, of cold water, or (what is better) bladders, filled with roughly-pounded ice, are placed around the penis upon the perineum, thighs, anus, and hypogastrium. If the patient do not pass more or less water, after half an hour of this treatment, I have him laid on the edge of the bed with a water-proof cloth under him, and then subject him for twenty or twenty-five minutes to a cold ascending douche, in a small continuous stream. At the end of this time I give an- other cold lavement, and continue refrigerants, and in an hour I have generally been rewarded by success." When it is necessary to puncture the bladder, it should be done either through the perineum, above the pubes, or through the rectum ; the operation of puncturing above the pubes is the one generally performed. How are these different operations performed ? When opened above the pubes, lay the patient on a table, shoulders and knees slightly raised; make an incision about three inches long above the symphysis, through the skin and linea alba, when the cellular tissue in front of the bladder will be exposed, and this organ may be opened with the point of a knife, or, what is better, with a trocar and canula; the canula or an elastic catheter should remain in the wound for some days. If the opening is made in the peri- neum, it may be done as in lithotomy. If it is done through the rectum, a curved trocar and canula, about seven inches long, should be introduced into the rectum on the concavity of the forefinger of the right hand ; the point should be placed on the triangular space behind the prostate ; and then be forced through the tunics of the rectum and bladder, and the trocar withdrawn ; when the urine will flow through the tube ; a flexible catheter may be introduced through the canula, and al- lowed to remain. Great care should be taken not to introduce the instrument high enough up to wound the peritoneum, which might be fatal. What is the treatment for incontinence of urine ? The internal use of cantharides, muriated tincture of iron, bark, opium, cold bath, and blisters, either singly or conjoined, in such a manner as may be indicated. 504 SURGERY. Urinary Calculus. Where are urinary calculi found? In the kidney, ureter, bladder, prostate gland, or urethra, but they are mostly found in the bladder. What are the symptoms of stone in the bladder ? Frequent desire to make water, and severe pain on voiding the last drops of it; sudden stoppage of the urine while passing, and flowing again frequently by change of posture ; and tenesmus. Sounding is, however, the only positive symptom, and should always be done before a course of treatment is adopted. What is the treatment for urinary calculus ? When there is a calculus passing the ureter, decisive treatment should be adopted. Blood should be drawn freely if the patient is robust, and a brisk purge given ; the warm bath and spirits of turpentine, or spirits of turpentine and opium, may be used with benefit; the tincture of the pokeberry juice has also been recommended. AVhen the bladder contains a stone, the operation of lithotomy, lithotrity, or lithotripsy must be performed. What circumstances are considered adverse to the success of lithotrity ? The smallness of the diameter, and greater irritability of the urethra before puberty ; or any obstruction to the free pass- age of instruments, as stricture, enlarged prostate, &c.; a saccu- lated condition of the bladder ; and an unusually irritable condition of the urethra or bladder. What circumstances are considered as favorable for its employ- ment ? A large and callous urethra, a capacious and apathetic bladder, with a good muscular power; a healthy prostate, and a small or moderately sized stone. The instruments for performing this operation are various, some surgeons preferring one, and some another. Under what circumstances should lithotomy be preferred ? Always, (when any operation is performed,) where the circum- stances exist that are adverse to the success of lithotrity ; although the existence of these only give a negative advantage to lithotomy. In what manner should the operation of lithotomy be performed? The patient should be placed in a favorable condition for the operation, the perineum should be shaved, a clyster of warm water administered an hour before, and his urine should also be retained SURGERY. 505 rwr that period at least. A firm table and a chair of the proper heighth should be selected, and all the apparatus should be in per- fect order, and placed so as to be easily procured when wanted. The first step is to introduce the staff, which should be as large as can be done with ease ; and having the groove presented a little to the left side of the urethra ; the stone should then be felt with the instrument, and the latter given in charge of an assistant. The patient should next be secured; apiece of broad worsted tape, three yards long, should be doubled and formed into a loop, which should be fastened on the wrists ; he should be directed to grasp the outer margin of the feet; the ends on each side should then b« passed around each hand and foot, so as to secure them firmly Two assistants, one at each knee, will be required to support them, and hold the thighs properly apart. The breech should be placed at the margin of the table. The assistant should hold the staff in the left hand nearly perpendicular, with the concavity of the curve resting on the upper part of the triangular ligament; and he should draw the scrotum slightly upwards and a little to the right side, and he should stand on the right of the patient. The surgeon should be seated in front of the perineum ; the condition of the prostate should be examined, and the exact situation of the rami of the pubes, and ischium, and the tuberosity should be traced. The knife recommended by Fergusson should be used, and held much in the maimer of a common bistoury. The point should be entered about one inch and three-fourths in front of the anus, about a line's breadth left of the raphe, pushed through the skin, and carried by a kind of sawing- motion down to the left side of the perineum, about an inch beyond the anus ; the middle of the incision being at equal distances from the latter part and the tuberosity; the blade should then be run along the surface of the exposed cellular tissue ; the forefinger of the left hand should be thrust down into the wound, and placed upon the membranous portion of the urethra ; if resistance is offered, the resisting parts should be divided by the knife The groove in the staff being felt by the finger, the knife should be passed along it, and made to perforate the urethra about three lines in front of the prostate, and then slid along the groove until it has entered the bladder, having slit open the side of the urethra and notched the margin of the prostate. If the stone is supposed to be large, the opening in tho 43 506 SURGERY. bladder should be enlarged slightly on withdrawing the knife. The forefinger of the left hand should be gently introduced into the bladder along the staff, so as to dilate the parts, and, when in the bladder, tG search for the stone and to retain it near the neck. The staff should then be removed by the assistant, and the forceps introduced slowly and carefully, as the finger is removed ; the stone should then be seized and extracted by a slow, zigzag movement; which, being done, the operation is completed. The interior of the bladder should be examined by the finger or a proper instru- ment, so as to ascertain whether there are any others remaining. The patient, being loosed, should remain in bed, either on his back or right side. The after-treatment should be regulated by circum stances. The wound generally closes in about three weeks, some- times earlier, and at other times later.—Fergusson. Amputation. What are the injuries for which Amputation is resorted to? Gun-shot wounds and fractures, mortification, tumors, diseased joints, and ulcers. What circumstances influence us in regard to the propriety of amputation in gun-shot wounds and fractures? When the chief arteries of a limb are divided, the muscles lacerated, and the bones badly broken, amputation should be performed; also when com- plicated with severe injury of the joints. What tumors may render amputation necessary ? Osteosarcoma, spina ventosa, exostosis, fungus hsematodes, &c. What are the different modes of performing amputation ? By the circular incision, and by what is termed the flap operation. Some surgeons prefer one mode, and some the other. How is the circular operation performed ? An assistant, or the left hand of the operator, should grasp the limb and retract the skin as far as possible ; the knife should then be made to encircle the limb, the edge sinking through the skin ; the integuments should be further retracted, and parts preventing this should be divided; the knife should be made to sweep round the limb again, close to the retracted skin, to the depth of about half an inch or more; through the aponeurosis and superficial muscular fibres: the parts should be still further retracted, and the knife again applied SURGERY. 507 bo as to divide all the muscles and textures down to the bone ; a re- tractor should then be applied to the part so as to cover the wound, (two ends, if one bone; and three, if two bones,) and drawn firmly upwards; and any muscle adhering to the bone and preventing retraction should be divided close to the cloth, at which point the saw should be applied to the bone. Great care should be taken to procure sufficient soft parts to effectually cover the end of the bone. The wound should then be dressed after the arteries are secured in such a manner as to produce union by the first intention, and the line of junction may be transverse, vertical, or oblique, according to the fancy of the surgeon ; the parts should then be retained by stitches, straps, and bandages. This description is a general one, and will apply to any of the limbs on which the circular operation may be performed. How is amputation at the Shoulder-joint performed by the flap operation ? There are several modes recommended ; some make vertical flaps, while others form horizontal ones. A good mode is to make a semilunar incision from a little behind the root of the Fig. 67. 508 SURGERY. acromion towards the coracoid process, and thus make a flap from the skin and deltoid ; which being raised, the joint may be opened from above ; and another flap preserved from the remaining parts below the bone. The arteries should then be secured, and the wound dressed in the usual way. (Fig. 67.) Fig. 68. How is amputation above the elbow performed ? The elbow should be separated from the side, and a tourniquet applied, or pressure made with the hands ; the arms should be transfixed three inches above the external condyle with a suitable knife, which should be carried obliquely downwards and forwards, so as to make the inner surface of a semilunar flap two or three inches in length; divide the opposite side in the same manner; draw the two flaps ipwards, pass a knife around the bone, which should next be sawn through, and the removal is finished. The arteries should be secured, and the flaps brought in contact and retained by the proper dressings. (Fig. 68.) How at the Elbow-joint? A semilunar incision should be made through the soft parts on its anterior and upner part obliquely to- SURGERY. Fig. 69. 509 wards the joint, which must be cut into; bend the limb backwards bo as to allow the knife to be carried across to the posterior sur^ ace, where a flap must be left, which, with that in front, will cover tne stump; m forming the posterior flap, the triceps must be cut force s ^ ^ ^ °leCraa°n pr0Cess divided with the saw or How is amputation of the Forearm performed? The elbow shghtly bent, the hand pronated ; pass a blade about six inches long from one side to the other behind or above the bones ; let it Je carried obliquely, so as to come out one inch and a half lower down ; raise the flap, pass the knife across close in front of the bones, and carry it obliquely downwards, when a second flap is formed; draw these apart, divide all the textures on and between the bones, apply a retractor, and saw off the bones close to it (Fig. 69.) 43* 510 SURGERY. Fig. 70. How at the Wrist-joint? Hold the hand in a horizontal posi- tion, back upwards ; take a scalpel or a large bistoury, carry it in a semilunar course down to the bones from one side to the other, about an inch or more below the articulation ; dissect up the flap, open the posterior part of the joint, bending the hand downwards at the same time; the textures on each side of the wrist should then be cut through, and a flap made similar in size and shape to the one already formed. (Fig. 70.) At what point should amputation of the Leg be performed? At the middle, when a choice can be had. Howr should it be done ? Apply a tourniquet or other compres- sion ; place the patient on a firm table, supported and held by assistants, one of whom should support the part to be removed; the surgeon should pass an amputating knife, seven or eight inches long, from one side to the other, close behind the bones, cut a flap from the back part of the leg, three or four inches long ; next draw SURGERY. 511 the knife across the fore part of the leg with a semicircular sweep between the points transfixed by the knife ; the flaps should be drawn up by the retractor, and the remaining parts divided upon and between the bones close to it, where the saw should be applied, and the separation completed. Fig. 71. How should amputation of the Thigh be performed ? The femoral artery should be controlled by a tourniquet or by compres- sion. The surgeon, standing on the outside of the limb, should Fig. 72. 512 SURGERY. Fig. 73. grasp the outer side of the thigh between his fingers and thumb, draw it from the side of the bone, pass the knife from before backwards, and cut downwards and outwards so as to form a flap; next, introduce the knife in front and carry it backwards as before, but on the other side of the bone, when, by cutting again obliquely towards the surface, the inner flap is formed : use a re- tractor, divide the remaining portions on the bone close to it, and use the saw. Some surgeons make the flaps from the anterior and posterior portions of the thigh instead of the lateral; and this method appears to possess some advantages, particularly for the upper portion of this limb. Liston prefers the anterior and poste- rior flaps, as shown in the figures. (Figs. 72 and 73.) How should amputation of the Penis be performed ? It should be grasped in the left hand, and separated by one stroke of the bistoury or catlin. The hemorrhage may be restrained by the pressure of an assistant until the arteries can be secured. Ligature of Arteries. At what point, and in what manner, should the Subclavian Artery be secured ? Above the clavicle, at a point on the outer (acromial) margin of the scalenus anticus muscle. Patient on his back, head elevated and slightly turned to the side opposite; shoulder of the side to be operated on drawn downwards and for- SURGERY 513 wards. The incision should be made three or four inches long, half an inch above and parallel with the clavicle, extending from the clavicular portion of the sterno-mastoid to the interior margin of the trapezius; the parts next to be divided are the platysma myoides and cellular texture ; the external jugular, when exposed, should be pressed to one side; and the dissection through fat and cellular substance down to the omo-hyoid should be carefully made ; draw this muscle to one side with a blunt hook ; dissect again carefully with a blunt implement, dividing carefully any muscles in the way, sufficiently to give room ; by then passing the finger down, the artery may be perceived pulsating; it should then be more exposed, and the aneurism needle passed under it from before backwards, and the ligature can then be made to en- circle the artery; the identity of the artery should be proved before making the ligature tight, by compressing it, and noticing the effect on the pulse. Leave the ends of the ligature out, (after tightening it,) and dress the wound properly. In what manner should the Arteria Innominata be secured ? Make an incision four inches in length, commencing over the middle of the upper part of the sternum one inch below its margin, and passing upwards parallel with the inner border of the sterno- mastoid. The skin, fibres of the platysma myoid, superficial^ fascia, a portion of the sterno-mastoid, cellular substance, the sterno-hyoid and sterno-thyroid should all be carefully divided; the vessel should then be looked for in the cellular membrane, opposite the upper margin of the sternum, and when found, the ligature may be passed round it. In what manner should the Common Carotid be secured? The upper third should be selected when practicable ; the patient on his back, shoulder slightly elevated, head turned to the opposite side ; commence the incision one inch and a half below the pomum Adami, over the inner margin of the sterno-mastoid, and carry it upwards three inches or more, parallel with its fibres. The skin, platysma myoides, and superficial fascia should all be divided to this extent; the fibres of the sterno-mastoid should be drawn slightly outwards, and the cellular tissue forming the sheath to the vessels cautiously opened with the knife, opposite the middle of the thyroid cartilage ; the artery can then be seen and felt; care- fully dissect the outer margin of the artery from its attachments, 2n 514 SURGERY and then pass the needle round it, keeping the point close upon the vessel, from without inwards, and the operation may be finished as in other cases. In what manner should the External Carotid be secured ? Place the patient as above ; make a lunated incision, convexity backwards, between the mastoid process and the body of the hyoid bone ; the skin, platysma myoides, and superficial fascia, should all be divided to the same extent, and the lower part of the parotid gland brought into view, which should be turned slightly upwards, and the external carotid may be exposed by separating the digas- tric and stylo-hyoid muscles; a ligature can then be thrown around it, carefully avoiding to include other parts. In what manner should the Humeral Artery be secured ? The lower third of the arm should be selected if possible. Make an incision three inches long through the skin and intervening tex- tures, along the inner margin of the biceps; carefully separate the nerves and veins that lie along with it, and pass a needle around the artery without including any of them. In what manner should the Radial Artery be secured ? The most favorable point is three inches above the wrist, where its pul- sations can be distinctly felt. The forearm should be placed in a supine position, on a firm table; make an incision two inches in length, about half an inch on the radial margin of the tendon of the flexor carpi radialis; the skin, aponeurosis, and a little cellu- lar substance being divided, the artery can be readily detected and secured. Higher up, this artery may be exposed between the supinator longus and the pronator teres. The Ulnar Artery may be secured most conveniently above the wrist about two inches; in which place it is accompanied by two veins and a nerve ; its situation is between the flexor carpi ulnaris and the flexor sublimis, and may be exposed by dividing the skin, fascia, and cellular substance between them. In what manner should the External Iliac Artery be secured ? Patient on a table, shoulders and knee slightly elevated; make an incision three and a half inches long, about an inch above and parallel with Poupart's ligament, one end being opposite the anterior superior spinous process, the other a little above the opening in the tendon of the external oblique; the skin, fascia, and superficial epigastric vessels being divided, the tendon just SURGERY. 515 named should then be cut to a similar extent; — now the lower margins of the internal oblique and transversalis muscles must be looked for, and the point of the finger or the director passed be- neath them ; they should be divided about half an inch upwards, when the fascia transversalis will be exposed almost exactly over the internal abdominal ring; make here a slight scratch or open- ing large enough to permit a view of the iliac fascia where it covers the psoas muscle, when the artery will be discovered on the soft brim of the pelvis, covered with a thin layer of cellular sub- stauce, forming a kind of sheath for it and the vein, which lies close upon the artery ; make a slight opening into the sheath, and insinuate the point of a needle from within outwards, so as to avoid the vein, and the operation should then be completed in the usual way. In what manner should the Femoral Artery be secured ? It may be done in the middle or higher up ; the patient should lie on his back, with the leg bent at the knee, and the thigh slightly rotated outwards, and bent upon the pelvis. Make an incision in the middle of the thigh three or four inches in length, parallel with the vessel and with the sartorius muscle. The skin, subcutaneous cellular textures, and aponeurosis being divided, the sartorius may be seen, which may be turned either outwards or inwards, and at the bottom of the space between the vastus internus and the ad- ductor longus the vessel may be discovered in close contact with the vein and saphena nerve ; pass the needle on either side of the vessel which may be most convenient, but in close contact, so as to prevent wounding the vein. In what manner should the Posterior Tibial Artery be secured ? If the situation of the ligature can be selected, it should be where the vessel lies between the malleolus and calcaneum. Make an incision two inches long midway between this process and the in- sertion of the tendo-Achilis, dividing the skin and aponeurotic fibres, which will expose the artery in company with two veins, which may be separated and the vessels secured. If we should wish to secure it four inches above the ankle, it may be done by making a free incision about half an inch posterior to the margin of the tibia dividing the skin, cellular substance, and fascia; the artery may then be found on the flexor communis and tibialis pos- ticus muscles, with a vein on each side. 516 SURGERY. The Anterior Tibial Artery may be secured over the arch of the foot by an incision one or two inches long over the convex part of the foot, commencing in front of the ankle, and extending to the space between the metatarsal bones of the great and second toes • the skin and strong aponeurosis must be cut through, which will expose the tendons of the extensor pollicis and extensor longus communis muscles, and the vessel will be found lying between them close to the bones, with a vein on each side ; they may then be easily separated, and the artery secured. This vessel may also be secured above the instep by making a free incision, and searching between the tendons already named; if more than a hand's breath above the ankle, the artery will be found between the extensor communis and tibialis anticus muscles; low down, it lies on the surface of the tibia, higher up on the in- terosseous membrane.—Fergusson. Paracentesis. How is the operation of paracentesis abdominis performed ? The patient is seated on the margin of a chair, the upper part of the abdomen encircled with a wide band, the middle over the stomach, and the ends made to cross behind, and each given to an assistant, Fig. 74. who should be directed to pull them with moderate tightness. Pass a trocar and canula into the abdomen through the linea alba, about an inch and a half below the umbilicus ; then withdraw the trocar, and allow the fluid to pass through the canula ; at the same time SURGERY. 517 keeping the band drawn tensely. The trocar may be pushed iu by a kind of plunge, but guarded by the finger from entering too far; or the skin may be first divided with a lancet, which will render less force necessary. The wound should be closed with a strip of adhesive plaster, and the bandage placed firmly around the patient. How is paracentesis thoracis performed ? Patient on the mar- gin of a bed or table, leaning slightly over on the sound side ; the point selected should be the seventh and eighth rib, a little in front of the angle; draw the skin upwards so as to bring what was opposite to the lowrer margin on a level with the upper; make an incision through the skin, cellular texture, and intercostal muscles, until the pleura is reached, which should be opened with the point of a knife or trocar. When the fluid is evacuated and the skin let go, it will close the opening, which should always be made at the upper edge of the rib, so as to avoid wounding the intercostal vessels. Great care should be taken to prevent air from entering the cavity of the chest. Escharotics. What are escharotics or caustics? Substances that exert a chemical action on the materials of which the organization is com- posed, so as to destroy its texture. There is a great diversity in the action of different substances of this class. What is the proper caustic to apply in cases of fungous granula- tions, commonly called proud flesh ? Nitrate of silver is generally sufficient: when it is not, take verdigris, sulphate of copper, nitric oxide of mercury, of each, two drachms, bichloride of mercury, one drachm, hogs' lard, enough to blend them well together; spread this on lint, and apply. —Brodie. In what manner are issues made by caustics ? For this purpose, the caustic potash: or strong nitric acid, is the best. When the former is used, cut a hole in some spread adhesive plaster, of the proper size to form the sore, and apply it on the skin ; rub the potash on the skin surrounded by the plaster, until it has penetrated through the skin ; then discontinue it. If nitric acid is used, apply it by means of lint on the end of the probe, and rub for some minutes. If nitrate of silver is used, make it into an ointment, and 44 518 SURGERY. lay on the part. If the issue tends to heal, touch it occasionally with caustic potash. Hemorrhage from Leech-bites. How may this be checked? Press into the hole small pledgets of lint dipped in spirits of wine, or muriated tincture of steel, or touch them with a pointed piece of lunar caustic. Another, and an excellent mode, is to cut a small piece of common glazed card, say about the size of half a dime, and apply it to the wound imme- diately after wiping it, hold it firmly on the part for five minutes, and it will then adhere. If necessary, a fine stitch must be passed through each of the bleeding orifices. Club-Foot. — Talipes. What is meant by club foot ? It is a deformity of the foot, pro- duced by irregular muscular contraction ; which may be caused by nervous disturbance, imperfect nutrition, injuries, confinement, rheumatism, &c. &c. It may be congenital, or acquired. What are the varieties? There are four. Talipes Equinus, iu which the foot rests on the ball, or the toes. The shortening is Fig. 75. Fig. 76. SURGERY. 519 produced in this variety by the contraction of the muscles inserted into the os calcis. The plantar fascia is also thickened. (Fig 75) Talipes Varus, which is the most common variety, is where the foot is turned inward and rests upon its outer edge or on the dorsum of the foot; the heel is also raised. The de-ree varies greatly in different cases. There is no dislocation, properly speak- ing, although the bones deviate from their natural position The tendons of the tibialis anticus and posticus, and the tendo-Achillis are most contracted, and the peronei are relaxed. The li-aments on the inner side are shortened, and those on the outer side are relaxed. (Fig. 76.) Talipes Valgus. In this variety, the foot is everted, and rests on its inner side. The peronei muscles are contracted, and the tibialis anticus and posticus are elongated. There is relaxatbu of the inner ligaments. It is a rare form. Talipes Calcaneus is a rare variety. The foot rests on the back part of the heel. Fig. 77. What is the proper treatment * In children, the application of a proper shoe or boot, or a rectification by the proper application 520 SURGERY. of adhesive strips, will generally suffice for a cure If not, the tendons of the contracted muscles should be divided, by putting the tendon on the stretch, while a narrow, sharp-pointed knife is thrust through the skin beneath the tendon with its cutting edge towards it; it should then be brought against the tendon and withdrawn, dividing the tendon as it escapes The patient is then prepared for the proper mechanical means, to be applied in three or four days. After the foot is brought to a straight position, it requires attention and a proper shoe for a long time, to perfect a cure. Inversion of Toe Nail. What is the proper treatment? If much inflamed, poultice, and touch with nitrate of silver. As soon as the tenderness will permit, introduce some lint under the corner of the nail, to raise it from its imbedded position, after having scraped or soaked it so as to render it soft. The whole should then be enveloped by adhesive plaster. In some cases, it may be necessary to remove a portion of the nail. PART VII. OBSTETEICS. 44* ;&21) / PART VII. — OBSTETRICS. The Pelvis. Where is the pelvis situated, and of what is it composed? It is between the last lumbar vertebra and the superior extremities of the thigh bones. It is composed of four bones in the adult; on its posterior and inferior parts by the sacrum and coccyx; and on its lateral, inferior, and anterior parts by the ossa innominata. What are the characteristics of the Sacrum ? It was originally composed of five pieces — its figure is triangular, with the base upwards ; has four surfaces, an anterior, posterior, and two lateral; and is pierced by four holes on each side for the passage of the sacral nerves. Superiorly it is attached to the last lumbar vertebra, and laterally to the ossa innominata. Its length is from four to four and a half inches, breadth about four inches, and the depth of its concavity is about three-fourths of an inch. What are the characteristics of the Coccyx ? It is 1£ inch in length, pyramidal, has its base upwards, articulates with the sacrum, aud is composed of three or four bony portions. What are the characteristics of the Ossa Innominata ? They are on each side, divided into three portions, which were originally distinct — the ilium, ischium, and pubes. The ilium on each side forms the highest lateral portion of the pelvis; the superior edge is nearly semicircular, tipped with carti- lage, and called the spine; the external surface is convex, and called the dorsum; the internal is concave, and called the fossa. It has two anterior, and two posterior spinous processes, forms with the os pubis the linea ilio-pectinea, and with the pubes and ischium the acetabulum. (523) 524 OBSTETRICS. The Ischium is the lowest of the three bones, on each side ; it terminates in a tuber below, from which a process runs upwards to join the pubis. The Pubis is the smallest of the three ; its longest portion forms a part of the acetabulum; it then diminishes in size, stretches over to join its fellow of the opposite side, and sends a branch down- wards to unite with a portion of the ischium in such a manner as leaves an opening, the foramen ovale. The innominata are joined posteriorly to the sacrum by carti- lages and appropriate ligaments ; the anterior junction is called the symphysis of the pubes. Where are the Sacro-sctatic Ligaments situated ? The pos- terior arises from the posterior inferior spinous process of the ilium. from the lower margin of the sacrum, and from the first bone of the coccyx; is inserted into the internal margin of the tuberosity of the ischium; and is extended along the internal face of the crus. The anterior is placed in front, and arises from the margin of the lower part of the sacrum, and the lateral margin of the coccyx; the fibres converge, and are inserted into the spinous process of the ischium. This is the arrangement on each side of the pelvis. How is the pelvis divided ? Into the large and small, or false and true; or the pelvis above and below the brim. The line of demarcation being the linea ileo-pectinea at the sides, the crista of the pubis in front, and the promontory of the sacrum behind. What is the distinction between the male and female pelvis ? The male pelvis has a contracted brim of a rounded form, or tri- angular shape, with the promontory of the sacrum projecting. The female pelvis is spacious, of an oval shape, with the sacrum slightly prominent, and greater space is afforded for the passage of the child. The cavity of the male pelvis is deep, while in the female it is shallow. In the male, there is a contracted angular arch of the pubes; in the female, there is a spacious and well-rounded arch, and the tuberosities of the ischia are much wider apart. The length of the eacro-sciatic ligament, and the mobility of the coccyx upon the sacrum serve also to distinguish the female pelvis. What are the parts of the pelvis the diameters of which are im portant ? The brim, cavity, and outlet. OBSTETRICS. 525 What are the superior and inferior openings sometimes called ? The superior and inferior straits. What are the diameters usually measured of the brim, cavity, and outlet? The straight or antero-posterior; the transverse; and the oblique. What are the measurements of the brim or superior strait ? The antero-posterior from the promontory of the sacrum (a) to the symphysis (a) is 4-3 inches; the transverse from the middle of the linea ilio-pectinea of one ilium (b) to the other (b) is 5-4 inches; and the oblique from one sacro-iliac symphysis (c) to the aceta- bulum opposite (c) is 4*8. What are the measurements of the cavity? The antero-pos- terior, from the centre of the hollow of the sacrum to that of the symphysis, is 4"8 inches ; the transverse, from the point correspond- ing to the lower margin of the acetabulum, on one side, to that of the other, is 43 inches ; and the oblique, drawn from the centre of the free space, formed by the sacro-sciatic notch and ligaments on one side, to the foramen ovale of the other, is 5-2 inches. (Fig. 1.) What are the measurements of the outlet or inferior strait? The antero-posterior, from the point of the coccyx (a) to the lower edge of the symphysis pubis (a), is 38 inches, but, during labor the mobility of the coccyx may allow this diameter to be increased one inch, or to 4*8 inches; the transverse, from one tuberosity of the ischium (b) to the other (b), is 4"3 inches ; and the oblique, from the middle of the lower edge of the sacro-sciatic ligament of one 526 OBSTETRICS- Fig. 2. ■ride (c), to the point of union between the ischium and descending ramus of the pubes on the other (c), is 4*8 inches.—Rigby. (Fig. 2.) The measurements of the pelvis are reported differently by different authors. What is meant by the axes of the pelvis ? They are lines drawn at right angles with the planes of the straits, through their centres. Fig. 3. What relation does the axis of the superior strait bear to the axis of the body. It forms an angle of 135°. A line drawn from the umbilicus (a) to the point of the coccyx (6) (Fig. 3), will re- present the axis of the superior strait. What is meant by the inclination of the pelvis ? The angle which the axis of the superior strait forms with the horizon, when OBSTETRICS. 527 a woman is in the upright position, marks what is called the incli- nation of her pelvis. What relation does the axis of the inferior strait bear to the superior? It forms with it nearly a right angle; and is repre- sented by a line drawn from the sacrum, just below the promontory (g) perpendicular to the plane of the inferior strait (/). The angle which the axis of one strait forms with the horizon, is inverse to that of the other. (Fig. 3.) What is the shape of a line that will represent the axis of the pelvis? It will be a curved line (g k) (Fig. 4), the shape of a male catheter passing through the centre of a series of planes extending from the sacrum to the pubes, from the linea ileo-pectinea to the coccyx and sub-pubic ligament. Fig. 4. i.j*,------n What is the arrangement of the two lateral inclined planes within the pelvis on each side ? They are divided into anterior and pos- terior. The anterior commences at a ridge running upwards from the spine of the ischium, extends to the symphysis pubis, passes down- wards and forwards over the obturator foramen, terminating on the anterior edge of the ramus of the pubis and ischium. The posterior commences at the same point, extends to the middle line of the sacrum, passes downwards and backwards behind the spine of the ischium, over the sacro-sciatic foramen, and 528 OBSTETRICS. sacro-sciatic ligaments, terminating on the posterior edge of tho tuberosities of the ischium, the lower edge of the sacro-sciatic liga- ment, and point of the coccyx. These planes influence the pre- senting part of the foetus ; when the occiput is brought in contact with the pelvis anterior to the spine of the ischium, it will pass down upon the anterior inclined plane, and emerge under the arch of the pubes; but it it enter the pelvis behind the spine of the ischium, it is liable to pass down the posterior inclined plane, rotate into the hollow of the sacrum, and emerge at the posterior commissure of the vulva. Of Deformity of the Pelvis. What is meant by a Deformity of the Pelvis ? Any deviations from its healthy dimensions, either by excess or diminution. What are the evils arising from an excess in size ? Precipita- tion of the uterus, within the pelvis, during gestation, with its consequences; and during parturition a too rapid labor, which may cause alarming hemorrhage. What are the remedies for the difficulties arising from an excess in size ? For the first, a proper sized pessary, or a utero-abdomi- nal supporter. For the second, forbidding the woman to bear down during labor; opposing the too rapid escape of the child by pressing on its head, or the perineum of the mother; and hemorrhage may be much diminished by brisk frictions on the abdomen over the uterus, and by ergot. What are the usual causes of the distortions of the pelvis ? Rachitis in infancy, and malacosteon in old age. What portion is generally distorted ? The upper strait, and this in its antero-posterior diameter; when the inferior strait^ distorted, it is generally in its transverse diameter, by the approxi- mation of the tubers of the ischia. There is not, however, any portion but what is liable to devia- tion from its healthy measurements. What is the smallest antero-posterior diameter of the superior strait that will ordinarily allow a labor to be terminated success fully to both mother and child ? Three inches ; if there is evei three and a half, labor is rendered tedious, painful, and uncertain OBSTETRICS. 529 In what position would you keep a child affected with rickets to prevent deformity of the pel- Fig. 5. vis ? In a horizontal one, and permit it to exercise its limbs freely upon a bed or mattress. To what other deformities is the pelvis liable? Exostosis and tumors, What are the means proposed for measuring the pelvis ? The pelvimeter, intro-pelvimeter, callipers, the introduction of the finger against the most project- ing part of the base of the sa- crum, the introduction of the hand in time of labor; and placing the fingers edgewise between the posterior part of the symphysis and the projection of the sacrum. The finger and the hand are most to be depended upon. (Figs. 5, 6, 7.) Fig. 6. Fig. 7. Of the Child's Head. What are the principal diameters of the child's head ? The oblique, from the symphysis of the chin to the posterior and supe- rior extremities of the parietal bones, or the posterior extremity of 4f 21 530 OBSTETRICS the sagittal suture, measuring 5 inches to 5] ; the longitudinal, from the centre of the forehead to the top of the lambdoidal suture, measuring 4 inches to 4|; the perpendicular, from the summit of the head to the base of the cranium, measuring from 3 to [>\ inches; the transverse, from one parietal protuberance to the other, measuring from 3 to 3| inches; and the cervico-bregmatic, extending from the occipital bone, near its junction with the spine, to the anterior fontanelle, measuring from 3 to 3i inches. Are these diameters ever altered during the progress of labor? They are liable to be from the suppleness of the bones of the head of the foetus ; but all cannot be diminished or increased at the same time ; if one is diminished, another must be increased. The extent to which these changes may take place varies in individual cases, owing to the more or less perfect ossification of the bones. What are the sutures of the foetal head which are interesting to the accoucheur ? The sagittal, or the line of union from the occipi- tal bone to the root of the nose, connecting the parietal and the two sides of the frontal bone with each other; the coronal, which connects the anterior portions of the parietal and the posterior portions of the frontal bone ; the lambdoidal, which connects the posterior portion of the parietal and the anterior portion of the occipital bones. What forms the anterior or bregmatic fontanelle, and how is it distinguished ? It is formed at the points of decussation of the sagittal and coronal sutures. It is distinguished by four bony angles, the edges of which are tipped with cartilage, and are smooth, soft, and yielding. What forms the posterior fontanelle, and how is it distinguished ? It is formed at the points of junction of the posterior end of the sagittal with the centre of the lambdoidal suture, and has three bony angles ; two by the parietal, and one by the occipital bones. What parts of the head are of most importance to understand, in order to determine the presentations ? The sutures and fan- tanelles. To what extent may the head be rotated on the trunk with safety to the child? One quarter of a circle, and not more. OBSTETRICS. 531 Of the Genital Organs. See Anatomy. Menstruation. What is meant by Menstruation ? It is that function in which the uterus periodically secretes a sanguinolent fluid, accompanied by the evolution of an ovule from the ovaries, which is a matured Graafian vesicle. What part gives origin to this secretion ? The internal coat of the uterus. What are the characteristics of this secretion ? It resembles blood, has a peculiar quality and odor; it is not coagulable, nor does it putrefy readily. At what period does menstruation take place ? It takes place at puberty, or that period at which the animal is capable of pro- pagating its species ; the age varies under the influences of climate, constitution, and modes of life; earlier in hot than cold countries^ sooner in cities than in the country, &c. What are the symptoms which precede menstruation ? The mammas increase in size, the voice is changed, the pubes are covered with hair, the best proportions are developed, and the mind is rapidly matured. Besides these, there is generally headache, dulness of the eyes, pains in the pelvic region, lassitude, whimsical appetite, leucorrhoea', &c, which gives place to a discharge from the vagina. What is the menstruous period ? From four to six days ; and during this time from four to six ounces of fluid are discharged. W hat are general symptoms during the menstrual flow ?° The appetite becomes capricious, the person is languid, pale, or hectic- ally florid, dark under the eyes, and frequently there is a dragging sensation about the hips and loins. At what age does it cease ? From forty-five to fifty. In this climate at about forty-six or seven. Does the regular appearance of the menses, in a healthy manner, every twenty-eight days, indicate a capability for procreation or reproduction ? It does. ^ Is the uterus influenced by any of its appendages in this func- tion ? The ovaries appear indispensable to it; as their absence, either natural or by removal, prevents the appearance of the menses. 532 OBSTETRICS Is menstruation a physiological or a pathological condition ? It is strictly a physiological function. Is the cause of menstruation well understood ? It is not; there have been many theories formed to account for it, but they are not entirely satisfactory. Derangement of the function of Menstruation. To what derangements is this function liable ? To a too tardy appearance of the menses. To its interruption after having been established. To excess of quantity. To menorrhagia To dysmenorrhea or painful menstruation. And to irregularities towards the decline of life. At what period of life, in this country, does menstruation take place ? From the fourteenth to the fifteenth year. Does age of itself present an indication for interference in re- gard to this function ? No ; there should be other evidences of womanhood ; and when these are absent, the girl should never be tortured by emmenagogues. These signs are enumerated under the head of Menstruation. What should be done where these signs to a greater or less ex- tent exist, and menstruation does not appear, with a delicate state of health of the patient ? There should be a regular course of exercise instituted when the patient can bear it; such as riding on horseback, walking, skipping the rope, &c. The dress should be attended to ; and the diet should consist of easily digested food, both animal and vegetable; all stimulating drinks should be avoided. Tincture of cantharides, particularly if leucorrhoea attends, may be given in doses of thirty drops, three times a day. Keeping the bowels regularly open with aloetic pills, with or with- out the sulphate of iron, is beneficial. When anaemia or chlorosis exists, the carbonate of iron, in large doses, is a very reliable remedy. What is to be done when a chronic disease exists ? Attentiou should be given to the disease when we have reason to suppose the absence of the menses depends upon it. What is understood by suppression of the menses ? It is the want of return of this discharge at the accustomed period, after it OBSTETRICS. 533 has been established, when not interrupted by pregnancy or suck- ling. What are the causes ? Cold, applied either in the interval or during the flow. What are the symptoms? Paleness, emaciation, debility, nervous symptoms, palpitation of the heart, difficulty of breathing, and a disturbance of the circulation ; to which may be added fluor albus, and more or less pain in the loins and pelvis. What is the treatment? It will depend upon the state of the circulation ; if the pulse is disturbed, we should prescribe blood- letting, purging, low diet, &c, until it is corrected; and then we can safely give emmenagogues ; among these aloetic and ferruginous pills, the ammoniated tincture of guaiacum and carbonate of iron, stand first. What is understood by dysmenorrhcea? It is a menstruous dis- charge, accompanied by pain of a forcing and bearing down kind, and a discharge of membranous substance or coagula. What is the treatment? During the paroxysms, the pain should be relieved by anodynes and antispasmodics, such as camphor, and camphor and opium, with perfect rest. In the intervals, use altera- tives and tonics after proper depletion. The pathological condi- tion of the uterus and its appendages should be attended to in all cases. Pregnancy. What changes take place after the period of impregnation ? The ovum increases in size, and is prominent on the ovarium ; absorp- tion of its peritoneal coat takes place; it is embraced by the fim- briated extremity of the Fallopian tube, and carried towards the cavity of the uterus. At what time is the ovum found in the uterus ? Probably about twenty days after impregnation. What is the appearance of the ovarium after the ovum is re- moved ? First, an effusion of blood into the cavity from whence the ovum was removed, and this is followed by a true corpus luteum. The Membranes, &c. What takes place during this time in the cavity of the uterus ? The internal surface throws out a vascilar tissue, which is termed 45* 534 OBSTETRICS. the membrana decidua; it lines the cavity of the uterus down to the internal os uteri, remains next to it during pregnancy, and forms the medium of contact between the uterus and the ovum. What are the membranes of the ovum ? There are two ; the chorion externally, and the amnion internally. They enclose the embryo and the water in which it floats. What takes place when the ovum arrives at the uterus ? The ovum adheres to the decidua (c), and causes a growth of that part with which it comes in contact, and is called the de- cidua reflexa; so that the decidua is then divided into that portion lining and in contact with the uterus, called decidua vera (c) ; and that portion in contact with the ovum, and called decidua re- flexa (e e) ; this arrangement corres- ponds with that of the pleura pulraonalis and costalis ; they come in contact about the fourth month. What are the uses of the amnion and chorion ? The amnion furnishes a quantity of fluid for the protection of its contents; the chorion furnishes a means of communication with the uterus, and is thought by some to form the basis of the placenta. What then does the ovum consist of after its establishment with- in the uterus ? The decidua, decidua reflexa, chorion, amnion, liquor amnii, foetus, and umbilical cord, with one extremity attached to the umbilicus of the child, and the other to the mem- branes, which for the present answers the purpose of the placenta. What are the uses of the liquor amnii ? Perhaps its uses are not entirely known ; but it allows space, and facilities for motion, development, &c , of the foetus. What composes the umbilical cord ? It consist of two arteries, a vein, a layer of amnion, and perhaps also the chorion ; the arte- ries are a continuation of the primitive iliacs; the vein passes under the edge of the liver, and enters the vena cava. The Placenta. What is the placenta and its characteristics ? It is that vascular mass by which the circulation is maintained between mother and Fig. 8 A OBSTETRICS. 535 child, and the latter is nourished. Its diameter is six or eight inches, and its thickness is from a few lines at its edge to one inch or more at its centre. It has two surfaces ; the uterine, which is rough, spongy, traversed by sulci (and it is believed by many that the decidua lines its whole surface); and the foetal, which is smooth, and lined by the amnion. Fig- 9. Fig. 10. What is the structure of the placenta ? It is essentially vascu- lar; the vessels being connected by weak tissue analogous to cellu- lar. These vessels are dependencies of the vascular systems of both mother and child, but have no direct connection with each other. Suppose an injection passed into the umbilical arteries, what heconies of it ? It passes into the veins of the placenta, and the whole plexus may be filled. The arteries may be filled in the same manner, by injecting the umbilical vein. Can an injection be passed into the foetal vessels from the uterine arteries ? It cannot. What are the functions of the placenta. It is an absorbing and respiratory organ to the foetus. What is meant by embryo ? It is the new being during the first three months of gestation ; during the balance of its intra-uterine existence it is called foetus. The Fcetal Circulation What are the peculiarities of the circulatory apparatus of the foetus ? There are five : 1st. The vena u.iubilicalis. 2d. The due 036 OBSTETRICS. tus venosus. 3d. The foramen ovale. 4th. The ductus arteriosus. 5th. The arterice umbilicales. What is the Vena Umbilicaiis ? It arises from the placenta, enters the abdomen through the navel, passes along the anterior margin of the suspensory ligament of the liver, is connected with the sinus of the vena portarum, and a great portion of its blood is distributed to the liver. What is the Ductus Venosus? It arises from the vena portarum, and empties into the vena cava ; it arises directly in the face of the umbilical vein, so that a probe may pass readily from one to the other, and might be considered as a continuance of it. What is the Foramen Ovale ? It is a large aperture between the two auricles of the heart, furnished with a valve, which closes when respiration begins. What is the Ductus Arteriosus ? It is a canal leading from the pulmonary artery into the aorta, and discharges into the aorta, at the lower part of the curvature. What are the Arterice Umbilicales ? They are two in number, and are a continuation of the external iliacs ; they pass through the navel, in company with the umbilical vein, twist spirally around it, and are distributed to the placenta. What is the course of the fcetal circulation ? It is from the placenta through the umbilical vein and ductus venosus into the ascending cava, which discharges the blood into the right auricle of the heart. The eustachian valve turns the greater part of the blood into the left auricle, through the foramen ovale. The left auricle may then be said to be distended with blood from the ascending cava, while the right is distended with the blood of the descending cava. The auricles contract together, and fill the ventricles. The ventricles also contract together and fill the pul- monary artery and aorta. The blood of the right ventricle, having got into the pulmonary artery, is principally discharged by the ductus arteriosus into the descending aorta. That of the left side, by being driven into the aorta, is mostly sent through the arteria innominata, the left carotid, and the left subclavian, to the head and upper extremities ; what remains, being mixed with the con- tents of the descending aorta, goes to the lower extremities; but by far the greater portion of the blood of the descending aorta passes through the umbilical arteries to the placenta, where it is OBSTETRICS. 537 rendered fit for the nutrition of the foetus, taken up by the umbilical veins, and repeats the same round until respiration is established. Changes in the Uterus from Impregnation. What are the changes which take place in the parietes of the uterus itself from impregnation ? There is an increased quantity of blood sent to it, which increases with gestation ; the vessels, from being small and convoluted, become enlarged and straighter. The fibres of the uterus, and all the structures entering into its composition become developed, so as to be recognised as muscular ; the organ increases in size with perfect regularity, and its position and distension give us a pretty accurate knowledge of the advance- ment of pregnancy. For the first three or four months the uterus is found lower in the vagina than when unimpregnated; after the fourth or fifth month, the fundus can be felt at the pubic region; at the sixth, half way between it and the umbilicus ; at the seventh, at the umbilicus; at the eighth, half way between the umbilicus and the scrobiculus cordis ; at the ninth, about the same, owing to the more perfect development of the neck. The neck of the uterus undergoes changes also after the sixth month ; it becomes shorter and shorter, and at the ninth month is entirely obliterated ; fur- nishing then the principal increase of space for the foetus. Of the body and fundus, the posterior portions contribute the most space, and hence the Fallopian tubes at the latter part of pregnancy are found in advance of the uterus. Of the Development of the Foetus. In what order is the product of conception developed ? To the fifteenth day it is a gelatinous, semi-transparent, flocculent, grayish mass; at thirty days, it is the size of a large ant, varying from three to five lines in length ; at six weeks, it is ten lines in length, about the size of a bee, and some of the rudiments of organs are visible; at two months, it is about two inches long, the weight is two ounces, and ossification has commenced in some parts ; at the third month, it is about three and a half inches long and weighs nearly three ounces, the umbilical cord is formed, and the genital organs are distinct; at the fourth month, it is from five to six inches long, and weighs from four to five ounces. 538 OBSTETRICS. During the fifth month, motion is perceptible by the mother, the length is from seven to nine inches, and the weight nine or ten ounces ; at the sixth month, the parts are more perfectly • developed, it weighs from one to two pounds, and its length is from nine to twelve inches. At the seventh month, all parts are more perfectly deve- loped ; the eyelids, which until now have been united by the membrana pupillaris, are sepa- rated ; the hair and nails grow, the weight is from two to three pounds, and the length is from twelve to fourteen inches. At eight months, the weight is from three to five pounds, the length sixteen inches or more, and all the parts show a much more perfect conditiou of develop- ment. At the ninth month, the head has considerable firmness, ossification is more complete, all the organs are capable of perform- ing their appropriate functions in a more perfect manner; the length of the foetus is about 20 inches, and the average weight is about 7 pounds in this country. Extra-Uterine Pregnancy. What are the varieties of extra-uterine pregnancy? Ovarian pregnancy, or when the embryo is developed in the ovary. Ventral or abdominal pregnancy, when the embryo becomes deposited and developed in the cavity of the abdomen. Tubal pregnancy, or when the embryo becomes developed in the tube. Interstitial pregnancy, or when the ovule becomes deposited between the layers of the muscular fibres of the uterus and is de- veloped. What are the consequences of extra-uterine pregnancy ? The OBSTETRICS. 539 consequences are usually serious : irritation, inflammation, suppu- ration, ulceration, internal hemorrhage, and sloughing are all liable to happen, and often to the extent of causing death to the mother. What is the proper treatment? Generally, a palliative treat- ment is the best. Gastrotomy has been recommended by some authors. Of the Signs of Pregnancy. How are the signs of pregnancy divided? Into the rational or sympathetic, and the positive, or physical signs. What are the rational signs of pregnancy ? Suppression of the menses; the nipples and papillae become enlarged, tumid dark- colored, and surrounded by an areola, morning sickness ; enlaro-e- ment of the abdomen, &c. ° Are these signs positive ? No ; they are all fallacious, and may be produced by other causes than pregnancy. What is the mode of examination to detect the physical signs? The examination of the abdomen by the hand, by auscultation, and ballottement. What do we detect by an examination of the abdomen with the hand ? The form of the tumor, and the movements of the foetus What may be detected by auscultation ? The pulsations of the foetal heart, and the uterine souffle, and to these may be added the movements of the foetus. Is the uterine souffle a sign to be invariably relied upon ? No ■ it is valuable, but not conclusive. Are the pulsations of the foetal heart to be relied upon ? They are conclusive when heard ; which can almost invariably be done when pregnancy exists, after the fourth month, although at this early period great care is required. The point where it may often be heard is about midway between the scrobiculus cordis and sym- physis pubis, or perhaps more frequently a little to the left of the middle line. These pulsations may be distinguished by their quickness, which are from 130 to 150 in a minute. In cases of double pregnancy, the sound of both fcetal hearts may mostly be heard in the last weeks of pregnancy. What is meant by ballottement, and what is its importance as a 540 OBSTETRICS. diagnostic of pregnancy ? The process of ballottement is performed by passing the finger to the mouth of the uterus, or midway between it and the symphysis pubis, while the other hand is applied upon the abdomen to the fundus ; the finger should be suddenly pushed up against the uterus, wrhile the palm of the other hand is placed on the abdomen to receive any impression which such a shock may produce ; the finger in the vagina is to be kept applied to the uterus, so that it may determine whether any floating body descends upon it. By these means we can determine whether the uterus contains a floating body; but it does not give us absolute knowledge of what that floating body consists. The woman should be in the erect position. Are there any other symptoms of pregnancy ? Yes ; the pre- sence of kiestine in the urine is looked upon as affording a symp- tom of value, not always to be depended upon, however, as it may exist in certain diseases; but, taken in connection with other symptoms, it may be valuable in coming to a conclusion. A Table exhibiting the Signs of Pregnancy at the different Periods RATIONAL SIGNS. SENSIBLE SIGNS. First and second months. 1. Suppression of the menses (numerous exceptions). 2. Nausea—vomiting. 3. Slight flatness of the hypogastric region. 4. Depression of the umbilical ring.. 6. Tumefaction and tenderness of the breasts. 1. Suppression of the menses (a few excep- tions). 2. Frequently, the apparation or the continu- ance of the vomitings. 3. A small protuberance in the hypogastiic region. I. Less depression of the umbilical cicatrix 1. Augmentation in the size and weight of the uterus. 2. Descent of the organ. 3. The womb is less movable. 4. Its walls have the consistence of caout- chouc. 5. The neck is directed downward, forward, and to the left. 6. The orifice of the os tincae is rounded in primiparae. but more patulous in others who have had children. 7. A slight softening in the mucous membrane covering the lips, and this membrane ap- pears cedematous. 1. The fundus uteri rises to the level of the superior strait towards the end of the third month, and is perceived at the close of the fourth about the middle of the space between the umbilicus and pubis. 2. A perceptible flatness on percussion in the hypogastric region. 3. A rounded tumor, as large as a child's head of a year old. may be detected there by the abdominal palpitation. 4. By resorting to this process and the vagi- nal touch jointly, the displacement en masse, and the volume of the uterus ma; be easily ascertained. Third and fourth months. OBSTETRICS. 541 RATIONAL SIGNS. SENSIBLE SIGNS. Third and fourth months — continued, i. Augmented swelling of the breasts, promi- nence of the nipples, and slight discolora- tion in the areola. S Eiesteine in the urine. 5. Tho neck has the same situation and di- rection during the third month, as in the preceeding one,"!; at the fourth it is ele- vated and directed backwards and to the left side. 6. The ramollissement of the periphery of the orifice is much better marked. The lat- ter is more open in multipara;, even admit- ting the extremity of the finger; but it is closed and always rounded in primiparse. Fifth and sixth months. t. Suppression of the menses (some rare ex- ceptions). 2. The disturbances in the digestive organs generally disappear. 3. Considerable development of the whole sub-umbilical region. i, A convex, fluctuating, rounded abdominal tumor, salient, particularly on the middle line, and sometimes exhibiting the foetal irregularities. 6. The umbilical depression is almost com- pletely effaced. 6. The discoloration in the areola is deeper — glandiform tubercles; areola spotted. 7. Eiesteine in the urine. 1. The fundus uteri is one finger's breath below the umbilicus at the end of the fifth month; and the same distance above it at the expiration of the sixth. 2. Foetal irregularities, and active movements, which are very perceptible. 3. The bruit du cceur and bruit de soufflet are now perceptible. 4. Ballottement. 5. A tumor is felt at the anterior-superior part of the vagina, which is sometimes soft and fluctuating, at others rounded, hard, and resisting. 6. The inferior half of the cervix uteri is softened. 7. The whole ungueal part of the first pha- langeal bone can penetrate the cavity of thn neck in multipara:. The latter is softened to the same extent in primiparae, but ihn orifice is closed. Seventh and eighth months. 1. Suppression of the menses (the exceptions are very rare). 2. Disorders of the stomach (very rare). 3. The abdominal tumor has the same cha- racters, except that it is more voluminous. i. A complete effacement of the umbilical depression, the dilation of the ring, and sometimes a pouting of the navel. 5. Numerous discolorations on the skin of the abdomen. J. Sometimes a varicose and cedematous con- dition of the vulva and inferior extremi- ties. I. Vaginal granulations — abundant leucor- rhoeal discharge. '. Deeper discoloration of the central areola, and an extension of the spotted areola. Sometimes there are numerous stains on the breasts; flow of milk ; complete develop- ment of the glandiform tubercles. '• Persistence of kiestoine in the urine. 1. Increased size of the abdomen. 2. The fundus uteri is three fingers' breadth above the umbilicus at the seventh month and four or five at the eighth. 3. The organ is nearly always inclined to the right. 4. More violent active movements of the foetus. 5. Bruits du cceur and de soufflet. 6. Ballottement is very clear during the seventh month, but more obscure in the eighth. 7. The ramollissement extends along the neck, above the vaginal insertion. In primipara;, the cervix is ovoid, and seems to have di- minished in length ; in others it is conoidal, the base being below, and sufficiently patu- lous to admit all the first phalanx. The neck and its superior fourth is still hard and shut up. 46 542 OBSTETRICS. RATIONAL SIGNS. SENSIBLE SIGNS. First fortnight )f the ninth month. 1. The vomitings frequently reappear. 2. The abdominal tumor has increased — the skin is much stretched, and very tense. 3. Difficulty of respiration. I. AU the other symptoms persist, and are increased in intensity. 1. The fundus uteri reaches the epigasrrk region, and gains the border of the false ribs on the right side. 2. Active movements. Bruits du coeur and de soufflet. 3. Often there is no proper ballottement. but merely a kind of rising of the tumor formed by the head. 4. The neck is softened throughout its whole length, excepting the circumference of tho internal orifice, which still remains eloped and resisting. In women, who have pre- viously borne children, the finger may be introduced into the cervix to the extent of a phalanx and a half, and in fact is only arrested by the internal orifice, which ia closed and wrinkled, though iu some cases already beginning to open. In pvimiparae, the ramollissement is equally extensive, and the neck is swollen in the middle in an ovoidal form, but the external orifice, although partially openel, does not permit the-introduction of a finger. Last fortnight of the ninth month 1. The vomitings often cease. 2. The abdomen is fallen. 3. The respiration less oppressed. 4. More difficulty in walking. 5. Frequent and ineffectual desires to urinate. 5 6. Hemorrhoids; augmentations of the oedema and varicose state of the lower extremities. 7. Pains in the loins, and colics. 1. The fundus uteri has sunk lower than in the first fortnight. 2. Active movements; bruits du coeur and de soufflet. 3. Ballottement often imperceptible. 4. The head more or less engaged in the ex- cavation. In multipara;, the internal orifice softens and dilates; the finger can then penetrate through a cylinder (as it were) an inch and a half in length, and come in contact with the naked membranes. In primipara, the internal orifice experiences the same modi- fication, but the external remains closed. Durintr the last week, in consequence of the spreading out at the internal orifice, the whole cavity of the neck becomes con- founded with that of the body, and the fin- ger, in reaching the membranes, only tra- verses a thin orifice in priuiiparae, but a rounded collar in others, of a variable thickness.— Cazeaux. Treatment during Pregnancy. What is the proper treatment during pregnancy ? All excite- ment should be avoided ; the exercise should be moderate, and of a kind calculated to invigorate the general health ; the diet should be simple and unirritating; and both diarrhoea and costiveness should be avoided or relieved. Castor oil, or pills of rhubarb and soap, form the best aperient. Sickness of the stomach may often be relieved by lime-water and milk. Any complication occurring should receive its appropriate treatment. OBSTETRICS. 543 Abortion. What is understood by abortion ? The expulsion of the ovum at any period prior to the sixth month : after that period, it is termed premature labor. The causes may be violent mental emotions; the effects of habit; anything which increases the velocity of the circulation of the blood ; diarrhoea, syphilis, acute disease of the mother, venery, violent exercise, blows on the abdomen, strong purges, &c, &c. What are the signs of abortion ? Absence of the morning sickness, which also very often occurs when the foetus is dead ; when this exists, we may infer that the child is alive; flaccidity of the breasts; tenesmus, pains of the back, abdomen, and weight and pain in the region of the uterus, expulsive pains, and hemor- rhage ; this last symptom cannot exist without the separation of a portion of the ovum. What are the means of its prevention ? In plethoric women, use small and repeated bleedings, with a general antiphlogistic course. Weak women require, on the other hand, tonics, wine, bark, and cold bathing. Violent exercise should be avoided, the mind kept composed, and mild aperients used, but purging should be carefully avoided. What is the proper treatment ? Bleeding when plethoric, cool- ing and saline draughts with laudanum proportioned to the amount of pain, keep the patient cool. Laudanum, opium, or morphine will often, when given in full doses, either by the mouth or by the rectum, quiet the symptoms and put a stop to its further progress, unless considerably advanced. Entire rest should be strictly en- joined, and, if hemorrhage exist, acetate of le>.d should be given, and ice used internally and externally, and tt e vagina plugged if necessary. The best tampon or plug is probably formed by what is termed the kite-tail plug, which consists of small strips of soft muslin, united together by a small cord. The tampon should only be used when there is little or no hope of saving the contents of the uterus, and hemorrhage exists ; ergot may be given with propriety, under the same circumstances, for the purpose of hastening the expulsion of the ovum. 544 OBSTETRICS Of the Action of the Uterus. What are the actions of the uterus ? It has two. The first tends to reduce it to its original size, after having been distended; this is called its tonic action. It is accomplished by all the fibres gathering themselves to a common centre, but particularly by the circular fibres. The second acts only when attempting to expel something, and is alternate in its action ; it has been termed the spasmodic or painful contraction of the uterus ; and never takes place unless the tonic action is perfect, or nearly so. Retroversion of the Uterus. What is meant by Retroversion of the uterus ? It is where the fundus is precipitated backwards, and places itself between the rectum and bladder; while the neck is mounted up behind the symphysis pubis. At what time may this displacement take place ? Either in the miimpregnated or the impregnated state; but usually in the latter. It occurs mostly between the second and fourth months of preg- nancy. What are the causes ? Whatever tends to depress the fundus; such as blows, pressure, sudden exertion, violent efforts to vomit, coughing, an over-distended bladder, and an accumulation of feces in the rectum. What are the symptoms ? When suddenly produced, the symp- toms may be severe ; and immediate interruption to the flow of urine, or to the passage of the feces, alternate pains, bearing down, disposition to faint, &c. When slowly induced, the symptoms are the same, only less urgent and severe, but increase in intensity as the uterus is developed, until relieved. The diagnosis should be verified by the touch ; and the disease may easily be distinguished by the vagina interposing between the finger and the tumor, the neck being mounted up behind the symphysis, and by its being obstinately fixed in its position What is the treatment? The catheter should be used, and the bowels emptied daily; if this plan does not succeed, it should be obstetrics. 545 replaced by mechanical means. The plan then to be pursued is to empty the bowels, either by injections or a cathartic ; draw off the urine with an elastic catheter; and bleed to fainting, or nearly so, if necessary. The bed should be prepared in such a manner that the patient may lie upon her back, with the perineum free from the edge of the bed, and the parts should be well lubricated with oil or lard. When faintness is induced by bleeding, the woman should be placed in the above position ; the fingers should be placed so as to form a straight line at their extremities ; they must then be gently pressed against the base of the tumor in the vagina so as to move it backwards a id upwards, along the hollow of the sacrum, until it is placed above the projection of this bone ; the hand should be withdrawn, a pessary introduced, and the woman kept quiet in bed for some days. It has also been recommended to place the patient under the effect of chloroform, and attempt reduction when in this condition. Anteversion of the Uterus. What is Anteversion of the uterus ? It is where the fundus is thrown forward and downward, so as to press against the poste- rior and inferior portion of the bladder, while the neck is carried backwards towards the projection of the sacrum. The symptoms are not so severe as iu retroversion. It may generally be relieved by opening the bowels and drawing off the urine. Of the Obliquities of the Uterus. How are they divided ? Into right and left lateral, and the an- terior. What is the treatment for these displacements of the uterus? Before labor, the woman should wear a bandage or supporter. During labor, the axes of the uterus and pelvis should be made to correspond, by placing the patient on the side opposite to the obliquity, and bringing the fundus into its proper place. If this does not accomplish the object, the os uteri should be hooked down by the finger, and brought to correspond with the axis of the pelvis. 46 * 2k 546 obstetrics. Of the Term of Utero-gestation. What is the average term of utero-gestation ? About nine calendar months, or forty weeks. What is the most favorable period for conception ? Immedi- ately after the menstrual evacuation. Of Labor. What is understood by the term Labor? It is the expulsive efforts of the uterus and mother in evacuating the contents of the uterus. Is its exciting cause well understood ? It cannot be explained in the present state of our knowledge. Has the mind any influence on labor ? Mental impressions may excite labor in some cases, and in others suspend or prevent it. Is the foetus active, or passive during labor? It is entirely passive; being acted upon by the uterus mainly, assisted by the voluntary powers of the mother. What are the symptoms of labor ? They are rigors, and nervous symptoms, frequent inclination to make water, or a suppression of it, tenesmus, the subsidence of the abdominal tumor, secretion of mucus, dilatation of the mouth of the uterus, and its alternate contractions. What is understood by false pains ? The pains are false when the os uteri is entirely unaffected by them; which may be ascer- tained by an examination. When these occur, they should be quieted by an injection of laudanum with starch, sufficient in quantity to accomplish the object, after evacuating the bowels. By what set of fibres is the os uteri opened ? By the longitu- dinal, which are opposed by the circular. Into how many stages is labor divided ? Three. The first is the period of dilatation of the os uteri sufficient to permit the child to pass, and occupies about ten-twelfths of the whole dura- tion of labor. (Fig. 12.) The second is the period of expulsion of the child from the uterus, and occupies about one-ninth. (Fig. IS.) The third stage includes the complete expulsion of the mem- Jk branes and placenta, and occupies about one-twenty-fourth of the whole duration of labor. Are the active duties of the accoucheur numerous in a natural labor ? No ; he should watch with care its progress and attending symptoms, so as to be able to render assistance promptly in case of difficulty ; but should not interfere when the case is a natural one. To be able to discriminate where interference is necessary, requires an accurate knowledge of a healthy labor, and the devia- tions to which it may be liable. What should be the position of the woman during labor ? She should be placed on her left side at the foot of the bed, in such a manner that she may fix her feet firmly against the bedpost; her hips within ten or twelve inches of the edge of the bed, with the lower extremities fixed, and the head supported by pillows. The bed should be properly protected by folded blankets from the discharge. What time would you choose for making an examination of the progress of labor ? The finger should be introduced into the vagina during a pain ; the examination of the presenting part and of the condition of the os uteri should be made both during pain and in its absence. Should the membranes be ruptured during labor? When the membranes remain entire, and the pains are efficient, with the os uteri fully dilated or dilatable, they should be ruptured by pressing the finger against them, or by cutting them with the nail. 543 obstetrics. When the head is emerging under the arch of the pubes, what are the duties of the accoucheur ? He should support the perineal tumor with the palm of the left hand, and retain it there until the head is freed from the vulva. When the head is in this position, is it proper to act upon it, and extract the foetus ? No ; the delivery should be trusted to the action of the uterus, unless it should become suspended, and there is danger of the life of the child. By a too sudden delivery, alarming hemorrhage may result. What is the first great object as regards the child after delivery ? To establish respiration, which generally takes place spontaneously; if it does not, measures should be taken to produce artificial respi- ration ; and heated cloths should be applied to the child rather than the warm bath. The sudden application of cold water will often excite respiratory efforts very efficiently. What are the means employed in producing artificial respira- tion? The nostrils should be closed, and air forced into the mouth either by the bellows, or from the mouth of the accoucheur; and again expelled by gently pressing upon the thorax. To what period after birth may respiration be suspended, and yet the child live ? For thirty, or even forty minutes in some instances ; so that our efforts should be continued so long as there is any chance of life. At what time is it proper to put a ligature on the cord, and cut it ? When the child cries, or respires freely; and there is evi- dence of a proper supply of arterial blood. How many ligatures are necessary ? One; except there be twins, in which case two are necessary. After the child is separated from the mother and given to the nurse, what should then be attended to ? The condition of the uterus should be ascertained by examining it through the parietes of the abdomen, when it will be found either contracted or relaxed. If contracted, the placenta may be in the vagina, and easily hooked down with the fingers, and drawn by the cord; when it has passed the os externum, it shall be grasped and twisted several times round, so that the membranes may be entirely withdrawn. If the uterus is relaxed, frictions should be made over the abdo- men so as to produce contraction. OBSTETRICS. 549 The condition of the uterus should be watched until its perma- nent tonic contraction is well established. If there is a retention of the placenta after tonic contraction has taken place, rubbing and pressing the belly may excite a greater degree of it, or, perhaps, alternate contraction sufficient to expel the placenta : but if this does not take place, the hand may be introduced, after .waiting an hour or two, which should then be done by introducing it into the uterus in the form of a cone; the placenta should be carefully detached, without leaving any portion behind, and the hand may be slowly withdrawn. What is understood by putting the patient to bed ? It consists in the removal of wet things and substituting dry ones; in being lifted where she is permanently to lie; and in the application of a bandage and compress over the abdomen. At what time should it be done ? If she is not in a profuse per- spiration, is not liable to, or has no hemorrhage, and the uterus well contracted, or not much exhausted, it should be done imme- diately. Upon what do after-pains depend, and what is the remedy ? After-pains are produced by coagula in the uterus, which are caused by a deficiency of its tonic contraction. The proper reme- dies are evacuation of the bowels, camphor, opium and its prepa- rations, and the extract of hyoscyamus. What should be the diet of a woman after delivery ? Gruel of oatmeal, tapioca, sago, mush and milk, rice, crackers, toast, weak tea, coffee, and chocolate. Animal food, spirits, wine, cordials, and all stimulating articles should be strictly avoided, unless ren- dered necessary by an exhausted condition of the system. After the first week, she may be allowed some oysters, eggs, beef tea, &c. When should the child be put to the breast ? If there is danger from hemorrhage, it should be applied as soon as possible; and at any rate as soon as it can be done conveniently without too much annoyance to the woman. If the bowels should be confined, at what time would it be proper to give a cathartic? On the third day; previous to this, unless there is some particular indication to fulfil, the bowels should not be disturbed. The state of the bladder should also always be attended to. 550 OBSTETRICS. What is meant by the lochi? The discharges which take place from the uterus after delivery. Is it necessary to administer purgatives to young children ? It is necessary that the bowels should be thoroughly cleansed of the meconium, either by their natural action, or by some laxative as molasses or castor oil; but as soon as there is a change of color produced in the evacuations, they should be discontinued. The condition of the bladder of the child should also be attended to, aild relieved if urine should accumulate in it. Is it proper to feed very young children ? Provided the mother does not furnish a supply of milk sufficient, but not otherwise ; the child may then have a little fresh cow's milk, diluted with one-third water, and sweetened with loaf sugar. Laceration of the Perineum. What preventives may be adopted to avoid laceration of the perineum during labor ? Support should be given to the perineum during the passage of the child's head and shoulder out of the vagina, by placing the palm of the hand firmly against it, and so cause the head to descend downwards and forwards. What is the proper treatment when it occurs ? When recent, efforts should be made to unite the parts by the first intention, and to accomplish this the patient should keep quiet, with her limbs close together. Surgeons direct the employment of sutures, pro- vided the laceration is extensive, and particularly if the sphincter ani is lacerated. When the ease is of some standing, or the parts indisposed to heal, the edges should be pared as in the hare-lip operation, and brought together so as to form a union. Sore Nipples. What is the proper treatment? Reduce the inflammation by general and local means ; use Pratt's artificial nipple and shield, and if the ulcerations become deep and chronic, touch them with nitrate of silver lightly. The above artificial nipple of Pratt's may be used with little or no pain, causes but slight disturbance of the sores, and of course, the principal impediment to cicatrization is thus removed. Gentle astringent washes, in the chronic stage, OBSTETRICS. 551 are also beneficial; of these, the sulphate of zinc and the tit cture of catechu are proper remedies. Previous to labor, the nipples should be often washed with a strong solution of tannin as a pre- ventive. Of Natural or Unassisted Labor. What is meant by a natural labor? Every labor may be con- sidered natural in which the woman might be delivered safely without help. What conditions should exist that natural labor may take place ? There should be regular contractions of the uterus, a favorable presentation, the pelvis of a proper size, a proportionate head, and the soft parts relaxed. What are considered to be the natural presentations ? There are four: 1st, of the head— 2d, of the/ee*_3d, of the knees— and 4th, of the breech. — Dewees. Of these, which is the most frequent and the most favorable ? The presentations of the head. How are the presentations of the head divided? There are six. What are their positions, and how are they distinguished ? The first, which is known by the posterior fontanelle being behind the left acetabulum, and the anterior before the right sacro-iliac sym- physis. The second, distinguished by the posterior fontanelle being be- hind the right acetabulum, and the anterior before the left sacro- iliac symphysis. The third, distinguished by the posterior fontanelle being behind the symphysis pubis, and the anterior before the projection of the sacrum. The fourth, distinguished by the anterior fontanelle being behind the left acetabulum, and the posterior before the right sacro-iliac symphysis. The fifth, distinguished by the anterior fontanelle being behind the right acetabulum, and the posterior before the right sacro-iliac symphysis. And the sixth is the reverse of the third. To remember these presentations easily, notice that the 1st, 2d, and 3d presentations are represented by the posterior fontanelle; and the 4th, 5th, and 6th, by the anterior fontanelle ; and that we 552 OBSTETRICS. constantly follow their numerical order, commencing with the left acetabulum, then with the right, and then go to the symphysis pubis; each fontanelle following the same route and order. What are the distinguishing marks of the presentation of the head ? Its roundness, firmness, sutures, and fontanelles. The particular position of the head relatively to the pelvis is determined by the situation of the sutures and fontanelles. Mechanism of Labor. What is the mechanism of the first presentation ? The head enters the superior strait obliquely, in the position described in the first presentation. The head is flexed, with the chin on the breast, and descends in this position, with its axis corresponding with the axis of the superior strait. (Fig. 14.) When it arrives at the sacro-sciatic Fig. 14. ligaments, rotation is performed by the head of 1-6 of a circle. while the body remains in the same position; the centre of the oc- cipital bone will then be found to correspond with the symphysis M obstetrics 553 pubis, and the sagittal suture with the antero-posterior diameter of the pelvis. As the head advances, the chin departs from the breast, the vertex advances, separates the external parts rises up towards the mons veneris, and describes about a quarter of a circle backwards ; this motion is called extension, and may be con- sidered perfect, just as the face is clearing the perineum. (Fig. 15.) Fig. 15. As soon as the head has escaped externally, it takes a position at right angles with the shoulders, or its natural position in relation to them ; this is called restitution. (Fig. 16.) In these motions, it will be seen that the small diameters of the head correspond with the small diameters of the pelvis ; and that it executes five motions, that of flexion, descent, rotation, extension, and resti- tution. Which shoulder presents at the symphysis pubis in this presen- tation ? The right shoulder. What is the mechanism of the second presentation? It is the same as the first, if we place the head in the position of the second presentation at the superior strait; and the left shoulder passes out under the arch of the pubes. What is the mechanism of the third presentation? In the 47 554 OB STETRICS. Fig. 16. third position, the head is presented at the superior strait with its longitudinal diameter, corresponding with the antero-posterior diameter of the pelvis; it descends in this manner, and performs the motions of flexion and extension, but not those of rotation and restitution. Which shoulder presents to the symphysis in this presentation ? There is no certainty whether it will be the right or left. What is the mechanism of the/our//i position ? The head pre- senting with the anterior fontanelle at the left acetabulum descends until a portion of the right parietal bone rests upon the inferior ^part of the sacrum, when rotation takes place, and the forehead is nlaced under the arch of the pubes; the anterior fontanelle will be found in the middle of the arch ; the posterior above the point of the sacrum; the occiput continues to advance over the coccyx and perineum until it is cleared from it; the occiput then turns back- wards towards the anus of the mother, and the face disengages itself from under the pubes. In this and the fifth, the forehead often rotates into the hollow of the sacrum : in fact, it is now well established that this is the most frequent mode of termination of the fourth and fifth positions of the head, and, also that it is the most favorable. OBSTETRICS. 555 Which JU'aMor presents to the arch of the pubes ? The left. To what position may this be changed with advantage ? To the second ; and the fifth may be reduced to the first. How is this accomplished ? The uterus must be well dilated, the membranes ruptured, the head occupying the lower strait, and the labor active. The point of the forefinger must be placed against the edge of the sagittal suture, before or behind the ante- rior fontanelle; in the absence of pain, press the part towards the left sacro-iliac symphysis, maintain it there during the next pain, and this must be repeated again and again until we succeed. This is the direction given by Dewees, but from closer observation in reference to the mechanism of the third and fourth positions, it is ascertained that the desired change is usually effected by nature, without any artificial interference. What is the mechanism of the fifth presentation ? The rela- tions of the child's head to the pelvis are the same as in the fourth, only the anterior fontanelle at the superior strait is placed at the right acetabulum; and the right shoulder presents at the arch of the pubes. What is the mechanism of the sixth presentation ? This pre- sentation is the reverse of the third ; and in addition to the great diameter of the head being parallel with the small diameter of the upper strait, the forehead has to come under the arch of the pubes; so that the first part of the labor resembles cases of the third pre- sentation, and the latter part resembles cases of the fourth and fifth when the occiput does not rotate forwards. Presentation of the Breech. What is the order of frequency of the natural presentations ? The breech is next in frequency to the head; then the feet and " knees. What is the principal danger in these cases where the body of the child is first delivered? It arises from delay in delivery of the head, and compression of the umbilical cord ; consequently, breech presentations, from the perfect manner in which the external parts are dilated, preparatory to the passage of the head, are less dan- gerous-than the feet and knee presentations, although it may be a little more tedious to the mother 556 OBSTETRICS. What are the symptoms of a breech presentation ? It may be known by the soft tumor wanting the characteristics of the head • having neither its sutures, hardness, nor roughness. A deep groove is observed leading to the anus and parts of generation, and after the rupture of the membranes a discharge of meconium will corro- borate, but not positively confirm, the diagnosis. What are the varieties of breech presentations ? There are four. In the first, the lower part of the spine and sacrum offer to the left acetabulum, and the abdomen looks towards the right sacro-iliac symphysis. (Fig. 11.) The following figures represent Fig. 17. Fie. 18. Fig. 19. the first presentation of the breech in its various turns through the pelvis, or its mechanism. In the second, the back of the child answers to the right acetabulum, and the belly to the left sacro-iliac junction. (Fig. 18.) In the third, the spine is behind the symphysis pubis, and the belly towards the projection of the sacrum. (Fig. 19.) The fourth is the reverse of this last. Wrhat is the proper management of cases of breech presentation ? It is not to inter- fere, unless complicated with some circum- stances which may render it necessary. OBSTETRICS. 557 Presentation of the Feet. What are the characteristics of feet presentations ? They are easily told by the projecting heels, the short toes, and from the hands, to which alone they bear any analogy by the absence of the thumb. What are the presentation of the feet ? There are four. In the first, the heels are anterior to the left acetabulum, and the toes are directed towards the right sacro-iliac symphysis. In all these cases, the legs are flexed upon the thighs, and the thighs on the pelvis. In the second, the heels are behind the right acetabulum, and the toes look towards the left sacro-iliac symphysis; in all these cases, the other parts of the body correspond to the position of the feet. In the third, the heels are at the symphysis pubis, and the toes to the sacrum. In the fourth, the position is reversed ; the heels are to the sacrum, and the toes to the pubes. r Presentation of the Knees. What are the presentations of the knees ? There are four. In theirs/, the legs are to the left side of the mother, and the thighs to the right. In the second, the legs are to the right, and the thighs to the left. In the third, the legs are under the arch of the pubes, and the thighs towards the sacrum. The fourth is the reverse of the third. Of Labors in which the Presentation is natural, but rendered difficult or preternatural. What are the causes which may render a natural labor preter- natural? They are, 1st, flooding: 2d, convulsions: 3d, syncope: 4th, hernia: 5th, obliquity of the uterus: 6th, partial contrac- tions of the uterus: 1th, compound pregnancy: 8th, descent of the eord: 9th, too short a cord: 10th, bad position of the head: 11th, exhaustion: 12th, hemorrhages from tJie lungs or other organs 47* 558 OBSTETRICS. Flooding as a complication of Natural Labor. Under what conditions of the os uteri may hemorrhage take place during labor ? It may be either partially dilated and rigid; or it may be dilated, or easily dilatable. What should be the treatment when the os uteri is rigid ? There should be no hasty or rash interference, and it would be the height of imprudence to enter the uterus and attempt turning. The dis- charge should be controlled by rest, a horizontal posture, by blood- letting if indicated, large doses of acetate of lead, cold applica- tions, and the tampon. In some cases, when the above means fail, benefit may be derived from promoting the contractions of the uterus by rupturing the membranes. What should be the treatment when the os uteri is dilated or dilatable? We should at.once proceed to turning, unless ruptur- ing the membranes should abate the discharge, or the activity of the labor promise a speedy delivery. If the labor is far advanced the forceps may be necessary. Convulsions. What course should be pursued in convulsions as regards de- livery ? If the os uteri is rigid, delivery should not be attempted ; bloodletting, cathartics, and such other means as may be called for, should be resorted to, until the uterus becomes relaxed; when we may proceed to turn, unless the natural powers of the uterus are sufficient to accomplish a delivery. When the uterus is dilated or easily dilatable, we should at once proceed to turning, after a copious bloodletting. In cases wnere the waters have been long drained off, and the head low in the pelvis, we should use the forceps. Syncope. What course should be pursued in cases complicated with syn- cope ? The cause should at once be sought out; and if it depends upon a peculiarity of the nervous system, little need be done. But, if it proceed from internal or concealed hemorrhage, we should deliver immediately, unless the state of the os uteri prevent. OBSTETRICS. 559 Hernia. When a hernia is in danger of becoming strangulated, what course should be adopted ? Turning, if the os uterfis in a proper condition. Bad position of the Head. What maybe considered bad positions of the head, particularly when the head is relatively large, or the pelvis relatively small ? When the head presents at the superior strait, as in the third and sixth presentations. When the chin departs from the breast too early. When the face presents from excessive departure of the chin from the breast. And when some part, as the hand or arm, accompanies the head. What is the remedy for the first of these difficulties ? The head shall be grasped so that the thumb may lie on one side, and the fingers on the other; it shall then be raised, and in the third presentation the vertex shall be turned towards one of the ace-" tabula; if the right hand be used, turn it towards the right ace- tabulum, and if the left towards the left acetabulum ; then trust to nature. The sixth presentation should be changed either to the fourth or the fifth, which will be as much rotation as the neck will bear. What is the remedy for too early departure of the chin from the breast? It is to restore it by pushing up the forehead in the absence of pain, and retain it there with the points of two or three fingers until a pain comes on, and the vertex is found to descend; it may then be trusted to nature. What are the varieties of face presentations ? There are four : in the 1st, the forehead offers to the left, and the chin to the right side of the pelvis ; the 2d is the reverse of this ; in the 3d, the forehead answers to the symphysis of the pubes, and the chin to the sacrum ; the 4th is the reverse of this. The following figures represent the positions of the head in the pelvis, where the face Dresents in the first position, or the mechanism of that position. (Figs. 20, 21, 22.) How may face presentations be distinguished? By the presence of the eyes, nose, mouth, and chin. 560 OBSTET RICS. At what period, and how may they be remedied ? When the uterus is dilated or dilatable, and the head has not passed the superior strait; with the waters recently expended. Pass the hand which is on the side on which the vertex and forehead are placed; in the first and second presentations, put the back of the fingers to the pos- terior part of the pelvis, and place-4hem on the side of the head, while the thumb is placed against the opposite side ; the head is then to be raised, the fingers carried over the vertex, and the thumb to the forehead ; while the fingers are made to draw .the vertex downwards, the thumb is to press the forehead upwards. This is to be done in the absence of pain, and retained until a pain comes on, and the head takes the proper direction. Fig. 21. Fig. 22. Nature is generally adequate to the safe delivery of face cases. They should not, therefore, as a general rule, be interfered with, unless the progress of the case becomes complicated, and inter* OBSTETRICS. 561 ference is necessary for the safety of the woman or child. These cases are ranked under the head of natural labor by many authors. What is the proper remedy when the hand presents with the head ? It should be prevented from descending by placing the point of the forefinger between the fingers of the child, and sup- porting it during a pain, at the same time directing it towards the face; as the head descends, the hand may in this way be made to retire within the cavity of the uterus. What is the remedy in the other cases of complication of a natural labor requiring interference ? Turning, when the condi- tion of the os uteri will admit of it; but in no case is the uterus to be entered, unless the os uteri is either dilated or easily dilatable. The forceps should be used when the head is low in the pelvis. What is the proper position of a woman for turning ? The back is the best; with the lower extremities over the edge of the bed, and the feet resting on chairs, so as to leave the perineum and coccyx free. What time should be chosen for the introduction of the hand, and how should it be done ? It should be formed into a cone, with the thumb looking towards the symphysis pubis, and intro- duced into the vagina during a pain, and into the uterus during its absence. Is it proper to turn a child after it has passed the os uteri ? No ; it should be done as soon as possible after the first stage of labor is completed. When the hand is in the uterus, to what part should it be passed ? The hand should grasp the head with the fingers on one side, and the thumb on the other; raise it in the axis of the superior strait, and place it in the iliac fossa towards which the palm of the hand looks ; where it must be retained by the wrist and forearm, while the fingers trace the side of the child to the feet, which should be grasped firmly, and both acted upon at the same time when practicable. (Fig. 23.) In what direction should the feet be conducted when bringing them down ? So that the toes should always look towards the abdomen of the child. (Fig. 22.) Is it proper to attempt to turn a child during a pain ? No ; the uterus might be lacerated. Is it proper to complete the delivery in cases of turning, or 2l 562 OBSTETRICS. Fig. 23. Fie. 24. bring down the feet and permit the natural powers to finish? When commenced, it should be completed slowly and steadily. When the feet are brought through the external parts, what Fie. 25. Fig. 26. OBSTETRICS. 563 should be their position ? The toes should loo"k towards the anus of the mother; and when it is delivered beyond the umbilicus, it should be made to pass through the arch of the pubes with its spine looking towards, or pressing against either the right or left leg of the pubes, that the head may enter the superior strait ob- liquely. (Figs. 25, 26.) When the axillae appear at the os externum, what should be done ? The one next the sacrum should be first delivered, by pass- ing a finger or two upon the point of the shoulder, and pressing it downwards, Fig. 27. tracing the arm to the elbow, which may be pressed upon downwards and forwards towards the face of the child, where it will almost always be disen- gaged. To deliver the second arm, turn the shoulder of that arm to that side of the pelvis to which the face of the child looks; and it will instantly become disengaged from the head, at the small diameter of the superior strait, and may be brought down in the same manner as the first. (Fig. 21.) When the child is all delivered ex- cept the head, what should then be attended to ? The position should first be ascertained ; and if it does not already exist, a proper relation should be established between the diameters of the pelvis and the head of the child ; a little force should now be applied in the direction of the axis of the superior strait. When in the inferior strait, the proper relation should again be established between the diameters of the head and this part of the pelvis. (Fig. 28.) The mother should now be directed to assist by her voluntary powers, and the child may be acted upon in the direction of the axis of the inferior strait, while we press against the occiput in such manner as will tend to disengage it from behind the pubes; and a very slight traction may be made on the lower jaw; this, however, should be done with great care. (Fig. 29.) What are the dangers arising from deliveries of this kind ? Compression of the cord, compression of the head and chest, and 564 OBSTETRICS. Fig. 28. Fig. 29. extension of the neck. To obviate the last difficulty, we should co-operate with the pains of the mother when they exist, and the whole should be conducted coolly and deliberately. Which hand should be employed in cases of turning ? Always use that hand which will look towards the face of the child. In the first presentation, it will be the left hand ; in the second, the right; and for the third and sixth either hand will be proper, or the one of which we have the greatest command. Of the Forceps. What kind of forceps are generally used ? There are two ; the short, and the long. The short are preferred wrben the head is very low in the pelvis, and the long when high up. The long forceps are, however, better adapted to both conditions, and should, on the whole, be preferred The "eclectic forceps" of Professor Hodge are to be preferred, on many accounts, to any others. (Fig. 30.) What do the forceps resemble, and when are they indicated? They may be compared to a pair of artificial hands, and are indi- obstetrics. Fig. 30. cated when the powers of the uterus cannot accomplish delivery, when the case is complicated requiring immediate delivery, and the head passed the os uteri. They are, however, sometimes applied at the commencement of the second stage of labor, but it should only be attempted when turning is impracticable, and by a person well skilled in their use. What is the best position of the woman for the application of the forceps ? The one recommended for turning. Should the condition of the bladder and rectum be attended to ? They should both be emptied before the forceps are used ; the ex- ternal parts and the instruments should also be coated with hog's lard. What should be the condition of the os uteri, and membranes? The os uteri and external parts should be relaxed, and the mem- branes ruptured. 48 566 OBSTETRICS. What is the mode of procedure in the first presentation, and the head low in the pelvis ? One or two fingers of the right hand should be introduced care- fully into the vagina, so as to separate the soft parts from the foetal head on the left side of the mother; the male blade should then be seized by the left hand, as we hold a pen, held obliquely over the right groin, and its blade introduced along the finger Fig. 31. towards the left sacro-iliac symphysis. As the blade passes up, its handle will of course be depressed and gradually brought towards the median line of the body, until it lies back against the perineum, and there retained in that position by an assistant. (Fig. 31.) The introduction of the female branch should then be accomplished in a similar manner, only the position of the hands is reversed, the left being introduced into the vagina, and the right holding the female blade of the forceps. (Fig. 32.) 567 The position of the forceps, when applied, will be represented by the two following figures. (Figs. 33 and 34.) Fig. 33. -4. ">G8 OBSTETRICS. To what parts of the head should the blades of the forceps be applied? To the sides of the head Fig. 34. over the ears of the child in the direction of its oblique diameter; and so that their concave edges will come under the arch of the pubes at the last period of labor. In cases of difficulty in causing the handles of the instrument to join, should they be brought together by force ? No ; the cause of their not locking must be ascertained, aud remedied; force should never be used. What are the modes of action of the forceps ? They have two modes of action ; that of compression and that of traction and compression. May the life of the child be destroyed by compression from the use of the forceps ? It may ; care should be taken in this respect, and, after each tractive effort, the forceps should be permitted to expand themselves. In what manner should traction be made ? It should be made from blade to blade, so that each may act as a lever upon the head. The extent of this motion of the handles must be governed by the distance of the head from the external parts; the less the head is advanced, the more circumscribed should be the motion, and the reverse. The general direction of this traction should correspond with the axis of that part of the pelvis through which the child is passing. Should a labor be completed by the forceps in all cases where their application is necessary ? They may be removed when the head has nearly passed through the external parts, provided the pains continue, but not otherwise. OBSTETRICS. 569 Of Locked or Impacted Head. What are the varieties of locked head ? There are two:__ 1st. Where the head is jammed with its greatest length between the pubes and sacrum. 2d. Where its thickness cannot pass, owing to the narrowness of the pelvis. In the first place, the points of pressure are the forehead and occiput; and in the second, it is the parietal protuberances. What are the causes? Long continued a:id vehement action of the uterus, and a disproportion between the diameters -.f the pelvis and head; either from malposition of the head, its size and solidity, or from deformity of the pelvis. What are the attending symptoms of a locked head ? Immo- bility, accompanied by swelling of the hairy scalp of the child, thickening of the os uteri, a swelling of the vagina and external parts. What are the dangers? The mother is exposed to inflamma- tion, sloughing, and gangrene, and the child to almost certain death. What are the indications ? The delivery of the child ; which should be effected by the forceps if the child is living, and 'if dead the crotchet may be employed. Uterine Hemorrhage. How is uterine hemorrhage divided ? Into the accidental and the unavoidable. What is meant by accidental hemorrhage ? It is that which occurs at any period of pregnancy from a detachment of the pla- centa, when situated at the body or fundus of the uterus. What is meant by unavoidable hemorrhage? It is that which occurs from the situation of the placenta over the month of the uterus. Accidental Hemorrhage. At what period of pregnancy may accidental hemorrhage take place ? At any time after the first month. What is the period of the greatest danger? As a general rule it is in proportion to the advancement of pregnancy. 48* ' 570 OBSTETRICS. What is the division of accidental hemorrhage for practical pur poses ? There are four divisions : — 1st. Hemorrhage which occurs at the period when the ovum is entirely surrounded by the decidua and decidua reflexa. 2d. That which occurs during the remaining period of utero- gestation. 3d. That which occurs between the birth of the child and the expulsion of the placenta. 4th. That which occurs subsequent to the expulsion of the placenta. What are the attachments of the ovum during the first period ? It is attached to the parietes of the uterus at all points of its sur- face ; and when separated entire resembles an ovular, spongy, fleshy mass. Hemorrhage may occur, therefore, from its separation at any part. What is the condition of the neck of the uterus indicating abor- tion ? When it becomes distended so as to resemble in feel the extremity of an egg, abortion will take place almost certainly. The cessation of morning sickness, a diminution of the abdominal tumor, the painful distension of the mammas with milk, followed by flaccid breasts, also almost certainly indicate that abortion will take place. Neither pain nor flooding is a positive symptom that abortion will follow. What are the indications in the treatment during this period ? To arrest the bleeding, subdue pain if present, and prevent a recur- rence of the hemorrhage. By what means may these be accomplished ? By perfect rest of body and mind ; the bed should be a mattress, or sacking bottom. Feather beds should be avoided. The room should be ventilated, the patient thiidy covered, the drinks cold, and every- thing of a stimulating nature entirely prohibited, either for food or drink. Bloodletting may be used or not, according as it may or may not be indicated by the force of the arterial system. Acetate of lead should be given in doses of two or three grains guarded with opium every two hours, or twenty or thirty grains with a drachm of laudanum dissolved in a gill of water; or starch may be used as an enema, and repeated if indicated. If pain exist, opium should be given so as to create a decided impression upon the uterus, or else it proves itself unavailing. OBSTETRICS. 5f] Ice-water may be applied to the pubes when the discharge is pro- fuse, but our greatest reliance should be on the tampon. In all cases where the hemorrhage is alarming, whether there is a certainty that abortion will take place or not, we should use the proper means for arresting it, and the tampon will almost certainly do it. At what period may the ovum be pierced for the purpose of arresting hemorrhage ? Never before the fifth month ; and, when it is ruptured before this period, the treatment of the case is more tedious from the retention of the placenta. When the ovum or placenta is partially expelled, and hemor- rhage is kept up by their presence, what course should be adopted ? It should be removed by the finger, Dewees' hook, or by forceps or scoop invented for this purpose. Sometimes ergot will act efficiently in removing them, and may be given with propriety. What are the indications in the treatment during the second period ? They are the same as for the first The same rules and treatment should be put in practice at once, and the tampon used early if necessary. Suppose these means fail, what should be done ? We should rupture the membranes, and proceed to deliver if necessary, pro- vided the os uteri is in a proper condition ; when it is not, we should rely upon the tampon until it becomes so. Rupturing the membranes will, in the majority of cases, be sufficient to arrest the discharge. In what other condition would it be improper to effect delivery ? When the woman is reduced to the last extremities of weakness, and the discharge suspended ; but if it continue, it is the only chance remaining. What are the limits of £he beneficial application of cold ? When it has controlled arterial action, and perhaps produced some con- tractions of the uterus; these being accomplished, little benefit can be derived from its continuance. What are the modes of delivery to be resorted to ? Turning, and the use of the forceps under the restrictions heretofore men- tioned. Can hemorrhage take place at any time without a separation of a part or the whole of the placenta ? It cannot. 572 OBSTETRICS. What are the immediate causes of hemorrhage after delivery ? A separation of the placenta, and atony or imperfect tonic contrac- tions of the uterus. What are the varieties ? It may be external, or internal and concealed. What are the symptoms of concealed hemorrhage ? There is a flaccid condition of the uterus, except of the neck, which is contracted ; it becomes enlarged, and may even equal the size which it had before labor ; the effects of the loss of blood are also soon exhibited, unless the hemorrhage is checked. What are the means used for hemorrhage after delivery ? The contraction of the uterus should be excited, and continued. Fric- tion with the tips of the fingers over the fundus will generally produce it, but if it swell we should grasp it with a sudden but moderate force. The hand should be introduced into the uterus if this does not at once arrest it, and the placenta delivered ; a dose of ergot should then be given, which will insure its contrac- tions afterwards. The excitement of this process will also have a tendency to pro- duce a permanent contraction. The sudden application of cold, frequently repeated, also has a beneficial effect in this way, applied either by wet cloths, by a douche on the abdomen, or as an injec- tion into the uterus. Firm, steady pressure over the uterus, but above all the application of the child to the breast, will almost always bring about permanent tonic contraction ; upon which alone the safety of the woman depends. The introduction of the hand into the uterus for the purpose of exciting its contractions, and extracting the coagula, is also recommended after the placenta is expelled, if necessary. What means may be adopted before delivery to prevent hemor- rhage in women subject to it ? By evacuating the waters, and di- minishing the force of the circulation, by making the woman pre- serve a horizontal position, by the interdiction of stimuli of every kind, and the exhibition of ergot just before the labor is completed. What are the symptoms of encysted placenta from hour-glass contraction ? It may be known by the fundus of the uterus reach- ing higher than common, by being smaller in its transverse diame- ter ; by an elastic feel of the cord ; by the absence of severe pain, by the placenta not being within reach of the finger; when the OBSTETRICS. 573 hand is introduced, the cord is found to pass through a small aperture, and the placenta is felt lying within the cavity formed by this contraction. What is the treatment? As soon as discovered, the woman mould be placed in the position for turning, the hand introduced into the vagina, and then passed along the cord until an entrance is gradually effected through the stricture; the mass should then be separated if adherent, and brought away by a gentle, cautious motion of the hand. The exhibition of chloroform will greatly facilitate this process. Unavoidable Hemorrhage. At what period of utero-gestation may unavoidable hemorrhage occur ? It generally occurs first between the sixth and seventh month, and gives us the first knowledge of the situation of the placenta over the mouth of the uterus. Why does it not occur earlier ? Because the neck of the uterus is not unfolded much before this period ; therefore the placenta is not disturbed, or separated. It does not necessarily follow at this time, or before labor commences ; but the patient is unavoidably liable from the mechanism of the expansion of the neck of the uterus. What are the symptoms of unavoidable hemorrhage ? When the full time arrives, hemorrhage comes on suddenly, and often alarmingly, without pain ; or, if attended with pain, it is increased at every pain. This should lead us to suspect a placental presen- tation or placenta prcevia. The hand should be passed into the vagina, and the finger into the os uteri, where the placenta may be distinguished by its firmness and fibrous structure from a coagulum ; to which alone it bears any resemblance. If a case of placental presentation be left to nature, in what ways may it terminate ? In one of two modes : the pains may occur with great rapidity, and delivery be successfully accomplished ; but death is nearly always the result from excessive hemorrhage ; this last result would be the usual one — therefore, the rule is to interfere in all cases. What is the treatment ? In slight cases, at the early periods of pregnancy, the ordinary treatment of hemorrhage may be suffi- cient; but when profuse, and having ascertained it to be a placen- tal presentation, the condition of the mouth of the uterus should 574 OBSTETRICS. be ascertained. If it is rigid, we should use those temporizing means adapted to the case, among which the tampon stands first; and if it is dilated or dilatable, recourse should be had to turning, subject to the rules formerly, mentioned. The membranes should be preserved entire; the hand should be insinuated between the os uteri and placenta, at the part where the separation has taken place; then passed up between the uterus and membranes before rupturing them. They may then be ruptured, the feet seized, and the child delivered ; this operation should, however, be performed with the greatest care. Another method of procedure has been recommended by Drs. Simpson, of Edinburgh, and Radford, of Manchester, which is to detach and extract the whole placenta before the child. The grounds for this recommendation are : 1st. That the entire detachment and removal of the placenta before delivery of the child, are not usually followed by any great hemor- rhage. 2d. That any that may have previously existed nearly always ceases as soon as the placenta is perfectly and entirely de tached from the uterus. 3d. That the discontinuance of the hemor rhage is explicable on the mutual vascular arrangement of the uterus and placenta, and that the bleeding principally occurs from the partially detached surface of the latter, and not from the uterus ; therefore, the cessation does not depend upon the pressure of the child's head upon the uterine vessels. This procedure is not, however, recommended by them in all cases, and only, 1st. When the patient is of very delicate and weakly constitution, and not able to bear the loss of blood. 2d. When the child is dead. 3d. In cases of exhaustion from hemor- rhage, and the os firm and unyielding. 4th. In cases of extreme exhaustion, although the os may be dilatable, but the powers of life unequal to the shock of turning. 5th. In prima-parae, when the soft parts are so contracted that they would be liable to be bruised or torn in turning. 6th. In contracted pelves. This practice is condemned by many eminent men, who recom- mend turning, even if the placenta be detached, so as to terminate the labor. If this course is adopted, and turning is not resorted to, a dose of ergot may be proper for the purpose of hastening delivery. CBSTETRICS. 575 Of Puerperal Convulsions. At wnat period of utero-gestation may a woman be attacked with puerperal convulsions ? At any period, but more particularly after the sixth month. How are puerperal convulsions divided? They are divided into the epileptic, the apopletic, and the hysterical. Do convulsions take place suddenly, or are they preceded by premonitory symptoms ? They are generally preceded by pre- monitory symptoms. What are the premonitory symptoms ? In the epileptic and apoplectic species, they are a strong determination of blood to the head, producing headache, ringing in the ears, temporary loss of vision, giddiness, &c. What is the proper treatment for this stage ? Bloodletting, brisk purging, and low diet; which will generally prevent an attack. The longer the premonitory symptoms exist, the milder will be the attack ; the cases which are attacked very suddenly are generally fatal. What are the symptoms of the epileptic variety ? After a longer or shorter continuance of the premonitory symptoms, the woman may be seized with quickly repeated spasms, violent agita- tion of the face, eyes, and the whole body. The face becomes flushed, livid, black, and the tongue is thrust between the teeth. The respiration is disturbed or suspended, the carotids beat violently, and froth issues from the mouth. The pulse in the beginning is full, frequent, and tense, but becomes rapid, small, and imperceptible ; a cold, clammy sweat appears, and the fit begins to decline. When the spasm goes off, the patient some- times remains comatose and insensible, with stertorous breathing. These paroxysms may follow each other in quick succession. There is also a variety of epileptic convulsious which are called anaemic ; proceeding from a very different condition of the system, and may be distinguished from the above by the pale face, glazy eye, shrunken features, colorless lip, cold moist skin, and other symptoms indicating a collapsed condition of the system. The treatment in these cases should of course be of a directly opposite kind. What are the symptoms of the apoplectic variety ? The pre- 576 OBSTETRI CS. monitory symptoms are of shorter duration than the epileptic, and those following are more violent. It may be considered as an ex- alted degree of the epileptic. What are the symptoms of the hysterical variety ? We have not the same premonitory symptoms as we have iu the epileptic; but wre may have ringing in the ears, palpitation of the heart, globus hystericus, &c. The convulsions are not so violent, the face is less flushed, and the muscles on the posterior part of the body are generally violently contracted. This last circumstance is considered by Dr. Dewees as strongly characteristic of this variety of convulsions. It also attacks women of delicate and nervous habits. What is the proper treatment in the epileptic and apoplectic varieties ? Bleeding should at once be had recourse to from a large orifice, and repeated as circumstances may indicate. Ca- thartics and purgative enemata should be given, cold applied to the head, and blisters or sinapisms to the extremities. After the adoption of the above means, so far as they may be indicated, Prof. Chapman places great reliance in the prompt exhibition ot opium, sufficiedt to produce sleep. Whenever the os uteri is in a proper condition, we may finish the labor, if it have commenced, by turning, or the forceps; our choice depending upon the stage of labor, and the circumstances regulating the application of each. What is the treatment for the hysterical variety ? A moderate bleeding in most instances, followed by tincture of assafcetida and laudanum, cold dash, &c. Of Inversion of the Uterus. What is meant by Inversion of the Uterus ? It is where the fundus is forced down into the cavity of the uterus, and through the os uteri into the vagina, or where the whole uterus is turned inside outwards, and the fundus appearing at the os externum. The former is termed partial, and the latter complete inversion. Under what circumstances may inversion of the uterus take place ? In certain cases of polypus and immediately after delivery. What are the causes? Any force applied to the fundus, whether by the cord, or externally, immediately after having been emptied suddenly, violent straining, attempts at coughing, sneezing, or by any sudden actiou of the abdominal muscles. A obstetrics. 577 How may an inversion be distinguished ? In the partial, it may be known by the absence of the hard, spherical tumor of the'fundus above the pubes, and by the presence of a globular, fleshy body in the os uteri, which is sensible to the touch. The patient complains of a dragging sensation in the groins and lumbar region, compelling her to strain violently; there is hemor- rhage, an oppressive sense of sinking, with nausea, or vomiting, co.d sweats, faintings, and often convulsions. In the complete, hemorrhage and violent pain are absent; although death may suddenly follow from the shock received by the nervous system, or from fainting. What is the treatment? It should be returned immediately, and the difficulty of doing this will be in proportion to the time elapsed from the accident. When the placenta is adherent, there is a dif- ference of opinion whether we should remove it, or return it with the uterus, and allow it to be thrown off afterwards by the contrac tions of this organ. In cases of complete inversion, the better practice is to separate it, as there is comparatively little danger from hemorrhage. In the partial, perhaps, it would be better to attempt to replace the uterus with the placenta ; but, if it offer much resistance and delay to the reduction, it should be at once removed. What is the manner of reduction ? The tumor should be firmly grasped, and pushed up bodily in the direction of the axis of the os uteri; and we should endeavor first to return that portion of the uterus which was expelled last from the os uteri When it has ascended so high that we are no longer able to grasp the tumor, we should spread the fingers at equal distances round it, and thus apply the pressure over a large space ; the direction of this pres- sure will vary with the axis of the pelvis ; when the fundus passes the os uteri, it usually recedes suddenly. If we find the uterus contracted above the pubes, the hand may be withdrawn ; but if it is flaccid and soft, the hand should be introduced into the uterus so as to excite active contractions, and prevent a return of the fundus. The patient should then be kept quiet, and not allowed to make any sudden exertion. When the uterus is partially inverted, and cannot be replaced, it is preferable that we should make the inversion complete, as recommended by Dr. Dewrees. In 49 2 m 578 OBSTETRICS. some cases of these chronic inversions, the uterus has been removed by ligature. Of Twins. What is the average proportion of Twins in this country ? About one in seventy-five. How are twins situated in regard to each other ? They may be enclosed in one common covering of membranes, and float in the same waters. In other instances, they may each have a separate amnion, while the chorion may be common to both ; or each may have its own membranes, waters, and placenta.—Dewees. How may a case of twins be known after the birth of the first child ? The abdominal tumor does not subside as it does in a case of a single child. The child may be felt through the abdominal and uterine parietes; there is generally a renewal of the pains, and the child can be felt per vaginam. After the birth of the first child, and it is ascertained that there is a second, what is to be done ? In the first place, two ligatures should be applied to the cord ; then divide it between them. Pain will either come on and deliver the child, (in which case we should conduct the case as though it was an original labor,) or there will be a suspension of pain. How are we to proceed when there is a suspension of pain ? In this case, the uterus will be either contracted or uncontracted. If in the first condition there may be hemorrhage, we should treat it as any other case of hemorrhage, and deliver if necessary ; or he- morrhage may be absent, in which case friction should be made until it contracts. If contracted, and pains do not pretty soon follow, say in half an hour, it will be better to proceed to delivery; but in no case where hemorrhage is absent, without this tonic contraction being secured. After delivery, hemorrhage should be carefully guarded against. Of the Presentation of the Arm and Shoulder. What are the presentations of the Arm and Shoulder ? They may present in four different ways at the superior strait. The position of the shoulder may be difficult to distinguish, OBSTETRICS. 579 unless the arm is also down; in which case, it will serve to indi- cate the position of the shoulder. In the first position, the head and side of the neck of the child are to the left side of the pelvis ; and the right arm down, with the back of the hand anterior, and the palm posterior. In the second, the head and side of the neck will be to the left side of the pelvis, the palm of the hand will look outwards, and the back to the posterior part of the pelvis. In the third, the head and side of the neck will be to the right side of the pelvis; the left arm down, with its back looking out- wards, and the palm inwards. In the fourth, the right arm will be down, with the palm look- ing outwards, and the back inwards. These positions are sometimes distinguished as first and second for the right shoulder, corresponding with our first and fourth; and first and second of the left shoulder, corresponding with our second and third. In the first of each, the head is on the left side of the pelvis, and in the second of each it is on the right. The preceding figures refer to this division, and may easily°be under- stood by the above explanation. Fig. 35. Fie. 36. When turning is resorted to, which hand should be used in these presentations ? In the first and fourth, the right hand may be ised ; and in the second and third, the left. There is a difference 580 OBSTETRICS. in the directions of authors as to the proper hand to use, and it n advised by some to use that hand of which we have the greatest command, whether it be the right or left. (Figs. 35, 36. '61.) What use should be made of the arm in shoulder presentations ? It offers no indications except that it points out the situation of the shoulder. There can be no ma- noeuvre performed upon it to ad vantage, so that traction, ampu- tation,