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• ,	SURGEON GENERAL'S OFFICE *
• •	LIBRARY
	ANNEX ---
	Section t..................................... __ .
	Form 113c No. .Jl.$AA-£.J?.. W.D..S.O.O.
	GOVERNMENT 1'RIKTIKO OIT1CI
 
 
 
1^2370
^tv^'V— 
 
        A
DICTIONARY
OF
DOMESTIC  MEDICINE
                    AND
       HOUSEHOLD SURGERY.
              CONTAINING INFORMATION
   ANATOMICAL AND PHYSIOLOGICAL, SANITARY AND HYGIENIC,
                TOGETHER WITH THE
TREATMENT OF ACCIDENT AND EMERGENCY AND THE
           MANAGEMENT OF ILLNESS.

                    BY
        SPENCER THOMSON, M.D., L.R.C.S.
               *i»
   ^ntli ^mmtatt, from % |[a$t ffimtfon ljUitimt*

            REVISED, WITH ADDITIONS,
                   BY
          HENRY H. SMITH, M. D.,
EMERITUS PROFESSOR OF THE PRINCIPLES AND PRACTICE OF SURGERY IN THE UNIVERSITY
             OF PENNSYLVANIA, ETC., ETC.
v^t
CLAXTON, REMSEX & HAFFELFINGER,
      624, 626 & 628 Market Street.
             1877.
-qiS<?8   ,          /
1 
a
Anne*
 WB
Entered, according to Act of Congress, in the year 1877, by
       CLAXTON, REMSEN & HAFFELFINGER,
In the  Office of the Librarian of Congress, at Washington.
 
TO
     THROUGHOUT  THE  WORLD,


                   THE AUTHORS

            DEDICATE  THIS  VOLUME,

IN THE FERVENT HOPE THAT ITS TEACHINGS MAY LARGELY TEND TO
       PREVENT, RELIEVE, OR CURE PHYSICAL INFIRMITY.


                                                   iii 
 
EDITOR'S   PREFACE.
   The Dictionary of Domestic Medicine  and Household Surgery, written by
 Dr. Spencer Thomson, of England, having been originally published in parts,
 anfi just completed, has received the highest encomiums from the various jour-
 nals of Great Britain.  " Many a useful life might have been spared, and many
 an insidious disease checked in the bud, had works such as that of Dr. Thomson
 been earlier in existence.  To the traveller by sea or by land, to the settler
 an(l emigrant far from medical aid, it must prove invaluable."
   jBeing written, however, with a view to  the peculiar wants of  his own coun-
 trymen, the author has  presented many  items  of information which possess
 rather too local an interest to prove useful to the American reader, such as the
 " Act  of Victoria regulating the sale of Arsenic," recommendations of London
 manufacturers, advantages of " English Watering-places," &c. &c.  In revising
 the  volume for the American press, the Editor  has  therefore  omitted these
 articles, corrected typographical errors, furnished many new  illustrations, and
 added  such matter  of a practical  kind as could be briefly incorporated with
 th^ text without impairing its original character.  All  the additional matter
 will be found  included  in brackets  [ ] in such a manner as to be  readily
 apparent to the reader,  and will, it is  hoped,  aid, rather  than impair the
 efforts  of its  accomplished  author in  the extension  of such knowledge as
 will furnish, in "thinly  peopled colonies, ready information respecting what
 is  best to be done  in many of the emergencies and accidents of daily life,"
as well as serve,  "as  a counter-agent to the impudent quackery which preys
upon the credulity and lamentable ignorance of the simplest principles of health
that pervades  the mass of the  people."   In  the United States  quackery has
certainly free  scope,  and nothing will be more  likely to  check it, than the
extension of such knowledge as  shows the community how they are  imposed
on by unprincipled men.   A desire to increase the circulation of  such informa-
tion, especially as presented by the  Author, has therefore been a prominent
object  with  the Editor in the prosecution of his duties.
  Philadelphia, April, 1877.
A 2
A 
AUTHOR'S   PREFATORY   ADDRESS.
  That works professing to afford popular information on  medical  subjects may
thoroughly answer the purpose for which  they are designed, one especial  point
requires ever to be kept in view—the information given must be  safely usable
by those who are put in possession of it.   It is an objection frequently adduced
against such works, that they place a little dangerous knowledge in  the hands <j)f
the public, in a form so apparently simple, as to make it a source rather of evil
than of benefit; and, undoubtedly, the allegation has in some respects been cor-
rect.  But is it necessary, in  preparing a work on domestic health,  to incur this
hazard ?   I think not.   For without entering  upon that difficult ground which
correct professional knowledge  and  educated judgment can alone  permit  to be
safely trodden, there is a wide and  extensive  field  for  exertion, and for useful-
ness, open to the unprofessional, in the kindly offices of a true Domestic Medi-
cine ;  the  timely help and solace of a simple Household Surgery, or better still,
in the watchful care,  more  generally known  as "Sanitary Precaution," which
tends rather to preserve  health than to cure disease.   "The  touch of a gentle
hand" will not be less gentle, because guided  by knowledge, nor  will  the safe
domestic remedies be less anxiously or carefully administered.   Inseparably con-
nected with the intelligent use of these remedies, there must be correct  general
ideas respecting the anatomical  arrangements and physiological requirements of
the human frame.   This also has been objected to.   I hesitate not to say, that
it is such knowledge as ought to be  in the possession of every responsible man.
Making apparent  the  importance,  and rational foundation  of the means of pre-
serving or  of invigorating health, or of restoring it when impaired, it  renders
submission to the  requirements of  those means, a more sure and cheerful service,
when rendered to the conviction of the understanding, rather than to the dictum
of an adviser.   Amid the humbler classes especially, the diffusion of such know-
ledge  is highly requisite  as  a counter-agent  to the impudent quackery which
preys upon the credulity and  lamentable ignorance of the  simplest principles of
health, which pervade the mass of the people.
  But health will fail, either in old or young, and accidents v:ill happen, in spite of
the most careful precaution;  it then  becomes a  question, how far non-profession?il
interference  may go.  In many of the emergencies  and accidents  of daily life,
even in a  settled  country, but more  especially in the thinly peopled  colonies,
ready information respecting what  is best  to be done, possessed by a neighbour
or a bystander,  is  often of the most essential service;  indeed, every medical man
must have witnessed how much mischief may result, either actively or passively,
and in a very short time, from ignorance of "even the most  obvious and common-
sense modes of  treatment.  The information upon these points, given in a  popu- 
                      AUTHOR'S PREFATORY ADDRESS.                    7

 Jar work, can scarcely be too full or too accurate.  In the requirements of House-
 hold Surgery, or  of  sudden  emergency, such as poisoning,  burning,  &c, the
 question  is,  " What must  be done ?"   Generally speaking, little or no skill  is
 requisite  to determine the nature of the case, or of the injury,  which is often too
 apparent: the anxious question, "What must we-do?" is that which calls for an-
 swer ; and if, sometimes, it happens that the exact nature of the accident be not
 sufficiently evident, that  is no reason why knowledge on  the  subject generally,
 aided by  common sense, may not do much to relieve.  Life may be saved, suffer-
 ing may always be alleviated.   Even to the resident in the midst of civilization,
 the "knowledge is power" to do  good; to the  settler and the emigrant  it  is
 invaluable.
   We come  to a point more liable  to cavil—the actual  treatment of disease, pro-
 perly so called, by the unprofessional, and how far it is well to afford information,
 which may tempt  the rash to use  that which education only can safely employ.
 It may be trite, but it is true, that in order to treat a disease safely, and with
 benefit, we must learn its nature.   Now, when it  is remembered how the nicest
 judgment that observation and experience can form,  the most  patient attention,
 aided  by practised ear and eye, by microscope  and test-tube,  are frequently ne-
 cessary to enable the conscientious  physician to judge of his case  before he can
 apply the remedy, it is evident how great must be the responsibility of those who,
 in rashness or ignorance, venture upon the treatment of serious disease, either in
 their own persons or in those of  others; incapable of judging of its nature, still
 less capable are they of selecting the appropriate treatment.   There is, however, a
 vast difference between the  management of real disease and of ordinary ailment—
 between endeavouring to strike at the root, or only to relieve the symptoms.  Any
 unprofessional man, or woman either, in this kingdom, who, with all the facility
 that there is for procuring skilled advice, ventures to take the medical  manage-
 ment of a case of real illness, acts most  unwarrantably;  but there are numbers of
 lesser ailments, many of the more  painful  incidents  and symptoms, simply and
 easily removable by means which all may employ, and with which it is most im-
 portant that  all should be acquainted;  which the  parent may use to  the child, or
 the pastor recommend to his parishioners, without fear.
   One step further.  If danger may result from  rash treatment, none can  arise
 from a general acquaintance with  the most prominent symptoms which herald
 the approach of dangerous sickness; these, I think, should be made known; while
 all  remarks upon the management,  whether limited as for use in this country, or
 more extended for the sake  of the dweller in remote or unsettled districts, I  trust
 so to guard as to make them safe and useful guides.
  I know well what is said by a few, about injuring the medical profession by
 making the public their  own doctors.   Nothing will be so likely to  make "long
 cases" as  for  the public to attempt  any such folly; but people of moderate means
 —who, as far as medical attendance is concerned, are worse off than the pauper—
 will not call in and fee their medical adviser for every slight matter, and, in the
 absence of a  little knowledge, will  have recourse to  the prescribing druggist, or
 to the  patent quackery which flourishes upon ignorance, and upon the  mystery
 with which some would  invest their calling.  And  not  patent quackery alone,
 but professional quackery also, is less likely to find footing under the roof of the
intelligent man, who, to common sense  and judgment, adds a little  knowlege of
the whys and wherefores of the treatment of himself and family.  Against  that
knowledge which might aid a sufferer from accident, or in the emergency of sud-
deD illr.tss, no humane man could offer  or receive  an objection. 
8
AUTHOR'S  PREFATORY ADDRESS.
  To resume.   The information which it  is proposed to offer in this  Dictionary
may be classed as  Anatomical and Physiological, Sanitary  or Hygienic, the
Treatment  of Accident  and Emergency,  and the  Management of Illness.  In
some respects, perhaps, the adoption of this classification might be advantageous,
but as a means  of ready reference, the alphabetical arrangement of subjects will,
it is thought, be found more convenient.
                                           SPENCER THOMSON,
                                               Ilaunton, Burton-npon- Trent.
                   PREFATORY  NOTICE.

  As it would involve much repetition, to  give the  forms, doses, and  mode of
administration of the various remedies each time they are individually mentioned,
the reader is referred, for the requisite information, to the individual articles them-
selves, and to the  article  "Materia Medica," which will  appear in its  proper
place, and under which all that is necessary for the purposes  of  the Dictionary
will be fully given.   When doses are  mentioned in the general articles—unless
otherwise specified—they are the average for an adult.                 S. T.
  [For Concluding Address of the Author,  see page 581.—Ed.] 
MEDICAL  DICTIONARY.
  ABDOMEN.—Fig9. i. and  ii.  The abdo-
men, or belly, the largest cavity of the body,

                 Fig. i.
 is bounded above by the chest, (Fig. ii. 7;)
 and below by the pelvic bones, which are
 joined in front, (Fig.  ii. 8.)   These bones,
 which every one may feel in their own per-
 son, likewise enclose a cavity—the cavity of
 the  pelvis—which is  sometimes  described
 separately from the cavity of the abdomen :
 but  the two are so completely united, that
 they  are  better treated of together.  The
 cavity of  the abdomen is divided from that
 of the chest,  by the midriff or diaphragm,
 (Fig. ii. 6 ;) posteriorly,  it is supported and
 protected by the spine; and it is enclosed by
 the short  ribs and abdominal muscles.   To
 facilitate description,  medically, the abdo-
 men is mapped out into regions by imagina-
 ry horizontal and vertical lines, drawn as
 represented in Fig. i.  The horizontal lines
 drawn across the abdomen divide  it into
 three zones, which, by  the vertical lines, are
divided  into nine anterior regions,  as  fol-
low:—1,  1, Right and  left Hypochondriac;
2, Epigastric ; 3, 3, Right and left Lumbar;
4, Umbilical;  5, 5, Right and left Iliac ;  6,
Hypogastric.  In the upper zone lies the
                 Fig. ii.
liver, (Fig. ii. 1,) extending from under the
right ribs across to the left.  The stomach
(Fig. ii. 2) has its small end  situated in the
epigastric, and its large end in the left hy-
pochondriac region, where it is in contact
with the spleen, or milt.  The pancreas, or
sweetbread, lies behind the  stomach.  The
middle zone contains the large bowel, (Fig.
ii. 3,) the omentum or caul, a portion of the
small intestines, (Fig. ii. 4;)  and, posterior-
ly,  lying close to the spine, the kidneys.
The inferior zone also contains, centrally, a
portion  of the small  intestines:  laterally,
the  extremities of the large intestines or co-
lon ; and, when it is distended, the superior
portion of the bladder.  All  these parts, or
viscera,  are  covered  and supported  by a 
A B L                 10                 ABO
smooth, glistening, moist  membrane, the
peritoneum, which is also continued over the
parts within the cavity bounded by the pel-
vic bones.  These are, more especially, the
bladder,  and terminating extremity of the
bowels, named  the  rectum, and, in the fe-
male, the womb and its  appendages.  Both
bladder and  womb, when distended, rise
from their own proper cavity into that of the
abdomen,  The viscera of the abdomen are
divided into solid and hollow :  of the former,
the liver is  an  example; of the latter, the
intestines and bladder.   These, of course,
give  different sounds,  when the covering of
the  abdomen,  beneath  which  they lie,  is
slightly struck with the finger—a fact of great
importance to the physician, in his examina-
tion of this cavity.  The contents of the ab-
domen shift their position considerably ac-
cording to posture.  The diseases to which
they are  liable  will be noticed under their
respective heads.  One of the most  import-
ant accidents to which this cavity is subject,
is protrusion of  a  portion of its  contents
through its walls,  constituting  hernia, or
rupture.  Accidental wounds penetrating the
cavity of the  belly are very generally  fatal,
and,  if they pierce any of the viscera, almost
necessarily so.
   Refer  to  Diaphragm—Liver—Stomach—
Intcxtincs—Hernia—Navel.
  ABLUTION. —Washing the  surface of the
body regularly, is, happily, in this country
at  least,  becoming daily more common; but
it is  far from being so general a habit as
it ought, particularly among the working-
classes, who stand most in need of it: many
go from January to December without even
thinking it  necessary to wash  more than the
face or hands.  The skin ought continually
to  be throwing off, or excreting, gaseous,
saline, and  greasy matter, which it is neces-
sary  for the health of the  body should be
thrown off;  but the  skin cannot do  this
properly if caked over with perspiration and
dirt, either its  own, or  the dust to which
many are exposed  in the  performance of
their  employments.   The  consequence of
neglect is, that  much is retained in the sys-
tem which ought not  to be there;  an addi-
tional load of duty is thrown  upon  other
excreting organs, as the liver and kidneys,
and if they have not  the power to compen-
sate  for  man's  own carelessness, languor,
low spirits, headaches, local accumulations
of blood, gout, gravel, and other diseases are
the result.  ' Fortunately,  complete  neglect
cannot entirely  stop  the  skin's  functions;
otherwise death itself must result.   I or the
purpose of cleansing the skin,  soft  water
ought to be  used, if possible, with soap—
good brown is quite the most effectual—and
a thorough purification of the entire surface
of the body should be effected at least once a
week, with these materials ;  along with this,
washing over the surface with simple water,
and rubbing well with a rough towel, every
night or morning, its  most convenient, wil'
suffice to  preserve a healthy state of skin
Those  who  are robust, and wasli  in  the
morning, ought to use  cold water immedi-
ately on  rising,  while  heat is  abundant;
but delicate persons cannot  sustain the de-
pression and  subtraction of animal heat,
which this occasions—it leaves them chilled,
languid, and with impaired digestion. There
are some individuals, in whom cold sponging
in the morning invariably produces heart-
burn and indigestion after breakfast; such
ought to try the water slightly warm, or con-
tent  themselves with  washing only a portion
of the skin each morning; if even this can-
not be borne, dry friction with a rough towel
or hair-glove  may be substituted.   After
washing, it is  always desirable  to  rub the
surface thoroughly with a towel till a warm
g+ow is produced.  For washing at night,
water  slightly  warm  is  always  to  be pre-
ferred.   The  feet  require  very  frequent
washing.  It is surprising  how insensible
even otherwise respectable  individuals  arj
upon this  point; were it not so, they would
never expose themselves to medical  men in
the disgusting state of dirt they frequently
do.  Happy are those who can have the use
of baths for the purposes of ablution, but
any man  who can command water and  a
towel need  not dispense with  the luxury.
For the aged,  frequent and  thorough ablu-
tion  is  most requisite;  the  often shameful
neglect of  this by those who have the care of
old people is  visited  upon them  in  queru-
lousness and  troublesome bodily ailments,
which attention to the duty would have pre-
vented. [Those subject to sore throat and
cold  in the head will generally derive benefit
from washing the neck and back of the head
daily in cold water.]
   liefer to Bath—Children—Skin.
   ABORTION—Miscarriage.—The  terms
abortion and miscarriage are applied to the
expulsion  of  the human foetus  from  the
womb of the mother,  previous to the seventh
month of  pregnancy ; that  is, before it  is
sufficiently  developed  to maintain  its own
independent existence.   When the process
occurs after that period, it is named  prema
ture labour.   Miscarriage involves pain and
weakness, in addition to the loss of offspring,
and  is often a severe trial to the  maternal
constitution.  It may  occur at  any period
of pregnancy, but particular stages are more 
ABO
11
ABO
 liable to the accident than others.  These are
 generally  considered to  be about  the  time
 of the first menstruation after conception:
 again at the twelfth week, and toward the
 seventh month ; the liability is increased at
 those times, which correspond to the men-
 strual period.  When abortion has once taken
 place, it is more liable to occur again ; and
 some have so strong a tendency to it, that
 they never go beyond a certain stage,  at
 which they invariably miscarry.  The cause
 of abortion may exist in the constitution of
 the female herself, and be the result of weak-
 ness and  irritability, of over-full  habit, or
 of a diseased condition  of the womb ; the
 foetus may die, or be  deficient in develop-
 ment, when  it is cast off  like a blighted
 fruit.  Suckling,  after  conception has taken
 place, is not unfrequently a cause of mis-
 carriage.  Active disease occurring during
 pregnancy, such as severe inflammation, fe-
 vers, eruptive fevers, &c,  are almost cer-
 tain  to  occasion  expulsion  of the uterine
 contents.  Continued diarrhoea, and the ac-
 tion of strong purgatives, particularly of the
 aloetic kind, are dangerous.   This is a very
 cogent reason for those who  are  pregnant
 avoiding all quack aperient medicines ;  they
 almost all contain aloes, and may be  very
 injurious.   All undue exertion or  agitation
 of body or  mind, sudden jerks or jumps,
 riding on  horseback in  the early, or  in a
 shaking carriage in the latter stages of preg-
 nancy, may any of them bring on the mis-
 hap ; to these may be added, exertion of the
 arms in doing any thing on a level above the
 head; costive bowels and straining conse-
 quent thereon, sensual indulgences, and lux-
 urious habits. Those who have once aborted
 ought to  be  extra  careful in  succeeding
 pregnancies,  and  all ought to bear in mind
 the possibility of the occurrence.
   The symptoms of threatened  abortion vary
 with  the  constitution;  in  the strong and
 plethoric,  it  is often preceded by shivering
 and febrile symptoms,  and by a feeling of
 weight in  the lower bowels;  in the weak,
 there is  languor, faintness, flaccidity of the
 breastg,  general depression, and pains in
 the back and loins.  Intermittent pains, and
 discharge  of  blood  from the  passage, tell
 that the  process has begun.  If miscarriage
 occurs within the first month or two after
 conception, the process may be accomplished
 with so little inconvenience as  to escape no-
 tice, and be mistaken for a menstrual period;
more  generally,  however, the severity of
the pain, and  an unusual clotted discharge,
render the  case evident.  The pain, the dis-
cbarge, and at the same time the danger of
an  abortion,  are in proportion to  the ad-
 vancement of the pregnancy.   When a mis-
 carriage goes on, the pains increase in force
 and frequency, and  continue with discharge
 of blood, fluid, or in clots, until the ovum ia
 expelled,  after which,  both become  mode-
 rated, till they cease altogether, and the red
 flow gives  place  to  a colourless one.  It is
 very important  that those in attendance
 upon the patient should examine every clot
 which comes away—if large, tear it in pieces
 —that they may ascertain whether the con-
 tents  of the womb are expelled or not, foi
 there is no safety or rest where miscarriage
 is progressing, till this has taken place, and
 every  thing is cast off.  When a medical man
 is in attendance, and in such cases  he ought
 to be,  all should  be reserved for his inspec-
 tion.
   As  soon as a female experiences threat-
 enings of abortion, she ought at once to retire
 to bed, upon a mattress, and keep perfectly
 quiet  till every symptom has disappeared:
 sometimes this  simple  measure,  promptly
 adopted, is sufficient to avert the threatened
 evil.   If there is much feeling of fulness,
 and the patient  is of full habit generally,
 eight  or a dozen leeches  may be applied to
 the lower part of the bowels ;  if there is fe-
 ver, salines may  be  given, such as the com-
 mon effervescing draught of carbonate of
 soda and tartaric acid, or  lemon-juice; or
 if the bowels  are much confined, seidlitz
 powders, assisting the action by cold clys-
 ters if necessary.  When the pains are se-
 vere, particularly in the weak and irritable,
 twenty or thirty  drops of laudanum should
 be  given, and may be repeated  in  a few
 hours  if  the symptom is unabated.  In the
 case of profuse discharge, the patient should
 be  kept very lightly  covered,  movement
 avoided, and  every article of  food  or drink
 given cold, or iced if possible, provided the
 vital powers  are not excessively reduced;
 cloths dipped in  cold or iced water should
 also be applied to the lower part of the body,
 and frequently changed;  acid drinks, with
 cream of tartar,  may be given freely.   Ten
 or fifteen drops of diluted sulphuric acid, or
 of aromatic sulphuric acid, [elixir vitriol,]
 may be given  in a  wineglassful of  water
 every  two  or three hours.    Should slight
 faintness come on, it is better not to  inter-
 fere with it, as it  may be salutary:  if it goes
 to an extent to threaten life, stimulants, (sal
 volatile or brandy and water,) must be had
 recourse  to.  But long before  matters go to
 this extent, proper medical assistance should
 be sought.  Profuse and continued discharge,
though it may not threaten life, must occasion
a weakness which is long in being overcome.
and which may ultimately favour the deve' 
ABO
li>
ABS
lopment  of fal x\  disease.  The discharge
may be kept uu  solely by a state of mat-
ters beyond the offices of domestic manage-
ment, but to be speedily rectified by a little
manual interference on the part of a medical
man, who, by assisting the womb to cast off
„he already partially expelled  contents, at
once puts an  end to further loss of blood.
But even if matters  be not sufficiently ad-
vanced to admit of this interference, the use
of measures or remedies which the unprofes-
sional cannot  or ought not to employ, may
save life, and must save strength.  Let no
one think lightly of the loss of blood; it saps
the foundations of health.  Should  circum-
stances occur  in  which medical  assistance
cannot be obtained,  at least not speedily,
and the flooding is profuse, and uncontrolled
by the means already mentioned, one grain
and a half of sugar of lead made into a pill
with crumb of bread, may be  given  every
two hours, and washed down with a draught
of vinegar  and water, to which, if there is
much  pain, from five to ten drops of lauda-
num should be added.  In addition, pieces
of linen or calico, soaked in a strong solution
of alum or decoction  of oak-bark, and oiled,
should be used to plug the passage, or the
astringent fluid may be thrown  up with a
syringe.   But, the  unprofessional  should
never adopt these measures, if  professional
advice is to  be had ;  if not, it is better they
should do so than matters go on uncontrolled.
Both during the time, and after miscarriage,
the general strength must be supported ; this
is better done by strong animal  soups, milk-
preparations, with eggs and  meat,  when it
is  proper, than by much stimulant; never-
theless, wine or malt liquor may be requi-
site.  Convalescence is to be  assisted by
tonic  medicines,  those  containing  mineral
acid, bark, or  iron, are generally the  most
appropriate.  The bowels will require atten-
tion, as indeed they do throughout.  Castor-
oil  is  very suitable; the cold or very cool
water clyster is most useful; a drachm of
Epsom salts, dissolved in half a pint of wa-
ter, either  cold  or  slightly warmed, and
fifteen drops of dilute sulphuric acid added,
forms a  most appropriate  aperient, which
should be taken before breakfast.
  Three  principles of treatment are to be
kept in mind in the management of miscar-
riage.
  The first, to prevent it, if possible, by rest,
opiates, &c.
  The second, to allay pain, moderate the
discharge of blood,  and save  and  support
strength.
  The third, when abortion must take place,
to expedite the separation of the  ovum.
   The  two first may be much assisted by
 judicious domestic  management;  the third
 must be done by the medical attendant only.
   Refer to  Pregnancy—Hemorrhage.
   ABRASION.—An  abrasion, by which the
 outer  or scarf skin or cuticle  is  forcibly
 removed, and the sensitive surface of the
 under true skin or cutis exposed, is a tri-
 fling, but sometimes  a painful accident, and
 it may be, where  the hands are necessarily
 subjected to the action of poisonous or irri-
 tating fluid, a dangerous one.  Though the
 protecting cuticle is quickly restored, it is
 necessary to provide  a substitute  in the
 mean time.   It must be an unirritating one.
 Persons often err by putting the common
 diachylon plaster  on abrasions,  and  fre-
 quently much irritation  and pain,  or even
 ulceration,   are  produced  by it.   Court-
 plaster does  not  irritate, but is not useful
 for a large surface, in which case gold-beat-
 er's leaf will be the best application, if not
 exposed to moisture.  Collodion has been used
 of late: it is not soon acted upon by water,
 but  it  causes severe smarting when  first
 put  on; this may be prevented by putting
 gold-beater's leaf next the sore, and collodion
 over it.  In the absence of the above, a little
 strong gum mucilage, with a piece of tissue-
 paper over it, is a good substitute.   Isinglass
 plaster is also  used, but those who are not
 in the habit of applying it,  find a difficulty
 in making it adhere.  The principle in treat-
 ing  an abrasion,  is to protect the  sensitive
 true skin by some light, perfectly unirritating,
 dry  application, till nature restores the na-
 tural covering.
   Refer to  Collodion—Plasters—Skin.
   ABSCESS.—A collection of purulent fluid
 in a cavity, formed  in the substance of any
 of the  bodily tissues, is named an abscess.
 The contained matter, or pus, may be either
 of a healthy or of an unhealthy character;
 if the former, it is of a yellowish-white co-
 lour, cream-like in consistence, and possesses
 a faint sickly odour; in the latter case, it
 may resemble whey, with bits of curdy sub-
 stances floating in  it, or it  may be bloody,
 fetid, &c.
   Abscesses are either acute or chronic, and
 may occur in nearly every tissue of the body.
 The first symptoms of an acute abscess are
 heat and tenderness of the part, followed by
i throbbing  pain.  If the  matter  is  deeply
 seated, no external marks may be visible for
| a time ; when it is near the surface, the skin
 quickly exhibits inflammatory swelling; this
 continuing, it becomes thinner with more or
 less rapidity, until, at last, it gives way, and
 permits the matter to escape. Such  'is the
 natural course of what we may call a healthy 
                  ABS

abscess; but this course is necessarily mo-
dified by the position and coverings of the
collection of matter.   Abscesses do not  al-
ways discharge through the skin, they may
do so internally.   Generally, as soon as the
contents of an abscess are discharged, the
pain, which has previously been severe,
ceases.   Boils may be classed as abscesses;
they  contain  a  distinct core,  or slough.
Chronic abscesses  may continue for weeks
or months without change  and give com-
paratively  little pain:  they  occur in weak
or scrofulous subjects, and  very generally
in glandular tissues.   In addition to pain
and swelling, the sense of fluctuation, as of
fluid contained  in a bag, which  an abscess
conveys to the finger, is a symptom valuable
in obscure cases ; but when  it is most valu-
able, it requires  the  educated touch of the
surgeon to discover it.   On the first suspicion
of an acute abscess,  frequent  fomentation
with water, as hot as it can  be borne, may
succeed in preventing its formation, if purga-
tive medicine be given atthe same time;  but if
it does not do this,it will then assist and hasten
its progress, while it soothes the pain.  When
it is tolerably certain that matter has formed,
thick, warm, soft poultices must be continu-
ally applied to the part, the position of which
should be regulated with as much regard to ease
as possible.  It  is  sometimes  the  popular
custom  to  apply irritants,  such as honey,
soap-and-sugar, and such like, to boils or ab-
scesses, with the view of assisting or "break-
ing" them: the practice is both hurtful and
cruel, and  ought  never to be followed.  For
fomentation, cloths  wrung  out of simple
water,  and for  poultice, bread  or linseed
are most generally applicable; when there
is much pain, decoction of poppy-heads may
be used for either, with advantage.  Medi-
cal men are in the habit of opening abscesses
or boils with the lancet or knife; but as to
do this  safely in every case requires anato-
mical knowledge, the unprofessional should
be content with simply relieving and assist-
ing the  painful progress by the means men-
tioned,  till  the matter is discharged  natu-
rally.   [It  is a bad practice to prick a boil
with a needle or pin :  if not freely opened, it
had  better be left to nature. ]  After this hap-
pens, poulticing ought to be.persevered in
for a few days, and then exchanged for sim-
ple water-dressing, which must be continued
till the  part is well.   A little opening medi-
cine should at  the  same  time be given.
Many persons are in the habit of squeezing
abscesses after the matter discharges: the
practice is  useless and painful; very gentle
pressure only is  admissible.    A  chronic
abscess  is  serious, from the indication  it
       B
J                 ABS

 gives of a weak and unhealthy condition oi
 body, and may also be so from size or posi-
 tion.   The formation of  an acute abscess if
 generally accompanied  with more  or les>
 general inflammatory fever.  In the chronic
 abscess, when there is fever, it has more of
 the hectic character, and is accompanied
 with night perspirations.   A chronic abscess
 sometimes requires speedy evacuation arti-
 ficially, and  constitutional  treatment is al-
 ways called for; the first ought always to
 be done by a medical man, and the latter
 also,  to be effectually carried  out.  Good
 light  nourishment,  with a due proportion of
 animal food, is  indispensable;  milk, if it
 agrees ;  wine or malt liquor, if there is  not
 much  fever.   Regulation of the  bowels by
 simple  aperients—iron,  mineral  acid, with
 infusion of bark, and cod-liver oil, are  the
 most  generally  applicable  remedies  in  the
 constitutional treatment of chronic abscess.
   Refer  to  Suppuration—Poultice— Water-
 dressing—Fever-hectic.
   ABSORBENTS.—Absorbents  are minute
 vessels distributed  throughout the body,  the
 office of which is to take up nutritive mate*
 rial, and convey it into the current of  the
 general circulation. The lacteal  absorbents
 are those which  take up the nutrient por-
 tion of the food, named chyle, from the ali-
 mentary canal;  they unite in one common
 trunk, which runs up in front of  the  spine,
 and joins the large vein going  directly to
 the heart.   Soon after  a full meal, these
 lacteal absorbent vessels become distended
 with  the milky-looking chyle, the essential
 nutriment, separated from the food by  the
 first  process of  digestion.  As  this chyle
 has to pass  through a set  of small glands
 —the  mesenteric—before  it can reach  the
 blood, it must  be  evident how  much  the
 health  of the latter fluid, and  the  nutri-
 tion of the body generally, must be inter-
 fered with when these glands become  dis-
 eased, as they frequently do in children.—
 See Tabes.
   The lymphatic absorbents are distributed
 throughout the body, and take up and con-
 vey back to  the general circulation  what-
 ever nutrient matter is fit to re-enter  the
 blood.   They  also pass  through glands,
 which are more  particularly observable on
 the sides of the  neck,  in the  arm-pits,
 groins, and  insides of the thighs.   These
 lymphatic glands are very apt  to become
 enlarged, inflamed, and  even to  suppurate,
 particularly  in weak constitutions, or when
 there happens to be a sore on a part  of  the
 body more distant  from the heart than  the
 gland.   In  some  persons, even  scratching
 the head with  the  comb will occasion  thu
1 
ABS                 14                A C A
glands of the  neck to become  swollen and
painful.   Popularly, these enlarged glands
go by the name of " waxen kernels."  When
any of the lymphatic glands exhibit symp-
toms of irritation, the first  thing is to as-
certain whether  this be  owing  to  some
scratch, wound, or sore on the body.   If the
glands of the groin inflame, the genital or-
gans and the  whole lower extremity must
be examined, even between the toes.   If the
glands of the  neck, the head must be well
looked over, for it is evidently useless to be
treating  the  secondary  effect, while the
cause, such as an irritable or irritated wound,
continues; for they  generally are,  even
though  very small, irritable  sores, which
cause inflamed glands.  If the exciting sore
be soothed by rest, fomentations, poultices,
&c ,  and a little  simple  opening medicine
given, the irritated gland will generally re-
sume  its healthy condition ;  if it seems in-
clined to continue inflamed,  it, too, must be
soothed by the same means,  and, if need be,
one or more leeches applied, and the bowels
more freely acted upon. Suppuration ought,
if possible, to be prevented, especially in
the neck, where it leaves an unseemly scar.
In this situation,  when matter has actually
formed, the visible after-traces of the occur-
rence will be much less  evident if the ab-
scess is opened at the proper time,  and in a
proper manner, by the surgeon. The lym-
phatic glands, especially  in weak or scrofu-
lous persons, are  apt  to  assume a state of
chronic enlargement and  slow suppuration.
As the root of the evil is in the constitution,
this must be invigorated in every possible
way, by  nourishing animal  diet, with pro-
bably wine or malt liquor, by early hours,
regular exercise,  and  change of air, to the
coast, if possible.  Cod-liver oil, half nutri-
ment,  half medicine,  is  most  useful, and
may algo be rubbed on the enlarged glands
with advantage.   [Washing  the swellings
with strong  brine, or  poulticing with  corn-
meal and brine, is also serviceable.]  Iron,
iodide of iron, bark, and tonic medicines ge-
nerally, are all indicated.
  Refer to Mesentery—Tabes—Olands—Scro-
fula.
  ABSORPTION.—Absorption  is not per-
formed by the  " absorbents"  alone; the
blood-vessels   take a considerable  share,
more  particularly in the  case of fluids;
neither is the process confined to the inte-
rior of the body ;  it may take place through
the skin, and  thus a  person who, from dis-
ease or accident,  is disabled from swallow-
ing fluids, may have his  distress partly re-
lieved by warm or tepid baths.  In  cases
of shipwreck,  or want of fresh water, fluid
may, without injury, be supplied  through
the  skin, by wrapping the body in cloths
soaked with  the sea-water.
   ABSTINENCE.—Abstinence  may be  a
great good  or a great evil.  In  those  who
live  fully and freely, eat much  animal food,
nnd  drink malt liquor or wine,  no remedv is
more useful either in their peculiar ailments,
or in general sickness, than abstinence.   If
the  constitution be tolerably sound, nature
will  right herself  if left unopposed ; many
a  dose of medicine may  be omitted when
such patients can be persuaded to " starve."
More persons  hurt themselves  by excess
than by the  reverse, but not a few do them-
selves much injury by too great abstinence.
They are generally ind vidutls of weak di-
gestive power, who, find ng that the less they
give the  stomach to do, the better they feel,
run  into the extreme,  md  consume barely
sufficient food  to supj ort health;  and  the
general  system suffeii;  the stomach,  the
liver, the bowels, the blood, and circulating
system are insufficiently supplied with sti-
mulus ; they  act and react on one another ;
the general   tone  is permanently lowered,
and  perhaps  organic  disease  originated.
This error has been  fostered by  medical
authorities,  and the case of Cornaro  and
others held  up as examples  of the health
and longevity to be attained by extreme ab-
stinence.  Undoubtedly some  men  will re-
tain  health   and   strength  on  much  less
nourishment  than others ;  but with most, a
tolerably liberal supply of varied food is re-
quisite, and  they cannot permanently lower
the standard without injury.  Living mode-
rately, instead of stinting the whole body to
favour the stomach, they ought by exercise,
relaxation, and other means—by medicine,
if requisite—so to strengthen the organ that
it  may comfortably digest sufficient for the
wants  and support of  the whole  system.
By acting on the reverse, nothing is gained
eventually, for the stomach, participating
in  the general debility, becomes daily more
unfit for  its office.   The effect of abstinence
on  those who  practise  it  on religious
grounds, is  too often  most injurious,  and
lays  the  foundation of organic disease of
the stomach.   [Fasting should never be
practised for *  length of time without con-
sulting a medi sal man.]
  Refer to Digestion—Regimen,  £c.—Starva-
tion.
   ACARI.—Ticks  or lice, generally the re-
sult  of filth, may show themselves upon the
head or body during sickness, notwithstand-
ing  the  most scrupulous  care,  and some
kinds of  cutaneous eruptions and sores are
with great difficulty freed from them. Wash- 
AC C
15
ACI
ing and cleanliness  are  the  great counter-
agents : after  washing, equal parts of sal
volatile and water may be used to the part.
[Free  greasing with sulphur or mercurial
ointment, and  then a good washing with soft
soap, is also serviceable.]  The itch-insect
is an acarus;  also the harvest-bug.
  Refer to  I.'ch—Harvest-bug.
  ACCLIMATION.—One of the  most won-
derful endowments of the human constitu-
tion is its  power of  accommodating itself
to the great varieties of climate which pre-
vail over  the  surface of the globe—of be-
coming acclimated.   The Anglo-Saxon race
appear to possess this power of constitution
in an eminent  degree, and, with comparative
impunity,  fix  their  habitations  amid  the
snows of the Arctic regions or under a tro-
pical sun.   The constitution, it  is true,  on
removal from  a cold  to a warm climate, may
not all at once accommodate itself entirely
to the change, but it is much more likely to
do  so quickly  and safely if assisted  by the
judicious  management of  the  individual.
The ignorance and inattention which  prevail
upon the  subject  of acclimation are truly
lamentable ; great numbers  of young men
yearly leave this country for hot climates,
without  one  word   being  said, or  idea
given them, as to the reasons for, and im-
portance  of,  certain rules for  preserving
health.  "Under the change of circumstances,
the  habits of their  oolder fatherland  are
continued,  and fever or cholera puts  an end
to many a  promising life, which a little ra-
tional  information and advice might have
preserved.
  The air  and its temperature  are largely
concerned  in  the process of acclimation;
the former is so  much more rarefied  in  hot
than in cold climates, that in the vital pro-
cess of respiration,  a comparatively much
smaller quantity is   habitually  consumed;
less oxygen is taken in, and  the process of
oxidation or combustion, which is continu-
ally going on within the body, is slower :
we  reasonably conclude that by this process
of combustion, the animal heat, in part  at
least, is maintained;  but, of course, in n,
hot  climate, a less active condition  is suf-
ficient to keep up the average temperature.
The process  of  oxidation or .combustion
effected on the  one  hand by the oxygen
inspired, is supported on the other by some
of the elements—carbon  and hydrogen—of
the food.   It  is evident, therefore, that if
an  individual  who has become resident in a
hot climate, makes a practice of consuming
as much nutriment  as he used to do with-
out, injury to health  in a cold one, he must
rake more  than is requisite; consequently
the blood  becomes overcharged with a load
of noxious matter, which the rarefied  air
and  inactive habits of warm  countries do
not tend to remove; and if the course be
continued, an attack of illness, probably of
a biliary nature, is the consequence.   Even
in temperate climates, the difference  be-
tween the consumption of oxygen in winter
and in summer is considerable.  In Germany
it  has  been calculated at one-eighth less in
the latter.*  How great must be the differ-
ence to those  who  permanently settle in
tropical heats!  certainly sufficient to  re-
quire much alteration in habits of  living.
The  abundant  animal diet,  the fats and
alcoholic drinks of the colder climes, all of
which  contain carbon  and  hydrogen in
abundance, and assist materially in sustain-
ing temperature,  must give place to the fa-
rinaceous  and watery fruits of warmer re-
gions ; vice versa,  on going from a warm or
temperate country to a colder, as the expe-
rience  of  all  arctic travellers testifies, a
larger  proportion  of animal diet, and that
of a more fat or oily character, is requisite
to maintain health and strength, and those
only who are capable of consuming  and di-
gesting this full  allowance, are  fit  for  en-
countering the cold of the north. From what
has been said,  it  is evident how important
due  regulation of the  food is to safe and
speedy acclimation ; it is the main element,
and  the one  most  under man's control.
Modern science and discovery will render
him  much assistance,  but  study  of  the
natural products  of the soil  and of native
habits  is essential.
   The  great increase of the functions of the
skin which  takes place on  removal to a
warm  climate  requires attention.   It ren-
ders the constitution more susceptible to the
influences of a damp or chill air, such as
frequently occurs in evening.  The  above
remarks  apply to our own olimate in sum-
mer.   The  best  preservative is  woollen
clothing of some  kind, be it ever so thin,
worn next the  skin.   Persons who, from a
warm climate,  of  wfyich they are either na-
tives, or to which  they have become accus-
tomed, come to reside in a variable  or cold
country, are peculiarly liable to affections
of the  chest or lungs,  and not unfrequently
become the  subjects of  consumption
   Refer  to Air—Respiration—Diet—Cloth-
ing.
   ACID.—The general characters  of an
acid are that  it  has a sour  taste,  reddens
vegetable  blues,  and  neutralizes  alkalies.
Acids are vegetable or mineral.   The prin-
* Liebig. 
A C N
l(j
A  D V
cipal vegetable a^ids used in medicine  are
acetic  acid  or vinegar, benzoic acid, citric
acid, gallic  and tartaric acid,  and  hydro-
cyanic or prussic acid.   The mineral acids
are,  hydrochloric  or  muriatic acid,  nitric
acid or aqua  fortis, nitro-muriatic  acid  or
aqua legia,  and sulphuric acid or oil of vi-
triol.   They may be referred to under their
respective heads.
  ACNE.—Acne is a disease of the  skin
which takes  the form of what are popularly
called  pimples.  Its seat is  in the  glands
which  secrete  the  oily matter.   Pimples
mostly occur  on  the face, or between  the
shoulders.   They are more common in per-
sons under  forty years  of age, are  gene-
rally dependent upon some derangement of
the digestive  organs, and will  frequently
continue to  recur in spite of medicinal  or
dietetic treatment.  At  the same time they
are much more likely to be got  rid of by
light  and cooling diet than by the reverse,
although they appear, and obstinately con-
tinue,  in the  most abstemious.   A  smart
dose of opening medicine is frequently fol-
lowed  by a crop of pimples  in the  predis-
posed, but the bowels should be kept regu-
lar.   Local  applications  do  comparatively
little  good.   As good  and  safe  a one  as
any is a lotion made with a little either of
the flowers or  milk of sulphur, rubbed up
in a little  soft water or rose-water,  in  the
proportion of  two drachms to a pint.
   ACONITE, or  Monkshood, or  Wolfs-
bane, is a virulent poison, but in  proper
hands a valuable remedy.  The most pro-
minent symptoms of  poisoning by monks-
hood, following irritation of the mouth and
stomach, are  general paralysis and loss of
sensation.   Of course, on the suspicion of
such an event, medical assistance should at
once  be sought.  In the interval,  vomiting
must, if possible, be produced by the readi-
est emetic,  such as mustard or salt, or  by
a feather carried down  the  throat.   When
vomiting has  come on, or been induced, it
should  be encouraged  by copious draughts
of thin gruel or warm  water, a little spirit
or  wine being added if the depression be
extreme.  The extremities should be placed
in hot mustard and water, and large mustard-
plasters down the spine will  assist to rouse
the nervous  system.   [Powdered alum, in
doses  of  a  teaspoonful, or  a little white
vitriol, will also be found an  active emetic]
In this, and in other cases in which  the na-
tural sensibility of the skin is impaired, care
should be taken that water is not used too
hot, as the patient's feelings afford no guide
in the matter.
   Refer to  Emetics—Mustard-Planter—Bath.
  ACUPUNCTURE.—Acupuncture is a mode
of treating  some  diseases by the insertion
of needles into the body, at or near  the seat
of  the  malady.   The  needles,  which  are
about two inches long, are fitted into a small
handle.  The method has long been known
and employed among the Chinese.   In  this
country it is chiefly used in rheumatic cases,
and the relief  is sometimes  instantaneous.
The pain of the operation is very trifling,
and such as none need shrink from.
   ACUTE.—Acute is a term used in contra-
distinction to chronic, as applied to diseases,
to denote such as  are characterized by  vio-
lent symptoms.   Inflammation of the lungs
and erysipelas are acute diseases; consump-
tion and ringworm are chronic.
   ADIPOSE.—Adipose—Fatty.
   ADHESION.—Adhesion  is the  growing
together of parts of  the body which are or
have been separated,  either  naturally  or
artificially.  A common  cut unites by  ad-
hesion, and  when  it  does  so  at  once, with-
out the  formation of matter, it is said to
unite "by the first intention."  It is evident
how essentially valuable  this property of
animal bodies must be.  It is effected, in the
first place, by the exudation of  a glue-like
liquid, which soon becomes solid.  For the
exudation of this  adhesive lymph, as it is
called, some degree  of inflammation in the
parts is requisite.   This tendency of certain
inflamed parts  to contract  adhesions  one
with  another, is often hurtful or  inconve-
nient.   In some inflammations of the chest
or abdomen it is especially so; and  in burns
of the fingers,  much  care is required to  pre-
vent theur being united in the  progress of
cure.
   ADVICE, MEDICAL.—When  a  medical
man  is consulted,  it is  a  tacit  acknow-
ledgment of confidence ;   that confidence
should be implicit, or placed elsewhere. In
the first place,  care should be taken that the
necessary directions given, are fully  and
accurately understood; being so, they should
be fully and  .accurately followed  out,  un-
less some evident change in the condition
of the  patient, or in  circumstances which
the prcscriber could not foresee, renders  a
departure from them necessary ; but of this
he should have as early notice  as  possible.
There is no greater folly than to call in  a
medical man, and then, either  from wilful-
ness or weakness of purpose, to controvert
or neglect  his prescribed rules.   It is only
equalled by that which conceals or deceives
j in the  particulars of a case, and  looks for
benefit.   It is too  commonly the case, in
illness, that officious persons are continuallv
 offering their counsel and opinions, disvurb 
ADV
17
A]) V
 ing the mind of the patient or of the friends,
 and perhaps undermining the trust reposed
 in  the attendant practitioner.  If it is re-
 flected for one moment how worthless  such
 counsel and  opinions must be, they would
 be less attended to than they are.  Again,
 if  proper confidence is felt in the judgment
 of the  medical attendant, his requirements
 should be  submitted  to without  remon-
 strance or  grumbling.   When doubt and
 uneasiness respecting the progress  or pros-
 pects of a case intrude themselves upon the
 mind of those most, interested, and a second
 opinion is  desired, the  matter should  be
 openly, at once, stated  to the ordinary
 medical  attendant,  and  his  views  and
 wishes heard; but never should another be
 called  in till this has been done.  Still less
 even if a medical man can be found to de-
 mean himself so far, should a clandestine
 opinion be taken.  Lastly, in  sending for
 medical assistance, especially  in  country
 districts, as full an account of the symp-
 toms of illness, or accident, as possible,
 should be transmitted by written note. The
 precaution must save time ; it may save life.
   [The following extract  from  the  Code of
 Ethics or rules of intercourse adopted by the
 medical profession in the United States, con-
 tains many points that  should be  remem-
 bered by every one requiring medical ser-
 vices,  as  they have always proved advan-
 tageous to patients:
   ' • Obligations of Patients to their Physicians.—
 § 1. The members of the medical profession,
 upon whom is enjoined  the performance of
 so  many important  and arduous duties to-
 ward the  community, and who are required
 to make so many sacrifices of comfort, ease,
 and health, for the welfare  of  those  who
 avail themselves of their services, certainly
 have a right  to  expect and require  that
 their patients should entertain a just sense
 of  the duties  which  they owe to their medi-
 cal attendants.
   \ 2.  The first duty of a patient is to se-
 lect as  his medical adviser one who  has re-
 ceived a regular professional education.  In
 no  trade or occupation do mankind  rely on
 the skill of an untaught artist;  and in me-
 dicine,  confessedly  the  most difficult and
 intricate of the sciences,  the world ought
 not to suppose that knowledge is intuitive.
  \ 3.  Patients should prefer a physician
 whose habits of life are regular, and who is
 not devoted to company, pleasure, or to any
 pursuit incompatible with his professional
 obligations.   A patient should, also, confide
 ihe care of himself and family,  as much as
posisble, to one physician;  for  a medical
man who  has become  acquainted with the
       b 2
 peculiarities  of  constitution,  habits,  and
 predispositions of those he attends, is more
 likely to be successful in his treatment than
 one who does not possess that knowledge.
   A patient who has thus selected his phy-
 sician should always apply for advice in
 what may appear to him trivial cases, for
 the most fatal results often supervene on the
 slightest  accidents.   It is of still more im-
 portance that he should apply for assistance
 in the forming stage of violent diseases: it
 is to  a neglect of this precept that medicine
 owes much of the uncertainty and imperfec-
 tion with which it has been reproached.
   § 4. Patients  should faithfully and unre-
 servedly communicate to their physician the
 supposed cause of their disease.  This is the
 more important, as many diseases of a men-
 tal origin simulate those  depending on ex-
 ternal causes, and yet are only to be cured
 by ministering to the mind diseased.   A Pa"
 tient should never be afraid of thus making
 his physician his friend  and adviser;  he
 should always bear in mind  that a medical
 man  is under the strongest  obligations of
 secrecy.   Even the female sex should never
 allow feelings of shame or delicacy to pre-
 vent  their disclosing the  seat,  symptoms,
 and causes of complaints peculiar to them.
 However  commendable  a modest reserve
 may be in the common occurrences  of life,
 its strict observance in medicine is often at-
 tended with  the most serious consequences,
 and a patient may sink under a painful and
 loathsome disease,  which might have been
 readily prevented  had  timely intimation
 been  given to the physician.
   \ 5. A patient should never weary his phy-
 sician with a tedious detail of events or mat-
 ters not appertaining to his disease.  Even
 as  relates to  his actual symptoms,  he will
 convey much more real information by giv-
 ing clear answers to interrogatories, than by
 the most minute account of his own framing.
 Neither should he obtrude upon his physi-
 cian the details of his business nor the his-
 tory of his family concerns.
   § 6. The obedience of a patient to the pre-
 scriptions of his  physician should be prompt
 and implicit.  He should never permit his
 own crude opinions as to their fitness, to
 influence  his  attention to them.  A  failure
 in one particular may render an otherwise
 judicious treatment  dangerous  and  even
 fatal.  This remark is equally applicable to
 diet, drink, and  exercise.   As patients be-
 come convalescent, they are very apt to sup-
pose that the rules prescribed for them may
be disregarded,  and  the consequence,  but
too often,  is  a  relapse.  Patients  should
never allow themselves to be persuaded to
                    2 
A  K R
IS
AFT
 take any medicine whatever, that may be
 recommended to them by the self-constituted
 doctors and doctoresses who are so frequent-
 ly met with,  and who  pretend to possess
 infallible remedies for the cure of every dis-
 ease.   However simple  some  of  their pre-
 scriptions may appear to be,  it often hap-
 pens that they are productive  of much mis-
 chief, and in all cases they are injurious, by
 contravening the plan of treatment adopted
 by the physician.
  \ 7.  A patient  should,  if possible, avoid
 even the friendly visits of a physician who is
 not attending him; and when he does receive
 them, he should never converse on the sub-
 ject of his disease, as an observation  may
 be made, without any intention of interfer-
 ence, which may destroy  his  confidence in
 the course  he is pursuing, and induce him
 to neglect the directions prescribed  to him.
 A patient should never send for a consulting
 physician without the express consent of his
 own medical attendant. It is of great import-
 ance that physicians should act in concert;
 for, although their modes of treatment may be
 attended with equal success when employed
 singly, yet conjointly they are very likely to
 be productive of disastrous results.
  \ 8. When a patient wishes to dismiss his phy-
sician, justice and common courtesy require
that he should declare his reasons for so doing.
  \ 9. Patients should always, when practi-
cable, send for their physician in the morn-
ing, before his usual hour of going out; for,
by being early aware of the visits he has to
pay during the day, the  physician is able to
apportion his time in such a manner  as  to
prevent an interference  of  engagements.
 Patients should  also avoid calling on their
medical  adviser  unnecessarily during  the
hours  devoted  to meals  or sleep.   They
should always be in readiness to receive the
visits of their physician, as the detention of
 a few minutes is often of serious inconve-
nience to him.
  §10. A patient should, after  his recovery,
 entertain a just and enduring sense  of  the
value  of the  services rendered him  by his
physician; for these are of such a character
that no mere pecuniary acknowledgment can
repay or cancel them."]
  AERATION.—Blood,  during its circula-
 tion through the body, becomes impure in
 quality, dark in  colour,  and  unfit  for  the
 support of the vital functions.   Being passed
 through  the  lungs by  the  powers of  the
 heart,  it  undergoes  purification, and  the
 Jark colour of the venous is exchanged for
 the bright red hue of the arterial fluid: it
 has undergone "aeration"—it has robbed
 the air drawn into the lungs of a portion of
its  oxygen, and given  off carbonic  acid.
This aeration of the blood is essential to the
maintenance of life;  if stopped entirely only
for a few minutes, death is the result. This
fact is obvious, and known to all;  not  so,
the injurious, ultimately fatal effects of tho
imperfect aeration  of  the blood,  to which
thousands of our town population are daily
and nightly exposed.   Living  in a contami-
nated atmosphere, the vital fluid never fully
purified, disease and shortened lives  must be
the result.
  Refer to Respiration—Blood—Circulation.
  ^ETHERS are volatile  liquids used  in
medicine as stimulants.
  Refer to Chloric sEther—Nitrous JElher-—
Sulphuric JEther.
  AFFUSION.—Affusion of cold water over
the body has been employed by medical men
in febrile diseases, more  especially in  scar-
latina.   The patient is seated naked in a
tub, and a pailful of cold water dashed over
the surface; he is then  to be  wiped tho-
roughly dry, and put to  bed.—The  method
is not much employed.
 AFTER-BIRTH.—In medical language, the
placenta.   It is usuallj' discharged at a pe-
riod varying from five to  forty minutes after
the birth of the child.   There is always some
little anxiety, both on the part of the pa-
tient and of the medical  attendant,  until
this concluding part of child-birth has been
accomplished.   Within the  above time,  in
most cases, sometimes immediately after the
child is born, the patient complains of  an
accession of labour-pain,  caused by the con-
traction of  the  womb, which casts  off the
after-birth; at  times expelling  it entirely
from the body,  but generally propelling it
so far toward the external orifice as to make
its withdrawal perfectly  easy.   When all is
as it should be, the business is concluded  by
the ordinary midwife without the least diffi-
culty.  At the same time, it must be remem-
bered,  that some of the most  formidable
accidents of the lying-in  chamber are con-
nected  with the management of this  part of
its  duties; and  if a female only be in at-
tendance,  not one moment  is to be lost in
summoning  proper medical  aid, should the
slightest  embarrassment occur.   Above  all
things, let the attendants beware of  any at-
tempt  to force matters by pulling strongly
at the  navel-cord—they can  only do mis-
chief.   The chief danger to be dreaded when
the after-birth  is retained, is loss of blood
or flooding.  If this comes on to any extent,
the patient  must be kept as quiet and cool
as possible; gentle but firm pressure must
be  maintained  over  the  bowels  generally,
and especially over their lower portion, by a 
AFT
19
AGE
bandage, and by the hand;  cloths dipped in
cold water are to be applied over the exter-
nal parts and frequently changed;  should
extreme  faintness occur, a little  wine, or
brandy, or sal-volatile, may be given in wa-
ter, but  stimulants must not be too readily
resorted  to.  The retention  of the  after-
birth is at times the result of irregular con-
traction, but often of adhesion to the womb:
the possibility of such an occurrence should
make those who are advanced in pregnancy
careful to avoid any thing which may press
upon any portion of the distended womb—as,
for instance,  the stays—and  guard against
habitually leaning, even gently, against any
hard body.  A  careful attendant will always
examine  the after-birth:  it  ought  to  be
nearly circular, about the size of a dinner-
plate,  and should not exhibit any signs of
tearing on the  surface which is  next the
womb.   The membranes which line the in-
terior of the womb  during pregnancy are
for the most part discharged along with the
after-birth, and are more readily and neatly
brought  away  by giving the  latter  body a
slightly twisting motion as it is withdrawn.
If they are very tender, a portion may re-
main and pass  off with  the discharge ; it is
well to be aware of the fact,  as persons are
often needlessly much alarmed  at  this oc-
curring a few hours or more after delivery.
Occasionally, the after-birth  is  so placed
over the  mouth of the womb, that it  must
necessarily be  detached  in the first stages
of labour; the  case is always attended with
danger, and  cannot be too soon put  under
medical  superintendence:  it may generally
be suspected, if, simultaneous with the occur-
rence  of labour  pains,  a free discharge of
blood takes place, which is increased every
time the pain recurs.   In the event,  as in
the country,  of any delay in  procuring me-
dical assistance, the measures  recommended
in the treatment of hemorrhage, in "Abor-
tion," may be resorted to.
  Refer  to Child-birth.
  AFTER-PAINS are the regularly recur-
ring pains which women experience  for a
day or  two after child-birth.   They are
rarely troublesome after a first confinement,
but  are apt to increase in severity at each
succeeding one.  After-pains  are, in mode-
ration, salutary, and are caused by the efforts
of the womb to attain that properly con-
tracted  condition on  which  the  woman's
Bafety depends.  If they are very severe,  it
is generally owing to the presence of clotted
blood,  which must be expelled before they
moderate.  A constant, unintermitting after-
pain coming on very soon after the termina-
tion of labour, is often symptomatic of inter-
nal flooding, and  should  be attended to an
cordingly.  If after-pains are very severe,
they can be advantageously relieved by the
administration of twenty drops of laudanum,
which may be repeated;  but if the amount
of pain  be moderate, this  is unnecessary.
If the discharge is not profuse, a hot flannel
to the lower  part of the abdomen affords
comfort.  After-pains are often kept up after
the first four-and-twenty or  six-and-thirty
hours by the bowels being loaded; a table-
spoonful of castor-oil is at  once a safe and
effectual remedy.   Too tight bandaging may
aggravate after-pains.
   Refer to Child-birth.
   AGE, OLD.—Althougn the  powers of life
may have  previously shown  symptoms of
decline,  the period of incipient old age is
usually fixed in women about  tne fifty-third,
and in men about the sixtieth year.  After
this, it generally becomes evident that the
vigour of prime is giving way, and that the
powers of the constitution are no longer able
to recruit themselves, or to  sustain exertion
with the same  ease  as formerly ;  diseases,
too, peculiar to this stage of life,begin to show
their symptoms  of  approach—symptoms
which can scarcely be too  soon detected or
too carefully watched.  As  time goes on, the
individual becomes  more  dependent  upon
the affectionate  care, and,  what is equally
important, the  intelligent supervision of
those around.   The subject of the treatment
of the aged has been  a neglected one.  A
valuable work, by Dr. Dajr, has  lately sup-
plied the want of a special  treatise upon it.
With old age, increases the liability to  such
hereditary diseases as gout,  gravel, rheu-
matism,  apoplexy, and  paralysis, and in
women  especially, to cancer.  Now the ef-
fects of  excesses and  dissipation  in  early
life, which may have been unfelt during the
vigor of manhood, too often add to the natu-
ral infirmities.   Whatever  may  have   been
the previous modes of  living, it is  always a
dangerous experiment to  make any material
or  sudden change in them;  after age has
begun to tell upon the constitution, it should
not be done but for important reasons, and
under direct  medical control.   The natural
sensations will  gradually guide  the indivi-
dual to those modifications ot previous habits
which accord with the  altered structures
and diminished powers, especially in the
case of   active  or violent exertions,  which
the hardening and ossification of the various
tissues,  but more particularly of the  coats
of  the  arteries,  render  hazardous.    The
weakened digestion of advanced life should
be considered in the  food, which, while it is
nutritious, ought  at the same  time  to be 
A (J E                20                 A G U
lightly cooked, and every thing like harden-
ing avoided.  Where the teeth are deficient,
meat should be well divided, either by minc-
ing before cooking,  or by the knife  after.
[Hashes  are  therefore well adapted to old
people.]   The meals should be light, not at
too long intervals.  If the dinner be early, as
it ought to be for the aged, who are not obliged
to hurry  off  to business, supper, though  a
light one, should always be taken.   The skin
of old people is  often  most shamefully and
disgustingly neglected, and no point in their
management  is more closely connected with
their comfort and health;  it should fre-
quently be sponged  with tepid water, and
well  rubbed  afterward with a rough  towel
to promote reaction.   It ought at the same
time to be carefully protected by woollen
clothing:  old people  are  most injuriously
susceptible of the changes of external tem-
perature,  particularly cold;  indeed the
change of a few degrees in the thermometer
may be the immediate cause of death in very
advanced  life, and the average number of
old people affected by apoplectic or paralytic
seizures,  is apt to be  notably increased at
the setting in of frost.   Exercise by the old
should be continued as long as they are able
to take it, but  never extended to fatigue.
Sleeplessness, so frequently and loudly com-
plained of by aged people,  is, in some re-
spects, natural; as  life advances, nature
would  seem to  require less of the soft re-
storer.  It is not well to endeavour to over-
come it by narcotic medicines.  If possible,
the time of sleep should, by habit, be kept to
the early hours of the night, and, in summer
especially, the tedium of the early morning
may  be relieved by reading, knitting, sew-
ing, or some  other light employment, even
in bed.  In advanced  life, the urinary or-
gans require  the greatest care; the call to
relieve them should never on any account be
delayed;  on  the slightest symptoms of de-
rangement, proper medical advice ought to
be taken  at once ;  it may prevent evils which
too often render the latter years miserable.
It is most important for old people to give
themselves time to empty the bladder tho-
roughly ;  they do this with more  difficulty
than the young.   The  medicines prescribed
for the aged should be, whenever it is  possi-
ble, of a warm  character, to counteract the
tendency to flatulent distension: large doses
of mercurials, neutral salts, and strong pur-
gatives,  are  all to be avoided.   Alkalies,
even when given to counteract a tendency to
the acid of gout or gravel, must be carefully
watched,  and not too long continued ;  they
may produce the opposite state  from that
which they are intended to correct—a much
greater evil.   Pills, especially if at all hard,
are  apt to pass  through the  bowels  un-
changed.   W hen an aperient is required by
an old person, none is more suitable than a
moderate  dose of infusion of senna, to which
a little  ginger, or a teaspoonful of bark or
of gentian is added, [or a little of Warner's
gout-cordial  may be  substituted.]   Six to
eight drachms of the compound decoction of
aloes answers well, if there is no great  ten-
dency to piles.  When the  bowels  are ha-
bitually constipated,  a clyster, of a pint to
a pint and a  half of warm soap-water, must
be  given  occasionally  as required:   this
counteracts the great tendency to faecal ac-
cumulation.   The doses of medicine  ought
always  to  be  diminished  after the period of
incipient old  age.
  Refer to Diet—Purgatives.
  AGUE,  or   Intermittent   Fever, is  a
disease  which prevails  chiefly in  marshy
districts;  the production of that condition
of the atmosphere which originates it being
generally  associated  with the presence of
decaying vegetable and animal matter.  To
this  peculiar atmospheric state  the  terms
marsh miasma and malaria  have been  ap-
plied.   A  certain  degree of  heat  appears
necessary  for the  origination of malaria.
Ague is unknown in  cold regions, and be-
comes more virulent  the nearer the tropics
are approached.   The malarious poison does
not  seem  to  extend  to  any great height
above the  surface of the marsh, and persons
who  are  compelled  by  circumstances  to
sleep in a  locality where  ague prevails,  are
more likely to escape the effects by occu-
pying rooms  in  the  upper  stories of the
house.  Moreover, marsh poison may be
carried  a considerable distance by the wind
—the leeward side of a malarious district
being always the most  dangerous.  High and
thickly  grown trees have the power  of at-
tracting and retaining  marsh miasmata.
Their vicinity, therefore,  in malarious  dis-
tricts, at night,  and especially  as sleeping
stations, is to be avoided. At  the same time
the fact is taken advantage of by the resi-
dents in  such districts: for if they  can
place their dwellings  so that a belt  of trees
intervenes between them  and  the marsh,
they are safe.  Strangers are more likely to
become  the subjects of ague than those  who
are regularly resident in  the district.   The
latter, however, if the- district be a decidedly
malarious one, even  if they  do  not  suffer
from regular  ague, are scarcely ever healthy
An individual should always consider  weli
before placing himself within the influence
of a malarious atmosphere ; no  worldly ad-
vantage can  be a set-r T  against the misc- 
A G TJ
21
AG  U
 rable condition of a man subject to periodic
 ague.   The emigrant, in choosing the scene
 of his future labours, ought to make himself
 very certain upon  this  head, and when he
 is assured, should be very careful [especially
 in new districts of the United States] not to
 expose himself, even for a night, to the in-
 fluence of malaria, if he possibly  can avoid
 it.  One  of the  most remarkable features
 of intermittent fever is  its tendency to re-
 turn upon  those who  have  once suffered
 from it.  An east wind,  indiscretion in diet,
 any thing which lowers  the tone of  the ge-
 neral  health, may bring  back the enemy.
 When  an attack of ague is about to come
 on,  the person complains of general lassi-
 tude,  oppression about the  stomach, and
 general chilliness, which at last amounts to
 actual shivering,  with   chattering of  the
 teeth, when the disease  is fully  established.
 By this time, the features are pinched and
 blue-looking,  and  the  whole  body seems
 shrunken, the pulse is  feeble,  the tongue
 pale, sometimes there is  vomiting,  and there
 may be stupor or convulsive action.   Flying
 pains  are felt throughout the head  and
 limbs.  After  a certain  time, this first (the
 cold) stage gives place to the second or hot;
 transient heat-flushes become more frequent,
 tilt  at last the coldness is entirely  super-
 seded  by a state of fever, with quick, full
 pulse, hot skin,  furred  tongue, and  thirst,
 with high-coloured urine,generally throbbing
 headache.  At length the third stage brings
 relief, by copious perspiration, the  symp-
 toms of  disease subside to  the level of
 health, and the  patient remains  compara-
 tively  well during what  is called the remis-
 sion, that is, until the  next  attack, which
 may come on in twenty-four, forty-eight, or
 seventy-two hours, or at longer or less re-
 gular periods.   The periodicity observed by
 the  attacks  of ague  is one  of  the  most
 marked features of  the disease, and the
 terms  quotidian, tertian,  quartan, are ap-
 plied to denote the interval of return.  The
 more frequent the paroxysms, the  more se-
 rious the character  of  the  malady,  as a
 general rule.  The marked features of ague,
 its occurrence  in particular localities, and
 its tendency to return, render it one of the
 diseases  most  easily and certainly distin-
 guishable by the unprofessional,  while, at
 the same  time, the peculiar circumstances
 under which it  often occurs, and the compa-
 ratively regular  modes  of treatment,  per-
 mit of  timely assistance  being extended to
 the sufferer in the absence of regular medi
cal advice.  When an individual is attacked
with the cold stage of the fever, the appli-
cation  of  external  warmth is at  once the
1 most natural  and beneficial  remedy.  This
 may be done either by means of bags of
 heated bran, salt, or any other convenient
 method; or if a vapour-bath be at hand  it
 may be used,  or an extempore one made by
 seating the patient, wrapped in a blanket,
 on a  chair over  a  bucket  containing hot
 water, which is kept steaming  by means of
 heated stones  thrown in it from  time to
 time.   Warm  diluent drinks may be freely
 allowed, as weak  tea, barley-water,  and
 such like ; only in  a very few debilitated
 cases  may a little wine be added.  Emetics
 have been given at this stage,  but are not
 advisable.  A brisk purgative  is, however,
 required  at  the commencement; none  is
 more convenient than a pill containing one
 grain  of  calomel  and three grains of the
 compound rhubarb pill.  Of  these, two may
 be given to an adult.  [The  compound ca-
 thartic or anti-bilious pill is  also often  ser-
 viceable, one,  two, or three being taken at
 once.] During the  hot  stage, opium may
 be given.   It may be administered as lauda-
 num, in one  dose, averaging full five-and-
 thirty drops to an adult, the  diluent drinks
 being  freely allowed at the same time.  The
 sweating stage is to be encouraged until the
 feverish symptoms are quite gone; if it then
 continues, wiping the skin dry and changing
 the linen will put a sufficient check upon it.
 The individual paroxysm being over, the
 object  is  next to  cure  the disease  and
 prevent the recurrence.  For this purpose,
 the one remedy, Peruvian bark, as formerly
 given, or its essence, quinine, as now admi-
 nistered,  is generally  sufficient.    If  the
 bowels are not thoroughly cleared  by the
 calomel and  rhubarb, this point  must  be
 insured by a full dose of castor-oil or some
 purgative,  apd two-grain doses of the  sul-
 phate  of  quinine in  solution, every  five
 hours,  immediately  commenced  with,  and
 continued night and day, paroxysm or not.
 The dose may require increasing to three
 grains, or even more, but perseverance with
 the quinine will  most generally succeed.
 The chief  objection to  this  remedy  is its
 high price, and others cheaper have  been
 sought.  [Sixteen grains  divided into  two
 doses,  and taken when free from fever,  will
 often prove more efficient than  the smaller
 and oft-repeated doses just advised.]  Arse-
nic is the  most to  be relied  on, but not
in unprofessional hands.  Sulphate of zinc.
or white vitriol, may be given in six-grain
doses twice or three times a day with safety,
and often with  success.   The use of either
of the remedies recommended must be con
tinued  for a week or ten days after  the
disease appears to have ceased, as relspse 
AG U
AGU
is apt to occur; but in the case of quinine,
should headache, deafness, or noise in the
ears be  complained  of, the administration
must be stopped or greatly moderated.
  Such are the principal general  modes of
treating ague which may safely be  had re-
course to by the  unprofessional, and  with
them no one who is resident in a  malarious
distriot, or no intending emigrant, who may
chance  to find  himself in such a district,
should be unacquainted.   At the same time,
however useful a knowledge of these gene-
ral  principles may be, it will  not be every
thing in all localities.   In each the disease
assumes varied features, which can only be
properly known and  treated  by the  resi-
dents.   Ague may resist  every remedy, or
may frequently  recur, so long as the  pa-
tient resides within the malarious influence,
or having been contracted, it  may be  kept
up  by  the air of another district, particu-
larly a cold or damp one, although it could
not  be  produced  by  it.  In  such  a case,
change to a dry and more genial  climate is
necessary,  for though  ague is not  imme-
diately fatal, its continuance undermines the
constitution  and originates serious disease.
Ague is most general in spring and autumn,
the  latter being the more dangerous  period
of attack.  Those  who are  temporarily or
permanently compelled to reside in  a mala-
rious district, will do well to keep  up the
general tone  of the system, by sufficiently
generous living or a moderate use of fer-
mented liquors.   They  should protect the
skin by woollen clothing, avoid  night air,
or,  if obliged to go into it, protect the  nose
and mouth by a handkerchief, [or veil ap-
plied over  the  faoe,] and  never go out in
the  morning without taking food,  or better,
Bome warm  fluid, previously.   A few doses
of quinine should be taken occasionally.
  Refer to Quinine—Zinc.
  Agi'e—(Note  on.)—Since the  above was
written, a paper has appeared in the Edin-
burgh Journal of Medical Science, for Octo-
ber, 1851, by Mr. Kerr, of Canada, strongly
recommending, from his own experience and
that of others, the use of a preparation of
iron in the treatment of ague.   The recom-
mendation  is well supported  by evidence,
and is a most important fact to all  who re-
side or  are likely  to reside in aguish dis-
tricts.   The salt of iron is named persesqui-
nitrate of iron.  Mr. Kerr gives the follow-
ing  method for its preparation, which is
simple enough to be followed by any careful
person:—"Take  of iron wire, that  known
by  tb/  name  of  number  17, one  ounce,
nitric   cid three fluid  ounces,  water  one
 hundred  and seventeen  fluid ounces.  Mix
 the nitric acid with fifteen ounces of water
 in an earthenware or glass vessel, put into
 it the iron wire broken into several  pieces,
 and so twisted as to extend into every portion of
 the liquid ; place the vessel in a moderately
 warm  situation, and  in eight  or  twelve
I hours the solution will be completed, when
 the liquid is to be poured off the remainder
 of the wire,  which should always be in ex-
 cess.  The  residue of the water is  now to
 be added, so as to increase the solution to
 one hundred and twenty  ounces.  The pro-
 cess may be carried on out of doors, if it
 be  not  cold  weather, on  account  of  the
 fumes,  or at least placed where these may
 be carried off."   Mr. Kerr, lays  down  the
 following method  of treatment:—" If the
 patient has paroxysms of ague, ten  grains
 of sulphate  of quinine, divided either into
 two or three portions,  ought to be  given
 before  the accession of the  paroxysm, say
 one portion  the  preceding night, and two,
 with two  hours between them, the following
 morning,  each  along with a teaspoonful of
 persesquinitrate  of  iron.  This  treatment
 will most probably prevent the accession of
 the paroxysm.   The  succeeding treatment
 consists in giving a teaspoonful of the  per-
 sesquinitrate, thrice a day, about an hour
 before meals.   In many individuals, quinine
 suspends a paroxysm of ague  only  for a
 fortnight or thereabout, the disease return-
 ing thereafter every second day as formerly.
 If  this relapse  be  anticipated, by  a few
 grains of quinine given as at first, ague will
 be  again prevented.  Patients  who, from
 previous  experience, know that the disease
 will return at the end of  a fortnight,  ought,
 therefore, to take quinine at the end of this
 period, and to  persevere in the use  of the
 persesquinitrate till  they are restored to
 perfect health.   Possibly five out of  twenty
 may require a  third  quantity of quinine at
 the «iid  of  a  second fortnight,  when  the
 patient's health ought to be so much im-
 proved by the  persesquinitrate of iron that
 the disposition to relapse shall have alto-
 gether ceased."   " If the state of fever in,
 or paroxysm of ague has commenced, two
 or three teaspoonfuls of  persesquinitrate of
 iron will greatly abridge the duration of the
 distressing headache and pains in the back
 and limbs, and often remove vomiting.  Be-
 sides using the medicine, the patient ought
 to avoid  fatigue and  exposure  to rain, till
 his health and  strength  are re-established.
 Constipation must of course be removed."
    AGUE-CAKE.—The  enlarged   spleen
 which  is frequently the result of repeated 
A  I 11
23
AIR
 attacks  of ague.   It forms a  perceptible
 tumour in the left hypochondriac region of
 the abdomen.
   Refer to Abdomen.
   AIR  and  ATMOSPHERE.—The air in
 which we live  and breathe consists simply
 of a mechanical mixture of the two  gases
 oxygen and nitrogen, in the proportion of
 twenty-three parts of the former to seventy-
 seven parts of the latter, by weight, in every
 hundred.  The atmosphere not only consists
 of this air, but also includes various other
 substances.   Of  these,  the principal  are
 watery vapour and carbonic acid: ammonia
 and nitric acid exist in  minute proportions,
 together  with  exhalations of various kinds
 and amount, according to situation and  cir-
 cumstances.  The weight of our atmosphere,
 amounting  to fifteen pounds upon every
 Bquare inch of surface  exposed to it at or-
 dinary levels, exerts a pressure of nearly
 fourteen  tons distributed over the  surface
 of every  grown man.  We do not feel this,
 because it is counteracted  by the aeriform
 elasticity of the fluids contained within  our
 bodies.   But when the pressure of the  at-
 mosphere is  taken off any  portion of  the
 surface, as by an exhausted cupping-glass,
 it is the elastic counteracting force within
 the body  which pushes up the covered por-
 tion of the skin.  The prime, essential con-
 stituent  of the atmosphere  is oxygen,  the
 sustainer of animal life: its dilution with
 four  parts of nitrogen  exactly adapts it to
 our requirements.   The proportions of oxy-
 gen and nitrogen in the atmosphere do  not
 vary ; its quality is  chiefly  altered by  the
 amount of  watery  vapour,  carbonic acid
 and other gases,  and exhalations, and  by
 the rarefying  or condensing  effects of heat
 or  cold.   The importance  to health of a
 due supply of pure air, and  the knowledge
 of the principal sources of its vitiation, is
 becoming every day better understood and
 acted upon.
   The most constant and extensive source
 of impurity is animal  respiration.   Every
 breathing animal, man  included, is conti-
 nually drawing air into  the  lungs, and  the
 next moment giving out, instead of the life-
 sustaining oxygen, poisonous carbonic acid.
 It is evident from this, that if an individual
 or individuals are enclosed in a room which
 possesses  no means of ventilation—in other
 words, which  has  not its  air continually
 changed—the  air  contained in that space
 must become unfit  to be breathed, health
 will  suffer, and life may be extinguished.
The headaches and uneasy sensations caused
by close, crowded rooms  are familiar to all.
The tragedy of the Black-Hole of Calcutta,
 and that of the  Irish steamer  a few sum-
 mers  ago,  are notorious.   In  the latter,
 sixty persons, fastened down in a close,  small
 cabin,  perished in  less  than  six hours.
 These individuals  were  actually poisoned
 by the carbonic acid gas they had  them-
 selves expired.   Such effects are too  obvi-
 ous to require comment; it is the gradual
 undermining  of health, the  slow  poisoning
 of those who habitually breathe  a vitiated
 air, to which attention requires to be drawn,
 and more particularly in the case of sleep-
 ing apartments.  AVhen it is considered that
 one per cent, of carbonic acid  in the air
 will cause uneasiness, that ten per cent, is
 the probable limit where immediate danger
 to life commences, and that every adult man
 vitiates at  least two hundred and sixteen
 cubic feet per hour of the pure element, it
 is  needless  to say more upon the  necessity
 for  proper  ventilation.  Moreover, exhala-
 tion from the surface of the  bodies even of
 the healthy  is constantly adding a consider-
 able  proportion  to the other sources of at-
 mospheric impurity.  Notwithstanding facts
 like the above, people lie singly or in num-
 bers, for six  or  eight hours every night,
 breathing over  and over  again  the  same
 contaminated atmosphere :  they sleep  hea-
 vily,  and rise in the morning  wondering,
 perhaps, that they feel even more languid
 than when they lay down at night.
   The notorious cases of low lodging-houses
 and other such resorts are not now alluded
 to, but  the less-suspected  nurseries and
 well-furnished apartments even of the higher
 classes, many of which, with door, window,
 and chimney closed,  and heavy curtains
 drawn round heavy sleepers,  are perfect
 hot-beds of  disease.  It  is time such igno-
 rant, culpable  disregard of all  the princi-
 ples of health should cease.  We  spend on
 an  average  one-third  of our lives in our
 bedrooms for the purpose of refreshing the
 body, how important then to have them as
 airy as possible, with free entrance for the
 good air, free exit for the deteriorated.  If
 the door of a room  must  be fastened  at
 night, let it be by a chain-bolt; or if it must
 be locked, let the upper panels be perforated,
 or the window fitted with a  pane of perfo-
 rated glass or zinc :  at all events, let air in
 somehow.   Keep  the chimney open, that it
 may carry off the impure;  this it will do,
particularly if fitted with an Arnott's venti-
lator.  Breathing the air in crowded assem-
blies o'f people is  only occasional, and ge-
nerally for a short time—it can  do compa-
ratively slight mischief; the air we breathe
for one-third of our lives cannot be vitiated
without the most  serious injury to  health 
A  I  R
24
ALB
 and curtailment of life.  Many a mother
 has mourned over the untimely grave of a
 child,  little  suspecting  how the close, hot
 nursery had  undermined the young  consti-
 tution,  before  the  fatal cold  or  epidemic
 snatched her treasure away.
   Diet, clothing, exercise, all claim serious
 attention:  still more, for old or young, the
 purity  and  ventilation  of the  sleeping
 apartment.
   Burning candles  or lamps vitiate air in
 the same manner as the respiratory process
 of animals. They consume oxygen and form
 carbonic acid, consequently they are unde-
 sirable in close rooms at night,  or indeed at
 any time, if there is insufficient renewal of
 the air.  A fire in  the  bedroom is recom-
 mended as  a means of ventilation, and un-
 doubtedly is  so as long  as it is burning
 briskly, if  kept well replenished, and if the
 chimney draws well;  but when, during the
 hours of sleep,  the fire  gets low, and the
 draught up the chimney is diminished, the
 air vitiated by the burning  embers is very
 apt  to become  diffused  through the apart-
 ment, and, with  it, sulphurous and  other
 fumes.  This point is one frequently over-
 looked, and, from the  very injurious  conse-
 quences which  may result,  requires strict
 attention.  Plants or flowers kept in a sleep-
 ing apartment  are  another  not unfrequent
 source of impure air ; for although  living
 vegetation  under the influence of  sunlight
 has the power of abstracting carbonic  acid
 from the atmosphere, which in fact it  con-
 tinually purifies from  the effects of animal
 respiration, in darkness the case is reversed:
 not only do leaves cease to absorb  carbonic
 acid, but they give it out.  When it  is re-
 membered,  that in a school in which pupils
had  been  taking lessons for three hours,
 with doors  and windows closed, the amount
 of carbonic acid has been found to be eight
 times the average; that much less than this
 causes uneasiness ;  that a little more  may
 cause death;  enough has been said to prove
 the  necessity for  preserving  the   air we
 breathe in a state  of the highest possible
 purity, and of avoiding every known source
 of deterioration.  In the room  of  sickness
the necessity is  increased tenfold;  both for
 the sake of the patient and of those around,
 the air must be kept pure.  In the few cases
in which ventilation cannot be had recourse
to,  Liebig  recommends the  use of slaked
lime spread  on  a board: this  quickly ab-
sorbs the carbonic acid of any closed space
in which it may be placed, and fresh air
 must rush in  through the crevices to supply
 the place of the former gas.   It scarce re-
 quires  mention that all  decomposing  sub-
 stances, in whatever situation, cannot fail to
 render the air impure—moiBt vegetable mat-
 ter  particularly.   Damp,  decaying wood,
 sawdust, straw, &c,  all  exhale carbonic
 acid, and in close places may also originate
 serious  disease.  It is worthy of note thai
 while  decomposing dead animal matter does
 not  seem so materially to affect health,  the
 morbid exhalations from living animal bodies
 poison the atmosphere  to such an extent as
 to occasion the most malignant fevers.
   Locality, it is well known, exerts much in-
 fluence over the purity of  the atmosphere.
 The air of towns  must of course be less
 pure,  principally from admixture of sul-
 phurous vapour, the product of combustion.
 The air of  the coast is  stimulating and
 strengthening,  probably in some measure
 owing to its  containing minute  portions of
 the  sea  constituents.   The  air of all  damp,
 low  situations  is  particularly  unhealthy;
 doubly so  if the  situation  is surrounded
 by elevations which  prevent atmospheric
 changes.  Intermittent fevers and diseases
 of a neuralgic character  prevail in these
 places.  The noxious influence is generally
 more  potent near  the ground,  and those
 who are compelled  to reside in such locali-
 ties  may escape much evil by occupying
 rooms  as elevated above the soil as possible.
   Dry  air is  generally good, but it may  be
 too  dry, and produce  disagreeable effects
 upon the skin, as chapped hands, &c.  Moist
 air,  when combined with cold, is worst  of
 all.   The  state of the atmosphere  varies
 much in the twenty-four hours.   The fresh
 air  of  early  morning,  salubrious  to  the
 strong and healthy, requires to be dried and
 warmed  by the sun before it is suitable for
 the invalid. Even in summer, in this climate,
 this  is  scarcely the case before eight o'clock.
 Exposure to  the  damp air  of evening and
 night must always  be shunned by the weak
 in health.  So noxious is it  in some tropical
 or marshy regions, that one night's sleep
 within its influence  is certain to be followed
 by an  attack of illness.   That a uniform
 temperature and  unchanging climate is not
 so well adapted to maintain health as a va-
 riable one, is admitted  on the authority and
 experience of Sir James Clark, Dr. Combe,
 and  others.
  Refer  to  Oxygen—Carbonic Acid—Nitro-
gen—Respiration — Ventilation—Perspiration
 *c.
   ALBINO.—An individual in whom  the
 usual colouring matter of the body is absent.
 The  complexion is unnaturally white, the
 hair white, the  eyes  appear  pink.   White
 rabbits with  red eyes  are  albino rabbitB.
 Albinos are rare among Europeans, but are 
ALB
25
AL1
 found more  frequently among the negrees.
 [When the person thus affected is a female,
 she is termed an Albiness.]
   ALBUMEN.—One of the principal  con-
 stituents of the animal  body.  The white
 of the egg is nearly pure albumen.  In the
 serum  or watery portion of  the  blood it
 exists in large proportion, and may be co-
 agulated from it by heat, like the white of
 an egg.  When it is recollected  that  from
 the  albumen of the egg (for the yelk is al-
 bumen also) the perfect chick is constructed,
 with its blood, muscles, bones,  and nerves, it
 will be seen how great must be the nourish-
 ing power of this substance.  Besides exist-
 ing in the blood, albumen forms a consider-
 able  proportion of the  animal  solids: it
 also exists  in the vegetable kingdom, more
 especially in the grains and pulses.  Heat
 first coagulates, and then hardens albumen,
 thus impairing  its digestibility—a reason
 for avoiding over-cooking meat, as well as
 eggs.
   ALCOHOL,  the  principle on which  the
 characteristic  properties of fermented and
 distilled liquors depend,  is  formed  from
 grape sugar which has undergone the vinous
 fermentation.  It is a  limpid, colourless,
 highly  inflammable liquid, of penetrating
 smell;  it is rarely, if ever, used either as
 medicine or beverage uncombined.  Distilled
 spirits, wines, malt  liquors, and fermented
 liquors generally, owe their intoxicating and
 stimulating properties to the alcohol which
 they  contain in  more  or less proportion.
 In medicine, alcohol is  used  to form tinc-
 tures, that is, to hold in solution certain ve-
 getable, and, in a few cases,  animal  sub-
 stances, which  are most conveniently ad-
 ministered  in  this  form.   Some of these,
 such as camphor, will dissolve  to the extent
 required only  in strong alcohol or rectified
 spirit:  for others a more diluted alcohol or
 proof spirit is sufficient.  In addition to its
 solvent properties, alcohol is likewise valu-
 able from its power of preserving the  infu-
 sions or  solutions  to  which  it  is added.
 One  ounce, by  measure,  of alcohol, mixed
 with a pint of water, forms a  good evapo-
 rating lotion to be used when it desirable to
 reduce the external  heat  of any portion of
 the body.
  Refer to Tincture—Fermentation—Sugar.
  ALE  and  BEER contain more or less sac-
charine matter, alcohol, and bitter principle
 of the  hop; they  also contain, especially
when old*and hard, a proportion of lactic
acid.   As an ordinary beverage  for  most
people,  good table beer is particularly  well
adapted.  It contains just enough spirit to
afford gentle, almost inappreciable stimula-
 tion, and its bitter undoubtedly assists to
 maintain the tone of the stomach, so apt to
 fail  in  the hard-working,  anxious-minded
 citizen.   Ale is too  strong  for  ordinary
 every-day use for the robust, but in  the de-
 licate, and  in convalescence from  illness,
 when it agrees, it is often admirably adapted
 to support the powers of the constitution.
 The India bitter beer agrees well with some
 persons, and the great amount of bitter it
 contains acts as  a powerful tonic to weak
 stomachs; [the same is the case  with the
 lager-beer now so much  employed in the
 United States.]   But for this very  reason,
 its use ought not to be persevered  in long
 at a time.  The amount of spirit it contains
 is not large, but  the  narcotic properties
 of the hop are apt to affect the head.  Malt
 liquors never  agree with  those  who  are
 liable to gout or gravel; and if their use be
 continued, they are almost certain  to induce
 a paroxysm of either of the  diseases, as the
 slightest degree of acidity or  hardness ag-
 gravates their bad effects  tenfold.  A single
 glass of hard ale is  sufficient to induce an
 attack of gravel in the predisposed.   Those
 who suffer from  plethora, and  consequent
 head symptoms,  from chronic  cough  or
 oppression of breathing, from gout,  gravel,
 or habitual acidity of the stomach, should
 never  touch  either ale or beer.  Hard or
 acid malt liquor is always injurious; some
 persons  on this account  habitually add  a
 small porth n of carbonate of soda to their
 malt liquor   The practice is  most hurtful,
 and  rapidly debilitates the stomach and de-
 teriorates the blood.
   ALIMENT.—Whatever  is  capable  of
 nourishing the body.   A  rough division is
 made into liquid and  solid aliment.   Amid
 the vast variety of  nutrient  materials with
 which  man has been furnished by his Crea-
 tor, it is by no means a matter  of indiffer-
 ence which he selects.   The first point is to
 be certain that the aliment used  contains all
 the principles required to support health and
 strength.  In a mixed diet this is  tolerably
 sure to be the case; not so when the food is
 restricted to one or two articles, and griev-
 ous mistakes  have occurred on this point.
  Some alimentary substances contain with
 in themselves whatever is required for the
 nourishment of the animal body.   Of these,
 albumen,  milk, and bread,  are examples;
 others, such as jelly, arrow-root, sugar, con-
 tain  only part of the elements required for
proper nourishment, and could not of them-
 selves support life ; indeed, man or animal,
fed upon them  exclusively, wouid  die of a
certain kind of starvation.  Children have
 actually been partially starved to death on 
ALI
26
ALI
arrow-root mucilage, made with water  and
sugar  alone, while those around considered
them to be receiving full nourishment.   At
the same time, even in the case of a single
nutrient  compound, such as  albumen, con-
taining all requisite principles, experience
has shown  that it is unfit to preserve health
and strength.  The whole alimentary system
requires  the stimulus of change.   Aliment,
it has  been said, is divided into liquid  and
solid, but before it can actually enter  the
system, it must all be reduced  to  the state
of liquid.   Some persons err in  diluting
their food too sparingly.  Aliment may be
very nutritious, but  difficult of digestion.
This question, however, falls more fitly under
the head  of Diet.
  ALIMENTARY CANAL.—The entire tube
through  which  the  food  passes   from  the
                  I i^. iii.
mouth to the anus ; the total length in man
averaging thirty-three  feet.   Its divisions
1 are the mouth, the  pharynx  or throat, tb«
 oesophagus or gullet, the stomach, the small
 intestines, and the large intestines and rec-
 tum. The oesophagus (fig. iii. 1) extends from
 the throat to the stomach, which it enters to-
 ward its larger extremity, (fig. iii,) passing
 down  the posterior  part of the chest. The
 shape of the stomach  will be  best under-
 stood  from  the figure, (fig. iii.)   It  has a
 larger extremity, 2,  and a  smaller, 3.  From
 the smaller proceeds the first portion  of the
 small intestine, (fig. iii. -J,) named the duo-
 denum, divided, however, from  the stomach
 at 4, by the pyloric valve.   The small  intes-
 tines,  6,  ti, divided  nominally into two
 more portions, jejunum and ilium, extend in
 a continuous coil  to the   length  of  about
 twenty-five feet, and then  enter the  large
 intestine  in the right iliac  region.   The
 opening of the small intestine into the large
 is slit-like, (fig. iv. C.,) and is protected by a
                   Kij;. iv.
valve, D. The large intestine, or colon, (fig.
iii. 9, 10, 11,) five feet long, ascends from
where it is entered by the smaller gut,  coe-
cum, (fig. iii. 7,) as high as the under surface
of the liver; it then passes across the abdo-
men, and descending, after making a pecu-
liar turn, ends in the  rectum or vent gut.
The  calibre of the colon is much greater
than that of the small intestine, and it is
thrown into sacculi or  folds by three longi-
tudinal  muscular  bands.   As soon as food
reaches the back  of  the throat, it  passes
from the power of the  voluntary to that of
the  involuntary muscles, and  is conveyed
into  the  stomach  by  a regular  wave-like
action of the muscular  gullet or oesophagus.
When persons eat too  fast, and one  morsel
is passed into the throat too quickly after
the   other,  this regular  muscular  action
becomes spasmodic, producing a very pain-
ful  sensation.  The mass  of  food from  a
meal, being collected at the larger  end of
the  stomach,  is there mixed  with  gastric 
A L K                  27                  A L 0
juice,  arid converted  into  a pulpy,  gray-
looking  mass,  the chyme,  which, as it is
formed, is propelled toward the  pyloric or
smaller extremity, by successive wave-like
motions of the  organ.   At the pyloric valve
all well-digested food  is allowed to pass,
but in the healthy stomach, any portions
which  are  not  thoroughly softened,  are
stopped, and passed back  into the organ.
The food, having passed through the pylorus
into the upper  part of the  small intestine,
quickly becomes mixed with the bile,  which
flows  into the  duodenum from the liver by
its proper duct, (Fig. iii.,) and also with the
pancreatic juice. The mass of chyme is now
propelled forward by a  worm-like  motion
of the small intestines, the nutrient portions
being absorbed from it, as it passes onward,
by the lacteal vessels.  The lining membrane
of the intestines is thrown into  folds to in-
crease the surface to which the chyme is
exposed.  Having traversed the  small, the
chyme is discharged into the large intestine,
or  colon, through the  slit-like valve, and
here the contents of the bowels, thought by
some to undergo a kind of second digestion,
assume the feculent character.  After yield-
ing up in the colon the remains of nutrient
matter, the mass is discharged through the
rectum and  anus.   The whole  of  these
movements  are effected  by the  muscular
powers of the alimentary canal itself.  The
main object of  the alimentary canal is, most
undoubtedly,  the  digestion of  food;  but
this is not its  only office—it is one of the
great and inoortant drains and sewers of
the body, and into it is cast a large propor-
tion of the used-up material of our frames,
which would be hurtful if retained, particu-
larly so in illness, such as fever.  The fact
is a cogent one why at all times the bowels
should be kept clear;  and  will  explain to
people wherefore,  during illness,  even when
food is not taken, and when  they often think
and say,  " there can  be nothing in a pa-
tient," the medical attendant is so careful
to keep this great drain, the alimentary ca-
nal, clear of its noxious contents.
  Refer to Abdomen—Absorption—Digestion.
  ALKALI.—An alkali is a  substance which
neutralizes  acids  more or  less  perfectly,
forming  by the combination a salt  which
differs  from either of its components; thus,
nitrate of potash or saltpetre is a compound
of potash and nitric acid.  Alkalies have also
the general property  of  turning vegetable
olues to green.   Potash, soda, and ammonia
are the three alkalies ; the two first are fixed.
the last is volatile.
  Refer to Potash—Soda—Ammonia.
  ALMOND.—The sweet almond, as an arti-
cle of food, is not digestible; when triturated
with gum and sugar, so as to form an emul-
sion, it constitutes a pleasant demulcent ve-
hicle for  medicine, in affections of the chest
or mucous membranes,  and may be taken
freely.   The bitter almond is most decidedly
unwholesome, unless in very small quantity
as a flavour ;  and some persons cannot even
take it in that way with impunity.   The es-
sential oil of bitter  almond contains, after
distillation, prussic acid in sufficient quan-
tity to act energetically as a poison.  A sin-
gle drop of the pure oil would be dangerous.
Cases of poisoning from eating bitter almonds
have occurred:  the symptoms and treatment
are very similar to those in poisoning by
prussic acid.   The strong peculiar odour of
the oil will in most cases betray the accident.
  Refer to Prussic Acid.
  ALOPECIA.—See Baldness.
  ALOES.—One of the most useful and ex-
tensively used purgatives.  It is seldom given
alone, and is scarcely employed domestically
except in its combinations,  particularly in
pills; indeed, there are few active  aperient
pills into the composition of which aloes does
not enter. The action of aloes is certain, and,
except in peculiar cases, easy and safe.  In
pregnancy, and where any tendency to piles
exists,  its use  had better  be avoided.   The
action of the medicine upon the stomach is,
in small  doses, tonic; but the principal ef-
fect of aloes is upon the lower bowels,  the
movements of which it appears to excite,
without increasing the discharges :  it seems
to act  similarly to  the bile, and when  that
is deficient, as a substitute for it.  The prepa-
rations into which aloes enters are general-
ly better provided ready made.  Of the pills,
the simple aloetic, the compound rhubarb,
and  the compound colocynth, are the best;
the last is the most active.   Of any of these,
one or  two pills, three grains each, may be
taken at  bedtime as. an average dose.   The
compound decoction of  aloes is a most  ex-
cellent form, and may safely be given when
quick action is required, in one to two ounce
doses.  For old  people, it often  answers
well, and is preferable to  pills.  It  is made
follows:—Take of aloes, saffron, and myrrh,
bruised, of each one drachm and a half; ex-
tract of liquorice seven drachms; carbonate
of potass three scruples;  water thirty fluid
ounces.  Mix  the whole together,  and boil
down to  twenty fluid ounces.  Filter, and
add  compound tincture of cinnamon seven
fluid ounces.   Aloetic  purgatives  may be
taken habitually for a long time without an
increase  of the dose being  required;  the
continued use, however, may induce piles.
  Refer to Purgatives—Pills. 
A  L T                 28                A M  A
  ALTERATIVE is a rather indefinite term ]
applied to certain medicines which are sup-
posed  to have the  power of changing the
various disordered actions of the body, with-
out producing any sensible effect when taken.
Mercury given in small doses, more particu-
larly as it  is in  Plummer's  pill, is perhaps
the best example of a medicinal alterative.
There is, however,  an alterative preferable
to medicine—obedience to the laws of health.
Temperance in eating and drinking, exercise,
attention to the state of the skin, and to the
ventilation of sleeping-rooms especially, are
alteratives which every one may employ.  A
course of medicinal alteratives must be left
to medical direction.
  ALUM is a compound salt of  sulphuric
acid, potash, and alumina.  It is a powerful
astringent, and is used as such in medicine.
In bleeding, especially from the  nose, lint
dipped in a strong  solution of alum, and ap-
plied  to the part as a plug,  will often stop
the flow, or, in  the case of  leech-bites, the
powder of  burnt alum  may be  sprinkled
upon  the puncture.   Internally, alum  is
given in cases of protracted diarrhoea, and
in hemorrhage from the lungs or stomach,
Ac.  In case of an individual being attacked
either with coughing up or vomiting of dark
blood, in the absence of medical assistance,
alum, which is generally easily procurable,
may be given in  doses of from five to twenty
grains every two or three hours.   In cases
of that painful  spasmodic affection of the
bowels named painter's colic—to which those
who  work  much among lead are liable—
alum has recently been found of much ad-
vantage, and might safely be given provi-
sionally, by an unprofessional hand, to ame-
liorate suffering—the  dose  is from ten  to
twenty grains every three or four hours.  As
an astringent gargle in relaxed sore throat,
alum is most useful in  the proportion of two
drachms to half a pint of water.   Alum may
be given in pill, but better in solution,  in
distilled water flavoured with cinnamon  or
some aromatic.  Alum whey, made with five
grains of the salt to every ounce of [hot] milk,
and  the curd strained  off, is a pleasant and
convenient  form:—a teacupful to be taken
three times a day.  A few grains of alum,
agitated with the  white  of  an  egg,  form  a
coagulum which, put between two folds of
muslin, is used with benefit  to the bed-sores
of the sick.  [It is also useful in  bringing a
"sty" to a head.   In  croup, a teaspoonful
of powdered alum,  repeated every  twenty
.ninutes, is a certain emetic]
   ALVEOLUS—The socket of a  tooth.
   Refer to Hemorrhage—Croup.
  ALVINE.—Connected with the belly—as
alvine discharges, concretions, &c.
  AMAUROSIS, the gutta serena of Milton,
is total or partial blindness, depending upon
disease of some portion of the nervous  con-
nections of the eye.  The retina, the brain,
the optic nerve, may any of them be the seat
of the disease.   The appearance of the eye
is unaltered beyond the dilatation of the pu-
pil, which  gives it a  peculiar  dark, deep
look,  but  the  expression  is  unmeaning.
Persons who exercise the eyes much on mi-
nute objects, or who are much exposed to the
glare of intense  light,  are liable to become
amaurotic ; but  in such cases, the disease is
mostly the  result of some amount of inflam-
mation going on within the eye itself,  and
if taken  in time, is remediable.  A person
threatened  with amaurosis, first observes, in
the day time, dark motes or specks floating,
as it were,  before the sight,  at first distinct
from one another, but gradually becoming
connected,  and forming, as it were, a thicker
and thicker veil as the  sight becomes ob-
scured.   In the  dark,  the motes or specks
frequently appear luminous.   Sudden flashes
of light appearing, is a symptom not unfre-
quent; there is usually pain in the eye and
head.   It must  not be supposed, however,
that every  one who sees  motes or specks is
becoming  amaurotic;  some persons  have
this peculiarity of vision, either habitually,
or whenever the stomach is  disordered.   In
addition  to the causes above stated, amau-
rotic blindness may be the  result either of
overfulness of blood or of the contrary con-
dition, of disease of the brain, of  indigestion,
sexual excess, hysteria,  gout, overnursing,
&c   In such a disease, requiring the nicest
discrimination of the medical practitioner as
to cause, before he can  adopt  appropriate
treatment,  no unprofessional person is quali-
fied to interfere.   An  individual threatened
with amaurosis cannot too soon submit him-
self to skilful advice, and should let no  con-
sideration  stand in the way of his doing so
as quickly  as possible.   Should  distance, or
any unavoidable cause, occasion delay, all
exercise of the eye should at once be stopped,
the general health and condition of the boweh
attended to, and, unless there is evidence of
extreme weakness, all stimulants avoided; if
the patient is a nursing female,  the  child
must be weaned  at  once.   Amaurosis, or
blindness without obvious cause, coming on
suddenly in a person of full habit of body, is
always a grave  symptom, and, as in such a
case every minute  may  be  valuable, if me-
dical aid cannot at once  be  got, six or eight
[European, or eighteen  American]  leeches 
A M E                29                 AMP
 may safely  be applied to the temples; an
 active purgative of twenty grains of jalap,
 and four or five of calomel, is to be given at
 once ; and after the leeches, cold  should be
 applied to the  head, and perfect quiet ob-
 served.  All further treatment in this dis-
 ease must depend on the individual judgment
 of the medical attendant.
   Refer to Eye—Brain.
   AMENORRHEA.—See Menstruation.
   AMMONIA.—Volatile Alkali.—Spirit
 of Hartshorn.—A gas in its pure state: is
 used in medicine in  solution, either in water
 or alcohol, or as a salt, in combination with
 carbonic acid or acetic acid.   In the former
 case, it constitutes  the  common  carbonate
 of  ammonia;  in the latter, the solution of
 acetate of ammonia is known popularly as
 "spirit of  mindererus."  The  solution of
 ammonia in water is  used of two different
 strengths; one very strong,  generally em-
 ployed externally ; the other more diluted—
 " diluted  solution of  ammonia"—given in
 cases of fainting, depression of the system,
 or as a stimulant antacid in indigestion; or
 in spasm,  in  doses  of from five to twenty
 drops, in water or  other  simple  fluid.  In
 cases where a very rapid effect is required,
 ammonia is advantageous ; but when  there
 is partial insensibility, care  must be taken
 that choking is not produced in the adminis-
 tration.   When combined with olive-oil, am-
 monia forms  a most useful and general-
 ly used stimulant  liniment,  [volatile  lini-
 ment.]  Two parts by measure of  oil, to one
 of the diluted solution of ammonia, is a con-
 venient strength;  or equal parts of  each
 may be used if a stronger form is requisite.
 Poisoning  by  ammonia  sometimes  occurs,
 particularly by mistake: the best and most
 convenient antidote is vinegar, or  any  vege-
 table acid.
   Carbonate of ammonia is  an instance of
 two gaseous bodies forming,  by their union,
 a firm solid.   The actions and uses of this
 salt are the  same  as those  of  ammonia;
 it may, however, be given in pill;  if in solu-
 tion,  five grains dissolved in three table-
 spoonfuls of water is an  average dose.
  The aromatic spirit of  ammonia, or sal-
 volatile, is perhaps the best and most con-
 venient form  for internal administration—
 certainly so for popular use.   It keeps good
 any length  of time  in a stoppered  bottle;
 and the dose, which is from a half to a whole
 teaspoonful, in three parts of a wineglass-
 ful of water, is  easily and readily adminis-
 tered.   Solution  of  acetate  of  ammonia,
 popularly known as " spirit of mindererus,"
is a very certain and safe diaphoretic,  pro-
ducing free perspiration.   In colds and slight
      c2
 febrile ailments, it may be  given  withoul
 fear,  in  tablespoonful  doses, diluted  with
 water, repeated every few hours, its effect
 being assisted by warm drinks and confine-
 ment to bed.
   AMMONIAC GUM.—A stimulant expecto-
 rant.used also in the form of stimulant plaster.
   AMPUTATION can never legitimately fall
 within the scope of unprofessional surgery,
 except when it is occasioned by violent acci-
 dent,  and when a longer  or shorter  time
 must  elapse  before surgical  assistance be
 procured.  The  immediate danger  in  such
 cases is fatal hemorrhage, or  bleeding; but,
 fortunately, from the usual  nature of the ac-
 cident, this does not occur to so great an
 extent as might be expected: the bruising
 or tearing which generally  accompanies the
 severance of the limb acts as a preventive.
 The first thing to be done  in such an acci-
 dent,  if there is much bleeding, is  to  tie  a
 handkerchief, a garter,  or band  of some
 kind,  round the limb, between the bleeding
 points and the body, [twisting it tight,] and
 if a pad can be placed over the trunk of the
 main artery, so much the better.  It is better
 not to attempt to wrap up the wound itself
 too soon ; it should be freely  exposed to the
 air; there is no better stauncher of blood
 than  a  cool  breeze:  above all things, the
 bathing with water, especially warm water,
 which is so frequently done, is to be avoided.
 In addition, the wounded member should be
 elevated above the  level of the body.  When
 the bleeding has ceased, which it will almost
 certainly do  if  these means are properly
 attended to,  a soft linen cloth, or cotton, if
 there is no linen at hand, should be placed
 over the wound,  the patient kept quiet in  a
 recumbent posture, with the limb  slightly
 but easily elevated, and nothing more  done
 until the surgeon's  arrival.  No mention has
 been made of the method by which the sur-
 geon secures a cut  artery by tying:  it i9 not
 a procedure to be  attempted  by the  unpro-
 fessional, except in most extreme  circum-
 stances, such as  the certainty of no  medical
 assistance being  procurable for many hours
 it might be days.  In such a  case, it would
 be impossible to keep the tight band round
 the limb without mischief  ensuing:  by
 slightly relaxing it, after some reaction has
 come  on, the situation of any  arteries likely
 to bleed would be made evident by their im-
 mediately doing so.   A slender but  firm
 hook,  or pair of small forceps, should be
 used to pull forward every bleeding point in
 succession, so far as to allow of a ligature
 [string]  of  silk or fine twine being  tied
| around it by a second person.  The cessa-
| tion of the flow of blood will indicate whether 
A  N JE
30
AN G
this has been done effectually; at the same
time, the oand round the limb must not be
removed, but only relaxed, and left so that it
can be instantaneously tightened, should he-
morrhage return.  In such an extreme case, '
it might be almost a matter of necessity to
detach a limb, the bone of which  had been
crushed through and the main artery severed,
by a few strokes of a sharp knife.  Of course,
after such  an accident, watch, with light,
must be kept up during night.  Should heat
and inflammation come on, cloths dipped in
cold water  may be freely applied.
  Refer to Artery—Hemorrhage—Tourniquet.
  ANAEMIA.— Chlorosis.—A condition of
constitution,  in  which the  quality of the
blood is deficient, in its red globules, or co-
louring  portions,  more  especially.   It  is
common in young females, especially of scro-
fulous  habit.  The  pallor of all those por-
tions of the body, such as the lips,  which are
usually well coloured, sufficiently indicates
the  disease.  Anaemia may arise from acci-
dental causes, such as deficient nourishment,
unhealthy situation, extreme  loss of blood,
or may be of constitutional origin.  In the
former case, it is  generally quickly recovered
from, if the constitution is a good one, under
the use of iron and good living; in the latter
case, it often requires long and patient per-
severance in these and other means to effect
a cure.  General languor and listlessness,
very heavy sleep, headache, mental debility,
impaired, capricious, or depraved appetite,
constipated bowels, and swelling of the feet,
are the general accompaniments of anaemia;
the  monthly  secretion  is  either  absent or
very pale.  The  primary cause of anaemia is
still obscure, but  the direct cause of the
symptoms  is undoubtedly poverty cf the
blood; and to improve the vital  fluid must
be the  great aim of treatment.  The bowels
should be  kept  open, not purged, by some
mild aperient, such as  the compound rhu-
barb or colocynth pill, and ten drops of the
muriated tincture of iron, or two grains of
the  ammoniated  tartrate of iron, given in a
wineglassful of water twice or three times a
day.  If the appetite is deficient, and does
not improve, a dose of tonic bitter, as quinine, ■
Balicine, or gentian, must be given along |
with or substituted for  one dose of iron, j
Codliver-oil is also useful.  The  diet must
be generous ; meat twice a day; eggs if pre-
ferred,  puddings in  small proportion, and
bread  partly substituted  for vegetables.
Malt liquor, especially porter, to the extent
of one of the usual pint bottles,  should be
taken in divided portions daily, or a couple
of glasses  of port wine,  if the former dis-
agrees.  An anaemic patient ought to retire ]
to rest by ten o'clock, and to rise, as a gen-
eral  rule,  by half-past  seven,  but ought
never to delay breakfast beyond the mere
time required for dressing ;  going out before
the meal is quite out of  the question,  and,
indeed, in some cases, where there is a ten-
dency to fainting, it is better to  have a cup
of coffee, or warm milk, before  lising, and
even to this, as a temporary remedy, it may
be requisite to add a teaspoonful of brandy.
The skin must be attended  to, but by tepid
sponging only.   The bed should be a hair
mattress.   Exercise in the open uir on foot
or horseback must be regular, but not car-
ried  beyond comfortable fatigue.   Change
of air to  the seaside,  or  to a  chalybeate
spring, is of great  service. Mothers  are
often  anxious about the non-appearance of
the monthly discharge; its absence is but  a
symptom of the disease, and it is better that
the constitution should not be drained eveu
by it, until it is able to  support it.  Such
are the general rules respecting amentia, but
a confirmed case should  always be submit-
ted to the  medical man:  causes may be ag-
gravating, or effects, such  as consumption,
springing  from  the disease, which  he only
can detect.  Moreover, in extreme cases of
this disease, sudden death has occurred.
  Refer to Chalybeates—Iron, Jfc.
  ANvESTHESlA.—Loss of sensation.
  ANALYSIS.—The art of separating and
distinguishing the various constituents of  a
compound body, either  as regards quality
or quantity.  In judicial inquiry it is  most
important, and  were its  power  and perfec-
tion more generally known, the dread of al-
most certain discovery would tend to check
the too common crime of poisoning.  It is
possible for the chemist  to make the thou-
sandth of  a grain of arsenic demonstrable.
  ANASARCA.—See Dropsy.
  ANATOMY.—The  science which  treats
of the structure of organized beings.  It is
divided under the  heads of General Anato-
my, which regards the general features and
relative position of the various  portions of
a body, and [Special  Structural] Anatomy,
which regards the intimate and microscopic
structure of the various  textures.
  ANCHYLOSIS.—Stiffening  of  a joint:
it may be complete or partial.   In the for-
mer case it is best let alone ;  in the latter,
much may be done to restore the motion of
the part  by friction with  oleaginous sub-
stances,  codliver-oil, &c ,  by bathing the
joint with  warm sea-water, and  by daily,
constant, gentle attempts at movement.
   ANEURISM.—See Artery.
  ANGINA PECTORIS, or Spasm  of the
Heart, is one of the most formidable and 
                A N (J

painful  of the affections which  terminate
human life.   It occurs more generally after
middle age,and is more frequent in men than
women.  The attack is characterized by the
sudden onset of  agonizing pain, referred to
the centre of the chest,  or a little to the left
side of it, passing through to  the spine, up
to the left shoulder, and  down  the arm of
the same side even to the extremities of the
fingers.   Sometimes both arms are affected.
Along with the pain, which is always said
to be  agony  beyond description, there is a
sensation as  of  instant impending death.
The paroxysm  ceases  as  suddenly  as it
comes on.   Angina pectoris  may be pre-
ceded by warning  symptoms, palpitation,
shortness of breathing, indigestion,  or it
may come  on unheralded by any of these,
generally during some slight  exertion, as
walking  up  hill, or during strong mental
emotion, but not unfrequently in the night,
after  the first sleep.   An attack of angina
pectoris  is  an   emergency  affecting life,
to  which there  are  few equal; full,  in-
stant  stimulation is demanded, and the first
agent of the kind at hand must be  used,
till other remedies  and proper  assistance
can be  procured.  A  glass of spirits and
water, as hot and strong as it can be swal-
lowed, and with it (if procurable instantly)
sixty  drops  of laudanum, must at once  be
given.  A strong mustard poultice  is  at
once to be applied to the front of the chest,
the same being placed between the shoulders,
and hot applications made to the feet.  If the
paroxysm be  not subdued in a quarter of an
hour,  the stimulant is to be repeated with
half the quantity of laudanum, and this
again, after the same interval, if requisite.
Spirits have  been mentioned, as being  the
most  readily procurable, but when  ether
and sal-volatile, either one  or  other,  or
both,  are at hand, they  are  preferable, and
must  be given in just so much  water as will
permit of their being swallowed ; a teaspoon-
ful of each, with sixty  drops of laudanum.
A person wiao has once suffered  an attack
of  angina should  never be without  these
three requisites, laudanum, or (better, Batt-
ley's sedative solution,) ether, sal-volatile.
It is needless, perhaps, to say,  that all these
measures  of  an  emergency  in which  not a
moment is to  be lost,  are while waiting  the
arrival of the medical  attendant, and that
to him must  be intrusted  the direction of
that regulated mode of life,  which  must
ever be adopted  after an attack of this dis-
ease.   The treatment of the emergency it
may be highly important for  an unprofes-
sional person to  be  acquainted with; that
jf  the interval, which may with care ex-
1                 ANI    .

tend to months, or even years, must be left
in the hands of educated skill alone.          „
 ANIMAL HEAT—Is the temperature which
every animal  body is enabled to  sustain,
independent  of surrounding media.   In
healthy men the average temperature of the
body is 98° or 99°, in some diseases it rises
considerably. Whether our animal tempera-
ture is sustained in part from other sources
or not, it  is generally now considered to be
chiefly due to  the continual union of the
carbon and hydrogen derived from the food,
and from the bodily tissues, with  the oxy-
gen conveyed to every portion of the living
frame from the lungs by the blood.   One
great fulfilment, therefore, of the  food we
digest is to keep us warm, by the continual
combustion of elements going on within us;
consequently, persons who can consume and
digest large quantities of food have much
greater power of resisting cold  than  those
who cannot, and chilliness is one very con-
stant symptom of impaired digestion ; the
stomach  being unable to keep the system
supplied with fuel.  The point is one of con-
siderable  importance  in  the selection of
crews for arctic expeditions, and ought to
have some  influence  with intending emi-
grants in their choice of a future home.  An
individual who suffers from habitual weak-
ness of digestion,  ought  to choose  a warm
or genial climate, in preference to a cold one.
Fats and  oils  especially,  which  contain
much carbon  and  hydrogen, afford great
protection against  severe cold ; accordingly,
all northern people,  like the Esquimaux,
consume them in large quantity, and Euro-
peans travelling in northern latitudes have
always copied the natives in this  respect.
Alcoholic  fluids, like  fat and oil,  contain
much carbon  and hydrogen, but their sti-
mulant properties  and more evanescent in-
fluence  render them unfit for ordinary con-
sumption  to sustain animal heat, although
on  extraordinary occasions they are invalu-
able. When from illness or any other cause,
sufficient food cannot be taken to keep up a
due temperature, fuel is supplied at the ex-
pense of the bodily tissues, more especially
of the fat, as is the case in hibernating ani-
mals ; and if illness, such as fever-, continues,
even the supply within the  body threatens
to fail, and the person is actually in danger
of dying of cold.  It then becomes impera-
tive to get into  the  circulation as  much
"respiratory food," as much nourishment
as possible,  simply as  fuel.   Much may be
done by strong  animal broths, but alcohol
is the great resource, in whatever form it is
most advisable ; it passes readily into and
mingles with the blood, and affords an im-
3 
•    A N I                  32                  A N  K
mediately available  supply of carbon and
hydrogen to keep the animal temperature
going.   The regular, steady supply of wine
when required in fever, must be kept up, and
this cannot be too strongly impressed upon
the mind of the attendant.   Half an hour's
nap on the part of the nurse may lose a life.
  But internal heat cannot do all in our cold
climate, and with artificial modes of  living.
It is of the utmost importance, especially in
the young and delicate, to maintain the full
temperature of the surface by proper cloth-
ing.   The subject is one respecting which
much carelessness  and ignorance prevails
in all classes of society in this country; and
children, half clothed for the  sake  of  ap-
pearance, with  bare chests and limbs, and
exercise not sufficiently active to counteract
the effects of the chill, are exposed to all the
evils resulting from internal congestions of
the blood repelled from the surface.  Warm
clothing is in  some respects a substitute for
food, and either man or animal requires less
nourishment when protected from  cold.   It
is well known to  agriculturists,  that sheep
or cattle will fatten more quickly  under
cover,  in winter, than  if  exposed  to  the
weather.  The reason is obvious: they  are
able to store up in their bodies that which
otherwise must have gone to keep  them
warm.   When it is considered, that abstrac-
tion of animal heat by cold and wet is  one
of the  most fertile sources of fatal disease,
the importance of maintaining the full tem-
perature of the body is manifest.  It is well
known that exercise is the best antagonist
to cold:  it is so by quickening the respira-
tion, and thus increasing the supply of oxy-
gen taken in  by the blood,  which is  also
circulated more rapidly.  In fact, to use the
simile which compares the body to a stove,
exercise gives a free draught for the process
of combustion.  Continued exposure to an
extreme  degree of cold, which  carries  off
the animal heat more quickly  than  it can
be generated,  it  is well known,  gives rise
to overpowering drowsiness,  which, once
yielded to, is death.  It must  be resisted,
and when one of a party thus exposed is in-
clined  to yield, the others must  resort to
every means calculated  to rouse, even, as
has been done,  by  threshing  him along:
the temper which is excited is a  most  ex-
cellent resistance to  cold.
  Refer  to Aeration—Blood—Lung—Circu-
lation—Food.
  ANIMATION SUSPENDED—Is  the term
applied  to that condition in which the  life
of the body  is threatened in consequence
of respiration having been stopped  or  im-
peded, but  in which there still exists  a
possibility  of life being  preserved.   The
chief causes of suspended animation are
drowning,  hanging,  immersion  in  choke-
damp or irrcspirable gas, and intense cold.
These may be referred to under their proper
heads.  [See Drowning,  Hanging, Choke-
damp.]
   ANISE.—An aromatic  and carminative,
which is used, chiefly in  the form of the
distilled water, to correct flatulence in chil-
dren, but is not so generally liked by them as
dill-water, which is equally efficacious. The
dose Is a teaspoonful.  The essential  oil of
aniseed  is  used to flavour  mixtures, and is
given in doses  of five or  six drops, for  an
adult, upon lump-sugar.
  Refer to  Carminative.
  ANKLE—Is the joint connecting the foot
with the leg, (fig. v.;) it belongs to the class

                 Fig. v.
of hinge joints, and  is formed by the ex-
tremities  of  the large and small bones of
the leg, [tibia and fibula,] (fig. v. 1  and 2,)
on the one side, and the smooth,  " articula-
ting" surface of a bone of the foot, named
the " astragalus," on the other,  the whole
being kept in place by means of strong liga-
ments, 4 and 5.  The position of the ankle
joint renders it peculiarly liable to injury—
strain,  dislocation, or fracture  of the leg
bones close to their extremities.   Whenever
the least  suspicion exists  that violence to
the ankle has caused more than a  sprain,
no  time  should be lost in submitting it to
the examination of the surgeon:  such inju-
ries are often extremely obscure, and there
is much difficulty in making out their exact
nature after  swelling has come on.  A sim-
ple sprain of the ankle  is to be treated in
the mode directed to be followed in these
injuries generally.  [See Sprain.]  In cases
of dislocation, occurring at a great  distance
from  medical aid,  and when, from  the ex-
treme distortion of the  foot, the  accident is
distinctly apparent, some attempt ought to
be made by those near to replace the parts: 
AN 0
33
ANT
for this  purpose, the sufferer  being laid
down, one  individual should grasp the leg
firmly just below the calf, whilst another,
grasping the heel with his left hand, and the
lower part-of the instep with his right, en-
deavours, by extension in the first place,
and slight  turning of the foot  toward its
proper position, to reduce the dislocation.
  The ankles in children  are very apt to
become gradually  distorted from  general
weakness, or from relaxtion of the ligaments.
As  the deformity is often not discovered
until  it  has  considerably advanced,  the
bones become  altered in shape, and even
the spine  affected, from  the habitual mal-
position  of the body.   The  best constitu-
tional remedies are attention to the general
health and strength of the child, as directed
in the article "Children," the prohibition of
long standing,  and enforcement of regular
but moderate  exercise.  The  ankles ought
to be bathed every morning with cold  salt
water, and well rubbed afterward with  a
rough  towel.   Many contrivances,  boots, of
various kinds,  &c, are and have  been used
in cases of weak ankles ; unless in extreme
cases, they are better avoided, and the case
left to the  gradual strengthening measures
above recommended.  If artificial supports
supply the place  of the natural ones, the
latter will  not  regain the proper  tone  and
strength  essential  for permanent cure.  One
of the many  forms of elastic sock or stock-
ing may, however, be worn with advantage.
In  addition to  the  above  means, consider-
able mechanical power may be  exerted by
making the  inner or outer margin of the
sole of the boot (for cloth boots should al-
ways be worn in such case) thicker or thin-
ner, according to the nature of the deform-
ity ; thus,  if the ankle be inclined  to pro-
ject inward,  the  sole should be  raised on
the  inner  side, and  vice  versa.    Regular
perseverance  in the above mode of treat-
ment will,  in   most cases,  effect  a cure
without the more  complicated contrivances
often used.  Attention,  too, ought always
to be paid to the habits of standing prac-
tised by the   child.   Children are some-
times born with ankles distorted. See Club-
  ANTACID—In medical language, mean*
whatever  directly neutralizes acid  secre-
tions, more especially of the stomach and
bowels.   The principal antacids are potash,
soda, ammonia, lime,  chalk, and magnesia.
The  use of antacids can only be palliative,
and their continued regular use is produc-
tive  of  serious  mischief;  they  inevitably
destroy the tone  of the stomach, and aggra-
vate permanently the evil they may tem-
porarily relieve.   Whenever antacids are
frequently called for,  it is a sign that there
is other disorder, though perhaps less pro-
minent,  which must be looked for and cor-
rected.
  Refer to Dyspepsia—Digestion.
  ANTHELMINTICS—Are medicines which
remove the different species of worms found
in the alimentary canal.   See Worms.
  ANTIMONY—Is the metallic  base of our
antimonial preparations:  of these, the most
useful  are tartarized antimony  or tartar
emetic,  antimonial   wine,  antimonial  or
James's powder, and  the compound, Plum-
mer's pill.  Of these, tartar emetic, the most
powerful,  is'a remedy which stands  without
a rival  as the controller of some forms of
inflammation.  A compound salt  of anti-
mony, potash, and tartaric acid, it is -formed
in crystals, but usually sold  as a white
powder.   It  is sufficiently soluble in water
to be  conveniently  administered  in  that
fluid, whith should always  be used  soft or
distilled :  a simple solution of the medicine
is  preferable  in most  cases.  In large doses,
tartar  emetic acts as a  powerful  irritant
poison,  causing  intense nausea,  vomiting,
severe pain in the bowels, purging? bloody
stools, and extreme general depression ; and
even in  comparatively small doses, these ef-
fects are  sometimes  liable to  be  developed
in degree, especially in children.    Great
caution, therefore, is  required.  In case of
a  poisonous  or  overdose of tartar emetio
having been swallowed, the best  remedy is
some astringent infusion, Peruvian  bark,
nutgalls, or strong tea.   There is consider-
able variation in the strength  of the dose
of tartar emetic given  by medical men:
when, under  necessity, it is dispensed by
others, the sixth to the  eighth of a grain
only should be  given to an adult.   A con-
venient form is to dissolve two  grains of
the salt in half a pint ofiisoft water slightly
warmed, and of  this, to give a tahlespoonful
every three or four hours, so as to keep up
continued  nausea.   Vomiting may follow
the  first dose or two,  but after that, in most
cases, the stomaoh becomes tolerant of the
remedy.  By giving tartarized  antimony
dissolved  in a moderately small quantity ol
FEET.
  Refer to Dislocation—Joint—Sprain, Sfc.
  ANODYNES—Must be regarded as consti-
tuting one of the most benevolent provisions
of the Creator for  the relief of his crea-
tures.  The removal of pain by  an anodyne
is like a breath of heaven.   The more gene-
rally used  anodynes are opium, belladonna,
aconite, conium, hyoscyamus, lettuce, hop,
camphor.
  ANOREXIA.—Loss of appetite. 
ANT                34                  A O R
 water, its irritant effects are less  liable to
 be exerted upon the bowels, and should they
 come on, a few drops of laudanum,  if other-
 wise admissible, must be given in some de-
-mulcent,  barley or rice  water, and the de-
 mulcent alone continued as common  drink.
 To children, tartarized  antimony  must be
 administered  with great  caution,  and is
 better avoided by the unprofessional, except
 in  the extreme cases of  croup or  severe
 inflammation of the lungs  plainly existing,
 and occurring at a distance from proper
 medical assistance.   In  the  former alarm-
 ing disease, tolerably full doses are required
 to  make  a  quick impression  upon  the
 system, and to  induce  speedy vomiting.
 For  a child of six or seven  years, a single
 grain  must be dissolved in  an ounce  of
 water, and  a teaspoonful  of the  solution,
 given, either alone or in a  little water as
 drink, every quarter  of an  hour,  till free
 vomiting  is produced.  In inflammation of
 the  lungs, half the dose  must  be given ;
 but  this advice, let it be remembered, ap-
 plies only to the severe diseases above men-
 tioned, when occurring at a distance from
 medical aid.  The practice of administering
 antimony  to children, generally, is not well,
 unless under medical sanction, and  in those
 of weak constitution  may  be productive of
 serious or fatal results.
   For a simple emetic, antimony is seldom
 well adapted, and should not be used when
 others are obtainable.
   ANTIMONIAL  WINE—Is a solution  of
 tartar emetic in wine, two grains to  the fluid
 ounce.  In  many cases, it  is a convenient
 preparation, but  of  course liable to  the
 same dangers as  the watery  solution ; it is
 much—too much used popularly, especially
 as  an emetic.   In inflammatory  diseases,
 the  amount of wine which must  be given
 with   each  dose is objectionable.   It  is
 most useful  as a simple diaphoretic, given
 at bedtime, in  doses of  from ten to thirty
 drops, and combined  with  half an ounce of
 spirit of mindererus.
   James's powder, although a  secret pre-
 paration,  is comparatively  so  mild  and
 certain in its  operation as  a  diaphoretic,
 that it is very generally prescribed by medi-
 cal men ;  dose, three to  eight grains.  The
 pharmaceutical imitation—antimonial pow-
 der—is not to be dtpended on.
   Plummer's pill contains antimony in small
 proportion.   See Plummer's Pill.
   ANTISEPTIC—A substance which coun-
 teracts the tendency  to  fermentation  or
 putrefaction in organized bodies. Chlorine,
 mineral acids, salt,  alcohol, volatile oils,
 cold  &c., all act  as  antiseptics.   [The es-
sential oil of camphor is an excellent anti-
septic and disinfectant.]
   Refer to Fermentation.
   ANTISPASMODIC—That which   allays
pain arising from  muscular spasm, or  in-
deed any severe pain unconnected with  in-
flammation.  Anodynes, therefore, are anti-
spasmodics, but there are others of the class
which are stimulants, and which do not ap-
pear to possess any anodyne  effect.  The
principal   stimulant   antispasmodics  are
ether—which may also be regarded as nno-
dyne—ammonia, valerian, asafoetida, musk,
and the various forms of spirit, brandy, &c.
The anodyne antispasmodics are quite the
safest for  unprofessional  administration :
they cannot do mischief,  which the stimu-
lants certainly  will, in the event of  inflam-
mation being present.  Heat is, however,
one of the  best,  and  certainly the  safest
antispasmodic for general  use :  in spasm of
the stomach, in colic, in  gravel, in  gall-
stone, indeed,  in pain generally, the con-
tinued  application of heat—as high a tem-
perature as can be well borne—acts certain-
ly, safely, gratefully.  The antispasmodics
above enumerated  are more directly appli-
cable  to the treatment of painful  spasm;
those which are employed  in the treatment
of spasmodic diseases, such  as  St.  Vitus's
dance,  hooping-cough, &c,  are  many  of
them more properly tonic remedies :   chloro-
form,  as a general antispasmodic,  is emi-
nently  serviceable,  [when given  by  the
mouth.  Its inhalation is dangerous.]
  Refer to Anodynes—Spasm—Heat, <fe.
  ANUS.—The  fundament, «,r  terminating
outlet of the alimentary canal.  Itching in
this situation is at times extremely trouble-
some : it will generally be  allayed by slight
relaxation of the bowels,  effected by a few
doses  of  sulphur   and magnesia,   half  a
drachm  of each taken every night,  and  by
the use of a lotion composed of two or three
grains  of acetate of lead  in the ounce  of
water.   Fissure of  the anus is a most pain-
ful affection, which requires the care of the
surgeon.   Prolapsus of the bowel, "falling
of the body," piles, and fistula, all occur in
this situation.   The anus  is kept closed by
a  sphincter  muscle  which  surrounds  it.
When this muscle loses its power, as it does
in some diseases,  involuntary  discharges
occur.
   Refer to  Fistula —Piles—Prolapsus.
   AORTA.—The main artery of the body,
which  arises directly from the heart, and
from which all  the  secondary arteries have
their  origin except  one, the pulmonary.
See fig. vi.  The aorta is divided   into an
ascending portion A, an  arch B, and  a  de- 
APE
35
APH
scending portion C, the latter  being sub-
divided into a thoracic portion C, and abdo-
minal C 2.    The origin  of  the  aorta from
the heart is just opposite  the junction of
the fourth rib with the breastbone.   The
passage  from the heart  into the  aorta is
closed by three "semilunar" valves, which,

                  Fig. vi.
when perfect, effectually prevent any regur-
gitation of blood.
  Refer to Artery—Heart.
  APERIENT.—Whatever opens the bowels
gently—a  laxative,  in  contradistinction to
purgatives and cathartics, which act strongly.
See Laxative.
  APHONIA.—Loss of voice may be owing
to inflammatory  swelling, either  acute or
chronic, or to ulceration of the lining mem-
brane  of  the larynx,  to  paralysis, or to
hysterical  affection.  Coming on suddenly,
accompanied with fever, pain in the larynx
and  upper part of the  throat, increased on
swallowing, with difficulty of breathing, the
above symptom must be regarded with some
apprehension, as  one of the concomitants of
a rapidly  fatal  disease,  acute laryngitis.
Loss of voice, however, frequently occurs
quite unconnected with the other symptoms
mentioned, and is then not to be so seriously
regarded.   Many  persons are  liable to it
after  exposure to  night  or foggy air, or
after much or loud talking   Persons living
in damp houses suffer  from this form of
aphonia, which  is  probably owing to the
thickening or great  susceptibility of tin
laryngeal membrane.  When it continues,
nothing affords greater relief than antimo-
nial ointment, or croton oil, rubbed over the '
forepart of the neck so as to produce a free
eruption.  Blisters may be used, but are not
so efficacious.  A  hot bran poultice  [or a
small mustard-plaster] applied to the throat
at night, and a teaspoonful of paregoric,
taken along with twenty drops of ipecacuan
wine, will often remove a threatened attack.
In the more chronic form, twenty drops of
tincture of squills may be substituted for the
ipecacuanha.  A sirup made with infusion
of horseradish is popularly and sometimes
beneficially  employed.   Persons who are
liable to loss of voice  ought never to expose
themselves to damp, cold, or night air, with-
out protecting the mouth by means of a light
shawl or respirator of  some kind, and should
keep  the feet well  protected,  not so  much
on account of the system itself, though that
is troublesome enough,  but because of the
indication it affords of general delicacy of
the bronchial membrane.   When along with
loss  of voice, there  exists hoarse cough,
pain, and  expectoration  of thick mucus,
ulceration is to be suspected, and the case
as soon as possible put under proper medical
care.  Aphonia  from  paralysis or'hysteria
must fall under the  general treatment of
these diseases.
  Refer to Larynx—Laryngitis—Expectorants
—Respirator.
  APHTHA.—Thrush is more especially a
disease of early infancy, affecting the mouth
and  fauces, the lining membrane of which,
in this disease, appears as  if sprinkled over
with bits of milk curd.  Recent researches
have discovered  that  upon  these patches a
filiform description of minute fungus  is de-
veloped, which  probably finds  a  congenial
habitat in  the disordered  secretions which
are the main feature of the disease;  excess
of acid, and  irritation of the mucous lining
of the bowels always existing.   The disease
is not generally serious: it is  accompanied
by slight fever  and drowsiness, and passes
off in eight or ten  days;  during  the  time,
however, it  interferes with the child taking
the breast properly.  Aphtha is very often
the result of improper  feeding with bread
and other things unfit for the infant stomach.
The first thing to be done when an infant is
affected with thrush  is  to  correct the acid
state of the bowels by a few grains of cal-
cined magnesia—in this case  preferable to
the fluid form—or if the bowels 1  e relaxed,
by chalk, following the antacid \y a  mild 
APN                  36                  APO
dose of ca.«tor-oil.  This may be repeated
every second day.  The quality of the milk,
and state of the nipple of the mother is to
be examined, and the food,  if any be given,
regulated;  milk and water, two parts of the
former  to  one of the latter—in which  a
little isinglass should be dissolved if there
is  diarrhoea—is to be  the  sole addition to
the mother's supply; all saccharine matters
being avoided.   If the state  of the bowels
be corrected, the thrush will generally get
well, but it is expedient to assist the cure
by the use of a solution of borax in water—
one drachm to half  a  pint—used  to wash
the mouth.   The common system of mixing
borax with  honey is not advisable,  as the
saccharine  matter may favour the fungoid
growth.  When the case is mild, the aphthae
separate in seven or eight days, leaving a
healing surface below,  and  the mouth soon
gets well; that is, if it be not injudiciously
scrubbed ("cleaned")  dailj by the  nurse.
In  children of weak constitution, or  who
are exposed to unhealthy influences,  thrush
may assume a  malignant  character;  the
aphthous specks become  black, and ulcera-
tions form on their site, diarrhoea increases,
and the belly  becomes tender, the child  is
drowsy, or  it may be convulsed.   In such
cases, the  chlorate  of potash, internally,
and saturated solution of  sulphate of  cop-
per applied to  the sores, as  recommended
by  Dr. West, [England,] are  most useful,
the strength being at  the  same time sup-
ported  by a teaspoonful of  strong broth, in
which  isinglass has been  dissolved, given
frequently.   When,  however, the disease
assumes this dangerous character, medical
assistance must be procured at once.  Chil-
dren past infancy, and even  adults are some-
times affected with aphtha.   Regulation of
the bowels by a mild aperient—castor-oil—
chlorate  of potash internally, and  borax
wash, are the best remedies.  Bismuth  is
sometimes useful.  The diet should be mild
and unirritating, chiefly milk and farina-
ceous articles.
  APNG2A.—Imperceptible breathing, such
as occurs in fainting, and in  some nervous
affections.
  APPETITE.—The  instinctive  desire for
food which  is  periodically,  and,  in  health,
regularly experienced, is  a  real  blessing
given  to us by God, and  its temperate en-
joyment is  a  sign of  a  sound mind in a
sound body. The sensation of hunger  doubt-
less originates in the system at large, and
its removal by the presence of food upon the
stomach  must be due to the sympathetic
connections of that organ with the system.
All that is required for the immediate ap-
peasement of hunger is the presence of n
substance, it may be of very small noun>n-
ing power,  in the stomach: the unctuous
earth consumed by the American Indians,
and  the berg meal of Norway,  act in this
way.  Taste has nothing to do in satisfying
the appetite.  Mr. Beaumont, who experi-
mented  in the  famous case of  St.  Martin,
found that  appetite was quite as well ap-
peased by food  passed into the  stomach  by
the external opening, as if it had been swal-
lowed.  A regular appetite is generally a
symptom  of a healthy state of  system;  as
soon as  disorder occurs, the appetite  flags,
nature  herself stops the  supplies, which,
instead  of nourishing the body,  would only
increase the embarrassment  of the  func-
tions; but this is not understood, and the
sick are too often tempted and  pressed  by
anxious attendants to take nourishment, to
their own  hurt and discomfort.   Even then
nature asserts  her right, and the stomach
rejects what it did not desire.  The longings
of appetite sometimes appear to be almost
instinctive, especially in illness, particularly
where there has been  much or obstinate
vomiting.  The patient will  express a strong
desire for some  article of  food or  drink
which  our  preconceived ideas  or theories
would certainly  forbid, but which,  being
permitted, seems  at  once to -agree.   When
the various morbid deviations from natural
appetite are considered, such latitude re-
quires of course great caution ;  but the fact
should not be lost sight of:—a variable ap-
petite, at one time deficient, at another mor-
bidly active, is  scarcely  consistent  with
health.  In children it is  often indicative
of worms.   Depraved  appetite  consists  in
the longing for or devouring substances not
intended for food, such as chalk, slate, pen-
cils, cinders, earth, &c.:  the symptom is not
unfrequently a  concomitant of the chlorotio
diseases of young females.   The " dirt-eat-
ing" of  tropical climates is another form of
depraved  appetite.
  APOPLEXY—Is an affection of the brain.
during the continuance of which, sense and
voluntary  motion  are wholly or partially ex-
tinguished : the patient lies unconscious, as
if in  deep sleep,  and cannot be roused  by
any  ordinary means.   More generally the
face is flushed, and the vessels  of the head
and  temples appear over-filled; there  is
snoring, or stertor, as it is called ; the mar-
gin of the upper  lip is partially or entirely
blown forward  at each  expiration,  and the
pkin is  covered with  profuse  perspiration:
if the eyes are examined, they appear blood-
shot  and   glassy-looking.  In  some  cases,
while the symptoms of insensibil'ty, per- 
APO
37
APO
spiration, &c,  are present, the face is pale,
and the appearance is  one  of general  de-
pression ; the weak pulse contrasting with
its full, hard condition in the former case.
If a person be found in a state of apoplexy,
as  he can give no  account of himself, it is
important  for  others  to  ascertain whether
there is any assignable cause for the circum-
stance.  The head should be examined  for
signs of violence; the breath for the odour
of alcoholic drink;  any circumstances likely
to give occasion to poisoning searched out;
but whatever the condition, no time should
be lost in procuring medical advice ;  in  the
mean while,  much is to be done by well-di-
rected attentions.  Few  attacks of apoplexy
come on without previous warning; the  pa-
tient,  if of  full habit,  has  suffered  from
headache or giddiness, especially on  stoop-
ing, or has  slept much  and heavily;   th#
mental faculties have been  sluggish,  the
memory affected, or vision impaired ;  there
may have  been numbness or pricking in a
limb, or in a finger only; to others, the face
and eyes have looked full and red;—if of
spare habit, there may also have been head-
ache, giddiness, impaired vision, and confu-
sion ; but there has been, also, marked  de-
bility of the mental powers, memory affected,
the power of following a consecutive  train
of thought impaired, articulation indistinct,
while with these the face has been pale,  the
pulse weak,  the whole manner inanimate,
rather than oppressed.  Individuals of san-
guine  temperament, with short necks and
large heads, particularly if they live  well,
are the subjects of the  first set of symptoms ;
those of spare habit, and weak, leuco-phleg-
matic constitution, of the second.   When in
an individual, at any time of life,  but  more
especially after the age of fifty, such symp-
toms show themselves, they should not be
neglected for a day.   It is evident, however,
that depending on two very opposite condi-
tions of body,  the treatment for each  must
be  very different.  The extent and gradua-
tion of this treatment  ought to be  intrusted
to the medical attendant; in the mean time,
if interval must elapse  before that can be
done, the man  of full  habit should at once
reduce  his diet, cut off  entirely, or nearly
so, his*stimulants and spices, and animal
food, eschew supper, take exercise moderate-
ly,  and rise  early.   He  should  purge  the
bowels freely by a couple of calomel and  co-
locynth pills, taken nightly for a few times,
and by salines, such as Seidlitz  powders or
Epsom salts,  a  couple  of teaspoonfuls of  the
latter in half a pint of water, every morning.
Mental excitement is to be avoided,  the head
kept well  raised  in  bed, any thing (either
       D
handkerchief or shirt) round the neck worn
perfectly  easy.  The man  of spare habit
must follow  a more negative plan.  Rest
and  quiet of  body and mind  are  for him
essential; any thing likely to tax the nervous
power, particularly of  a sexual character,
must be avoided; over-fatigue is dangerous;
while the bowels are  kept regular, they
must not  be  purged ;  the diet, easy of di-
gestion, ought to be nourishing; and stimu-
lants, if habitually taken, must not—unless
found directly to  cause uneasiness in the
head—be   discontinued,  without   medical
sanction;  spices, however, should be  avoid-
ed.  The  temperature of the skin generally,
and of the extremities, should be sufficiently
preserved.  When an individual is  seized
with symptoms denoting apoplexy,  it being
ascertained that they neither proceed from
violence to the head, from  intoxication, nor
narcotic poison—(see  Head—Intoxication—
Poison)—during the longer or shorter inter-
val which  may elapse before the medical man
can arrive, much is to be done.  The patient
should be laid on the back, the head and
shoulders  well raised, the  neck bared, and
a free current of air permitted to the head.
If there is much redness and  congestion of
the face and head, with full,  hard pulse, in
a person  of full habit, if, as may happen,
medical aid is far distant in point of time,
and if there is any one present competent to
bleed from the arm, it  may be done to the
extent of from sixteen to twenty-four ounces;
it may not do good, but in such a case it can
scarcely do harm.   If leeches are to  be had
in the case now supposed,  from one to two
dozen of them  may be applied over the head,
temples,  and behind  the ears,  either as an
adjunct to, or substitute for bleeding from
the arm.   The amount of blood taken in this
way, must be left a little to the discretion of
an intelligent lay adviser.  In addition, free
purging should be resorted to.  As the power
of swallowing is lost or impaired, medical
men usually effect this by means of a drop
of croton  oil  placed on  the tongue,  and re-
peated if requisite; but in the circumstances
now  supposed, this can  scarcely be  obtain-
able, and  instead of it,  a clyster containing
salt or soap-water, Epsom salts, turpentine,
castor-oil,  or  whatever purgative is most
readily available, must be given; the warmth
of the feet must be preserved, but  not ex-
cited, by hot water,  mustard, &c.   All at-
tempts at  giving nourishment must be sus-
pended for many hours.   In the event of the
attack presenting the opposite symptoms,
those of depression, all attempts at depletion
are to be avoided; indeed,  it may be requi-
site, in an extreme case, to get a few spoon- 
A Q U                38                A R R
fuls of wine swallowed :  purging must be let
alone, but  the  extremities should be kept
well  warmed, and mustard poultices may be
freely applied to the legs, thighs, or between
the shoulders;  liquid nourishment,  such as
meat broth, must be got down in teaspoon-
fuls  at a time.  To  the  medical  attendant
must be left all beside.   An attack of apo-
plexy may  either disappear or be removed,
and  leave the patient apparently  in perfect
health, or  it may leave him paralyzed in
body and weakened in mind, the man, but
not the same man—changed; strength has
been exchanged for weakness in every way,
for weakness which  increases as  time goes
on, loss of memory, irritability, childish de-
sires, and childish weeping, till in  all proba-
bility one  or more attacks  of  the  disease
close the scene.  Lastly, apoplexy may pass
on to deeper and deeper insensibility; no
sign  of consciousness is ever given,  the
breathing becomes more laboured,  the na-
tural offices are performed involuntarily, the
sweat becomes the cold one of death, which
takes place with or without convulsions.
  Apoplexy may come  on suddenly;  the
person is struck by a blow, but  this form is
less to be dreaded than that which creeps on
more insidiously.  An individual becomes
giddy and faint for a few minutes, perhaps
vomits, but seems to recover; shortly after,
however, he becomes dull, the eyes heavy,
and insensibility gradually comes  over him.
The  first form is most probably owing to
sudden congestion in  the head, or to rapid
effusion of  blood; the latter to  slower effu-
sion : in  this case, the first shock is felt at
the instant the  vessel  gives way, but it re-
quires the  further gradual effusion  to com-
plete the attack.  An individual who has
once suffered an attack of apoplexy,  and re-
covered,  cannot too  carefully avoid every
possible exciting cause.   A momentary im-
prudence, the  stooping to tie a shoe, look-
ing at objects much above the level of sight,
&c, a warm bath, may be sufficient to induce
serious  symptoms.   Especially must  the
bowels be  kept so easy that  straining at
stool is never required.  The system of diet
and regimen should be strictly laid down by
the medical attendant, and as  strictly ad-
hered to by the patient; the mind carefully
kept from excitement.   In no disease, with
exception,  perhaps, of that of the heart,
does  the  man who possesses  habitual self-
control, in  body and mind, possess more ad-
vantage, than  in apoplectic  tendency, over
Ahe slave of passion or of temper.
  Refer to  Paralysis.
  AQUAFORTIS.—Nitric Acid.—Refer to
A'ilric Acid.
    AQUA-REGIA.— Nitro-Miriatig  Acid.
 —Refer to Nitro-Muriatic Acid.
   AREOLA. —A term applied medically to
 the infl.imed circle which surrounds a vesi-
 cular or pustular elevation, such as that of
 the vaccine vesicle.  Also  applied to  the
 coloured circle surrounding  the female nip-
 ple.  Generally, not invariably, previous to
 pregnancy, this areola is light iu colour,  but
 in the majority  of cases, soon after concep-
 tion, it begins to darken, and in some indi-
 viduals, especially in  those of  dark com-
 plexion, it becomes  of a deep brown.  The
 change of colour in the areola, is, therefore,
 classed amid the more certain signs of preg-
 nancy ; but as it has been known to exist in
 the virgin, and  is not universally developed
 in the  pregnant female, it can  never alone
 be taken  as a decisive proof, but only as a
 corroborative, along with other symptoms.
   Refer to Pregnancy.
   ARM-PIT.—See Axilla.
   ARNICA  MONTANA. — Leopard's-bane
 is a plant  bearing a composite flower, found
 in mountainous  regions.  It is scarcely, if
 ever, prescribed internally in this  country;
 as an external  application, however, it is
 much and beneficially used in the treatment
 of wounds and  contusions.   From one  to
 two drachms of the tincture  in half a pint
 of water  forms  a convenient lotion.  The
 homoeopathic  practitioners  claim arnica as
 one of their own  remedies, and their chemists
 ask for their tincture an extravagantly high
 price.  The drug itself has long been used
 externally, on the Continent, and the tincture
 may be procured equally good,  and  much
 cheaper, at many respectable chemists. Like
 every thing else, there is  much  spurious
 tincture sold.   When  the pure tincture is
 dropped into  water,  it gives it a  milky or
 opalescent appearance.
   AROMAT1CS.—Stimulants derived from
 the vegetable kingdom, possessing a more or
 less powerful and generally agreeable odour,
 a warm and agreeable taste.  They are  for
 the most  part products of warm  climates,
 and appear specially adapted to the relaxed
 constitutions of the natives.   A free use of
 aromatics  is said to counteract the  effects of
 malaria in tropical countries.  Some stimu-
 lant is certainly requisite in  those climates,
 and the native productions bestowed by Pro-
 vidence are evidently much  better  adapted
 to fulfil the indication  than alcoholic  ex-
 citants.   Mace,   cloves,  cinnamon, are  all
 aromatics. Angelica is one of the few aro-
 matics of  temperate climates, and  perhaps
 the best.
   ARROW-ROOT—Now so  well known, is
i procured of the best quality from  the West 
ARS
39
ARS
Indies, especially from Bermuda, whence it
is imported in soldered tin cases.  It is now
also imported from East India, and an infe-
rior kind is brought from Tahiti.  Arrow-
root is subject to much mixture and adulte-
ration, but generally—as with potato-starch,
&c—of a harmless character as regards the
consumer. The "Lancet" periodical has re-
cently, by means of its  "Sanitary Commis-
sion,"  thoroughly investigated  the subject
of these adulterations.  The best arrow-root
ought  to  be  pure white, slightly glistening
in the mass, and  the powder of which it is
composed, collected together in small crumbs
or lumps, which break  down with  a  slight
crackling sensation beneath the finger.  Ar-
row-root  is pure starch, and forms a pecu-
liarly stiff jelly.  As an article of sick-cookery
it is invaluable, where mild support is re-
quired without stimulation, and in convale-
scence and chronic disease.  There are few
stomachs with which it disagrees, and infants
both like and do well with it.  At the same
time, it is proper to caution against the too
common error of  trusting too much  to the
nutritive  powers of arrow-root alone,  espe-
cially  for  children.  It  may give support
indirectly, that is to say, by supplying mate-
rial for respiration and animal heat, it may
save the tissues of the body, or it may even
go  to build up  some of  these tissues, but
alone it can never make  bone or muscle, for
the simple reason that  it does  not contain
the  elements  necessary  for these  constitu-
ents of the frame.   A child fed exclusively
on arrow-root, water, and sugar, and such
has  been  the case, must  become unhealthy,
and, without  fail,  rickety.   The  case  is
abundantly altered, when milk is combined
with arrow-root.  In this fluid exists what-
ever is requisite for the  animal frame, nitro-
gen for its muscle, phosphorus for its nerve,
earthy salts for its bone.   The combination
of arrow-root with milk is one of  the best
which  can be given to a child, or to an  adult
in the early stages of  convalescence  from
illness.
  ARSENIC is a metal. The substance which
usually goes  under the name, and which is
also called white arsenic, is an oxide  of the
metal;  it is a too well-known poison,  and is
perhaps  more universally used than  any
other for  destroying life.   Its tastelessness,
cheapness, and  the  culpable facility with
which  it has hitherto been obtainable have
combined to  make  it familiar.  Much con-
troversy has at times  taken place respecting
the effect of arsenic upon the  palate; it is
certain  the taste is very faint, but extreme
irritation of the portions of the lining mucous
membrance of the  mouth and other parts
quickly follows its  contact.  The length of
time after arsenic has been swallowed that
symptoms  take to  show themselves varies
much, depending in all probability upon the
state of the stomach as to emptiness, or the
reverse.   Sometimes they appear in a few
minutes, at other times not for hours.   Poi-
soning by arsenic is distinguished by faint-
ness, nausea, intense burning pain at the pit
of the stomach, and vomiting of its ordinary
contents, followed by that of a turbid brown
fluid, and mucus, often streaked with blood;
intense  burning  heat  in  the  throat, and
thirst;  purging  ensues, cold sweats,  con-
vulsions, death.  The eyes may become in-
flamed, but  this is  more general when  the
case is prolonged,  as it may be, in conse-
quence of  the small dose, or from  other
circumstances ; in this  case an eruption on
the skin is not unfrequent.  The symptoms
of course vary, particularly that of  pain,
which occasionally has been almost entirely
absent.   It  must, too, be remembered, that
the symptoms of cholera morbus and those
of arsenical poison very closely resemble
one another.  When poisoning by arsenic is
suspected, of course the first measure is to
procure efficient  medical aid.   In the mean
time, it is requisite to get as much of the
poison as possible evacuated from  the sto-
mach ; it is seldom necessary  to  produce
vomiting, that most generally comes on soon;
but if it has  not done so, five-and-twenty
grains of white vitriol,  (sulphate of zinc,) if
procurable,  should be given at once, in a
little water; if this is not done, a table-
spoonful  of  mustard in water, (or pounded
alum,) or tickling the throat with a feather,
should be resorted to;  milk, [or"white  of
egg,] which  by its coagulation may envelope
the poison, or thick mucilagious drinks, olive-
oil, alone or mixed with lime-water, may,
any or all, be given, and with them  mag-
nesia.  The great object must be  to  clear
the stomach of the poison as thoroughly and
speedily as possible, for, unlike many other
poisons,  there  is no  chemical antidote to
arsenic which can  be relied on.  A prepa-
ration of iron has  been vaunted, but it is
of doubtful efficacy: if either this or  the
stomach-pump is used, it will be in medical
hands.   In  following the directions already
given, the friends or neighbours of  the poi-
soned person  will  be doing good  service.
Should the  patient survive, and pass on to
the second stage of arsenical poisoning, in-
flammation  of the stomach, nervous symp-
toms, &c, will perhaps end life, or recovery
may follow; but these changes must neces-
sarily be attended to under medical guidance.
White arsenic  is not the only preparation o* 
ART
40
ART
the metal by which  poisoning  occurs ;  the
colouring substances known by  the name of
King's yellow and Scheele's green are both
compounds of arsenic, and being frequently
and  culpably  used in confectionary, have
proved fatal.  Similar symptoms occur and
similar treatment  is to be followed as after
poisoning by white  arsenic.   Whether  in
poisoning by arsenic, or by any  other agent,
the vomited matters should always be care-
fully preserved in a  vessel by themselves,
for medical  inspection; and if  there is any
suspicion of foul play, some responsible per-
son should  place  them under lock and key.
Did those who perpetrate the crime of poi-
soning by  arsenic know  beforehand  with
what certainty the chemist can separate, for
exhibition in a court of justice, the instru-
ment of their wickedness from  the body of
the victim,  perhaps years after it  has been
buried, selfish fear,  if no other considera-
tion, might stop the deed.
  ARTERY.—An  artery  is  a vessel which
invariably  conveys  blood  away  from  the
heart, the blood, with one exception—in the
pulmonary,  or  artery of the lungs—being
bright red,  "arterial," and  flowing in waves
or pulsations, corresponding with the beats
of the heart.  When red ^florid  blood flows,
or is  spirted from a wound in jets, an artery
is certainly  wounded, and  the case is most
probably serious.   Blood from a vein is dark
and black-looking, and flows in a continuous
stream.
  From the aorta (see fig. vii. 1,1) the main
artery of the body, directly connected  with
the heart, various secondary vessels are given
off, to supply the  head and upper extremi-
ties,  and the viscera  of the chest and abdo-
men.  Low  down  in  the latter cavity,  the
aorta itself divides or bifurcates into the two
larg» vessels which supply  the  lower limbs
(fig. vii. 2, 2.)  From  the secondary arteries
other branches are given off, until, at  last,
by division and subdivision, the vessels be-
come " capillary," hair-like in their minute-
ness, forming an intricate network, in which
the arteries end and the veins  begin.   Ar-
teries consist  of  three separate  coats—an
outer or  protective, an inner or lining, and
a middle, partly elastic and partly muscular.
It is the  thickness and firmness of this  mid-
dle coat  which chiefly distinguishes the ar-
tery from the vein.
  As a general rule, the main arterial trunks
run upon the anterior and inner surfaces of
the body;   some  knowledge of their posi-
tions, and especially of those points in their
course at which they can be most easily felt
and compressed, may at times be useful to all.
It is no uncommon thing for medical men to
be called to accidents in which immense and
injurious loss of blood has taken place from

                  FiK. vii.
 a wounded artery, which might have been
 saved to the sufferer by any one possessed
 of sufficient knowledge and presence of mind
 to put his thumb on the main trunk of the
 vessel.  In figure vii. the  portions  of the
 main  arteries most easily found and com-
 pressed are  marked black, and  any one,
 unless very corpulent, may verify the posi-
 tions  by  examination of his own person.
 Wherever  the finger is placed  upon an ar-
 tery, pulsation is felt.
   In woonds of arteries of the head, such
 as upon the temples, there is the advantage
 of the bone, against which it is possible di-
I rectly to compress  the  bleeding  point, and
I when this  can be done, it is thi> beet method; 
                  ART

 otherwise, pressure may be exerted accord-
 ing  to the position of the wound, at A in
 front of  the ear, or just behind the ear; or
 at B,  where the  pulsation of an arterial
 branch may be  found, as it winds over the
 edge of the lower jaw.
   In wounds of the large carotid arteries of
 the neck, pressure is  unfortunately of little
 avail; there is no point to press against: it
 is impossible to compress the artery without
 at the same time compressing the large vein,
 and from the size of the vessel and its prox-
 imity to the heart, the current of  blood has
 much power.  The vessels may be felt beat-
 ing on each side of the windpipe.
   In wounds of the large arteries  about the
 shoulder and  arm-pit,  pressure  must  be
 made with the thumb, or handle of a mode-
 rate-sized key wrapped in a few folds of a
 handkerchief, upon the large  vessel,  at the
 point D, just behind the middle of the collar
 bone, and where it passes over the first rib.
 In the event of a wounded artery lower down
 in the arm, the  compression may be exerted
 over any portion of the course (E) just in-
 Bide the large muscle.  At  the bend  of the
 arm, the  artery divides  into  two  main
 branches,  one  of which (F)  the  pulse ar-
 tery, runs toward the thumb;  the other (S)
 toward the little finger,  in which courses
 both may be felt; from  the free  intercom-
 munication of the arteries of the hand, press-
 ure  is more certain to arrest hemorrhage if
 exerted upon the single trunk of the arm (E).
 In case of arterial bleeding from wounds of
 the lower extremity, it is most certainly and
 easily arrested by pressure on the large ar-
 tery of the thigh, at the  point H,  in or just
 below the groin.  In  all  these cases,  press-
 ure may be exerted by means  of the thumb,
 or by some convenient body, such as the key
 above named.   To compress arteries  in the
 limbs, surgeons use the tourniquet, specially
 adapted for  the purpose; but as a tempo-
 rary substitute,  a handkerchief  tolerably
 firmly tied round the  member, between the
 body and the wound, will answer well; if
 any  one  has knowledge  enough to place  a
 pad—a rolled-up stocking will do—over the
 course of the main vessel, so much the bet-

  ARTERIAL  HEMORRHAGE—May also
 be arrested  by compression  directly upon
 the bleeding point, and this should be tried
 until the'surgeon's arrival, but it must be in
positions, such as the hand, foot, &c,  where
pads can be  firmly bound over the wound.
These pads must be  graduated,  that is, a
Bmall firm one is to be placed directly over
the bleeding vessel,  over the first pad a
larger, and one still  larger over  that, and
      d 2
1                ART

 the whole to be firmly bound with a bandage
 or ribbon—or strip of cloth of some kind; at
 the same time, the site of the wound is to be
 raised above the level of the body.  Above
 all  things, loose wrapping up is to be avoided:
 the wound had better be exposed to the air
 than  enveloped in a hot poultice of clotted
 blood, which  only causes it  to bleed the
 more.  Two cases which recently occurred
 in the writer's  practice will illustrate the
 above directions:—1. A girl, when cutting
 some bacon off the flitch, slipped the knife
 and plunged it into  her hand, dividing one
 of the arteries; it bled fast, and when she
 was seen  by the author some  time after, a
 large quantity of blood had been lost; com-
 presses and a bandage being at once applied,
 not another  drop of blood was lost;  the
 wound was undisturbed for a good many
 days, and quickly healed.  2. A man, when
 sheep-shearing, had  the shears driven into
 his hand by a plunge of the animal, and the
 artery which runs between the  thumb and
 forefinger severed;  he had to come three
 miles to the author's  house, and must  have
 lost above a quart of blood.   In this  case
 the vessel was  tied,  but in either of the
 cases, if, instead of the wound being loosely
 covered, and the hand kept down, some one
 had been sufficiently informed  to tie a firm
 pad over the wound, until proper assistance
 was obtained,  it could not fail to have saved
 either of these individuals a considerable
 amount of blood—and to a poor man, blood
 is money: he  must pay the  butcher some
 hard  days' work, to make up a pound of the
 vital fluid.  Various styptics to arrest bleed-
 ing are recommended, such as  alum, mati-
 co,  fungus, &c.; but in arterial hemorrhage,
 pressure is more to be trusted to.  Surgeons
 arrest hemorrhage  from a cut artery by
 tying the ends with a ligature of silk or firm
 twine.  This might be done in emigrant life
 under necessity.  The  bleeding  point being
 distinctly seen, is by one person to be pulled
 forward, either by a pair of forceps, or  by a
 hook-tenaculum (see Instruments) made for
 the purpose,  sufficiently far  to allow  of
 another individual tying it securely.   The
 sailor's reef-knot is the proper  one for the
 purpose. The end of the vessel next the heart
 is to be tied; but should the lower end bleed,
 as it may do, especially in a few hours after
 the accident, it must be tied also.  The  ends
 of the ligature must not be cut off, but the
 wound should be covered with a cloth dipped
 in simple water, till the surgeon's assistance
 —as it must be—has been procured.  After
 arterial hemorrhage, a persou should always
 be watched, with light,  during the  night,
 and a handkerchief, which could be tightened
4 
ART                42                ART
at any moment, kept closely round the limb.
The application of water, unless it be ice-
cold or nearly so, to  a bleeding artery, is
better avoided—free exposure to  the air is
preferable.  In severe hemorrhage or, flood-
ing after delivery, compression of the aorta
(fig. vii. 1) may be of much avail in prevent-
ing further loss of blood until the arrival of
the medical man.  The hand of an attendant
must be firmly pressed  into the centre of the
abdomen, until the pulsation of the aorta is
felt, and felt to be acting against  the com-
pression, but not beyond it.  The  pressure
must not be relaxed for an instant.
  ARTERIES  are liable to the disease of
aneurism, in which one or more of  the coats
become distended at some particular  point,
into a  sac or pouch  filled with blood.  The
progress of the disease  is for this sac to grow
larger, while its  coverings become thinner
and thinner, until at last they give way, and
the individual dies  from loss of blood.  In
many cases, surgical interference can save
life by arresting the disease, and the sooner
this is done  the better.  Aneurism may be
suspected when a tumour is felt, which dis-
tinctly pulsates, conveys to the finger a thrill-
ing sensation, and becomes smaller and less
tense  when the current of blood through the
artery leading to it is interrupted.  In such
a case the surgeon  should  at once be con-
sulted.  It is  not, however, every tumour
which  pulsates that is  aneurism, for  proxi-
mity to a large artery may give the appear-
ance of its doing  so.
  ARTICHOKES—Whether  the vegetable
properly 60 called,  or  the root, Jerusalem
artichoke—are not  adapted for persons of
weak digestion, for those liable to flatulence,
or for the aged.   On some  persons, the ar-
tichoke proper acts as an aperient.
  ARTICULATION.—See Joint.
  ARTISAN, (a Workman.)—The  diseases
to which workmen are liable in consequence
of the nature of, or materials employed in,
their respective businesses, always a subject
of great interest, is too extensive to  admit
of being otherwise than very briefly entered
into in the present work.   Legislation and
invention  have of late  years done  much to
screen the various classes of artisans from i
many sources of injury to health to  which
they were  formerly exposed; much  more
remains to be done, and would  perhaps be
done more quickly, were it not for  the apa-
thy, and sometimes even  contradiction, of
those who were chiefly to  be benefited.  It
is useless to supply miners with Davy lamps,
and fork-grinders with magnetic respirators,
when the means of safety are so constantly
and carelessly neglected.   One  immense |
source of evil—now  happily ameliorated—
has been exertion too prolonged, especially
in the young; nutriment which should have
gone to build up the growing frame, is con
sumed in mere physical exertion; the powers
of the brain  are  used up in the same, and
if not deformity of body, at least great weak-
ness, and with it mental  inaptitude,  are the
consequences. Many of those who are liable
to disease in consequence of the materials
they work in, owe much to their own want
of cleanliness:  this is the case with regard
to the metals, especially lead; and a striking
improvement has taken  place in the health
of workmen who have been compelled to ob-
serve certain  rules of cleanliness,  such  as
washing the  hands  before their  meals.
Workers in quicksilver are liable, in addi-
tion to affections of the teeth and gums, to
a species of  shaking palsy, or tremour  of
the limbs.  Modellers in  coloured wax, ma-
kers of wax-flowers, &c, are  in  danger of
suffering  injury from absorption through
the skin of the hand of the poisonous co-
louring ingredients, and should be extremely
careful. Workers in lead, such as plumbers,
type-founders, or painters who  use it in the
form of white or carbonate of lead,  are apt
to suffer  from paralysis, more  particularly
of the  muscles of  the forearm ; their more
usual disease, however,  is  the  "painter's
colic," or dry belly-ache.  See Colic.  Cop-
per-smiths, smelters, lucifer-match makers,
all have their peculiar affections, that of the
latter being a disease of the jawbone.  Those
who are employed in  filing or dry-grinding
substances which give off a hard dust, are
peculiarly liable to chest diseases, from the
mechanical irritation caused by the particles
continually inhaled.   So much  is this the
case in some  trades—such as the Sheffield
fork-grinders—that most, if not all, their
members die  before  reaching  the  age  of
forty.  Millers, and those employed among
fine dust of a softer quality, are not so likely
to become consumptive as the former class,
but have a greater tendency to asthma; they
also suffer from the consequences of the cu-
taneous pores and functions being clogged
and hindered by the  dust.   Grocers and
bakers, who  are in  the  habit  of handling
flour,  sugar,  &c., suffer  frequently from a
disagreeable  skin disease affecting  the fin-
gers, well known by the name of "grocer's
itch."  Housemaids who kneel at  work have
their  peculiar swelling,  which  forms, and
sometimes suppurates, (gathers,) over the
knee-cap : this may be prevented by kneel-
ing on a  soft substance.   Thatchers who
press  their knees  against the  steps of the
ladder are exposed to the same thing.  Cler- 
ASS                  43                 AST
 gymen,  actors, and public speakers have
 their peculiar throat affection;  in short,
 there is scarcely a trade or profession which
 does not expose  its follower to some pecu-
 liar ailment; but there is  scarcely one of
 these ailments which may not  be prevented
 or much ameliorated by proper  care—by
 cleanliness more especially,  but also by at-
 tention  to  the various  other  prophylactic
 means which are now so generally known
 and provided.
   Refer to Colic—Consumption—Lead—Skin,
 &*.
   ASCARIDES.—See Worms.
   ASCITES.—See  Dropsy.
   ASPARAGUS—When young, well boiled,
 and not overloaded with melted  butter, is
 wholesome and digestible;  it  gives a pecu-
 liar odour to the urine.  Its peculiar vege-
 table  principle, asparagin,  contains  ni-
 trogen.
   ASPHYXIA.—Suspension of sensible vital
 phenomena, in consequence of  the blood not
 having undergone the proper change by re-
 spiration.  In this condition, the brain, the
 lungs, the organs of the body generally, all
 suffer from the circulation  of  blood not be-
 ing duly arterialized ; the heart is less and
 less excited, until,  at last, it ceases to act,
 and death  ensues,  unless the  cause of the
 asphyxiated condition, such as hanging, &c,
 be quickly removed, and suitable measures
 adopted for removing the suspended anima-
 tion.  See Animation suspended.
   ASS'S MILK—According to Dr. Paris,
 " bears  a stronger  resemblance to human
 milk than any other;" it contains  much su-
 gar and curd. It is a most excellent dietetic
 article and restorative in all cases of debi-
 lity.   Drank too freely, it  acts  upon the
 bowels.
   ASSAFOETIDA—A gum resin and power-
 ful antispasmodic,  is useful in  hysterical
 cases,  and in flatulent  distension of the
 bowels;  in the latter case, especially, given
 as a clyster, (injection,) it is the most effica-
 cious agent we possess.   Two  teaspoonfuls
 of the tincture of assafoetida may be added
 to a simple gruel clyster, or to one of the
 purgative clysters, if requisite.   When assa-
 foetida is given by the mouth, it is best used
 in the form of pill. The compound galbanum
 pill, of which it forms an ingredient, may be
 given in three-grain doses three times a day.
 Where aperient action is required, especially
 in deficient menstruation, the aloes and as-
 safoetida pill is a most excellent combination,
 and may be given,  three grains,  twice or
 three times a day.   The—to most people—
Jisgusting smell  of  assafoetida is  a great
obstacle  to  its  employment;  and  yet  in
 some countries it is used as a condraent, as
 we use onion.
   Refer to Clyster.
   ASSIMILATION.—The first process of nu-
 trition  in  animals, by  which the nutrient
 portion of the food is rendered fit for absorp-
 tion by the veins and lacteal vessels, which
 convey it  into the general current of the
 circulation.
   Refer to Digestion.
   ASTHMA—Is an affection of the  chest,
 characterized by distressing inability of the
 person suffering from it to inspire sufficient
 air to fill  the lungs.   The term, although
 applied by medical  men to a defined disease,
 is used popularly to denote any difficulty of
 breathing, from whatever  cause occurring,
 whether from disease of the heart, or any of
 the varied affections of the lungs.  Asthma,
 although a nervous or spasmodic  affection,
 is very frequently  connected  with  actual
 changes in  the  lungs themselves.   Asth-
 matic  fits, or paroxysms, come  on at  irre-
 gular intervals; for several days, or rather
 nights, successively, the patient is attacked,
 and a considerable time  may then  elapse
 before he again suffers: not that a regular
 asthmatic is in the interval entirely free from
 uneasiness, for there is generally some slight
 oppression of the breathing, liable to be ag-
 gravated by slight  causes.  Changes in the
 weather, peculiarity of situation, errors in
 diet,  anxiety, fatigue,  mental  excitement,
 may any of them induce a paroxysm of asth-
 ma in  the predisposed.  The attack itself is
 premised by feelings of indigestion and flatu-
 lence,  frontal headache, chilliness, languor,
 and drowsiness.  After having experienced
 these sensations during the day,  the asth-
 matic individual is  probably awakened from
 his first sleep by a  distressing  sensation of
 constriction of the chest;  he is forced to sit
 up in bed, labouring for breath, or,  it may
 be, to  seek an open window.  The distressed
 state  of the  breathing, if not relieved by
 remedies, continues for some hours, and at
 last gradually subsides; the characteristic
 wheezing  becomes less; the cough,  almost
 impossible  before, is now brought out, and
 sleep, never more welcome, comes on.  The
 latter  stage of the  paroxysm of asthma is
 generally  accompanied with expectoration
 of mucus—sometimes  it is not; and upon
 this a distinction into dry and humid asthma
 is  founded.  Confirmed asthmatics have u
 distressed cast of countenance, and acquire
 a  peculiar rounding  or elevation of  the
 shoulders, perfectly characteristic. Asthma
may occur  at any period of life, but is more
general about the middle; and men are more
commonly  the subjects of it than women. 
AST
44
AST
The disease, in itself,  though most distress-
ing, is not dangerous,  further than  as it
tends to  lay the foundation of other affec-
tions of the lungs or of the heart.
  No one can witness a paroxysm of asthma
without distressing anxiety  to relieve  the
Buffering individual, and not without alarm,
if it  is the first time of seeing the attack.
The patient seems as  if  he  must die  for
want of air in  the lungs,  but death rarely
if  ever  occurs.   In  a  disease of so long
Btanding and of so peculiar a character as
asthma, those who are the subjects  of it
generally have  their own  remedy,  to which
they habitually have recourse.  The reme-
dies are very  various, and indeed happily
so, for what gives immediate and full relief
to one person totally fails in another.   The
practice of smoking the  leaves and  stems of
stramonium or thorn-apple is now exten-
sively and popularly resorted to ; with some
it succeeds admirably, to others it  seems to
be hurtful; it  may be tried.   Antispasmo-
dics and stimulants, as might be expected,
are frequently beneficial.  iEther  and lau-
danum is a favourite combination; half a
teaspoonful of the former along with twenty
drops of the latter being  given in a wine-
glassful of water.  A  teaspoonful of sal-
volatile  may be substituted for the aether,
but is scarcely so efficacious. Twenty grains
of powdered ipecacuanha, given  in half a
wineglassful of water, to act  as an emetic,
may be of service, particularly if the attack
has come on after a full meal,  or if there is
any suspicion of the stomach being loaded.
Some experience much  benefit  from strong
coffee, drank without milk or sugar. The in-
halation of chloroform, a few drops sprinkled
on a pocket-handkerchief, has lately been
found to afford relief; but this remedy, in
the first instance, must not be tried without
medical sanction.  Dr. Watson recommends
the fumes of burning nitre (saltpetre)  dif-
fused through  the  air of the  apartment, by
means of pieces of blotting-paper dipped in
a saturated solution of the salt, and dried.
One  of these,  about  the size  of the hand,
ignited and placed upon  a plate or tile in
the room, quickly diffuses its fames through-
out the apartment.   When there  is  great
dryness and deficient  expectoration, steam,
inhaled either  simply or with a few drops
of sulphuric sether, is worth a trial. If there
is  much  acidity of stomach, ten  or fifteen
grains of carbonate of soda with a teaspoon-
ful of sal-volatile in a little water should be
given.   Indeed, when an  attack of asthma
is threatened or has come on,  care must be
always taken  as far  as possible to remove
imy existing disordered action   A basin of
 warm tea and retirement to a warm bed
 will remove the chilly  sensation.  Consti-
 pated bowels  ought  to  be  relieved by a
 gentle dose of castor-oil, or of rhubarb and
; magnesia ;  flutulence or acidity corrected.
1 Flatulence  particularly must be obviated,
I and all sources of it  avoided.  Effervescing
I draughts,  soda-water, and  such-like, are
 almost always  hurtful. The  effects of situa-
 tion and of atmospheric  peculiarity upon
 asthmatics   are  most varied;  some  can
 breathe  freely  in clear dry air, which drives
 others into  a damp cellar for temporary re-
 lief; a close, warm  room which suits one
 will be unbearable to another.  Individuals
 who are never free  from asthma in some
 situations lose  their attacks  as soon as they
 remove.  These are peculiarities of which all
 should be aware.  Certain  odours produce
 asthmatic breathing  in  the  predisposed;
 the powder of  ipecacuanha is notorious for
 this effect;  and the smell of new-made hay,
 so pleasant  to most,  produces hay-asthma
 in a few unfortunate individuals.
    The  habitual  asthmatic   soon  becomes
 aware  how much  his  freedom  from pa-
 roxysms of the disease depends on the state
 of the general health, particularly of the di-
 gestive organs.  He may not be altogether
 able to command situation, he cannot avoid
 atmospherical vicissitudes;  but  he  can, by
 temperate living, exercise, attention to the
 bowels and to  the  functions of the skin  in
 particular,  pass long intervals without an
 attack.  Sponging the chest and shoulders
 every morning with cold or salt water, fric-
 tion being  afterward made  with a towel  or
 hair-glove, is a practice to be recommended,
 provided no other predisposition  forbids.
 Asthma is  one of those  diseases long con-
 tinued, marked in character, and not imme-
 diately  affecting life, for which  much may
 be done by well-timed  and  well-directed
 domestic management,  while the frequent
 recurrence  of  the attacks renders  the at-
 tendance of a  medical man  a serious con-
 sideration  in  the  case of limited  income.
 Nevertheless an asthmatic  patient ought,
 from time  to time, to be  examined profes-
 sionally, especially should there occur any
I change in the nature of the paroxysm, which
! may be indicative  of  other and  serious
 disease.
   ASTRINGENTS—Produce contraction and
 condensation when applied  to living tissues
 capable of such effects.   In  cases of relaxa-
 tion or  debility, in haemorrhage, either ex-
 ternal or internal, in increased and injurious
 secretions from glands or mucous surfaces,
| astringents  are  the chief   remedy.  The
| amount of  astringent action, however, de- 
                 ATM

pends greatly upon the mode and  circum-
stances of its  application.   The astringent
principle in the vegetable  kingdom, in the
form either of tannic  or of gallic  acid, is
very widely diffused.   The  principal vege-
table astringents used in medicine are oak-
bark, galls,, kino, catechu, tormentilla, uva-
ursi or bear-berry, logwood, &c. The mineral
astringents are the acids, alum, salts of iron,
particularly the muriate, sulphates of cop-
per and zinc, and nitrate and oxide of silver,
and salts of lead.   Cold,  in any form, is
astringent.  Refer to the individual heads.
  ATMOSPHERE.—See Air.
  ATONY.—Deficient  tone  of the  system,
characterized by debility and laxity of the
muscular fibre generally.
  ATROPHY,  (Wasting)—May  be either
general or local.  General atrophy is in one
sense natural  to advanced  life, when the
powers  of  nutrition being  diminished, the
muscles, the brain, and the organs generally,
shrink.   There may be fat, but at the  same
time much atrophy of the other bodily com-
ponents.  Atrophy occurring earlier in life,
without obvious cause,  ought to be regarded
suspiciously.   When an individual, without
departing from ordinary habits, begins to
lose flesh, the cause ought to be looked for ;
and, if  the  change continue,  the  person
should be submitted to a thorough  medical
examination, and the existence of incipient
disease ascertained if possible.  In young
children atrophy occurs as  a consequence
of  faulty digestion, most  frequently  from
improper feeding;  it also is the result of a
diseased condition of the glands of the belly
through  which the nutrient portion of the
food passes on its way to the general circu-
lation.   For  this condition, codliver-oil is
the remedy, given in teaspoonful doses twice
a day, to an infant of six  or eight months
old, and the same quantity well rubbed into
the skin of the abdomen night and morning.
Some medicines, such as iodine, have the
power of  causing  local  or  even  general
atrophy.
  Local  atrophy is liable  to occur  from
various causes.  Whatever  diminishes the
supply of blood to  a part, will  cause  it to
waste.   Pressure on the main  artery of a
limb, obliteration of the smaller vessels of
a part by previous inflammation, disuse of a
member  from  paralysis or  any other cause,
are all followed by diminution in size of the
part affected.
  Refer to  Age—Infancy.
  AUSCULTATION.—The  application  of
the sense of  hearing  to the detection  of
disease.  This art is most extensively useful
to the medical man in affections of the chest.
i                 AXI

but it is also of great assistance in diseases
of the abdomen.   Indeed, it  is applicable
to all  cases, especially  affections  of  the
blood-vessels, fractures, &c, in  which mo-
tion  makes  a sound  audible.  When  the
medical man by tapping  on the body with
his fingers, or by any other means, elicits va-
rious sounds, it is called percussion ; and the
present meaning of auscultation  is  the prac-
tical  knowledge of those  sounds which  are
produced by the movements within the living
body.  Probably no addition to the science
and practice of medicine has more extended
the power of detecting the existence and
nature  of diseased action than the practice
of auscultation.   The stethoscope,  now so
well  known  from  its universal  use by me-
dical men, is but a conductor of  sound, used
for obvious reasons of delicacy, convenience,
and  in  some cases  to prevent  unpleasant
contact.with the uncleanly,  but  the  sounds
are  equally  well  heard  by the unassisted
ear.  Some medical men affect  to despise the
aid of auscultation and of the stethoscope,
but it can only be such as want either  the
capacity or industry to learn its  proper use.
The  stethoscopic  examination  of females
may  always be conducted with perfect deli-
cacy  and sufficient nicety, through a cover-
ing of  linen;  and never, as  sometimes is
done, though rarely, should this means of
investigation be   denied  to the attendant
practitioner.
   AXILLA.—The armpit is an important
region of the body, on account of  the large
blood-vessels and nerves  which occupy its
space.   A wound of  the large  artery in this
situation, unless efficient means are speedily
adopted to control  the bleeding,  must  be
quickly fatal.  When, from the copious flow
of florid blood from  a wound in or near the
armpit,  such an  accident  is supposed to
have occurred, a bystander should with all
speed exert pressure by means of his thumb
upon the artery as it passes  over the first
rib,  just behind  the middle of the collar-
bone, until  the  effusion  of blood  ceases.
This  pressure of course must be kept up, but
as to do so with the  thumb simply would be
too fatiguing, some  solid  body—the handle
of a moderate-sized key is generally recom-
mended—must be wrapped in  a  few folds
of handkerchief and used for the purpose.
While this is done, if medical  assistance be
many hours  distant,  as an  additional safe-
guard, firm graduated pads should  be tightly
fixed into the hollow of the  axilla,  and
firmly retained by a handkerchief or small
shawl crossed over  the opposite shoulder;
but  this must be a supplementary aid until
the  artery is properly secured  by the sur
4J 
A X U
46
B A X
geon.  The pressure behind the  collarbone
cannot be relaxed  for one moment without
risk to life.
  Refer to Artery.
  AXUNGE,  (Hoo's-lard)—Is used as the
principal  component of various  ointments,
but  is often injurious  in  consequence of
being slightly rancid, in which case, instead
of soothing, it has an extremely irritating
effect, especially upon abraded or blistered
surfaces.  Even when  applied fresh, if al-
lowed to remain too long unchanged, it will
become a  source of irritation.
  AZOTE, (Nitrogen.)—One of the gaseous
components of the atmospheric air, of which
it forms 77 per cent, by weight.   It is one
of the most abundant and widely distributed
of the elementary  bodies.  With oxygen it
forms various compounds,  of which  nitric
acid is the best  known.   Combined  with
hydrogen  it  forms  ammonia.  Nitrogen  is
regarded  as the characteristic  element of
animal substances;  it  is also  present in
vegetables, but in smaller proportion.
  BACK.—Pains in the back  may be owing
to an affection of the spine  itself, or of the
kidneys;   to  rheumatism of the muscles,
(lumbago,) or to sympathy with disorder in
some distant organ :  in females they are
often owing to disorders of the uterus.
  Refer to Spine—Kidneys—Lumbago, $c.
  BACON.—The flesh,  or  rather fat  and
flesh of the hog, salted and dried, and some-
times smoked,  [which forms a  prominent
article of diet, especially in the Southern and
Western portions of the United States.]  As
an article  of food, it is undoubtedly a relish-
ing,  convenient, and  in some degree nutri-
tious addition to the general fare ; at the
same time, it is a question whether it does not
in some districts form too large a  proportion
of the ordinary nutriment consumed,  and
whether an  advantageous exchange might
not be made, in part at least, for  a more fa-
rinaceous  diet.  Owing to the great propor-
tion  of fat in bacon, there is comparatively
little of those elements of food which go to
build up the constituent tissues of the  ani-
mal  body, and  which  are  contained  so
abundantly in the grains and pulses.  Where
the choice lies between bacon and bread, or
bread and milk, or oatmeal and milk, there
is no question that  much more real nourish-
ment will be obtained from the vegetable
grain and milk, which contain whatever  is
requisite   for every portion  of  the frame,
than from that of  which simple fat forms
bo large a share, and which cannot dp more
than afford respiratory food, or, at the  best,
add  fat to the body.   To  full-grown  men
this  may be of comparatively little import-
1 nnce, but  to growing  children  and youths
 it  must of  necessity  be a  consideration
 whether, in  consuming  the amount of nu-
 triment circumstances permit, they consume
 that which really will afford them  strength
 and substance  or not.   [Where it is eaten
 with corn-bread, much of this objection  is
j removed, and Southern labourers often livo
 upon it alone for weeks.]  Bacon, used as
 a dietetic, as is usually done, with break-
 fast, is often of much  service  in  cases of
 biliary disorder.  It is the fat alone, toasted
 in  slices before the fire, which   must be
 eaten: the lean is hurtful,  and  must be
| discarded  by the bilious  dyspeptic.  When
| used in this way, a slight aperient  action is
 exerted, and  it is to this, gently carrying oil
 its daily proportion of bile, that the benefi-
 cial effect is to be attributed.
   BALDNESS.—See Hair.
   BALSAM.—The term is  derived from two
 Hebrew words, signifying the  "prince of
 oils."   It  was  formerly  applied  to  many
 more substances than it is at present.   The
 balsams of Peru,  Tolu,  and Copaiba are
 those  most  generally known  medicinally.
 The two former are used  popularly as ex-
 ternal applications.  Tolu balsam is used to
 impart a pleasant flavour to lozenges, cough
 mixtures,  &c, &c.; at  the  same time,  it
 undoubtedly  exerts a beneficial expectorant
 action.  Quarter of an ounce of gum acacia
 powder, an ounce of Tolu syrup, one drachm
 and a half to two drachms of ipecacuanha
 wine, and  sufficient water to make up six
 fluid ounces,  forms a pleasant  and  good
 cough mixture for children, to be  given in
 from  teaspoonful  to tablespoonful doses,
 according  to  age.   When fever is absent,
 and the cough  getting loose,  a drachm of
 tincture of squill may be added with advan-
 tage to the above.
   BALSAM  OF COPAIBA acts decidedly
 upon the mucous surfaces of the body, and
 is employed, in bronchitis,  and in  irritation
 of the urinary passages.  It is extremely
 nauseous,  and liable to disagree  with the
 stomach. These properties are endeavoured
 to  be overcome by enclosing  the  medicine
 in gelatine capsules, and by preparing it  in
 various  ways,  as  by  covering the  taste
 with aromatics, such as cinnamon or pep-
 permint-water.   When active inflammatory
 or febrile  action is present, copaiba  must
 not be used.
   BANDAGES—Are strips of calico, linen,
 flannel, or of any other convenient material,
 employed  in rolls, to envelop any portion
 of the  body requiring artificial support, or
 upon which it is requisite to produce press •
\ ure, or to retain dressing.    The art  oi 
BAN
47
BAN
applying a bandage well, that is, both neat-
ly and  efficiently, requires  some  practice
and attention, but it is often a most useful
accomplishment; for a bandage, if required
at all, must be properly applied, otherwise
it is worse than useless ; if, therefore, none
but the surgeon can undertake the task, it
necessitates a much more frequent attend-
ance on his  part than  might otherwise be
requisite.  In general,  the first few appli-
cations  of  a  bandage will be made by the
medical attendant himself, and ought to be
in the  presence of the  individual to whom
the duty  may  be afterward  deputed.   By
careful  attention on the one hand, and kind
explanation  on the other, much  may be
learned and  taught, but not all, as the  in-
experienced  bandager will discover on the
first attempt.  By all  means, therefore, let
the first attempt be made on some one in
health, before the call is made to the invalid.
Attention  to the following  directions  will
facilitate the application of the previous
practical lesson, or in some measure supply
its place, if from circumstances it has been
wanting.   Whatever the material, the width
of the bandage or roller  must be propor-
tioned in some degree to the size of the part
to which it is to  be applied; if too narrow, it
is apt to be stringy, and to cut; if too broad,
it does  not adapt itself readily to the  ine-
qualities, and the pressure is unequal.  For
an ordinary sized adult male leg, a bandage
of. two  and  a half inches broad is a good
proportion; for the arm of the same person,
one of two inches ought to be sufficiently
well adapted.   The material for bandages
must neither  be too strong nor too weak; or-
dinary " shirting calico" is a very convenient
texture.  The  length,  of course, must vary
according to what is required, but rollers are
usually put up in six or eight-yard lengths;
they are better  torn in one continuous strip,
free from joinings and without selvage edge
The strip, when prepared for use, must be
rolled up as  firmly as possible, either into  a
single or double head, (fig. viii.;) the former
is much  the  most generally employed.  If
the bandage is a new one, of calico or linen.
the loose threads of  the  roll at each end
must  be roved off;  otherwise they  become
troublesome  when  the  roller is  applied.
Bandages may be applied in simple  circles,
(fig. ix. B ,) in spiral, &c, or in reverses,
(fig. ix. C;   They are also applied in  va-
rious other forms to suit the different por-
tions of the body.   In applying a bandage,
the rolled-up  strip being held  in the right
hand, the end which is commenced with is
secured by the first turn.   If it be the sim-
ple circular bandage, round the trunk of the
body, or round a limb of nearly equal girth
throughout, either naturally or from swell-
ing, the roller is carried round and round,
each succeeding turn slightly overlapping the
one before it; if the spiral bandage be re-
quired, the rolls are carried up very oblique-
ly ; but if, as most  likely, it is  the reversed
bandage, then, wherever the inequality of
the parts prevents its being laid on flatly
and evenly, the band must be  turned upon

                  Fig. ix.
itself, (fig. ix. C,) so as to become reversed,
the surface of  the cloth which was next the
skin being turned  outward,  and vice verso).
It is difficult to describe the manoeuvre, and
it is a little difficult at  first to execute it
neatly and well; but when practised, it be-
comes perfectly simple.   This is by  far the
most useful  form of bandage, and a  person
who can  put it  on well will  have  but
little difficulty in  accomplishing the other
varieties.
                  Fig. x.
 
BAN                48                BAN
  For the purpose of retaining dressings upon
the head, nothing answers better than a close-
fitting calico cap ; a handkerchief will often
serve every purpose, or the split cloth (fig. x.)
may be used ; applied as in fig. xi. by the up-
Fig. xi.
per tails being brought beneath  the under
ones and fastened under the chin, the under
tails being carried to the back of the head.
 When it is  desirable to retain the head in one
position, it  may be done by bands attached
to a cap, and fastened as required to a band
going round the chest.  When for this pur-
pose, or to fix a broken rib, such a band  is
required, it ought to be from eight to ten
inches  wide, made of tolerably strong double
calico,  and sewed firmly round the body.
   To retain a  pad or poultice in  the arm-pit,
a good-sized  handkerchief  answers better
than any bandage, the middle being placed
at the arm-pit, the ends crossed, at  the side
of the  neck opposite, carried under  the cor-
responding arm-pit, crossed  and  brought
and tied on the shoulder.  Slinging the arm,
a very  simple  business, is often very badly
done;  in almost every case  the  forearm
should be supported throughout its entire
length, and it is generally well to  include
the hand, especially in children. The simple
sling handkerchief may be put on,  as  at
fig. xii., but a much  more  confining sling is

                  Fig. xM.
made by enveloping the elbow in the long
side of a triangular handkerchief, fastened
up into a little pouch at the centre, and the
point, including the hand, being fastened
up to one of the ends going round the neck,
(fig. xiii.)

                 Fig. xiii.
   Upon the trunk of  the  body,  dressings,
blisters, &c, may be retained by means of
a broad band of any convenient material,
fastened round and prevented from slipping
down by braces over the shoulders, (fig. xiv.)
Fig. xiv.
   For bandaging  the  abdomen, a  broad
band, of any material  that is suitable, is
generally made, the  ends split for conve-
nience of fastening either before or behind,
and  a triangular  piece cut out  of  either
edge at the centre,  nnd  the edges joined, in
order to fit  the shape  of the region.   In
order to retain poultices, &c, at or near
the groin, a  piece of  cloth is to be shaped
to fit the  region,  (fig. xv.,) a band long
enough  to  go round the body,  cross  and
fasten in front, is to be sewed to one end, (1,)
and  to  the   opposite  point  another  small
band (2)  is attached, which, passing between
the legs,  is brought up to the band behind. 
BAN               49               BAN
Fig. xv.
To retain dressings, &c.  between the legs
or nates, the double T bandage  (fig. xvi.)
is used.  For the groin and parts adjacent,
the spica or figure of 8 bandage is also used.

                  Fig. xvi.
A roller eight yards  long is taken, the end
secured by one or two turns round the pel-
vis, and then the bandage is brought down
across the front of the thigh, carried evenly
between the legs, and again brought up and
carried round the pelvis—this being repeat-
ed at each  turn  till the roller is exhausted,
(fig. xvii.)
Fig. xvii.
ankle, bringing the roller  under the  heel,
then round  the ankle  so as to secure the
end, from thence going down to the  toes,
and carrying the bandage up from that point
round the foot and leg, reversing where re-
quired.   The arm is to be bandaged, with
the requisite modifications, by the  reverse,
like  the leg.  As a  general rule, leg band-
ages, habitually worn,  ought to be put on
before the individual gets out of bed in the
morning.  A bandage which gives pain after
its application, without obvious cause, ought
to be taken off and reapplied.   If there  is
reason  to suspect  inflammatory  swelling
beneath, it will be  well to try the use of
cold water before disturbing matters. There
is some little  management required in tak-
ing  off  a  roller as  well as putting it on:
as  each  successive turn  is unrolled,  it
should be gathered in a bunch in the hand,
and  not, as is often done, three or four yards
of bandage at full length pulled round the
limb every  time.  A many-tailed  bandage
(fig. xviii.) is used to bandage the leg where

                 Fig. xviii.
ZZ3
it is an  object to avoid the slightest move-
ment.   It is formed of a number of short
strips of bandage, long enough  each to go
once and a half round the limb.  They are
placed obliquely, and overlapping one an-
other ; they may, or may not be joined by
a central strip, (1.)   Upon these arranged
strips the  limb  is  laid,  and each strip in
succession is brought round the limb, every
succeeding securing the previous one.  The
advantage  of the many-tailed  bandage  is
that it can  be changed, either partly or en-
tirely, if soiled,  without  the slightest dis-
turbance.   It is only necessary to attach a
fresh strip to that which  is to be removed,
and pull the one away, and the other into
its place. When, from movement, a bandage
is  liable to  become displaced, the  incon-
venience is in great measure prevented by
brushing a weak  solution of starch or gum
over the turns as soon as applied.   This  is
different from the starch bandage which  is
so useful in many cases—fractures, &c. For
  For the Extremities, the simple roller, ap-
plied in reversed turns, is  generally used.
Bandaging from above downward may be
required, but generally it is upward.  There
are various methods of commencing the ap-
plication of the roller at the foot.   The heel
is covered by laying the  end on the inner
      E 
                  BAR                {

 this bandage, the roller is thoroughly satu-
 rated, as it is put on, with strong starch or
 flour paste, and, if requisite, brown paper
 pasted on the top  of the first bandage,  and
 another dry one  put  over  all.   In thinly
 settled countries, where it might be requi-
 site to move a person soon after a fracture,
 the  foregoing application would prove sim-
 ple, safe,  and  efficacious.   It must  not,
 however, be put on till inflammation  has
 subsided.   In many cases, in which band-
 ages used formerly to be applied, they have
 been superseded  by elastic materials,  of
 Which stockings and belts of all kinds are
 fabricated:  elastic rollers are also manu-
 factured.   The  flannel bandage unites at
 the  same  time  support  and protection to
 the surface. It is useful in rheumatic cases,
 and also when applied over the abdomen in
 diseases of that cavity.         •
   BARBADOES LEG.—See Elephantiasis.
   BARK.—The  term,  used alone, is always
 applied to the bark of the  cinchona,  also
 called Peruvian  or Jesuit's bark, which was
 introduced into Europe from  South America
 about 1640, and at first was enormously ex-
 pensive.   Many marvellous tales are told of
 the  way in which the virtues of cinchona
 bark were first discovered by the natives of
 the country, but they have been proved er-
 roneous.   The remarkable power of bark in
 curing, not only intermittent fever and ague,
 but periodic diseases generally, and its effi-
 cacy as a general tonic, has  rendered it one
 of  the most valuable  drugs possessed  by
 man.  The varieties of cinchona have been
 classed as pale,  yellow, and  red barks,  but
 there are many more than these, and some
 of them are almost worthless as medicines.
 The kind  of bark has now,  however, since
 the  discovery of quinine,  become  almost a
 matter of indifference to the general  pur-
 chaser.  When the drug itself, either whole
 or in powder, is  required, the only security
 is to procure it from a respectable chemist
 The powder, which was  formerly  given  so
 largely, is scarcely ever now prescribed, but
 the infusion, decoction, and tincture of bark
 still retain  their places.  The infusion  may
 be made by pouring  a  pint of boiling water
 upon an ounce of coarsely powdered bark, and
 allowing it to stand near the fire,!n a covered
 vessel, for five or six hours; the dose  is a
 wineglassful twice  or three times a day.  The
 decoction is made by adding double the quan-
 tity of water to the same quantity of bark,
 and  boiling down to one-half.  The dose is
 about the same as the infusion.   A favourite
domestic method of administering bark is to
steep an ounce of the powder for a week in
a bottle of port wine, and give of this a small
                 B  A R

wineglassful  once  or twice  a day.  Where
the stimulant is admissible, the form is a
good one.  If the  tincture is required, it is
better to buy it.  The characteristic proper-
ties of bark are concentrated in the alkaloid
substances, quinia  and cinchonia.  The for-
mer of these  is much the most widely known
and  used, but the latter is considered  by
many equally efficacious.  Quinia or quinine
is used in medicine, in the form of sulphate,
or rather disulphate.   Pure white in colour,
it is in the form of silky crystals, and has a
most intensely bitter taste.   Its high price
renders it liable  to  much adulteration:  it
ought, therefore, always to be procured from
respectable parties.  The dose of quinine is
one grain twice a day, as a general  tonic,
but as an anti-periodic in ague, neuralgia,
&c, much larger and  more  frequent doses
are required—[usually 16 grains between
each chill.]  It may be given in pill, made up
with bread crumb and honey, or dissolved, by
the addition  of five  or ten  drops of  dilute
sulphuric acid in  a small wineglassful  of
water,  or it may  be taken  in  a  glass  of
sherry, if stimulants are admissible.
  As a curative agent in ague, and in dis-
eases generally of an intermittent or periodic
character, bark, either in its original  state,
or in the form of quinine, is quite unrivalled
—as a tonic, in diseases of debility, in the
advanced stages of fever, or at its very com-
mencement   in weakened digestion,  it is
equally efficacious.  In some persons, qui-
nine, even in small doses, is apt to occasion
headache and other uncomfortable symp-
toms, and  to disorder  the  bowels.   When
given as  a stomach tonic  it cannot be long
continued with  advantage.   Where  there
exists inflammatory  action, or tendency to
head affection, quinine must never be given,
except by  medical  sanction.   Quinine  in
combination with iron (the citrate of quinine
and iron) forms  an admirable tonic  in cer-
tain cases, in one-giain doses.   The  use of
quinine in various  diseases will be found un-
der the separate heads, such as Ague, Neu-^
ralgia, §c.
  BARLEY, when  prepared  as pearl-barley,
is one of the most useful additions to sick
cookery; its decoction, " barley-water," be-
ing a pleasant and extremely beneficial de-
mulcent in all affections of the mucous mem-
brane, and forming a grateful and nutritious
beverage in  fever; it ought, however, to be
made considerably thicker in the former case
than in the latter.  To make  plain barley-
water, two and a half ounces of pearl-barley
are to be well washed in cold water, half a
pint of boiling water is then  to be poured
upon the grain, the whole boiled  for a few
>0 
BAT                 51                BAT
minutes, and the water strained off, a couple
of quarts of  boiling water  must then  be
poured on, the quantity boiled down one-half
and  strained.  This process  does not quite
exhaust  the barley,  and another portion of
water may be boiled upon it, by those to
whom the saving is an object.   A little lemon
or orange peel is a pleasant addition to the
beverage.  A compound and  very pleasant
drink is made by adding to a quart of simple
barley-water, figs sliced, and  raisins stoned,
of each two and a half ounces, liquorice-root
sliced five drachms, and a pint of water, the
whole  to be  boiled down to a quart and
strained.  This compound decoction is not so
well adapted for a fever drink as the simpler
form.
   In irritation of the urinary  passages, from
gravel, or after the application of a blister,
or from  any other  cause, barley-water is
most valuable; its soothing  properties  are
still further increased by the addition of an
ounce of gum arabic to each  pint of  liquor.
In catarrh, and irritable cough, or  simply
as an article of mild unstimulating nourish-
ment, it is  serviceable.   The  late Dr. A. T.
Thomson recommended equal parts of barley-
water and milk, sweetened with a little refined
sugar, as a  good  food  for infants brought
up by hand.   It may act upon the bowels.
   BAROMETER.—The instrument by which
the amount of atmospheric pressure is deter-
mined.   Late observations would indicate
that during the prevalence of epidemic dis-
ease, such as cholera and influenza, the in-
dications of  the barometer are more than
usually affected.
   BARRENNESS.—Sterility of the  female
may be the result of defect of structure in
some portion of the generative organs, or of
functional  disorder  resulting from local or
constitutional causes.   Such  cases always
require the care and consideration of a me-
dical attendant.
   BASILIC  VEIN.—Frequently opened in
the operation of bleeding from the arm.—See
Blood-letting.
   BASILICON OINTMENT, or Resin Oint-
ment—Is made with three  parts of resin,
three of wax,  and four of olive-oil.   The
resin and wax  are melted together, the oil
added, and the whole squeezed through linen.
It is a stimulant ointment, not as much used
at the present day as formerly.
  BATH.—Applications to the surface  of
the body, either general or partial,  in  the
form of liquid, vapour, or gas, are now com-
prehended under the term bath.
  Water baths may be simple or medicated.
  As  regards  temperature,  they may be
;old, tepid, and hot.
  As  regards  application,  they  may  bo
general or  partial, shower, cold  affusion,
douche, sponge, wet sheet.
  Vapour and hot air are both used as baths.
  The extreme vascularity, the nervous sen-
sibility and  sympathies of the skin, and  its
important functions as an excreting organ,
all  render  it a  most important  medium
through which to impress and  act upon the
system generally.  The subject, till of late
years,  has  been  strangely  neglected and
overlooked by medical men.  Brought promi-
nently forward under the name of Hydropa-
thy, or the Water-cure, by Preissnitz and his
followers, it has unfortunately been carried
far beyond  its legitimate lengths, and be-
come associated, in name, with quackery and
undue  pretensions.   That much good  is to
be done by the use aud application of water
simply, in the treatment of disease and dis-
order,  there can be no  question;  neither
can it  be doubted, that much  and serious
evil has  resulted from the indiscriminate
and ignorant employment  of  its powerful
agency.  With  the  medical  profession   it
rests to place the subject upon its legitimate
basis, by taking it into their own hands, and
employing it rationally and scientifically.
  The cold bath maybe of any temperature
up to 80° or 85° Fahr., the effect upon the
system varying, of course, according to the
temperature, the length of time it is endured,
and the amount of muscular movement ex-
erted  during that time.   A single plunge
into ice-cold water may depress less than a
longer  continued bath of  a higher tempera-
ture.   As a  rule,  individuals of weak nerv-
ous and circulatory  powers do not  bear
■well the effects of cold bathing: it robs them
of an amount of animal heat which they
cannot readily again make up ; it produces
nervous  exhaustion,  and  perhaps internal
congestion,  unrelieved by reaction to the
surface.
  When an individual, after the cold bath in
any form, remains chilled, the  fingers and
lips blue, the countenance pale, and when
languor and drowsiness succeed, he may be
certain that  more harm than benefit is being
derived from the custom, and  that it  must
be modified  or given up.
  In such a case, if the bath has been usually
taken before breakfast, the hour should  be
altered to a  couple of hours after that meal,
This with some  will be quite sufficient to
make  the difference between  agreeing  or
not: indeed, it requires  a  person of  very
good vital power to derive real benefit and
comfort from bathing  before breakfast.  If
the change in hour does not alter the effects
of the cold  bath,  some.Vning may be due to 
BAT                52                 BAT
its  ow  temperature;  or the bather,  espe-
cia.ly if he  be  not a swimmer, may expose
himself too long to the depressing influence:
he may be in the habit of going into the wa-
ter after his powers have been exhausted by
much exercise,  or when  he is in too chilled
a condition.  All  these  points require con-
sideration, before either  the undoubted good
effects or the comfort of bathing are  given
up as unattainable.   The last  point  men-
tioned is one on which particular caution is
required ; many persons, in dread of going in
to bathe too hot, run to the other extreme, and
allow themselves to become so chilled that
reaction will not come on.  After coming out
of a cold bath, the skin  ought to be well
rubbed  with a  rough towel, till a glow  is
felt; or the hair glove, now so well known,
may be used.   The above remarks   apply
to the application of cold water generally
to the  skin, in whatever form.   Few old
people can  take cold baths with advantage,
and the perseverance in their use may lay
the foundation  of rheumatic,  urinary,  or
other disease.   Those  who are liable to head
affection should not take the general cold
bath ; for them the shower bath is prefera-
ble.   Females  should not  bathe in cold wa-
ter  during  the  menstrual period.    Some
persons who cannot bathe in fresh water,
can do so in the sea, the saline ingredients
producing a more stimulant effect upon the
skin; sometimes,  however, the stimulation
goes so far as  to  produce a painful  rash,
which forces the person to give up the cus-
tom.  The  restorative and tonic effects of
cold bathing are undoubted in many cases,
if the mode of  taking it be properly regu-
lated.   As a general rule, five or six minutes'
immersion is sufficiently long.  [In winter,
or with delicate persons, two minutes or less
will suffice, unless  the reaction is perfect.]
  Sea-water undoubtedly exerts a more tonic
influence upon the  bather than fresh; more-
over its temperature  is  more  equable, and
seldom  so low as that of the latter.   From
the beginning of June  to the end of Septem-
ber, according to weather, may be considered
the sea-bathing season, during which the
temperature of the water on our shores
averages from  55° to 70° Fahr.  When a
bath is  either  ordered as a remedy or de-
sired as a comfort, and if  when cold it does
not agree—
  The tepid bath, of a temperature varying
from 85° to  94° may be  used;  about 88° is
an,agreeable and convenient standard.  Of
course the  tepid bath involves the use of a
receptacle for the water.  It does not produce
the shock to the system  like the cold  bath,
and  the person may  remain in it from a
quarter of an hour to twenty minutes.  The
tepid bath relaxes and purines the skin, and
promotes  the insensible perspiration.  Foi
the purposes of cleanliness  and comfort it
is most generally applicable.  After fatigue
from travelling, hunting,  shooting, &c,  in
irritable states of the system,  with  dry or
chafed skin, the tepid bath is at once grate-
ful to thejeeling and salutary.   Neither the
tepid bath, nor any other, is useful or safe
if taken soon after a full meal.
  The  warm or hot  bath is,  or ought to be,
a remedial agent only, not one for general
use.   Its  temperature ranges from  95°  to
102° Fahr.; 96° is the most  general  stand-
ard.   The warm bath is  used  to promote
reaction, to allay spasmodic or inflammatory
pain, to soothe  convulsive action, or is car-
ried  to its fullest extent, to cause faintness.
The time for remaining in the warm bath is
generally  from  twenty to five-and-twenty
minutes, but  this must be regulated some-
what by the effect required.   The hot  bath
of the temperature of 100° Fahr. is a power-
ful stimulant agent, to be used cautiously,
and rarely without  medical  advice ;  in dis-
ease  characterized  by extreme depression,
coldness, &c, it is useful.   In  the employ-
ment of these baths generally, persons who
are  the  subjects of  any organic disease,
or have a tendency to acute attacks of func-
tional  disorder, such  as  determination of
blood to the  head,  &c, must be  very cau-
tious, and ought if possible to have medical
advice.  The regulation of the temperature
of baths ought never to be  left to the sen-
sations;  the thermometer is the only trust-
worthy guide,  and, indeed, is  an  article
which  no house ought to  be without.  The
price of the instrument is  now  extremely
low,  and whether for the bath, the temper-
ature of the room,  or the instruction  of a
child, it is equally useful.   Baths are made
either  to contain the whole person, as in the
"slipper bath,"  (fig. xix.,) the  hip  bath,
(fig. xx.,) or the foot and leg bath, (fig.  xxi.)

                 Fig. xix.
Tn choosing a bath, it is well  to have one
which will answer the desired purpose with 
B A T                53                 BAT
 aB small  a quantity  of  water as possible.
 Every house where it  can be afforded should
 have the  means of  providing a bath,  and
 every  village ought  to  have its  movable
 " Parish Bath," for the use of the poor.
  Mode of Application of Bath.—The Shower
 Bath, whether of fresh or  salt water, whether
 quite cold or tepid, is a valuable agent in
 the  treatment of many nervous affections;
 it will suit some whom the  general bath will
 not.   It is well  for persons of weak habit,
 or who suffer from the head, to have a  thin
 layer of warm water put in  the bottom of
 the  shower bath before getting in.   Useful
 hand shower baths are  now  manufactured
 for children.
  Cold  Affusion.—See Affusion.
  The Douche Bath  consists of a compact
 stream  of water, either  warm or eold, al-
 lowed to impinge forcibly upon any portion
 of the body. In some bathing establishments,
 especially in Europe, the douche stream is
 of great force and bulk.   Domestically, the
 most familiar douche instrument is the pump,
 and  a most efficient one it is to strengthen a
 limb which remains weak after an accident,
 such as fracture or sprain; it must be used
 till aching is produced. The most convenient
 domestic douche is a watering-pot without, a
rose, but a jug will do;  in short, whatever
will  send  a stream of water  upon the part
required.   Additional force  is obtained by
the person administering the douche stand-
ing upon a chair.
      e 2
  Sponging the skin with water is used  in
lieu of a bath, for purposes of cleanliness
and comfort.  It may produce depression if
employed before breakfast.  Partial spong-
ing, sponging  with  tepid water, changing
the hour, or having a cup of coffee on rising,
may obviate  the effect.    Rough friction
should be employed afterward.
  The  wet sheet bath is sometimes, by mis-
nomer, called the cold wet sheet.  It is,  in
fact, a warm bath, or rather a large warm
poultice, kept warm  by the animal heat.  It
is formed by enveloping a person in a sheet,
wrung out of cold or tepid water, and cover-
ing or  packing him up with layers of  blan-
kets ; very free perspiration is the result.
It is a most useful remedy,  and might with
advantage be more generally used.  Spong-
ing with  cold water after the use of this
bath is occasionally practised.
  The  vapour bath produces free perspira-
tion, and may be used whenever that  is re-
quired, as in  incipient cold.  It is very re-
laxing.  Many  different  forms of vapour
bath have been invented.  A small kettle  to
place on the fire, with a tube  to convey the
steam  underneath the blanket or cloth  in
which  the person is enveloped, forms a good
vapour bath.  A simple extempore vapour
bath may be made by placing a vessel of
boiling water underneath the coverings of
the patient, and keeping  up the steam by
means  of hot stones or metal;  [or by wrap-
ping him in a blanket wrung out of hot wa-
ter, and covered with other dry blankets  to
prevent the evaporation.]
  The  hot air bath is used for the same pur-
poses as the vapour bath, but is more sti-
mulating.  Apparatus of various kinds for
this bath  may be  had  at  the  manufac-
turer's.
  Medicated baths are used, but only under
medical direction.
  Hip baths and Foot baths  are used where
a full  bath is  unnecessary.  The former,
either  cold, tepid, or  warm,  is extremely
useful  in  affections of the loins, hips, &c.
The foot bath, generally used as a deriva-
tive, ought to be of as high a temperature
as can  be  borne  and ought to redden the
skin after the immersion.  If a stronger ef-
fect is requisite, an ounce of mustard, and a
couple  of handfuls of salt may be put in the
water.   To reap the  full benefit of the foot
bath, the extremities should either be clothed
in woollen  stockings, or wrapped in flannel
immediately on  coming out of the water.
The  fact must  always  be kept in  mind,  in
using the foot bath in cases of insensibility,
that it  may be so  hot as  to scald, and yet
cannot  be complained of.   The best mode  is 
B  AT
54
BED
 to use the thermometer, and not to raise the
 heat above 110°.
   Fomentations, poultices, &c, may all  be
 regarded as partial baths, but will be treated
 of under their separate heats.
   BATH—City, celebrated for  hot  springs,
 the only ones in England.  The waters are
 used for bathing, and are drunk. They are
 found useful  in gout, rheumatism,  paraly-
 sis, liver and stomach affections.   Persons
 who suffer from impaired health, in conse-
 quence of long  residence in  a  hot  climate,
 frequently derive considerable benefit from
 the use of the Bath waters.  A pint of the
 water is said to contain—
  Muriate of lime..................... 1-2
  Muriate of magnesia..............1-6
  Sulphate of lime....................9-5
  Sulphate of soda...................0-9
  Silex...................................0-2
  Oxide of iron........................001985
  Loss...................................0-58016

 Saline ingredient.....................14 grains.
  Carbonic acid 1*2 cubic inches.
  BATTLEY'S SOLUTION OF OPIUM—
 Is a secret preparation, but one largely pre-
 scribed  by medical men on  account of its
 efficacy. It is more purely  sedative than
 the other preparations of opium, and is said
 to be twice the strength of laudanum—but
 this it is not.   Twenty drops of  the sedative
solution are  almost equal to  thirty-four of
laudanum.  It more certainly produces sleep
than the latter, and excites less.
  BEAN.—The various species  of bean are
most  nutritious to those whose  stomachs
can digest them : they are used either young
and fresh gathered, or old.  The nutriment
they   afford, as  shown  in the case of the
miners  in South America, who  live almost
exclusively upon them,  is calculated to sus-
tain a high condition of muscular develop-
ment  and vigor.   Garden-beans, as brought
to table in this country, must  be avoided
by those of   weak digestion.   They are
less likely to disagree  if deprived of their
skins.
  BEBEERINE.—A recently introduced sub-
stitute for quinine.  A powerful bitter, and
slightly stimulant tonic.
  BED  —Bedroom—in  health—in sick-
ness.—The fact that civilized people spend
on an average about one-third of their lives in
their bedrooms, is quite conclusive as to the
importance of their salubrity being a first
consideration  with every  one.   Whatever
the  public  rooms, bedrooms  should be as
spacious, lofty, and well-aired  as circum-
stances  will   permit.   Unfortunately the
reverse of this is the general rule,  and we
 have  close,  small  sleeping  apartments
 crowded  and ill-ventilated  nurseries, and
 bad health.   Good ventilation will do much,
 but it will do far more if aided by plenty
 of space.   During the day-time,  there is
 much less danger of persons generally suf-
 fering from want of fresh air  than during
 the night, when, in sleep,  they  are  many
 hours confined to one  place.  Every respi-
 ration of the sleeper  contaminates  a cer-
 tain  amount  of  air, and, as a  matter of
 course, the  smaller  the space  around, the
 sooner will  the contamination of the whole
 body of  air  contained in  that space be
 completed;  it  will  become loaded with
 an amount of carbonic  acid injurious to
 health.    The  room must   be  sufficiently
 large—and  this  is rarely the case in mo-
 dern houses—to supply pure air for respira-
 tion during six  or  eight hours,  or  some
 means must be provided for carrying off the
 impure atmosphere.  This, certainly, is not
 to be effected  by  closed doors and windows,
 and blocked-up chimneys, assisted  in their
 injurious  operation by closely-drawn cur-
 tains,  which  might be contrived  for the
 Bpecial  purpose of  enveloping  sleepers in
 their own exhalations, rendering sleep un-
 refreshing,  and  waking a  painful rather
 than a pleasurable operation.  It cannot be
 otherwise, after the poison of carbonic acid
 has been regularly inhaled for the  last few
 hours of slumber.
   If the door of  a sleeping apartment must
 be locked, the upper panels ought to be per-
 forated  for  the  admission of air,  but the
 purpose  is  much better answered by the
 door being left ajar, while it may be render-
 ed equally secure by means of a chain-bolt.
 There  is  an  advantage  in  admitting the
 fresh air  by this channel, for it must be
 warmed in some degree in its passage through
 the house.
  Air may be  admitted directly from with-
 out, through  the window, left slightly open
 at the top, or  better, by means of a barred
 glass, or perforated piece of zinc or tin.
 Some of  these  plates  are  made  so that
 the perforations may be opened or closed al
pleasure.
  It is not  sufficient to  let in pure air—the
impure  must  have some means of escape,
 and for this, the chimney—and no sleeping-
room either for rich or poor should be with-
 out  one—is the  most  neady channel,  and
perhaps the best, if under proper  arrange-
ments.  In former times, when fire-places
were ample and lofty, the chimneys were of
themselves sufficient to carry off bad air;
but  since, by  change of fashion, the open-
ings have been lowered and contracted, thej 
B  E D
55
BED
cannot dc this.   The air, warmed by respi-
ration, ascends to the top of the room, where
it  must  remain till it becomes  cooler, but
not more wholesome.   It  descends  to be
rebreathed,  and  reaches  the level of  the
breather's nostrils before it can  pass up an
ordinary chimney.   All this may be obviated
by making a proper opening for the  escape
of the impure warm air into the chimney.
Dr. Neil Arnott's chimney ventilator (fig.
xxii.)  is contrived for this purpose.   A
Fig. xxii.
and becomes choked with ashes, it has not
sufficient power to create a draught.   The
current of air is reversed—instead of pass-
ing up the chimney, it  passes down, carry-
ing with it into the room a very deteriorated
atmosphere, perhaps loaded with  sulphur-
ous gases.-—None  who regard  health  will
have curtained beds.   It is difficult to con-
ceive what other purpose  the huge masses
of drapery around a " four-post bed"  can
serve   than to  collect dust,  and  when
drawn,  to  confine impure air  around the
sleepers.
  For the young and middle-aged, hair, or
where  these cannot be afforded, firm wool
mattresses should  always be used: feather
beds, never.   The cotton mattress requires
more  frequent dressing and cleaning than
the hair.  For the aged, who are  deficient
in natural warmth, a  feather  bed is quite
admissible.  However perfect the provision
for ventilation of  a  bedroom  during  the
night may be, it must require additional
purification in the morning.  As a  rule, the
window should  be  opened as  soon as the
occupant  is about  to  leave the room, or
even before, in summer, and the bed clothes
turned down over the end of the bedstead,
or thrown entirely off, for  at least  an  hour
before the bed is made up for the  day.   In
this way perspiration, and emanations which
take place from every animal body, are
evaporated and got rid of.  Turn-up beds,
box-beds,  and all  enclosures of the kind,
are perfect abominations.  Slops of all kinds
should  be  removed from sleeping rooms as
early  as possible. Children even more than
adults require fresh,  pure air during sleep;
yet how often are  nurseries crowded  and
shut close up during the  night—the  beds
made  as soon as left  vacant, and the little
creatures  confined  to  the  room in  which
they have slept for a great part of  the day.
This ought not  to be,  nor would it be, but
for the generally prevailing ignorance upon
all  points connected with health  and the
rules for its  preservation.   There are few
parents but would make sacrifices to give
their children  a change of room, were they
sufficiently aware of the importance of so
doing.   Even self-interest would dictate the
course,  could they know how often  the first
cause  of illness, and all its expenses,  has
originated in the badly-aired nursery.
  It is  much  to be  regretted  that in the
houses of the poor, crowding at night is so
frequently compelled by circumstances.  If
it must be so,  its evils  ought to be  counter-
acted  by the  means of ventilation already
pointed out, and by strict cleanliness.   At
the same time, floors should not be washed
brick is taken out of the wall at the top of
the room,  so  as to make an opening into
the shaft of the chimney, the opening being
kept  closed,  and smoke prevented during
the use  of fires,  by means of a  balance
valve, b.   Thus, a bedroom,  to be healthy,
must have a sufficient entrance for good air;
must have a proper exit  for that which  has
been  rendered impure;  should have space
if possible.   The greater the  number  of
sleepers, the more requisite the  fulfilment
of these conditions.  It must also be borne
in mind, that a light, and especially a gas-
light, equally with the lungs, contaminates
the air.   It  is advisable when a light is
burned  in a  sleeping-room, to  place it so
that the fumes may pass up the chimney :
if a gas-light, it ought to be provided with
a special tube to carry off its fumes.   With-
out this, it must be a source of evil; with
it, of good ; for in the latter case it increases
the current of air through the room gene-
rally.
  Fires  in bedrooms are frequent  sources
of impure air, uncomfortable  sleep, and
morning headaches.  During the first hours
of night,  when  burning briskly, the  fire
promotes  ventilation ;  but  when,  as  often
occurs toward morning, it smoulders down,
* 
BED
5(3
BED
 in damp weather, and when they are wash-
 ed, it should be done early enough in the
 day to permit of their being thoroughly dry
 before  the  room window is  closed for the
 night.   Rooms which are at all crowded at
 night  ought to be whitewashed at  least
 twice a year.
   The chamber of sickness requires all the
 provisions for health  to be attended to with
 increased care, more especially if the illness
 be of an infectious character.   In this case,
 as free ventilation with cool pure air as the
 case will admit—the window, if possible,
 being open during the day—must be continu-
 ally preserved; and all superfluous furniture
 or clothing,  of cotton  or wool especially, and
 bed hangings, removed;  dirty linen must be
 taken  away at once,  and excretions—kept,
 as they should be, for the inspection of the
 medical  attendant—removed to an unoccu-
 pied room,  or  out  of doors.  The  zeal for
 cleanliness,  however,  must never, either in
 infectious disorders or not, go  so far  as to
 dictate washing the  floor of an  apartment
 occupied by the  sick; a  gentle  sweeping
 with tea-leaves, to  prevent dust,  is all that
 is allowable.  Cooking of any kind is out of
 the question.   If it  is possible  to have a
 second  bed  into which the sick person can
 be moved occasionally, it is a valuable re-
 source.  A  thermometer  to  regulate the
 temperature of a sick-room is at all times a
 safer  guide  than the  sensations  of indivi-
 duals,  and the  best average temperature to
 be maintained is from 55° to 60° Fahr.  All
 sources  of  unpleasant  or teasing noise,
 creaking hinges or shoes,  the ticking of a
 clock, &c, are to be obviated;  if there is a
 mirror into  which the invalid  can gaze, it
 should be removed.   Vessels,  whether for
 food or medicine, should be carefully cleansed
 each time of using.  The medicines ought to
 he kept in some sort of order in a place by
 themselves—never,  as  is frequently done by
 the poor, placed in the window, where they
 are liable to be decomposed by the action of
 light, or by the sun's rays.  All external ap-
 plications should be unmistakably marked.
  Even in disease of an infectious character,
 if proper ventilation and cleanliness be ob-
 served,  the  attendants upon the sick  have
comparatively little to fear, though, at the
same time,  every additional  precautionary
measure is to be adopted.  Fumigations of
tobacco,  burning  nitre, &c, &c,  are worse
than useless; they give no real protection,
and only deteriorate the air, or irritate the
patient.  Chlorine is the only effectual dis-
infectant to be employed, and by far the best
preparation  for the purpose is Collins's pa-
tent disinfecting powder, which requires no
trouble,  and maintains  a  continued,  suffi-
ciently effective, and not unpleasant chlorin-
ated atmosphere in the apartment. [Chloride
of lime wet with water or a little oil of vitriol
and water, also answers admirably.]  Vino-
gar, sprinkled or burned, has no power of
protecting against,  or  of destroying  the
power of morbid emanations; but it is some-
times grateful  to the patient and pleasant
to the attendants.  Darkening a sick-room
is too often resorted to, and  should not be
done except by order of the medical attend-
ant, for some special reason.  Bed and body
linen  of course  require to  be  frequently
changed, in fevers,  &c, once in twenty-four
hours if  possible; that is,  if it can be done
without exhausting the patient.
  Those  in attendance upon the sick, espe-
cially of an infectious disorder,  should live
sufficiently well,  and,  if accustomed to it,
take a moderate proportion of wine or malt
liquor; but not, as many do, have recourse
to extra potations of brandy, which can afford
no power of resistance, but only render the
body more susceptible of noxious influence,
when  the depression which  follows excess
supervenes.  A sitter-up should have tea or
coffee during the night, and those who have
to go  about a fever-patient in the morning,
ought  previously to take a cup  of one or
other of  these beverages.  The breath and
exhalations generally  of any one  labour-
ing under an infectious  disorder should be
avoided,  as well as any continued position,
toward which a draught of air  may be di-
rected/row the patient.  With these precau-
tions, those whose duty calls them to attend
upon  the sick,  ought never to shrink  from
that duty, but face it with cheerfulness and
trustful reliance upon Providence.
  There are now so many inventions for pro-
moting the comfort and convenience of the
sick, that it would be impossible  to enume-
rate them here, but a few of the most useful
requisites may be suggested.
  A measure, marked for  spoonfuls, to be
used instead of metal spoons, which vary in
size, and are apt to be  stained; a drop or
minim measure;  a piece of water-proof
sheeting, either of gutta percha or some one
of the numerous  materials  now manufac-
tured ; a fan ;  a night-light, either simple or
made  to keep water hot;  an air or water
cushion,  of waterproof material.  A "sick-
feeder" or half-covered  cup, with  a spout
and handle, is most useful  for giving either
liquid aliment or medicine in severe illness,
when  it  is desirable that  a  patient's  head
should not be elevated.   After severe illness
of any kind, the chamber which has been
used ought to undergo a thorough cleansing: 
                  BED

after fever or  other infectious  disorder,
every thing should be individually cleaned.
The room itself ought to be papered, paint-
ed, or whitewashed  afresh, the bed-frame
taken  down, scoured, and  with  other furni-
ture exposed to the open air for some days;
feather-beds and  hair-mattresses taken to
pieces,  their coverings washed,  their con-
tents rebaked  or  fumigated; whatever can
be washed,  should  be.   Expose  articles
which  have been  about the sick freely to
the action of air  or water, and  they will
speedily get rid of the noxious  particles,—
"fomites," as  they are called.  Shut  them
up, or bundle them  together, and they will
retain the power of propagating disease for
months,  it may be for years.
   The crowded rooms of the poor have been
mentioned—bad enough in health, they be-
come ten times worse in sickness, and this
is chiefly felt in country districts.   In towns,
a person seized with an infectious disorder,
if accommodation  and means at  home are
insufficient, has the hospital as  a resource;
in the  country  he  has not; the consequence
is that, to their own detriment and  that of
others, the sick are compelled to  be lodged
in the  crowded  family dwelling, with every
chance of the disease  spreading through the
house or village—the case  is continually oc-
curring.   It might easily be prevented, by
providing some isolated cottage in a healthy
situation, properly laid out and furnished for
the reception of the sick, with accommoda-
tion for  a wife  or a mother when  nursing
the invalid.  Such a  small village hospital,
whether  for the reception  of those afflicted
with infectious disease, or indeed  any se-
vere disease, would be most invaluable to
all; it might  be maintained for the use of
a small  surrounding  district at trifling ex-
pense ;  and there is many a female recipient
of parish relief who might be worse employed
than attending to  it.
   BEDS—Water—Elastic—Spring, &c.—
All who  have attended much upon the sick,
must be  painfully  aware, that with even the
greatest  precaution, it is sometimes impos-
sible to prevent the formation of " bed-sores"
upon the most prominent and exposed parts
of the  body.   To  obviate  this,  and relieve
the great suffering attendant upon long con-
finement  to the horizontal  posture, many
different kinds  of beds have been contrived.
It is not. necessary to describe  the various
constructions  of bed, but persons should
have some idea of the means of relief in
their power. Dr. Arnott, to whom the profes-
sion and the public are indebted for nume-
rous useful inventions connected with mecha-
aical medicine,  has invented an hydrostatic
                BEE

or water-bed, which in  some cases answers
admirably.  Mr.  Hooper, of  London, has
recently manufactured,  in conjunction with
his water-pillows, a most excellent invalid's
bed, of vulcanized India-rubber; and  an
adjusting bed, made of a number of extended
straps of webbing, any one of  which can be
relaxed at pleasure, is also a recent  inven-
tion, and one adapted to fulfil many useful
indications in illness.   [A variety of air or
water-beds, pillows,  &c. may  be  readily
obtained in Philadelphia or New York at the
stores for the sale of India-rubber goods.]
  There are many other varieties of bed for
fractures,  spinal disease, &c. &c.
  BEE.—See Stings.
  BEEF.—Beef Tea.—Beef, the most strong-
ly nutritious animal  flesh in use, is not
quite so digestible and  light as  mutton for
those of weak digestion; but  this depends
in some degree  upon the part selected.  A
slice from a coarse-grained shoulder of mut-
ton may be much more difficult of  diges-
tion than one from the under side of  a sir-
loin.  As a general rule, however, mutton
is preferable for the dyspeptic  and the con-
valescent.
  Beef-tea  is a most important  article in
sick cookery, but is very often badly made,
and much  too weak for the  purposes for
which  it  is  ordered.   In diseases of ex-
haustion, or in the last stage of fever, strong
beef-tea is  perhaps the form of nourishment
most easily assimilated, and adapted to af-
ford powerful support to the system.   Beef-
tea may be made from beef cut into thin
slices,  and placed  in  an uncorked  bottle
with a little water, the bottle  being placed
in a pot of water, and  the contents thus
boiled.  But  the  method recommended  by
Professor  Liebig is superior  to  any  other.
This celebrated chemist directs a pound of
lean beef,  free from  fat and bone, to be
chopped small, as for mince-meat, and to be
" uniformly mixed  with its own weight of
cold water, slowly  heated to  boiling, and
the liquid,  after boiling briskly for a minute
or two," to be "strained through a towel."
A little salt,  or any  allowable  seasoning,
may be added.  [Or one pound of beef, pre-
pared in a  similar manner ( should be placed
in one  pint of cold water, allowed to heat
slowly, and then  simmered  for  five hours,
after which it may be seasoned.]
  BEER.—See Ale.
  BEET-ROOT—Contains so  large a quan-
tity of sugar  as to make its  extraction an
object of commerce.   The sweetening pow-
ers are less than those of cane-sugar.   The
root itself, when boiled, is  easy of diges-
tion.  Its beautiful colouring matter mighj
5' 
BEL                 te                BIL
often be  substituted for more deleterious
substances.
  BELLADONNA.—The deadly nightshade
grows wild in many parts of Britain.  The
juice of the  plant  is powerfully narcotic
and  anodyne.  It is a  valuable  medicine
in proper hands.   Domestically, belladonna
should be known  as a  poison,  which has
proved fatal to children, who  have been
tempted to eat its violet-black  shining ber-
ries, which  are about as large  as  a wild
cherry, and  furrowed on each  side.   The
dowers  (fig. xxiii.) grow solitary from the
Fig. xxiii.
axils  of the leaves,  are bell-shaped, and
purple at the border.  Wherever the plant
is found, children should be warned against
it.  The symptoms of poisoning by night-
shade  are dryness of the mouth and throat,
difficulty in swallowing,  a kind of laughing
delirium, followed by insensibility and ex-
treme  dilatation  of  the  pupil.  With such
symptoms, a powerful stimulant emetic can-
not be too soon administered,  and  will pro-
bably make the case  clear,  by bringing up
the black skins of the berries.   Cold douche
to the  head, mustard plasters to the back
and legs, and sal-volatile internally, are ap-
propriate remedies, and  may  be used until
the arrival  of the medical attendant.
  Belladonna  is said to have the power of
protecting  against  the infection of scarlet
fever, when given in  repeated small doses,
during  the  prevalence of the disease,  to
those exposed ;  but the evidence is very con-
tradictory.   Eight grains of the extract are
to be rubbed up with a fluid  ounce of water,
and of this, from  five to twenty drops, ac-
cording to age, given twice a day.   It would
be right to try the remedy during  the pre-
valence of a malignant epidemic.
  BELLY.—See Abdomen.
  BENZOIC  ACID—Obtained from gum
benzoin, is in the form of white silky scales,
 and has a penetrating, not unpleasant odour.
 It has been found  useful in cases of  obsti-
 nate " wetting of the bed" in children.  Dose,
 five grains made into pills with bread crumbs,
 twice a day, to a child of ten years old.  It
 is an ingredient in paregoric.
   BERIBERI  and BARBIERS.—Diseases
 peculiar to India.—See Tropical Diseases.
   BILE.—The peculiar fluid secreted by the
 liver from the blood, is in man of a brown-
 ish-yellow colour,  and has  a bitter  taste.
 Its composition is complex, and it undoubt-
 edly fulfils more than one  important  office
 in the functions of the body.   Bile is  sepa-
 rated by the liver  from  dark blood, which,
 passing  through  that gland, on  its way to
 the  heart, from  the  abdominal  organs, is
 thus purified  of  noxious matters, contain-
 ing  a  large  amount  of carbon,  before  re-
 entering the general circulation.   The sepa-
 rated bile is discharged into the duodenum,
 (see Alimentary Canal,) and mixing with
 the digested food, appears to assist in fitting
 certain  of the constituents for  absorption
 into, and assimilation  or  transformation in
 the  body.  A  large proportion of the con-
 stituents of bile are along with the food  re-
 absorbed into the system, and  are probably
 intended and adapted  to support the pro-
 cesses  of  respiratory combustion.    It ia
 chiefly the colouring matter of the bile which
 is discharged from the  bowels  in  health.
 Bile itself, when  duly formed, even  when
 absorbed along  with  its colouring  matter
 into the blood, as we see in jaundice, scarce-
 ly produces injurious  effects upon the sys-
 tem, but the elements  of bile allowed to re-
 main unformed in the blood, act almost like
 a narcotic  poison.—See Liver, Digestion,
 &c.
   BILIARY   DISORDER—Including  Bi-
 lious or-British Cholera, [Cholera  Mor-
 bus.]—Biliary derangement  is so frequent
 an  ailment in civilized  life—its   history is
 so  intimately connected  with the general
 principles of health, and the prevention, or
 at least  alleviation, of  the disorder  is so
 much under individual control, that it has
 special claims upon our attention.
  It has been shown in the last article, that
in ordinary health  there must be a certain
balance  maintained between  the  secretion
and ultimate destination of the bile, the as-
similation of food, and the functions of re-
spiration:  that  in the  excreted bile the
blood is freed from  certain  principles, con-
taining  a large   amount  of carbon, which
could not be retained in it without injury to
health.   That  further, the bile, after beimj
separated from the blood by the  liver, and
thrown out into the general  tract of the ali- 
BI  L
59
B1L
mentary canal, performs an important part
in the function of assimilation;  and that,
lastly, a considerable proportion of the bile
—without  the colouring matter—is reab-
sorbed into the system, with the nutriment,
in such a state as to fit it, or rather its car-
bon, for union with the oxygen which enters
by  the  lungs,  so  that while  heat is gene-
rated, the  carbon, by taking the form of
carbonic acid, is fitted  for excretion by the
lungs or skin.  Upon these facts hinge the
causes  of  one  at least of the most preva-
lent biliary  disorders, that which  depends
upon the introduction into  the system of a
proportion of carbon aliment  too great to
be removed by the oxygen obtainable through
the  lungs, and which has its  ordinary ter-
mination in  the attacks which are  termed
"bilious attacks," "sickheadaches," "bow-
el complaints,!' "bilious or British cholera,"
according  to the  manner in which the pa-
tient is affected.
   The second form of biliary disorder de-
pends upon  torpidity or inactivity of the
liver itself.  The third  form is the  reverse
of the  first; the  gland  itself may  be  suf-
ficiently active, but the blood does not afford
sufficient material  for it to  work upon, and
bile is deficient.   This  is most frequent in
children.
   In addition  to those  affections, there  is
jaundice, which  will be treated of in its
proper  place.
   The first form of biliary disorder, that de-
pendent upon the accumulation  of carbon,
or of the elements of bile in the blood, must
evidently be owing to one of the following
causes, or  a combination of them: either too
much food, especially of a highly carbonized
character, such  as fats, oils, sugar, &c, is
habitually consumed, or the habits  are too
physically inactive to keep  the functions of
respiration,  animal heat, and motor change
and  circulation  in healthy action.  Or the
external atmosphere is so  temporarily or
permanently rarefied by heat that the indi-
vidual cannot obtain the full supply of oxy-
gen  in  respiration; lastly,  the  excretory
functions  of the  skin  may  be  impeded.
Now, although  it is unquestionable  that
some individuals have a much greater tend-
ency to biliary disorder than others, it is
also unquestionable that all have it in their
power in a great  degree, if not entirely, to
control or obviate that  tendency, by atten-
tion  to, and practical  application of, the
above principles.  In those who suffer ha-
bitually from sick-headaches—which depend
generally upon the presence of  bile in the
stomach—and from  other  forms of biliary
disorder common to this country, [especially
in the Southern and Western portions of th»
United States,] there is generally traceable
great error in diet.  Fats, as found'in ham
and bacon generally, melted butter, pastry,
meat, malt liquors or wine, and other highly
carbonized articles of diet, are taken too
freely, or at least are too regularly indulged
in, while at the same time very little activt
exercise is taken; the blood becomes over-
loaded with  carbon;  languor,  sleepiness,
headaches, giddiness, loss of appetite, furred
tongue, depression of spirits are the conse-
quences, and continue until at last the sys-
tem  is relieved, wholly or partially, by an
excessive  excretion  of vitiated bile, which
passes off  eithet by vomiting or  purging.
That deficient exercise has much to do with
the formation of such a state of system is
evident from the much  greater prevalence
of such attacks among  females,  who  take
little exercise, than among men; and indeed
they would still be more prevalent among the
former, were it not  for  the monthly relief.
Habitual neglect of the skin, also, by imped-
ing the excretion of carbonic acid from its
extensive  surface, undoubtedly  assists the
evil.  Again, we have bilious attacks,  more
especially those known by the name of British
cholera, (cholera morbus,) prevalent among
the community generally; but at particular
periods of  the  year—that is, in summer or
autumn—during or immediately succeeding a
prevailing high temperature, and to this high
temperature must we look for the cause; for
while, as a general rule, habits have not been
changed, people have been—in consequence
of the rarefied atmosphere—inhaling a less
proportiun of oxygen than usual.  Liebig
calculates  the  difference at one-eighth be-
tween winter and summer in Germany.  Here
we have another traceable and universally
acting cause, permitting the  accumulation
of carbon  in  the blood,  and  one which is
likewise found to operate upon Europeans
especially, who, in tropical climates, adhere
too nearly to the habits of comparatively full
living admissible in colder climates.
   From what has now been said it is evident
how much the avoidance of biliary disorder
is under individual control; the question is
in reality not one of medicine, but of diet
and regimen:  medicine certainly may be
required,  but not by any means  to the ex-
tent it is often used.   Those who are ha-
bitually liable to biliary disorder ought most
strictly to regulate the diet; fats of all kinds,
(except,  in some cases, bacon,)  must be
avoided;  butter  either entirely avoided, or
used in very small proportion, and  never
when melted;  animal food may be taken in
moderation, but  should  never be consumed 
BIL
60
BIL
at night;  much sugar, strong tea or coffee,
malt liquor, and the heavier wines, such as
port or sweet wines,  are  all bad.  In addi-
tion to plain  meat, bread, well-boiled vege-
tables, farinaceous preparations, and fruits,
ripe or cooked, are the best articles of diet,
and if  stimulants  are  required,  a  little
sherry, brandy, or gin, with water.   Exer-
cise regularly in the open air mitst be taken,
and the skin  kept  clear and  in an  active
sta,te.  If the bowels are confined, a pint of
warm water, used as a clyster, will  be a
most suitable aperient, or one  or two  of the
compound  rhubarb and  blue  pills may be
taken; it  is much better,  however, not to
trust  to medicine.  When,  from any cause,
the languor,  sleepiness, furred tongue, &c,
give notice of an  impending bilious attack,
five or six grains of blue pill should be taken,
and followed by a black draught or dose of
infusion of senna  and salts,  or of caster-oil,
in the morning.  Having thus cleared the
system, it is better to trust to diet and regi-
men than to a repetition of the dose as a
corrective of indulgence.
  British Cholera, [Cholera Morbus.]—
When, during prevailing high temperature,
an individual is threatened with an attack of
bilious cholera, or, as it  is frequently called,
when unattended with  vomiting,  " bowel
complaint," there is for  some time pre-
viously much  languor and  sleepiness, espe-
cially after meals, h-sadache, pain between
the shoulders, furred tongue,  loss of appe-
tite, fulness in the region  of  the stomach,
and high-coloured  urine.   The complex-
ion, perhaps, is dusky.   When such  symp-
toms  show themselves, one  or two doses of
calomel  or blue pill—four grains  of the
former, six or eight  of the  latter—is nearly
all  that is required for their removal.   The
mercurial  may be  followed or not,  as re-
quired, by a dose of senna-tea or castor-oil.
The diet  of course  ought  to be restricted.
If there is any tendency to heat or feverish-
ness, ten grains of carbonate of potash along
with a teaspoonful of sweet spirit of nitre,
taken in a wineglassful  of water, or of infu-
sion of dandelion, twice a day, will relieve.
   If  the  symptoms above mentioned are
neglected, the acute bilious attack, usually
known as bilious or British cholera, [cholera
morbus,] is  the winding-up:  it is  ushered
in by a sensation of chilliness, giddiness, or
headaches, bitter taste  in  the  mouth, and
nausea in most cases, quickly succeeded by
vomiting  of bile,  and griping and purging.
An attack of this kind may pass off lightly,
leaving the  patient better than for some
time previously, or it may be so severe as to
threaten life.   In the latter case the vomit-
ing is incessant, the  purging profuse, pain«
ful, and exhausting, and the motions, which
were  at  first feculent and bilious, become
light-coloured,  like  thin  gruel \  there is
much thirst, cold and blue skin  covered
with  cold perspiration, cramps, much de-
pression, the pulse imperceptible, or nearly
so, and perhaps the  secretion of urine sup-
pressed.  In short it is difficult to distinguish
the attack from one of the malignant Asiatic
iholera.  Between the severe form and the
mildest the  disease  occurs  in every degree
of severity.   If severe, the attack is always
painful  and  alarming, and may be dan-
gerous ;  and in the country, or at a distance
from  medical aid, requires  to  be quickly
dealt  with.   The first thing to  be kept in
mind  is,  that the manifestations are not the
disease, that the actual outbreak is only an
effort of nature to free the system of morbid
matter; that we may guide, control, and stop
if matters go too fast, but must  not thwart.
A mild attack of British cholera [bilious
diarrhoea] is better left alone, as far as me-
dicine is concerned;  diluent drinks, such as
barley or rice water, &c,  being given to
dilute the  bile, which  is generally  acrid,
and to assist its  passage  from the system.
In a severer attack, when  pain, purging, and
other symptoms  become  urgent, it  is time
to interfere.   The patient, if not in bed—
which, however, frequently  happens, from
the attacks coming on in  the night—should
go there at once, and hot  applications, bran
and such like, used to the bowels to relieve
the pain ; or more extensively to the limbs,
back, &c, if there is much  coldness or cramp.
A mustard-plaster the size of the hand, to
the pit of stomach, will sometimes abate the
sickness—general friction  is   serviceable.
Twenty to five-and-twenty drops of lauda-
num  should be  given  to  allay pain  and
moderate purging,  and  repeated  two or
three, or even  more times  in  succession,
every half-hour till some  effect is produced
—if the first dose comes up, the second should
be given at once;  if that does not stay, then
the third.   If the stomach  will not retain
liquid of any kind, if it  is to be procured,
the powde'r of opium should be given in  a
one-grain pill;  and if it remains, the dose
repeated, if  required, in  an hour, or a half
dose  given.  Sometimes  the vomiting is so
obstinate that no ordinary means will stop
it.  Many families in the country now keep
creosote for toothache; in such a  case as
the above, a single  drop rubbed up with  a
little gum or thick barley-water might be
tried, and  repeated  once ;  or four t<> eight
drops of chloroform in a little sugar and
water, or brandy and water, might have the 
BIL
61
BIL,
 desired  effect.  Two tablespoonful doses of
 the  ordinary chalk-mixture, either  with or
 without the laudanum, or half-drachm doses
 of aromatic confection, will be useful when
 purging continues.  In  addition  to  these
 means, diluent demulcent drinks, barley and
 rice-water, with isinglass  or  gelatine  dis-
 solved in them, are to be freely taken.   In
 case of extreme  depression, stimulants, hot
 brandy and water, &c, are to be  adminis-
 tered.   The  attack of bilious cholera is so
 sudden and its course so rapid, that if there
 is any great  distance to send  for  medical
 assistance,  there will be full  time  for the
 employment of the above  means, not only
 to the  relief but also to the  safety of the
 patient.
   After the attack has somewhat subsided,
 keeping in mind that the tendency of it is
 to clear the system, the bowels must not be
 allowed to get confined, but kept  slightly
 relaxed; if requisite, a dessertspoonful of
 castor-oil, with half a dozen drops of lauda-
 num, or a small dose of rhubarb and mag-
 nesia, with or without laudanum,  may be
 given.   The diet should be  chiefly of a dilu-
 ent character, for a short time, but nourish-
 ing.  Should any  of  the  symptoms which
 preceded the attack, such as languor, fulness
 about the region of the liver, pain between
 the shoulders, furred tongue, &c, continue,
 a few doses of the compound  rhubarb  and
 blue pill will be advisable;  if  the  stomach
 remains weak,  from  five to ten grains of
 carbonate of potash in a wineglassful of in-
 fusion of calumba  or gentian will be  found
 useful—if the tongue is perfectly clean, and
 there is debility, one grain of quinine in half
 a glass of sherry twice a day.
   There are, however, states of biliary dis-
 order,  generally connected with  stomach
 derangement also,  which  are not the conse-
 quence of  excess of aliment, but may even
 arise from  the reverse, and which  require
 the aid of  medicine for their removal;  the
 liver is  torpid, the  blood  is  insufficiently
 freed from its superfluous  carbon, and, in
 addition to  impaired digestion, the indi-
 vidual suffers from the  train  of symptoms
 above  enumerated  as attendant upon such
 a condition of the  circulating  fluid, mental
 and  physical depression being the most pro-
 minent.  The bowels  are confined  and  the
 motions  inclined to be light or chalky, at
 other times  almost black.   There  is pain
 between the shoulders and sensation of ful-
 ness in the region  of the stomach.  When
 such a train of symptoms occurs it is better
 to take proper medical advice;  if this can-
 not be done, in order to relieve, a few grains
of blue  pill,  or grey powder  given every
night, or every other night, are each to be
followed by a moderate  dose of castor-oil,
or infusion of senna in the morning.   At
first the infusion of taraxacum, with five to
ten grains of carbonate of potash, and, if the
stomach is weak, a teaspoonful of tincture
of calumba, taken  twice a  day, will  be of
much  service.   The diet should be nourish-
ing  and easy of digestion,  such as plain
meat, potato, and light puddings, but pastry,
cheese, and oily preparations of all kinds—
except toasted bacon—must be avoided.  In
cases of debility, wine, malt liquor, or a little
weak brandy and water, whichever generally
agrees best, are not to be  allowed merely,
but  must be taken medicinally in modera-
tion.   Daily exercise to the extent of  slight
fatigue, relaxation from business, cheerful
company, early  hours, and attention  to the
state of the skin, by means of the tepid bath
or sponging, are all  assistant means, and
will  even of themselves be sufficient  to  re-
move slight attacks.  Where the bowels are
obstinate, clysters of tepid water  are espe-
cially useful, and preferable to the continual
use of purgatives, which weaken the digestive
power of the stomach.  When the tongue is
tolerably clear,  and debility of the stomach
or of the system generally remains, twenty
drops of dilute nitric acid may be taken with
advantage twice a day, either in water or in
infusion of taraxacum, with or without the
addition of a tonic bitter.
  It is important to have a clear distinction
in the mind between  the two conditions of
biliary disorder treated of.  In  the former,
that which precedes the attack of British
cholera, the liver fails because there is more
given it to  perform than it can  do, even in
its most healthy state.  In  the latter, the
liver itself is  incapable of doing the work
it ought, to maintain  a healthy condition of
body.   In the former case, reduction of diet
is evidently the most common-sense pre-
vention and cure.  In the latter, the  organ
must be brought up to its work, and made,
if possible, to  do its part in the assimilation
of sufficient  nutriment  for  health.   The
diet  is to be regulated, not diminished, the
general functions kept active, and especially
the nervous system, by moderate exhilarat-
ing exercise both of  mind  and  body, is to
be maintained in  such a state of regular
tonicity as  will enable it to impart that due
stimulation—which is so much wanted  in
these  cases—to every function  connected
with assimilation.  When cases of chronic
biliary disorder  present feverish symptoms,
the mercurial at night, and  the aperient in
the morning are still to be  used, and also
the potash  and taraxacum, but without the 
13 I X
02
BIN
bitter;  animal food and stimulants strictly
forbidden, and milk and farinaceous diet sub-
stituted ; the tepid bath used, and clysters.
  Although such general  directions as will
be found useful in the treatment of chronic
biliary disorder  have been given, it is  not
recommended  that home medicine  should
be resorted to  when  medical assistance is
within reach.  Much certainly may be done
by judicious management, but it is probable
that efficient medical advice will save both
time and suffering
   In children,  particularly  those  of  fair
complexion, deficiency of biliary secretion is
frequently evidenced by the irregular action
of the  bowels,  and  light-coloured chalky
motions.   It is of course desirable to correct
this, but it must not be attempted  by the
"grey powders," (mercury with chalk,) so
usually resorted  to   They will, undoubted-
ly, for a time improve the appearance of the
motions by causing an increased flow of bile,
but this  is obtained at the expense of  the
system, which does not appear able to fur-
nish sufficient material for the secretion. In
a few days the motions are as deficient in
bile as ever.  Such a condition can  only be
permanently corrected by a good  allowance
of animal food, and general tonic treatment,
iron being especially requisite; a few grains
of gray powder,  however,  being  given once
or twice a week.
   BINDER.—The bandage  which is  put
round  the  abdomen  of  the  mother after
child-birth, and which forms a most import-
ant requisite, both as regards the comfort
and  safety of the patient.   Many forms of
binder are used,  but  none are so generally
applicable  or so  efficient  as  a light, small
tablecloth, or shawl,  or square  of  calico,
folded  broad like a cravat, so that it will
embrace the whole of the  lower  portion of
the abdomen, and  can be tied in a double
knot at  the  back,  outside  the  bed-dress,
where it is under the control of the attendant.
The binder ought always to be put on at the
commencement of labour, and tied so as just
to give comfortable and moderate support to
the abdomen:  as the process of parturition
progresses  it must be gradually tightened,
and as soon as the child is born, as much so
as will afford comfortable support.  Lastly,
after  the  separation  of the  after-birth, it
must  be tightened  again.   In  all these
changes, the best guide is  the feeling of the
patient, comfortable  efficient support being
all that is requisite;  if tied too tightly, the
binder will do mischief.  The greatest bene-
fit which results from the early application
of the binder is the prevention of faintness.
The  sudden  emptying  of the  abdominal
I cavity which takes place when  the  child is
 expelled, is  quite as frequently a cause  of
 the above symptom  as  loss  of blood, the
 effect being in great measure purely me-
 chanical, and  similar to what occurs when
 fluid  is drawn from  the belly in  dropsy.
 This mechanical support given by the binder,
 moreover,  exerts  regular  and  regulated
 pressure, which must give some assistance
 to the efforts of the womb, and  lastly, after
 the concluding processes of labour are over,
 it is no slight  advantage to have a firm, ef-
 ficient binder in its place, instead of having
 to disturb  the patient by its adjustment. In
 cases  of hemorrhage or flooding,  such an
 arrangement may  be of the very  highest
 importance.  In  the  course  of an hour or
 two after labour is concluded,  the form of
 binder which has been recommended above
 can be  exchanged for the ordinary broad
 band,  fastened round the abdomen by pins
 or buckles, or for one of the numerous forma
 of binder,  shaped  to fit the abdomen, of
 which fig.  xxiv. represents one  of the most
Fig. xxiv.
useful.  It is made of the shape representeu,
of double calico, and about ten inches wide
in the centre;  one of the ends being rather
Fig. xxv.
 
BIR
63
BLA
broader  than the other, so as to admit of
the latter running through the slit, (fig. xxv.,)
and both being sufficiently long to be brought
round and fastened in front. [In the United
States it is  not usual  to  apply  the binder
until after the delivery of the after-birth.]
  Refer to  Child-birth.
  BIRTH.—See Child-birth.
  BISMUTH—Is a metal.   Its only medi-
cinal  preparation  is  the oxyde,  sometimes
called the nitrate of bismuth, which occurs
in the form of a  yellowish-white, rather
heavy powder.   It  is found useful and fre-
quently  prescribed in nervous pain of the
stomach, gastralgia, and id waterbrash.  In
the distressing diarrhoea of the last stages
of consumption, it will sometimes afford re-
lief when other remedies have failed.   The
usual dose is five or six grains, twice or three
times a day, in any thick vehicle, such as lin-
seed-tea, or thick barley-water.
  BISTOURY.—A small surgical knife.
  BITES.—See Wounds.
  BLACK-DRQP—Is a preparation of opium,
formerly secret.   It is, essentially, a prepa-
ration of acetate of opium, and is  devoid
of some of the stimulating properties of
crude  opium.   Black-drop  is  estimated
at three times  the  strength  of  ordinary
laudanum.
  BLACK-DRAUGHT—So well known as a
domestic remedy, is a mixture of infusion
of senna with Epsom salts, and frequently
some aromatic, such as ginger or caraway.
It is a certain and active purgative, but not
well suited for weak habits.  Quarter of an
ounce of senna-leaves may be infused in a
pint of water; to this is added one ounce of
Epsom salts; along with it, if there  is no
fever, a  couple  of  drachms of tincture of
senna;  of this mixture, a small teacupful
[or ordinary wineglass] should be taken every
two hours, till the desired effect is produced.
  BLADDER.—The  urinary  bladder  (fig.
xxvi.) is the receptacle for the urine, after
it has been  secreted by the  kidneys, and
Fig. xxvi.
previous to its discharge from the body.  It
is an oblong membranous bag, composed of
three layers or coats, the middle one being
muscular, and is situated in the pelvis, just
behind  the pubic  bone, rising, however,
when much distended,  into  the abdomen.
At the neck of the bladder, in the male, is
situated the prostate gland,  (fig. i.)
  Many of the diseases and disorders of the
bladder  are  brought on by carelessness,
neglect,  or too great  subservience  to the
conventional  restraints of  society;  those
persons especially, who  habitually or neces-
sarily are frequently compelled to restrain
the desire, and forego  for a time the relief
of emptying a distended bladder, are liable
to affeetions of the organ.   In early child-
hood, but sometimes even beyond puberty,
the bladder habitually empties itself during
sleep; night after night this occurs, and
proves a serious annoyance, and expense
too, from the consequent destruction of bed-
ding.  The habit or disorder is sometimes
extremely difficult, if not quite impossible,
to eradicate.   The regular use of the cold
hip-bath every morning  is one of the most
efficient  remedies, and the tincture of mu-
riate of iron, or " tincture of steel,"  as it is
frequently called, given twice a day, in ten-
drop doses, in water, is often useful.  Ben-
zoic acid and nitrate of potash are both said
to have proved successful.   In such  cases,
fluid is to be taken  in  small quantity only
in the  evening.   Malt  liquor  always in-
creases the evil.  Where the habit is invete-
rate,  it is  better to use one of the India-
rubber urinals attached to the person, than
to allow the patient to be a nuisance to him-
self  and others.   [This habit  in children
may be overcome by attention, and  the pa-
rent or nurse who will insist on the child's
rising  at 9  or 10 p. m.  and  urinating, will
find  that they can accomplish a cure in a
few nights.  I have never known an instance
where it failed.  Whipping  is  worse than
useless:  it increases the evil.]
  Rupture of the bladder is  almost invaria-
bly fatal.  It is generally caused by blows
or falls when the viscus is full of urine, but
sometimes  without violence, simply from
over-distension.   In the former case, intoxi-
cation is in most instances the first cause of
the accident;  the individual sits drinking
till the bladder is quite full, staggers out to
relieve himself, and  either falling or stum-
bling against some object, the urine is effused
into the cavity of the abdomen or surround-
ing tissue;   agonizing  pain  and extreme
vital depression are the immediate  conse-
quences, and the patient speedily dies.   In
the latter cases, when the bladder is rup- 
BLA                64                 B L I
tured froa over-distension without violence,
it is generally caused  by long retention of
urine, from obstruction to its discharge. In
this  case, the first sensation of rupture  is
rather one of relief than otherwise ; the rent!
being at the lower part of the  organ, the
fluid is diffused into the loose tissues of the
scrotum and surrounding parts,  giving rise !
to  severe inflammation  and mortification.
The  bladder is sometimes  ruptured  by ex
treme violence, such as that of the passage
of a  cart over its region.  In all these cases,
the attendance of a surgeon  is absolutely
requisite, if possible.  Death  is all but in-
evitable ;  but if life cannot be saved, much
relief may be afforded  by the  moderate use
of stimulants and the free use of large doses
of opium.
  Strangury.—During the prime of life, the
bladder is not generally liable  to suffer from
chronic  disorder, except in persons of dissi-
pated or intemperate habits; but one acute
and  very painful  affection,  strangury—
generally caused by the application  of  a
blister—is not uncommon.  The  affection is
characterized  by burning  pain, extending
through the urinary passages up to the neck
of the bladder,  accompanied with constant
and  distressing desire, and straining effort
to pass urine, which will only  oome away in
very small quantities, often mixed with blood.
While it lasts, the condition is  a  painful and
most distressing one.   The means of relief
are warm hip-baths, demulcent drinks co-
piously  taken,  such as barley-water with
gum arabic, linseed-tea, &c.   Warm  clys-
ters, consisting of half a pint of gruel con-
taining  twenty or thirty drops of laudanum,
give much relief;  [an opium pill pushed into
the bowel answers the  same purpose, and is
readily accomplished. ] Twenty drops of lau-
danum,  or ten or fifteen drops of the sedative
solution, may also be given by the mouth, and
repeated  if requisite.   When  the patient is
not in the bath, hot bran poultices are to be
used over the lower part of the abdomen.
  Stoppage  of  Urine. — With declining
years, the bladder becomes more subject to
disorder and disease;  perhaps the most fre-
quent affection  is sudden  inability  of the
organ to  expel the urine.   This may arise
from its  having been allowed to become
over-distended;   from  cold; from drinking
hard malt liquor—a very frequent cause  in
England—or sometimes  from  external vio-
lence.   The case  is one of much distress and
alarm, and being not devoid of danger, can-
not be too soon placed  under proper medical
treatment.  In the mean while, the  person
should be got into a hip-bath, of  the temper-
ature of 90° Fahr., and kept in for at least
half an hour, a warm bed being ready to re-
ceive him on coming out, and hot bran poul-
tices be applied as soon as he is placed  in
bed. Just before entering the bath, a table-
spoonful  of castor-oil  with ten  or fifteen
drops of  laudanum should be administered
It is not improbable, that relief may be ob-
tained by these means; but  all efforts  at
straining  must be  avoided  as useless and
hurtful.  Of course fluid must be eschewed
as long as  the stoppage continues.  While
the above measures  are being carried out,
medical assistance  ought to be  procured;
for, should other means fail, the introduc-
tion of the catheter must be resorted to,  to
save life.   Nevertheless, the prosecution  of
the mode of treatment recommended, if it
does not prevent such  a necessity, will cer-
tainly facilitate a sometimes difficult opera-
tion.  [The common practice of administer*
ing sweet spirits of  nitre,  gin, or other
diuretics, is most injurious when the patient
is thus situated.  They increase the flow  of
urine into the bladder, but not the power of
evacuating it.]
   Weakness of Bladder.—Weakness of th«
bladder, and inability perfectly to retain the
urine, is  a frequent disorder  of  advanced
age:  it often commences with and is accom-
panied by imperfect emptying of  the organ,
either through  carelessness or  weakness.
Sponging the lower parts of the abdomen,
&c. &c, with vinegar and water, or  salt-
water, may be of service.  Dr. Day recom-
mends the use of tincture of the ergot of rye
in  these cases; but as a general rule they
should be placed under regular medical su-
perintendence.  The  same may  be said  of
that very troublesome complaint  of old age,
catarrh of the bladder, in which large quan-
tities of thick mucus are discharged.
   Stone  in the  bladder may be suspected
when the urine is  liable to become bloody
alter  exercise, when  there is pain in the
bladder and surrounding parts, in  the back
and down the thighs, and when the stream
of  urine is apt to stop suddenly during the
act of passing.   Under such circumstances,
proper advice cannot be too soon obtained.
   Refer to Kidney—Urine—Blister.
   BLEEDING.—See Hemorrhage.
   BLINDNESS.—Loss of sight may be the
one effect of a great variety of causes.  Dis-
order of the brain itself, or sympathy of that
organ with  the stomach, may be the  occa-
sion of the  symptom.   The optic nerve, or
its expansion within the eye, named theretina,
may be the affected parts ; or, lastly, some of
the transparent  structures of the organ of
vision may, by becoming opaque, obstruct.
wholly or partially, both light and vision. 
BLI
65
BLI
  Loss of sight may come  on suddenly, or
very gradually;  in the former case,-it is
generally consequent  upon  some disorder,
actual or sympathetic, of the brain or nerv-
ous tissues, and is  always to be regarded
seriously.  It may last only for a few seconds,
or it may be permanent.   In diseases such
as apoplexy, or water in the head, loss  of
sight is a very constant symptom ;  at least,
the eye  is insensible to the  usual impres-
sions.  In  these  cases it is  dependent upon
pressure on the  brain.  In diseases  of  ex-
haustion, or after copious loss of blood,  the
same symptom occurs.
  A transient loss of sight, unrepeated, and
occurring unaccompanied by symptoms in-
dicative  of head affection, will sometimes
be  occasioned by simple disorder  of  the
stomach, which abstinence  and one or two
doses of the blue and compound colocynth
or  rhubarb pills will  rectify;  but  in  the
event of the symptoms recurring, and with
it other  symptoms, such as headache, gid-
diness,  or  sickness, medical  advice  should
be instantly procured ; in the mean while, if
the person be of full habit, a few leeches
may be applied to the temples, a smart dose
of calomel and compound colocynth  taken,
and abstinence and  perfect quiet enjoined;
if the habit be spare,  milder action upon
the bowels, moderate diet, and quiet will  be
the safest  course till the case is seen by a
medical man.   For other information on this
point, see Amaurosis.
  Blindness which ensues in consequence of
changes  of structure in the eye itself, is
either the result  of active inflammation, or
if not, is very gradual in its approaches.
  Refer  to Eye, diseases of.
  BLISTER.—The term is applied either to
that which causes effusion  of  serum—the
watery portion of the blood—underneath the
scarf or outer skin, or it  is  used to  denote
the effect itself,  that is, the  bag or  vesicle
containing fluid, which is  formed.   There
are various methods of producing blisters
on  the skin; in  fact, any powerful irritant
may have the effect;  and we may regard the
effusion  of fluid  underneath  the insensible
or outer skin as an  effort of nature to pro-
tect the true and acutely sensitive skin from
the action of the irritant substance.  Steam,
boiling  water, strong  ammonia, mustard,
and many other irritants, have the power of
raising blisters, and are used for the purpose
by medical men ; but by far the most con-
venient,  certain, and  generally  adopted
agent, is the cantharis vesicatoria, or Spanish
fly.  The most usual form in which it  is used
is the common blistering plaster, which being
spread upon leather, or some other material,
       f 2
[such as brown paper or muslin,] is applied
to the skin.   A solution of the active prin-
ciple of cantharides in strong acetic acid,
and a collodion blistering fluid are also used;
but the most convenient, elegant, and suffi-
ciently efficacious  applications, if properly
applied, are the blistering tissues or papers.*
   To the old form of the  blistering-plaster
there are many objections ;  its weight and
smell in the first place, its tendency to leave
small particles of irritating matter adhering
after its removal, and more especially its
liability to occasion strangury, (see Bladder,)
rendered  an  improvement  desirable, and
the end has been quite accomplished by the
very efficient  blistering-tissues now manu-
factured.  They are light, almost free from
smell, are removed with the greatest ease,
are not liable to affect the kidneys or blad-
der,  and  are remarkably well suited for
children.  In  applying a blister to any por-
tion  of the  body,  the  first  care must be to
insure accurate contact with every portion of
the surface it is intended to affect, the fitting
to irregularities being insured by snipping
the edges, and all  hairs, whether about the
head and face or  elsewhere, being shaved
off clean, just before the  blister is put on.
In the case of the paper blisters, it is better
to add  the weight of a folded napkin placed
about them.   If the old form of blistering-
plaster be used, a few drops of oil rubbed
over the surface  will  increase its  activity
and facilitate  its removal; this, however, is
still better insured, and the injurious effects
apt to follow the use of  this preparation
prevented, by the interposition of a piece of
thin muslin  [or tissue-paper] between  the
plaster and the skin.   The evening is gene-
rally the best period of the four and twenty
hours for the application of a blister, which,
on an  average, takes twelve hours to rise
well, but sometimes much  longer, especially
in those  who have very dry skins,  or  are
far advanced in life, or when there is much
nervous  depression.   In  children, and in
those of very delicate skin, the time is much
under  twelve hours.   In the  former,  the
action  of a  blister ought   to  be closely
observed, and the more so the younger the
child:  the  application being  removed  as
soon as it begins to rise,  and a soft bread
poultice  substituted, and  kept on for a few
hours,  full rising will  usually take place.
When a  blister has well  risen, the plaster
being removed, and  a cloth  placed so as to
catch the fluid, the vesicle or bag of water
is to be  punctured at the most  dependent
 •Brown's blistering tissue and Smith's tissue  are
both good preparation*. The former is the cheapest 
BLI
60
B L O
part  by the  point of a penknife, or with a
pair of scissors, and the thin skin which has
been  raised  allowed to  subside unbroken,
and the dressing applied.  If there are more
vesicles than one, each  must be punctured,
unless very small.  It is very common for
medical  men to be told that a blister  has
only risen in one place, or at the lower part;
but this is generally erroneous, the blister
having risen all over, but the fluid gravi-
tated  to the lower side.   It sometimes hap-
pens  that instead  of  watery fluid, blisters
contain a jelly-like matter, which  will  not
run out: no attempt at squeezing should be
made  in such a case.; if the  dressing be ap-
plied, gradual oozing will drain the  vesicles.
  Very various methods of dressing blisters
have  been proposed  and practised,  that
more  generally followed  being by means of
lint and  linen spread with  lard or simple
cerate or spermaceti ointment.  The use of
jewellers' fine  cotton, or cotton wadding,
has been proposed by Dr. Douglas Maclagan,
of Edinburgh, and is  said to answer well;
but by far the pleasantest and lightest dress-
ing  the  writer  has  met  with,  and  one
which once used has .always been preferred
by his patients, is Brown's tissue-dressing,
which consists of a cerate evenly and thinly
spread upon fine tissue-paper.   This elegant
dressing forms as it were a second cuticle,
it becomes adherent to the surface by means
of the dried  serum, and  is so light as to
require no extra applications to retain it in
place—in this point differing from the heavy,
ointment-covered, serum-hardened  lint  of
linen, which in many situations it is impos-
sible  to  keep on, and  which,  falling  off,
usually pulls the cuticle with  it.  When a blis-
ter, from mismanagement or any other cause,
becomes  inflamed,  or,  as it is popularly
called, gets "the fire in it," a soft bread and
milk  poultice applied for a  few hours will
give great relief.  Blisters should always be
healed: the custom of dressing them with irri-
tant ointments to keep them " open," is at
once  barbarous  and injurious;  the teasing
pain,  by its irritating effect upon the nervous
system,,  does much harm.    If  continued
counter-irritation is required, it   is  much
better to  apply a succession of small blis-
ters,  not  on, but close  to the  same spot.
" Flying  blisters"  are  blisters which  are
taken off as soon as the skin  is reddened and
irritated: a  diluted mustard  poultice  an-
swers much the same purpose.
   Blisters are often  applied  domestically,
without medical advice, but often injuriously,
during  the continuance of acute inflamma-
tion  and  fever.  In such cases,  especially
when put on just over, or very near the af-
fected  part,  they do harm; they increasi
general fever, and may aggravate instead
of relieving the local disease.   This error
is frequently perpetrated in cases of acute
inflammation affecting the throat, or in pleu-
risy, when a bran poultice would be much
more serviceable.  In persons who are suf-
fering under or who are liable to affections
of the  kidneys, blisters must not be used,
except  under medical  sanction,  and tltut
will  be given in  but  few cases.   Persons
are sometimes needlessly much  alarmed at
the fact of a blister  not rising.  Unques-
tionably,  such  a result may be  owing to
extreme and fatal depression, but is quite
as frequently due to trivial causes.
   THE BLOOD.—The  vital fluid.   "The
life."—As  the  living  blood circulates  in
the living  body,  it is made up of "liquor
sanguinis," or the  liquid of the blood, and
of blood corpuscles or globules.   The liquor
sanguinis holds dissolved  the animal prin-
ciples,   fibrine  and albumen, and various
mineral salts, and in it float the globules.
When blood is  drawn  from  the body, it
separates,  as most are  aware, into a solid
and  watery portion.  The  former consists
of the  fibrine, which thus solidifies out of
the liquid blood, when withdrawn from the
direct  influence of vitality, and entangles
the gloubles in the process: the latter, or
serum—the  same kind of fluid  which is
thrown  out  in a blister—still  retains  in
solution the albumen  and the  salts,  the
former  being easily  coagulated, like  the
white of egg, by heat.   The blood corpus-
cles, or  globules, are of  two kinds, red, (fig.
xxvii.,) which are much  the most numer-
ous,—and  white, or  colorless, (fig. xxviii.)
Fig. xxvii.
Fig. xxviii.
These bodies are of course very minute, the
average diameter of the human red globule
being 3200th of an inch—of the colourless,
a little more.  The red globules of the blood
are composed of  a membrane  which en-
closes the coloured fluid; under the micro-
scope they have the appearance of flattened
discs with  a depression  in the centre, (fig.
xxvii.)  When fresh drawn from  the body,
they have a tendency to arrange themselves
in connected rows.  Blood circulates in the
living  body in the two very different forms
of arterial and venous blood.   In the former 
B  L 0                07               B L 0
case, it flows in the  arteries, is bright red,
and conveys life-giving influence and nou-
rishment to every portion of the frame; in
the latter, it is black-looking, flows  in the
veins, and possesses properties destructive
to life, until, by the action of the liver,  and
more  especially by exposure to the  action
of the atmosphere in the lungs, it becomes
purified.   The properties and composition
of the blood in  health,  and  the changes
which these undergo in disease, have of late
years received much  attention, and  many
important discoveries  bearing upon  the
nature and treatment of disease have been
the result; but  the greatest improvement as
regards the blood, in the practice of medi-
cine, is the much greater caution exercised
in the abstraction of the vital fluid.   Bleed-
ing from  the  arm, which formerly was so
generally resorted to,  even as  periodical a
habit,  is  comparatively  rarely practised.
This is strikingly evident from the newspaper
reports.   Very few years ago,  the addition
to Ihe accounts of  accidents,  of whatever
kind, might have been stereotyped, that "a
surgeon came  and bled" the sufferer,  and
with  it the too  frequent addition  of  the
" vital  spark had fled;" and  certainly, if
any thing could extinguish the spark  of life
flickering after the  shock of a severe acci-
dent,  it must have been  the senseless, un-
meaning custom of bleeding, when perhaps
brandy and  water  or ammonia  were re-
quired.  The disappearance of such notices
as above from the public prints evince the
improved practice;  but even  now, in the
country,  it is  difficult to  persuade people
that they do not require  bleeding after an
accident,   and  all  bad  consequences  are
attributed to the omission of the mysterious
agency of  blood-letting.   Blood,  we  are
told on the highest authority, is the " life,"
or at  least the  medium of life  to the  body,
and it is, we know, the great feeder of every
portion of the frame;  and to feed, it must
be fed, and every drop extracted unnecessa-
rily is money from the poor man's pocket;
but worse still, if largely abstracted by de-
sign, or lost by accident, it frequently can-
not be recovered, and the constitution re-
ceives a  shock, and facility of yielding to
disease, which  it never gets the better of.
  Blood-letting.—But yet in  blood-letting
we have a powerful auxiliary in the  treat-
ment of some diseases, although one to be
used with due  caution;  and the ability to
perform  the  operation may be serviceable
in remote or thinly-settled districts.  Any
man who has the idea of using the  lancet,
if required, should see the operation per-
formed.   One practical lesson, accompanied
1 with a little kind explanation, is worth an
 description, although this may be useful as
 a reminder afterward.
   Bleeding with the lancet may be perform
 ed wherever a  superficial vein can be de-
 tected.  The large vein of the neck (the ju-
 gular) is  not unfrequently opened by the
 surgeon—also the veins  of  the hand  or
 foot;  but the bend of the elbow  is the most
 usual site  of  the  operation.  In this po-
 sition, if regularly distributed, there shou'^i
 be a  tolerably  large vein (fig. xxix.  2, '6)
Fig. xxix.
Fig. xxx.
running up each side of the arm,  and a
central  vein, (4,) which, dividing into two
branches,  sends  one to  each of  the vessels
above mentioned.   It  is the  branch  (fig.
xxix. 5) going to the outer vein which is
usually  opened in bleeding.   The veins on
the inner side of the arm, being as a gene-
ral rule avoided by the surgeon, if blood in
sufficient quantity can be procured from the
more external branches.  The reason of the
selection is the presence of the main artery
of the arm  close beneath the inner veins,
and the possibility of its being wounded in
the operation.   A skilful bleeder  may un-
doubtedly avoid  so serious a mishap.  But
certainly  no unprofessional person should
run the risk; and, indeed, in whatever  situ-
ation, and by whomsoever a vein is opened
in the arm, it must  always be ascertained
beforehand, by pressing the finger down  upon
the part, that no artery is pulsating under-
neath. 
                 BLO                 (

   The first thing, when  the  operation  of
bleeding from the  arm is to be performed,
is to have all things in readiness.  These
are  a bandage of some kind,  or soft half
handkerchief, a  piece of linen folded six or
eight times into a pad an inch and a half
square, a basin, or two or three cups, a  stick
to support the patient's arm if requisite, a
towel, and a little cold water.  The  band
is to  be tied round the arm, with a  bow-
knot, about two  and a half inches above
the  elbow,  (fig.  xxix.  1,)  with  sufficient
tightness  to stop  the  flow of blood in the
veins, but not in the artery, which may be
ascertained by feeling the pulse at the wrist.
The  operator, while  supporting the arm of
the patient with  the fingers of the left hand,
presses upon the  vein  with the thumb,  a
Bhort distance below the intended opening—
this  pressure  serving   to steady the  vein
under the  incision of the  lancet; and  also,
if the operator be alone, to prevent the free
flow of blood until he  has had time to lay
down his  lancet and hold the basin.   The
lancet being held between the thumb and
forefinger  of the  right  hand, with its  sides
in the  position represented,  (fig. xxx.) and
the  hand  being supported  by the  other
fingers, the point of the instrument is to be
made to pierce  the vessel, and it is carried
forward so as slightly to enlarge the open-
ing,  and  then  withdrawn.   If the blood
does not  flow freely,  the patient  may  be
made to  grasp a stick, or any  solid  body
which will partly fill the hand.   When  it is
desired to stop the flow of blood, the  band
is to be  untied, the left  thumb and  fore-
finger  being placed upon the wound,  so as
to pinch together its sides ;  the arm, if re-
quisite, cleansed; the linen pad substituted
for the thumb upon the wound,  and secured
by the band or handkerchief passed round the
Fig. xxxi.
                  BLU

arm in the form of a figure of 8, (fig. xxx' |
The arm ought to be  kept at rest  for  some
hours after the operation, and not used in
exertion for some days.
  Such  is  the operation of bleeding—not
to be undertaken  rashly—never by one who
has not  seen  it  performed ;  but yet one
which  it  is desirable that  some  one in a
remote district should  have the  ability to
perform.  Again  it is repeated, the lessons
must, in  the  first instance, be  practical,
and then  the few simple directions above
given may afford  timely aid to  the memory.
It must be kept  in mind that a person in
the  upright posture faints sooner  from loss
of blood  than  one who is  lying down, and
that when  faintness does come on, a  little
cold water and a perfectly flat position are
the  best restoratives.
  The emergencies in which bleeding may
be ventured upon by the unprofessional will
be noticed under  their proper heads.
  Local  Blood-letting,  Cupping,   Leeching,
Scarifying.—See their respective articles.
  BLOWS—May  be serious either  from the
violence used in their infliction or from the
site of  the injury.   A  blow on  the  head
may cause merely bruising of the  scalp; if
more  severe,  concussion  or  injury to the
brain, or fracture of the skull.  The latter
accident  is most  likely  to  happen at the
side of the temple, where the bone is thin;
but severe injury to  the brain frequently
occurs from blows at the under  and  back
parts  of the head.  A severe blow on the
spine  may cause paralysis  of the lower
limbs, with  or without fracturing the ver-
tebrae.  When  a  blow, even comparatively
slight, is inflicted upon a spot  immediately
over a collection of nerves, most distressing
effects, and sometimes immediate death may
result.  Such is the case from blows on the
neck,  on the pit of the stomach, or over the
region of the  heart.   The  deadly  faintness
which ensues should instantly  be  combated
by the first stimulant—ammonia,  ether, or
spirit of  any kind—which can be procured.
Cold water should be suddenly dashed over
the  surface or down the spine.    If this is
unsuccessful, the  patient is to be put into a
warm bed,  and  artificial respiration em-
ployed along with external heat,  mustard-
plasters to the spine and  pit of the stomach,
and stimulant injections.
  Refer to Brain—Bruises, See.
  BLUE  DISEASE.—Cyanosis.—A condi-
tion dating from birth, in which, from mal-
formation of the  heart,  the blood is  only
partialy  arterialized  in  the  lungs.   Few
subjects of this disease survive infancy, hut
there  are instances of their attaining ma-
18 
                 BLU                 6

 ture age.  The disease is  characterized by
 the  purple appearance of parts which are
 usually red, by languor of all the functions,
 and by  great  susceptibility to  cold.  The
 disease must  not be  confounded with the
 leaden.-blue colour of the skin brought on
 by long-continued internal use of nitrate of
 silver.  [Dr. Charles Meigs, of Philadelphia,
 advises keeping the child on the right side,
 and thinks it  is always useful.  The sim-
 plicity of the measure should insure  its
 trial. ]
   BLUE  PILLS.—See Mercurials.
   BOIL.—A boil consists of local  inflam-
 mation affecting the  true skin  and subja-
 cent cellular membrane.  A whitish-looking
 point, in  the  conical  centre, is surrounded
 by an inflamed hard base.   A core or slough
 occupies  the  interior of the  boil, and this
 must be discharged before there is relief to
 the  often  intense pain, and before  a cure
 can be effected.  The pain may, however,
 be soothed, and  the natural process facili-
 tated, by  the  use of  warm  fomentations,
 simple, or made with  poppy capsules, and
 poultices; the latter being continued until
 the  core  is fully thrown  out:  after which
 simple water-dressing maybe applied. Per-
 sons who are  compelled to go  about their
 occupations during the progress of a severe
 boil, will find a small piece of lint, dipped in
 olive-oil, and retained in its place by a disc
 of adhesive plaster,  a very soothing and
 convenient application.   Boils  are  apt to
 recur  in succession, for the  reason, proba-
 bly, that  they  depend  upon some derange-
 ment of the system, which requires atten-
 tion.  If the  person  (and boils generally
 occur  in  the  young)  be of full habit, the
 diet should be reduced, all  fat and rich
 things eschewed, meat partially or entirely
 given up for a time, and stimulants avoided.
 A blue pill and black draught, or one or
 two doses of calomel and compound rhubarb
 pill, are to be taken, and regularly for some
 time every morning  a  teaspoonful of Epsom
 salts in half a pint of  water.  If the habit
 is delicate, a few five-grain doses of Plum-
 mer's  pill may  be  given at  bedtime,  or
 the bowels regulated  by the blue pill and
 compound rhubarb.   The diet should not
 be reduced, but regulated, and  the general
 means of health  attended to.
  Boils are popularly said  to be "healthy,"
 and in one sense they  may be so, that is, if
 the deranged  state  of the system  relieves
itself by their eruption ; but they are also to
be regarded as warnings that some  change
in habits or that medicine is required.  A
series of neglected boils may wind up with a
carbuncle.  Carbuncle  is of the same nature
9                BOI

 ns a boil, but more severe and dangerous.—•
 See Carbuncle.
   BOILING—Is  the process in cookery by
 which food  is submitted to the action of
 water at the boiling  point  of 212° Fahr
 Theoretically this  is  the case, but in the
 cooking  of  meat especially boiling should
 not be permitted.  According to Liebig, a
 temperature fifty or sixty degrees  lower is
 sufficient, if proper time be given, to cook
 meat thoroughly, while it is rendered much
 more  tender and easier of digestion  than
 when the process is carried on more quickly,
 and by a greater degree of heat.   In fact,
 meat to be properly cooked in this way ought
 rather to be stewed than boiled. Something,
 however, must depend upon the end in view
 in cooking the meat.   If it  is desired to be
 simply a piece of well-cooked meat,  not only
 as regards taste but as to nutritive powers,
 the  method recommended by Liebig should
 be followed ; that is, the water in which the
 meat is to be cooked should be made to boil
 briskly at the time the latter is put into it,
 and for a few minutes after, and then suffi-
 cient cold water is to be thrown into the pot
 to reduce the temperature of the whole to
 150°,  at  about which point  it  should be
 maintained   until the meat is thoroughly
 cooked, that is, till all appearance of red-
 ness has disappeared.   The principle of the
 process is, that by the sudden immersion of
 the meat in boiling water the most  external
 of the constituents of the  flesh, but  more
 particularly the  albumen, become quickly
 hardened and coagulated, so  as to form a
 kind of case around  the interior portions.
 Of course, if the high temperature is pre-
 served, this process of hardening will go on
 throughout  the whole mass, which is thus—■
 and too often it is the case—made hard and
 indigestible.  But  in consequence of the
 reduction of temperature produced by the
 addition of cold water, this  is prevented,
 the  meat is cooked by a heat which cannot
 harden it, and its nutritive soluble principles
 are kept from exuding by the case-harden-
 ing  of the  first few minutes' boiling.   The
 reverse of the above  must, in some degree, .
 be the case  when meat is boiled for the sake
 of the soup: it must  then be put  into the
 water while it is  cold,  and the temperature
 gradually raised  to near the boiling point.
 In this way there is no outer hardening tc
 interfere with the water dissolving out the
 soluble nutrient principles of the whole  mass
 —the latter of course losing proportionally.
 As meat  cannot be cooked in water without
 a  certain portion of  its nutrient  matters
 being  dissolved  out, the water should  never
 be thrown away; if the saving is unimportant 
BOL
70
BRA
to those who cook the meat, there are plenty
of poor to  receive the unused  liquor; but
if it is a consideration that nothing be lost,
then may the soup be turned to account by
beiug consumed along with the meat.  Of
course the  cooking may be so  managed as
to make both palatable.
  Vegetables require thorough  boiling, ami
often disagree for want of it.—Refer to Food.
  BOLUS.—A large, rather soft pill, which
can be swallowed.  This form of administer-
ing medicine is  not at present much used.
   BONE—Is the  component of  the hard
frame-work of the animal body which sup-
ports and protects, and to which are attached
the soft parts.   Bone, in mass, is made up
of mineral, or earthy, and of animal matter,
and both are so intimately united and diffused
through one another that either, the one by
the action of heat, or  the  other by the aid
of an acid,  may be entirely removed, and
yet the form of the bone maintained by the
remaining constituent.   The animal matter
of bone is nearly pure gelatine, which may
be and is used as an  article of food in va-
rious ways.  The extraction  by manufactur-
ing process  is complete; but for  domestic
purposes much of the bone gelatine may be
extracted by the use  of Papin's  digester.
There  is not perhaps as much real nutri-
ment in gelatine as popularly imagined, but
there is quite enough to make its extraction
important, even domestically, as an addition
to soups.
  The bones of the body are divided into flat
bones, like those of the head; long bones, as
of the arm and thigh, and irregular bones,
of which the vertebrae are examples.  The
outer case of a bone is always  harder than
the interior, nnd is covered by a firm invest-
ing membrane,  the periosteum.  Bones are
liable to various diseases;  one  of  these,
caries, is to this tissue what ulceration is to
the soft parts of the body ; another, necrosis,
is the actual death of  the bony substance.
In both these cases there is  generally deep-
seated continued pain  in the bone, followed
by swelling  and redness of the soft parts
coverjng the affected  spot; matter  forms
and is discharged, but healing does not take
place as after a common abscess; the dis-
charge  continues, is  thin,  perhaps  acrid,
frequently fetid, and communicates a dark
slain to the dressings.   The opening  in the
skin, or rather openings, for there are usu-
ally more than one, may be small, or there
may be diffused ulcerations of the integu-
■nent.  Tnese  diseases—unless  from  situa-
tion, as in the head—are not rapidly fatal,
but ii  unremedied, wear out the patient by
long-continued irritation.   The suspicion of
their existence  should be  the signal for
placing the sufferer under  proper medical
advice without delay.   Too often they are
trifled with, and one quack ointment  after
another—each  professing  more  than its
neighbour—is had recourse to,  while the
constitution of the patient suffers irretriev-
ably.  Bones may become softened in con-
sequence of a deficiency of earthy matter.
In  adults  this is the  result  of  defective
constitution, insufficient nourishment, and
unhealthy dwellings, and is  a fatal disease.
In children the  disease named rickets, in
which the bones likewise become soft and
capable of bending, is the result of similar
causes;  but in the latter,  good  diet, change
of situation, nnd a course of tonic remedies
will effect a cure.
  Refer to Rickets—Fractures—Papin's Di-
gester.
  BORAX—Is a compound  of boracic acid
and  soda.  It is well  known, and used do-
mestically in  cases of sore mouth ; but its
good  effects, especially in thrush, are often
nullified  by its  n lmixture  with  honey or
saccharine  matters.  As a general rule, bo-
rax is most advantageously used in the form
of lotion, a drachm and a half in half a pint
of water being a  convenient strength.  In
mercurial salivation this wash for the mouth
is very serviceable.  [A saturated solution
of borax forms an  excellent  wash  to cleanse
the head from dandriff; but some fatty or
oily substance,  as  beefs  marrow or bear's
grease, should be subsequently used to pre-
vent  the dryness which follows the use of
the borax]
  BOUGIE.—A surgical instrument used for
the dilatation of the male urethra.
  BOWELS.—The tract of  the alimentary
canal contained within  the  abdomen.—See
Alimentary  Canal.
  BRAIN.—The brain is the large mass of
nervous matter contained within the cranium
or Bkull-case.   By anatomists and in medi-
cal science  the  organ is  variously divided
and  subdivided, but  more  especially into
the cerebrum, or large brain, (fig. xxxii. 1,)
and   the cerebellum, or  little brain, (fig.
xxxii. 2,) the  latter being  situated at the
inferior and  posterior  part of the  cavity
within the head.   The nervous  matter  is
partly white and opaque, and partly greyish
and semi-transparent.  The whole organ is
supported  and  enveloped by  three  mem-
branes, and is defended from  all ordinary
injury by the arched bones of the head.
  Concussion op  the Brain.—One of the
most frequent  injuries to which the  brain
is exposed  is concussion.    Either in  conse
quence of a fall or a blow, a person becomes 
BRA                71                BRA
stunned ; the effect may be but momentary,
there is transient unconsciousness, and the
individual  "comes  to  himself,"  without
 further symptoms; but  if  the  concussion
 be severe the state of unconsciousness con-
 tinues, the  power of motion is almost or en-
 tirely lost,  the breathing is  slow and quiet,
 the pupils frequently  contracted, but some-
 times dilated, and very  generally there is
 vomiting;  the  pulse is  small and weak.
 This condition  may continue for  a  longer
 or shorter period,  according to the violence
 of the  shock, and  may terminate in death;
 but if it be  simple concussion, there is gene-
 rally a restoration of the usual condition of
 health, which is  permanent or  otherwise.
 In some cases of simple concussion of the
 brain but little  active interference  is re-
 quired ; the patient should, if possible, be
 put in bed,  and the warmth of the surface,
 particularly of the feet, attended to ; if there
 is extreme depression, a little sal-volatile or
 brandy and water may be given, but sparingly,
 on account  of the subsequent reaction.  The
 chief danger  to be apprehended after  con-
 cussion of the brain is'inflammation, affect-
 ing either the organ  itself or its  covering
 membranes, and on  this account  the  suf-
 ferer from  the  accident  ought to be.very
 careful for  at least ten  days or a fortnight
 after the receipt of the injury.  All alcoholic
 stimulant is to be avoided, and rest both of
 body and mind  submitted  to; the bowels
 being kept  relaxed  by  the use of  gentle
 aperients.   If the immediate reaction is
 great, that is, if a few hours after the acci-
 dent there is much pain in the head, shiver-
 ing, followed by heat, quickened pulse, and
 sickness, the case demands the most serious
 attention, and should  be  seen by a medical
 man as soon as possible.  In such a case as
 this occurring—and they frequently do occur
__at a distance from medical aid, an unpro-
fessional person who could  bleed would be
quite justified in abstracting  from a  man
of full habit from  twelve to twenty ounces
of blood, and in applying a dozen or a dozen
 and a half of leeches about the head, either
 with or without the  general blood-letting;
 or  eight or ten ounces of blood might be
 taken from the nape of the neck by cupping.
 The hair should be cut  or shaved off, and
 the head kept cool with cold or iced appli-
 cations ; the most  perfect quiet,  in  a dark
 situation, observed, and active purging with
 calomel  and colocynth, jalap and calomel,
 or  the most active  aperient at hand.   The
 diet is to be reduced to the very lowest ebb.
 Such cases are  generally so  urgent,  and
 their cause and nature so palpable, that they
 not only require the most active treatment,
 but also render that treatment justifiable in
 the hands of the unprofessional, in the ab-
 sence of, or during a lengthened interval
 of,  the non-arrival  of medical assistance.
 Symptoms similar to those detailed  above,
 though not directly  referable  to  reaction,
 may, coming on some days after a concus-
 sion  of the brain,  indicate the commence-
 ment of inflammatory action.   In such  a
 case  bleeding must be more cautiously re-
 sorted to, but the other measures should be
 carried out.   It  ought to be known, that
 direct violence to the head  is not  always
 requisite  to produce concussion; a  heavy
 fall on the feet may equally cause it,  by the
 shock conveyed  through the spine  to the
 brain.  But violence may go  beyond  the
 production of mere concussion—there may
 be  rupture of the substance of the brain, or
 of a single vessel, causing effusion of blood.
 In  such  a case, the  individual may never
 rally from the first condition of unconscious-
 ness, or he may rally only partially,  to sink
 again, as reaction comes on,  into a state of
 apoplectic stupor,  or become  the subject
 of those  symptoms of inflammation  of the
 brain already described;  in which case, of
 course, the same treatment is to be pursued.
 If the case runs  on to a fatal termination,
 there is  generally apoplectic stupor, para-
 lysis, and convulsions, one or all of them.
  Fracture of the Skull.—Violence, ap-
 plied either directly to the head, or commu-
 nicated to the skull through the spine, may
 be  sufficient  to fracture the bone with or
 without breaking the skin.  The accident is
 sometimes sufficiently obvious  even  to the
 inexperienced; at other times, as in the case
 of a simple crack, it is not detectable even
 by the most skilful; but whether plainly ap-
 parent,  or only suspected, the  existence of
 fracture  amounts to the  same thing,  as far
 as the unprofessional  are concerned, as con-
 cussion ;  the case ought to be seen as soon
 as possible by the surgeon.  The  symptoms
 will in many respects resemble those of and
following  concussion, and may be similarly 
BRA                72                BRA
treated;  if there is an external  wound as
well  as  fracture,  simple water dressing
should be used.   When a portion  of bone is
driven down upon the brain by external vio-
lence, it  occasions  apoplectic insensibility
by the pressure it produces.   In such cases,
the aid of a surgeon is imperatively called
for, to relieve  the  brain  by elevating the
depressed bone.
  The brain, or its investing membranes, are
liable to  become  inflamed.  Shivering,  fol-
lowed  by hot skin, thirst,  furred  tongue,
intense pain  in the  head,  intolerance of
light,  the eyes being blood-shot  and  wild-
looking, sickness, and delirium, are the most
general symptoms.   At other times,  a se-
vere attack of convulsions ushers  in the dis-
ease,  or  continued  nnd obstinate vomiting
may be the first symptom of the brain  being
affected, the more direct symptoms referable
to the head coming on later.  However it
may be,  such cases can only have proper
energetic treatment  in the hands of the prac-
titioner ;  but until his assistance can be pro-
cured, the plan of treatment recommended
to be followed in cases of inflammation after
violence is to be adopted—particularly cold
to the head, thoroughly applied.
  Inflammation of the brain  may  arise from
a variety of causes—violence is   one of the
most common; but it may arise in  the course
of acute  disease, or after the suppression of
an accustomed  discharge,  and it  is not un-
common  in cases where there has  been a
long-continued discharge from the ear.
  In children, particularly those of a scrofu-
lous constitution,  inflammation of the brain
at its  conclusion frequently takes the  form
of what is popularly termed—
  Water in  the Head,  or water on  the
brain.  The fatality of this  disease when it
has once established itself in the constitu-
tion,  renders a  knowledge  of  its earlier
Bymptoms a matter of serious and  important
interest  to  every parent.   As   mentioned
above, children of  scrofulous constitution
are most liable to  this disease, and should
be  closely  watched, especially  from  the
Becond to the sixth or seventh year of  life,
the most general period of attack, and par-
ticularly  after  the  child has suffered  from
any of the diseases  incidental to  childhood.
At first, the patient is languid, looks heavy,
is subject to irregular heats and chills ; the
appetite  is capricious, the bowels irregular,
and the discharges  from them unnatural in
colour.  The sleep is disturbed, there is fre-
quent starting, moaning, perhaps screaming;
the teeth are grated, and the thumbs folded
across the palm of the hand.  When awake,
the brow is contracted; the  nose  is continu-
ally picked; and the child, if able to speak,
complains of the head, which is hot.  As the
disease advances beyond the first  stage,  all
these symptoms become more marked, and
probably obstinate vomiting,  and when the
stomach is empty, retching, occur.   Toward
the termination of the disease, insensibility,
dilated  pupils, convulsions, &c.  come on;
but long before the lntter stages, the case
should be under proper medical treatment.
The  object here is to put parents on  their
guard as to the advances of an insidious nnd
very fatal malady—not  to induce them  to
incur the responsibility, and, unless  under
very extreme circumstances indeed, the cul-
pable responsibility, of its treatment.  Many
of the symptoms above detailed undoubtedly
occur, in less alarming combination, in many
of the diseases of children ; but come as they
may,  and when they  may, they should not
be neglected.  Some amount  of  treatment
ought however to be employed to save time,
and the most important and safest indica-
tion is to purge the child well with calomel
nnd scammony—the head is to be kept cold,
and quiet strictly to be  observed.  One  or
two  leeches  may  be   applied.   The  term
" water in the head,"  as regards the disease
above treated of, is erroneous; the effusion
of water which takes place is but one of the
stages of the affection, which is truly inflam-
mation of the brain and its coverings.  The
causes are  numerous,  but  sometimes the
disease arises without  any being distinctly
traceable;  the irritation of teething, long-
continued disorder of the digestive organs,
falls or blows on the head, exposure of the
child's head to the heat of the sun, infantile
febrile disorders, may any of them give the
first  impetus  to  the  diseased  tendencies.
Most important, as undoubtedly it is,  to de-
tect the first symptoms of threatened inflam-
mation of the brain in children, still more so
is  it to detect and improve that state of con-
stitution which facilitates the incursion of
that and so many other disorders.   If a
child  is scrofulous, or has a tendency to a
scrofulous constitution, let not parents fool-
ishly shut their eyes to the fact, but rather
endeavour as far as possible to correct the
misfortune; more  especially,  let  them be-
ware, lest they in  any way foster  into acti-
vity the seeds of so deadly a malady as acute
dropsy in the head.   Those  children who
are most obnoxious to its attack  are often
the most endowed intellectually ; and there
is  a morbid tendency  to excitement  in the
brain, which gives it power beyond what is
natural to its age.   If  permitted or encour-
aged, the child will give up the sports ami
exercise of its  time of life, for  the sake of 
BRA
73
BRA
 mental employment, and  sometimes a  pa-
 rent's pride permits  the erroneous  system,
 which in all probability leads either to early
 death from active disease of the brain, or to
 the possession in after life of a sickly body
 and morbid mind.  In no children  is it so
 necessary to insist upon strict observance of
 all the laws of physical health, as in  those
 who exhibit precocious development of mind.
   Water in the head, properly so called, is
 a chronic disease, dating from birth or very
 early  infancy.   The effusion of water  ad-
 vances by slow degrees, distending more and
 more the brain and the bones of the head,
 until the latter  attains an enormous size.
 The head  has measured  as  much as forty-
 four inches in circumference.   The disease
 Way last for years.
   Brain in Old Age.—In the aged the brain
 becomes more liable to disease than hereto-
 fore.'   Congestion of  blood from  various
 causes, more especially in consequence  of
 disease of  the heart, is frequent, but quite
 as often, headache, giddiness, slowness  of
 intellect, or paralysis, arise from deficiency
 of blood in  the brain.  The distinction is
 important, as in the latter  case lowering
 measures are  certain to be  followed by an
 aggravation  of the disorder.   Softening of
 the brain, so frequent a disease of advanced
 life, has many symptoms similar to  those
 consequent upon deficiency of blood, but in
 an aggravated degree;  the mental functions
 are  more  regularly  and  permanently im-
 paired, and paralysis is more certain.   Al-
 though cerebral softening is incurable, if its
 threatenings  are  early detected it  may be
 retarded by the- use of  tonics and abundant
 nutriment.  The arteries of  the aged brain
 lose their elasticity, become brittle and liable
 to rupture  if unduly distended, a fact which
 renders all excitements, whether of the pas-
 sions or otherwise, so dangerous "to those
 advanced in  life.  The other affections of
 the brain,  such as apoplexy, paralysis,  de-
 lirium tremens,  will be found under  their
 respective heads.
   BRAN—Is the broken-up testa or skin of
 the grain of wheat, which is separated from
 the flour after grinding.  When heated, it is
 one of the  most useful  adjuncts we  possess
 in the alleviation of disease  and pain, and
 particularly in a domestic  point of view.   It
 is generally to be procured,  is soon made
 hot,  and retains the heat well; it is at the
 same time soft and adaptable.
  Heated bran is best applied in a flannel
bag, which should be made  ample  in size,
compared with the part affected.  It may be
either a dry or a moist  application, but the
latter is in most cases preferable.  The best
       G
method of heating  is  in  the frying-pan,
sprinkling with hot  water  during the pro-
cess, so as to give just perceptible moisture,
and turning it over and over until the sub-
stance is thoroughly hot throughout.   It is
to be quickly transferred to the bag, and the
latter  fastened by  pins  or  thread.   When
moist,  if covered, after  it is applied to the
skin, by a piece of oiled silk, oiled calico, cr
any other water-proof material, the heat will
not only be better retained,  but the vapour
also, and no dampness will be communicated
to the  clothes.  Sometimes,  the bran is put
into the bag dry, and the bag and all dipped
into boiling water, but in this way too much
moisture is absorbed.
   Dry hot bran may produce perspiration,
but frequently it causes only feverish dry
heat,  and if it does not do harm, does little
good, compared with the soothing heat and
vapour of the moist preparation, which is in
fact a continued local vapour-bath, causing
free  perspiration from the skin over  the
affected part, and often relieving to an ex-
tent sufficient to render the use of leeches
or cupping,  which  would  otherwise have
been required, uncalled for.
   In  severe  pain,  whether  spasmodic  or
inflammatory, the bag  of hot  moist bran,
efficiently used, is one of the best, softest,
and  most certain alleviators we  possess;
and, greater  advantage than all, may be
used in most  cases  of pain with the most
perfect safety.  In many acute inflamma-
tory affections, such as those of the chest
or abdomen, its use is very often preferable,
both as regards the comfort and real good
of the patient, to either blister or mustard-
plaster.   In the inflammatory affections of
childhood, and in threatened croup, it is in-
valuable, from its easy application, soothing,
and at the same time, most beneficial effect.
When weight is an objection, of course the
bag must be more lightly filled.  The bran
may be heated in a  dry state, and the effects
of moisture procured by laying underneath
it a double fold of flannel wrung out of hot
water.  Again  it is repeated, that the hot
bran bag, to be efficient, must be sufficiently
ample  and well filled to retain the  heat  so
long that  frequent changing is not required.
It must  be  thoroughly hot, slightly moist,
but not wet, and is better covered after it is
put to  the part by some material which will
prevent  evaporation.    [Soaking   a limb
night  and morning, in  warm  water, which
contains sufficient bran to thicken it slightly,
will be found an excellent remedy  in "salt
rheum," and other forms of " dry tetter."]
  For the dietetic uses of bran, see Bread.
  BRANDY—Is  procured   by  distillation 
B  K A
4
BRE
from  grape wines, and, according to  Dr.
Paris, owes its peculiar flavour to the pre-
sence of an etherial  spirit, formed by the
action of the acetic or tartaric  acid on the
alcohol.
  Brandy,  like every other  ardent  spirit,
ought not  to  be  freely or regularly  used,
either diluted  or otherwise.  As  an addition
to our stimulant medicines, and as a dietetic,
it is most valuable.  As a medicine, it does
not, perhaps, possess any particular advan-
tage over pure spirit of  any kind; but in
England, at least, it is preferred by most to
either whisky  or gin, and it is generally the
first procurable stimulant in most cases. As
a dietetic, dyspeptics,  and the aged, who
require  stimulant, and  yet  cannot take it
in other forms, can often  use regularly and
with the greatest  benefit a measured  quan-
tity of brandy in  a little cold  water, with
their meals once  or  twice a day, and cer-
tainly without  any of that subsequent de-
pression, or craving  for  an  increase of the
dose, which is by some said to  be the con-
sequence of the habit.   [The  substitution
of the tincture of ginger will often do better
than brandy in the cases of  dyspeptics.]
  BRANKS.—The Scotch  name  for  the
mumps.
  BREAD.—The term as usually applied in
this country,  means the  leavened, raised,
or fermented loaf of wheaten flour, but may
also be appropriate to any of the other forms
in which  flour or meal  is made up, either
from wheat or the  other bread corns.   The
flour of wheat consists of three ingredients;
the  gluten,  which approaches animal matter
in composition, starch, and mucilage. Wheat
flour, simply made into  a cake with water,
and baked, like the "damper" of Australia,
will undoubtedly yield nourishment equally
as well as  leavened  bread,  to  those whose
digestion is equal  to the task ;  but for the
general purposes of civilized life, leavened
bread is much to be preferred for the great-
er  ease with  which  it  is dissolved in the
stomach.   "The careful mixture  with the
saliva during the mastication of bread is a
condition essential to the rapid digestion of
the  starch.   Hence the  increase of digesti-
bility obtained in bread  by the porous form
given to it.  This porosity and  lightness is
produced in the dough by a process of fer-
mentation.   Beer-yeast  is  added to  the
dough, which brings  into fermentation the
sugar formed by the action of the gluten on
the  starch; and the open porous texture of
the  mass  is the result of the carbonic acid
thus formed in every part  of  it.   Many
chemists  are of opinion  that the  flour, by
the  fermentation in the  dough,  loses  some-
what of its nutritious constituents, from a
decomposition of  the gluten ;  and it  has
been proposed to  render the dough porous
without  fermentation, by menus  of  sub-
stances, which, when brought into contact,
yield carbonic acid."  Baron Liebig, from
whose "Letters" the above extract is taken,
says " this view appears to have little found-
ation."
  Various kinds of "digestive bread," raised
without  fermentation, are, however,  now
used.  Carbonate  of ammonia (hartshorn)
has  been employed for this purpose ;   but
carbonate of soda, with the addition of some
acid—buttermilk will do—to disengage the
carbonic acid, is the most general agent.
The  following method is a good one:—Two
drachms of carbonate of soda in fine pow-
der  are to be well mixed with a pound and
a half of flour ; to rather less than a pint
of water, there is to be added two and a
half  drachms of  muriatic acid,  and  the
water and acid together are to be added to,
and  mixed up  with the flour.   A rather
liquid dough, which must be baked immedi-
ately, is formed, and if properly managed,
is well and lightly raised by the disengage-
ment of the carbonic acid from  the soda,
the latter being at the same time converted
into  common salt by union with the  muria-
tic acid.  These various kinds of unferment-
ed bread have been extolled as particularly
digestible, but it is a question whether they
are morer so than the ordinary bread which
has  undergone fermentation.   To be  tho-
roughly  wholesome,  bread must  be well
raised, well baked, and at least twenty-four
hours old before it is used.   The  finer  de-
scriptions of bread made with fine  flour  are
apt to constipate, and  the  coarser, which
contain much  coarse bran, are too irritating
for many stomachs.  It is a matter of much
importance as regards the nutritive proper-
ties  of bread, " the  staff of life," in what
manner the flour from which^it  is made is
prepared.  Generally, in consequence of the
very  large  separation of bran  effected in^
grinding, in this country  at least, a great
proportion of the real nutriment is  abstract-
ed, and the finer  flour which remains  has
much too large a preponderance of starch,
which does not afford real nutriment. This
fact  was well exemplified by the experiment
of Magendie, who fed two dogs on wheaten
bread exclusively; but to one he gave that
made of fine flour, deprived of bran; to the
other the coarse brown bread made of bran
and  flour together.   The former died in
forty days,  while  the latter  was  perfectly
healthy at the end of the period.  The first
dog was  in  fact starved, in the same way 
                BRE

 that he would jave been if fed upon arrow-
 root, or sugar alone.   The experiment indi-
 cates vcy significantly how much real nu-
 triment is lost by the copious separation of
 the bran in preparing fine flour.  It  is not
 necessary for bran  to be coarse ; by more
 thoroughly  grinding it into  the flour, ^not
 only would  bread made from  the flour be
 much  more  nutritious and wholesome, but
 the actual amount of bread food supplied
 to  the people  would  be considerably  in-
 creased.  Moreover, the  mechanical  aperi-
 ent  action  of the  bran  upon  the bowels,
 could  not fail  to  be useful  in a country
 where constipation  is so  general a disorder
 as  it  is in this.  No one who is liable to
 habitual constipation should regularly con-
 sume fine bread.
   In times of scarcity, bread  is liable to
 adulteration with flour from potatoes,  beans,
 or with rice, and  other cheap  grains.  So
 far as the  health of the  consumer is con-
 cerned, such adulterations cannot be very
 injurious ; and the deleterious additions to
 flour,  of  plaster of Paris, chalk,  &c. are
 now scarcely ever heard  of.   During  times
 of plenty almost the  only adulteration of
 bread, and  that chiefly of the  lighter and
 finer   kinds,  is with  alum ;   indeed, the
 " Lancet Sanitary Commission" (London) re-
 cently found this to be the only adulteration
 practised by those bakers whose bread they
 examined.  The addition cannot be looked
 upon  as  harmless,  if for no other reason
 than the constipating  effects it must exert
 upon the  consumers.   A certain proportion
 of bread  should form an  addition to every
 meal, with those whose digestion is  at all
 weak.   It must  not be new ; fatal accidents
 have occurred  from the distension  of the
 stomach  by an excessive  meal of newly-
 baked bread.   Sour  bread  is, of course,
 most unwholesome.   A  great mistake  is
 often  made  in feeding young  infants upon
 bread  in various forms ; it always occasions
 disorder,  griping,  and flatulence.   If cir-
 stances render it necessary that bread must
 be given,  it should, at all events, be  slowly
 toasted, or rebaked as  hard as a biscuit or
 rusk throughout, and then well soaked.
  Biscuits, though not raised, are rendered
 more digestible by the double baking from
 svbich  they derive their name.
  Refer to Grain—Flour,  $c. §c.
  BREAKFAST—The first morning  meal,
 >s to the strong  and healthy a most  enjoy-
 able one, and it may always  be  taken as
 one of  the best signs of health when  a man
can eat and digest  a good breakfast, espe-
cially  after  exercise.   The  circumstance
 Lhat the strong and healthy can enjoy with
3                 BRE

 impunity a full breakfast, has given an erro-
 neous idea as to the advisability of invalids
 making it a hearty meal, and still worse, of
 prefacing it by exercise.  With very many,
 perhaps the majority of people, especially
 in towns, the interval  between rising  and
 breakfast is not  one of great vigour.   The
 powers both of body and mind are undoubt-
 edly recruited if there has been due rest,
 but they are not in full action, and if, inju-
 diciously, too long an interval is permitted
 to elapse before food is taken, they become
 exhausted, and still more so if physical ex-
 ertion is engaged in.   Instead, as is  too
 frequently supposed, the exertion improving
 the digestive power, it weakens it.  Appetite
 there may be, but digestion will, in a weak
 individual,  be sadly deficient;  the nervous
 power which should aid the process has been
 used up.   The very same deficiency of ner-
 vous power renders a full  breakfast,  under
 any circumstances, inadmissible for those of
 weak digestion; instead of giving strength it
 causes discomfort and inaptitude for business
 for the first hours of the forenoon.  Thus it
 is, why it speaks well for the health and con-
 stitution of the individual who can make the
 first meal of the morning a hearty one.
   It  would,  perhaps, be difficult  to  find a
 social custom more  suited to the present
 state of civilized  life than the warm  tea,
 coffee, or cocoa breakfast,  taken along with
 bread, and, if it agrees, with the addition of
 meat, fish, or egg;  it just affords the  gentle
 stimulation which the system requires.  The
 amount and nature of the nourishment taken
 at breakfast must vary, of course,  with the
 habits  and  powers of the individual; if
 digestion is weak it is better to be content
 with little, and wait for an early luncheon.
 Some dyspeptics  can scarcely take any kind
 of food at the morning meal without its  dis-
 agreeing;  such will sometimes  find it! of
 advantage, when it can be done, to hafe a
 small cup  of hot  coffee, or of some  warm
 fluid, brought to them  just before rising;
 with  others, a very slight supper just before
 going to bed, a  biscuit or piece of  toast,
 with  a little  wine  and water, will relieve
 the weakness in the morning.  Above all, it
 should be kept in mind by those with  whom
 breakfast is apt to disagree, that exhaustion
 of any kind  before the  meal, such  as walk-
 ing, gardening, bathing, or even cold spong-
 ing,  are almost certainly injurious.  As a
 breakfast for children, bread  and milk is
 better than the stimulants tea and.coffee;
 for strong children, nothing is better than
 oatmeal  porridge, such as is  used in Scot-
 land and Northern England.
  Refer to Digestion—Bathing.
7 
BRE
76
RHE
  BREAST. — The  term,  as here  used,  is
applied to the female  breast,  the  organ
peculiarly devoted to the  nourishment of
offspring.   The essential component of the
breast is  the  " mammary''  gland,  which
secretes the milk.   This gland, along with
the breast generally, becomes fully deve-
loped and  fitted for its functions as woman-
hood  advances; and, at the same time, the
nipple enlarges, if it is permitted to do  so
by the stays, which too often offer such im-
pediment  to its development as  to entail
much  suffering when women  come  to  be
mothers.  Too frequently, when the  nipple
ought to be fit for the suckling of the child,
it  is found so flattened into the breast that
it  is nearly impossible, sometimes quite so,
to  get it drawn out sufficiently ; much suf-
fering, and not unfrequently abscess in the
breast is the consequence.
  Females are  often morbidly  sensitive re-
specting any ailment affecting the breast,
and  render themselves unnecessarily mise-
rable if they detect, or fancy thej' can, any
thing unusual.   Sympathetic pains are put
down  as  the  certain  precursors  of some
dreaded disease; or the  slightest  hardness
is  observed  and fingered till  it really be-
comes tender and inflamed, and in  conse-
quence enlarged.   In such  cases,  if the
patient is  reasonable, and can be persuaded
to  give up the habitual interference with
the ailment, the uneasy symptoms and sus-
pected "lump" will often disappear together.
Still, they may not  do  so, at least quickly,
but  that is no  reason  why the affection is
necessarily a serious one; the best plan  in
these cases is to take professional  advice
without delay;  if  the  cause of  alarm  is
unimportant the mind is set at rest; should
it  be otherwise, its  nature cannot be  too
soon detected.   Above all things, tampering
with  such matters must be avoided; the
rubbings,  &c. too often employed may irri-
tate a slight swelling into rapid and painful
increase, or something worse.
   If the above advice is followed, as it ought
to  be, it is unnecessary in a work  like  this
to  treat of that dreaded disease, cancer  of
the breast.  A suspected case ought neither
to  be left to unprofessional opinion nor do-
mestic treatment; and to detail the incipient
symptoms, which are many of them common
to  more harmless affections, might  only tend
to  excite groundless fears. When cancer has
reached the confirmed open stage, opiates
and narcotics are the chief sources of physi-
cal comfort: hemlock poultices will some-
times  relievo  pain,  and a chlorine  lotion
will  in some measure  neutralize the fetor.
The disease generally occurs after the age
of forty.
  Inflammation  and  Abscess  of  the
Breast.—The  disease   from  which  the
female breast  most frequently suffers  is
inflammation, followed by abscess, [or "ga-
thering."]   This  may occur at any time,
but most commonly it is within the first few
weeks  after  childbirth.   Generally within
twenty-four hours after the birth of a child
the breasts become turgid and slightly hot,
from  the increased flow of blood  which  is
directed  toward them  to supply the secre-
tion of milk.  In  this excited condition, and
indeed during suckling generally, they are
peculiarly liable to become inflamed; cold,
any slight bruise, such as that from a bone
in the stays, over-distension with milk,  or
even mental excitement,  may, any of them,
give rise to the inflammation which ends  in
abscess.  All these causes, and any others
likely  to injure,  must  therefore  be most
carefully avoided, and particularly the ac-
cumulation  of mi^i,  to prevent which the
breasts should be well  emptied.   If from
flatness of the nipple, weakness of the child,
or any other cause, the milk  is  not well
drawn out, measures which will relieve must
be adopted. Various forms of breast-pumps
are used, the suction being  made  through
them, either mechanically or by the mouth.
A leech-glass is  tolerably convenient, or a
wide-mouthed bottle, capable of holding a
couple of quarts, may be employed, being
first dipped into  hot water to exhaust the
air, and then applied to the breast,  the suc-
tion exerted as it cools causing the milk to
flow freely.  Some nurses have the art  of
drawing  the breasts with the mouth more
thoroughly than  any instrument, and when
such aid  can be procured it is right to make
use of it.   [Young pups are also sometimes
employed, and, when their paws are covered
with rag, draw the breast without causing
pain.]  The first symptoms  of threatened
abscess [or gathered breast] are pain and
knotty hardness in the part;  if the process
goes on unchecked, there is much throbbing
and sensation of  weight, the skin over the
part affected becomes red, gradually thins,
and at last gives way, allowing the escape
of the matter occasionally mixed with milk.
Some amount of irritative fever accompanies
the  progress of  the affection.   After the
discharge of the matter the abscess  may
quickly heal, or  it may remain open and
running for a considerable time.
  The first few hours  of threatened mam-
mary abscess are the  most valuable; if it
is to  be  prevented, it must  be  then.  The 
BRE
i i
BRI
 breasts being well emptied, gentle friction,
 continued for ten minutes at a time, .and
 repeated every four or five hours, must be
 most assiduously employed.  A soft palm is
 indispensable for the process, and fresh olive
 or almond oil is the best for  rendering the
 friction easy ; the various applications, such
 as goose-fat, &c.  &c,  often  recommended
 and used, are disagreeable, and not better
 than the  simple  oil, the mechanical friction
 being  the active agent for  good.  During
 the intervals between the  friction, the best
 application  is  lint soaked in tepid water
 and covered with oiled silk.  The bowels
 should be kept clear:  ten grains of Plum-
 mer's  pill may  be given,  and followed  in
 four hours by castor-oil, and from six to ten
 grains of carbonate of potash, with the same
 quantity of nitrate of potash, are to be given
 every five or six hours in a wineglassful of
 water. The diet  should be light and cooling.
 Leeching the breast in  cases of threatened
 abscess is useless, and tepid moisture is
 better than much heat.   It is of much im-
 portance  to  support the  breast, and it is
 sometimes found beneficial to exert press-
 ure by strapping with plaster, or, as lately
 practised, by means of collodion applied  all
 over, which, as it  dries, contracts and pro-
 duces  an  equable compression.  When, from
 the throbbing character of the pain, or from
 the tension and inflammation of the skin,
 there  is reason to suspect  that matter has
 formed, the treatment must be changed ; hot
 fomentations  and poultices are to be regu-
 larly applied, the distressing weight  of the
 whole   breast  being  relieved by slinging
 with a handkerchief round the neck.   The
 bowels are to be kept open, not purged, the
 pain and restlessness relieved by an opiate
 at night;  cooling  drinks allowed, and the
 diet light but nourishing.  In certain stages,
 and under certain conditions, it is the prac-
 tice of medical  men to open breast or milk
 abscess with the lancet; for the unprofes-
 sional the safest course is to permit it  to
 discharge  itself.   The  hot poultices ought
 to  be  continued for a few days after the
 evacuation  of the  matter, and then ex-
 changed for simple water-dressing.
   After the discharge of the abscess, a more
 nourishing diet is  to be allowed, and wine
 or  malt liquor may probably be required.
 If there is much debility, a wineglassful  of
 infusion of bark with thirty minims of sal-
 volatile, or a  grain of quinine in a glass  of
 sherry, may be taken  twice a day.   If the
 system is relaxed, and tendency to perspira-
 tion exists, twenty minims of diluted nitric
acid should be substituted for the sal-volatile
in the bark infusion.  As long as mammary
      a2
 abscess is merely threatened, the child ought
 to be allowed to suck, but from the time of
 matter having formed till its  discharge, it
 must be kept from the affected breast.
   If hardness remains after the breast  is*
 healed, friction may be used with soap lini-
 ment,  either simply or with  the addition of
 a drachm of compound tincture of iodine to
 each ounce.
   Refer to Nipple, Sfc. $c.
   The breasts of infants a few  days after
 birth are liable to become distended with a
 thick milky-looking fluid, which some nurses
 barbarously squeeze out.  This should never
 be practised; bathing with warm  water, and
 the use of cold cream, or some simple oint-
 ment,  is all that is requisite.
   Youths, about puberty, occasionally suffer
 from a hard, slightly painful swelling around
 the nipple, which  sometimes creates alarm.
 It is of no moment, and requires no treat-
 ment beyond warm fomentation,  if painful.
  BREATH  and BREATHING.—Breath is
 the mixture  of gas and watery vapour ex-
 haled from the lungs at each expiration. Its
 indications are often valuable guides in the
 treatment of sickness.  In febrile diseases
 the breathing becomes quickened, and more
 especially so  when the lungs are affected.
 In affections of the head or of the nervous
 system,  it is  often slow, and  very gentle,
 sometimes irregular,  or it  may be laboured
 —" stertorous."   The position which a per-
 son suffering from disease, particularly of
 the chest, instinctively assumes,  as that in
 which  he can most easily breathe, is always
 to be observed.
  The odour of the breath is a good  index
 of the state of the body.   When tainted,  it
 is so,  not uncommonly, from decayed teeth,
 or from a morbid secretion of the tonsils;
 but more frequently, in children especially,
 it is indicative of disordered stomach, and
 of loaded bowels.  The cause of the symp-
 tom should always be inquired into, and as
 far as possible remedied.   A brisk purgative
 may be all that is required.  Disease of the
 lungs is sometimes accompanied  with into-
 lerably fetid breath.
  Refer to Aeration—Lung—Respiration.
  BRIGHT'S  DISEASE—Is an affection of
 the kidneys,  first described  by Dr. Bright.
 Its most peculiar symptom is the presence
 of the  serum of the blood  in the urine, so
 that when the latter fluid  is heated to near
 boiling, the  albumen  becomes  coagulated
like the white of an egg, causing merely a
 cloudiness if in small  proportion,  but some-
times existing in such quantity as to form i
nearly solid  mass.  This condition of  the
urine is always to be looked upon seriously. 
BRI
7S
BRU
 It sometimes comes on slowly, more particu-
 larly in those addicted to the excessive use
 of ardent spirits; or it may be the imme-
 diate consequence  of severe cold  and re-
'pressed perspiration; it is not an unfrequent
 sequel to scarlet fever.  The  sudden deve-
 lopment of this condition of urine is accom-
 panied with feverish symptoms and dropsical
 swelling of the  face, with  stiffness  of  the
 eyelids, swelling of the extremities, and if
 it proceed far, of the trunk of the body also.
 It ought at once to be submitted to the treat-
 ment of a medical man.   In the absence of
 this assistance,  should sudden swelling, as
 above described, come on, and with it symp-
 toms of general fever, a portion of  the urine
 may be heated in a metal spoon to boiling;
 if it becomes thick or cloudy, and if it is not
 cleared by the addition  of  a few  drops  of
 vinegar, it may safely be concluded that the
 kidneys  are  suffering.   From  six  to  ten
 ounces of blood, according to habit, may be
 taken from the loins by cupping, the patient
 confined to bed, and a bath of the temper-
 ature of 90° taken for half an hour, once in
 twenty-four hours.   A diaphoretic mixture
 —such as that of acetate of ammonia—is to
 be given, and the bowels purged with calo-
 mel and compound  powder of jalap, or some
 other brisk purgative.   The diet must  be
 kept low  as long as fever continues.  The
 case ought  not to  be trusted  to  domestic
 treatment further than is unavoidable.
   Refer to Scarlet fever.
   BRITISH CHOLERA.—See Biliary Dis-
 order.
   BROCOLI—Belongs to the cabbage tribe,
 the  portion eaten  being the undeveloped
 flower-buds.   When well boiled, it is one of
 our lightest and  most wholesome vegetables.
   BROILING—Is, perhaps,  the most primi-
 tive method of cooking; the savage puts
 his piece of flesh or his fish upon the burning
 coals and  broils it.  In civilized  life,  the
 gridiron is made the medium for the process.
 The principle involved in  broiling is, that by
 sudden  exposure to the fire, the outer por-
 tions of the meat are so hardened that they
 retain the juices of the inner,  during the
 process of cooking.   This is still more fully
 effected by brushing over the surface  of the
 meat with white  of egg before putting on the
 fire.  Broiling is not so  well adapted  for
 weak stomachs as either roasting or boiling;
 but  meat cooked in this way is  very nutri-
 tious.
   BROKEN BONES.—See Fractures.
   BRONCHITIS—Is  inflammation of  the
 membrane  lining the air-tubes or bronchi, j
 In its subacute and chronic forms  it is  one
 of the most common diseases, prevailing at
all seasons, but especially in cold and damp.
weather.  It may be either acute, subacute,
or chronic, and varies according  to  age.
Acute bronchitis may commence directly in
the chest after exposure to cold; but very
often,  particularly in children, the lining
membranes  of the  eyelids,  nostrils,  and
throat  are first  affected,  and the disease
spreads downward into the air-passages of
the chest.  In the latter case, watering of
the eyes, &c. precedes the actual bronchitic
attack  for a day or two.   Acute bronchitis,
as it occurs in the adult, is  a severe disease,
requiring the most prompt medical attend-
ance ; it is generally the result of exposure
to cold in some way, but may be caused by
irritant vapours.  In it the  fever is high, the
breathing extremely oppressed, the cough
frequent, and expectoration at first difficult.
The disease terminates, either with the sub-
sidence of these  symptoms, the  breathing
and expectoration in particular, becoming
easy; or respiration becomes more and more
oppressed and difficult,  the  mucus, which
ought to be expectorated, accumulates in the
bronchial tubes, and the blood  being un-
changed, the lips and surface  generally be-
come  blue  and  cold; delirium  preceding
death.   The rapid progress which this dis-
ease sometimes makes, from its commence-
ment  to a fatal  termination,  renders the
sending for medical assistance as quickly us
possible an imperative duty;  but the same
reason renders it important that those around
should be aware of the best method of treat-
ment.  Confinement  to bed is  a matter of
course; but foot-baths, hot bran poultices
to the  chest, and warm diluent drinks are
all serviceable.  In a person of full habit,
from eight to twelve leeches may be applied
to the  chest, or five or six ounces of blood
taken from between the shoulders by cup-
ping;  but  the chief dependence is  to be
placed upon nauseant medicines, and ipeca-
cuanha is the best and safest.   Four grains
should be given in a little water every twenty
minutes, till free vomiting is produced; and
this  repeated every  two  or  three hours.
About an hour after the first vomiting, four
grains  of calomel are to be  given, and if the
disease continues severe,  repeated in six or
eight hours.   In the  event of symptoms of
collapse  or sinking  coming on before the
arrival of medical assistance,  it will be ne-
cessary to  stop  the  nauseating treatment,
and to give stimulants, such  as five grains
of carbonate  of ammonia, in  three table-
spoonfuls of water, every half-hour or hour;
or a teaspoonful of sal-volatile may be given
instead, in the same quantity of water, and
at the same intervals.  If  these stimuli or« 
B  R O                79                B R 0
 not to oe procured, the most readily obtain-
 able alcoholic stimulant must be substituted ;
 but  ammonia  is  always preferable;   the
 strength must-at the same time be sustained
 by tablespoonfuls of strong meat-broth fre-
 quently given.   When the urgency of  the
 attack has yielded under the use of the nau-
 seant and  emetic systems, the severity of the
 treatment may be relaxed, and the following
 substituted:—Three grains of ipecacuanha
 powder, a drachm  of carbonate of potash,
 and an ounce and a half of spirit of minde-
 rerus are to  be made into  an eight-ounce
 mixture with water; and of this, two table-
 spoonfuls should be given every three or four
 hours.   If the  cough is very troublesome,
 three or four drops of laudanum  may  be
 added to some  of the doses—but this  cau-
 tiously.   The diet should be light and nour-
 ishing.
   The  acute  bronchitis  of children is  not
 usually so rapid and strongly marked a dis-
 ease as that just described; it often begins
 with the irritation of the membrane of the
 nose and eyes,  and  extends itself into  the
 chest.  Languor,  succeeded  by fever,  op-
 pressed  and  quickened  respiration,  and
 cough,  are the usual symptoms.  If  these
 set in severely, from one to four leeches, ac-
 cording to the age of the child,  may in an
 early stage of the disease be  applied to the
 chest; but here, as  in the adult, the chief
 dependence must be on ipecacuanha, half a
 grain to a grain, or more, frequently repeat-
 ed so as to cause occasional vomiting.  Bran
 poultices ought to be used to the chest.  The
 warm bath may be useful in the first stage
 of depression; but when fever is high, it is
 not advisable.   If the child is unweaned, it
 must not be allowed to suck, either from the
 breast or bottle, during  a severe attack of
 bronchitis,  but  ought to  be  fed with the
 breast-milk, or its  usual  food, by means of
 a  spoon.  The bowels, of course, will-require
 attention.   It is of the greatest importance
 to attend  to  the  atmosphere  surrounding
 either child or  adult suffering from bron-
 chitis :  the chamber should be well venti-
 lated, and the temperature not  suffered to
 fall below 55°  Fahr.  In  the latter stages of
 infantile bronchitis, a small blister, about
 the size of half a dollar, applied for a few
 hours to the forepart of the chest, may give
 relief.  Bronchitis in children is  so hazard-
 ous,  and frequently fatal a disease, that its
 domestic treatment ought never to be under-
 taken, except under necessity.  Its exciting
 cause is almost invariably cold and moisture,
particularly during  the prevalence of east
wind  in the spring  months ;  while careless
and  insufficient  clothing  among the poor, |
 and absurd modes of dressing  amid  th<
 higher  classes,  render children more sus
 ceptible of these injurious influences.
   Subacute and chronic bronchitis, known
 also as winter-cough,  catarrh, and often
 erroneously  called influenza, is  quite  the
 commonest form of this chest affection, and
 assumes every  condition, from the almost
 acute attack, to the cough which comes on
 with the first advent of cold weather, and
 lasts through the winter and spring.  The
 malady may commence with irritation  of
 any portion of  the continuous membrane
 of the eyes, nostrils, throat, or  trachea; the
 part affected feels sore and raw, and, instead
 of its usual bland mucus,  secretes a thin
 somewhat acrid fluid.  Along with the local
 symptoms  there is more  or less  feverish
 disturbance of the system,  and often severe
 frontal headache;  cough is  or is not pre-
 sent, at first, according to the part affected.
 If a threatened  attack of  subacute bron-
 chitis is to  be checked, it  must be done in
 the  earliest stage,  and for this  purpose
 nothing is more  efficacious than the vapour-
 bath, and, in  its absence, the  employment
 of means to produce free perspiration, such
 as hot foot-baths, a hot bed, and the free use
 of warm diluent drinks.  The most  efficient
 medicine for the purpose of checking the
 disease is opium, in small  doses,  and  no
 better form can be found than that of pare-
 goric ;  one or two teaspoonfuls, along with r
 tablespoonful  of spirit  of mindererus, a'
 twenty  drops either of ipecacuanha  or ar
 monial  wine, being given at bedtime, al
 with sufficient water to fill a  wineglass.
 teaspoonful  of spirit of sweet nitre m,v'
 substituted  for  the spirit of  minderei
 An aperient should be taken in the mon
 ing.   The above dose  may be repeated for
 two or three nights in succession, if the dis-
 ease is  unchecked.  In this case, of course,
 confinement to  the  house,   or  to  bed,  is
 required ; and  demulcent  drinks—barley-
 water  is the best—are to be freely  used.
 There is seldom  occasion for much medi-
 cine.   For the alleviation of  the cough, the
 following mixture will  be found useful:—
 Tolu syrup, one  ounce and  a  half;  thick
 mucilage of gum-arabic, one ounce and  a
 half; ipecacuanha wine, one drachm; water
 sufficient to  make  up  six ounces.  Of this,
 a  tablespoonful  may  be taken every four
 hours.   If the cough is very troublesome,
 forty drops of laudanum may be added, and
 toward  the  end of the attack, a drachm
 of tincture  of squills.  Bran poultices  to
 the throat and chest are of  service at the
commencement of subacute bronchitis; mus-
tard-plasters are not advisable when there 
B R 0                 80               B R 0
 is  much fever or heat of skin, but a small
 blister to the upper  part  of the chest will
 frequently stop the further progress of the
 malady.   In the attacks, the diet of course
 ought to be  reduced, and  meat and stimuli
 eschewed while they  last.   An attack of
 subacute  bronchitis ought never, if it pos-
 sibly can be avoided,  be  allowed to esta-
 blish itself for any length of time; consump-
 tion, asthma, and other chest affections are
 too nearly allied  to  it; and too  often the
 seeds of  fatal  disease, which  otherwise
 might  have lain  dormant for years,  are
 quickened into  activity by the  neglected
 cold.
   The  bronchitic  attacks of the aged  are
 always to be regarded with serious atten-
 tion ; what  in youth might be but a slight
 cold, may now be a fatal  disease.    This
 arises partly from the  viscid  nature of the
 secreted mucus, but more especially from
 the inability of persons advanced in life to
 expectorate  it;  accumulation of  phlegm
 takes place in the bronchial tubes, the oxy-
 genation of  the  blood is  interfered  with,
 torpidity of  the vital functions ensues, and
 adds to  the already existing inability to free
 the lungs, and death quickly  takes place,
 often unexpectedly sudden.  For  the above
 reasons, colds in old people must always be
 watched; all  lowering measures  must be
 avoided, the diet kept nourishing, and the
Lmedicines be stimulantexpectorants. Opium
  hould not be ventured  on without medical
  inction; the compound squill pill is useful.
ORimphor in  the form of julep,  carbonate of
  Lmonia, and  sal-volatile are  frequently
the aired.   The  inhalation of steam  will
florist the expectoration of  viscid mucus.
ot/onfirmed  chronic  bronchitis, or  winter-
 cough,  requires rather management than
 medicine.  Protection of the skin generally,
 particularly  that of the chest,  by flannel
■ worn next it, being most important.  Some
 persons derive much comfort from wearing
 on the chest a dressed hare skin, with  the
 fur inward; it is probable that some of
 the benefit in this case arises from a gentle
 counter-irritant effect.   The feet, of course,
 are to be well protected from cold and damp
 by  thick, or  gutta-percha  or  cork-soled
 shoes:  and the air passing  into the lungs
 warmed  by  means of  one of  the various
 respirators now in use.   As  an  ordinary
 method  for allaying  irritation, a  teaspoon-
 ful of paregoric, taken at  bedtime in a lit-
 cie water, is most serviceable ; or, where
 the opium is objectionable,  three or  four
 grains  of extract  of henbane, or of hem-
 lock, in  the  form of  pill.  In  all forms of
 bronchitis the condition of the  stomach and
I digestive  organs  require due  attention.
| When  cough  is frequent and  violent,  the
 mechanical  efl'ect  upon  the  stomach  is
 liable  to disorder digestion, and this again
 reacts upon the lungs, increasing irritation :
 for this reason the food must be kept light,
 and a dose of  compound  rhubarb and blue
 pill taken occasionally.   The  infusion of
 hop, at once a good bitter tonic and a seda-
 tive, is useful.   In some forms of bronchitis,
 in which  the  cough assumes a spasmodic
 character,  and  particularly  in  children,
 coming on when the stomach  is empty, a
 little food taken  will more certainly allay
 its  incessant  irritation   than any other
 means.
   Refer to Expectorants.
   BRONCHOCELE—Goitre—Derbyshire
 Neck—Full   Throat—Are all names  for
 the same disease,  an enlargement of  the
 "thyroid  gland,"  situated in front of  the
 windpipe. The disease is endemic, that is to
 say, it is  confined to particular districts of
 country.   In  England, Derbyshire  and  the
 adjoining counties  of  Stafford, Leicester,
 and Nottingham form its chief locality.   In
 Switzerland  and  the Tyrol it  is common;
 and it occurs  in Hindostan, Canada,  &c.
 &c.
   Full throat  varies in  size, from  the  en-
 largement so slight as to be scarcely per-
 ceptable—or  even,  in some  eyes,  to  add
 grace   to  the   neck—to  a  tumour many
 pounds in weight.   In England  or America,
 however,  it seldom attains the immense size
 it does elsewhere.   The thyroid gland con-
 sists of two lobes, which  lie  on either side
 of the windpipe, and of a connecting neck.
 The whole of  these parts may suffer  en-
 largement at  once, or only  one of them.
 Bronchocele  is  much  more  common in
 females than in males; indeed, in this coun-
 try it is rarely seen among the  latter ;  and
 in both sexes, as a general rule, does  not
 appear till after puberty ;  children, how-
 ever, do  suffer from it even from  earliest
 infancy.  The  rise and  progress of bron-
 chocele are for the most part slow,  and un-
 accompanied   with  pain;  but  occasionally
 rapid enlargement occurs, and  then pain is
 severe.  Coughs, child-bearing,  strong mus-
 cular exertions, are all liable to induce and
 accelerate the  progress of bronchocele :  the
 monthly period also exerts considerable in-
 fluence upon it.  Females of lymphatic tem-
 perament are more  liable to be  attacked.
   Bronchocele is a disease for the most part
 devoid of danger; the chief  inconvenience
 attending it, when of large size, being  im-
 pediment to  the breathing,  and fulness of
 tht head arising from obstruction to  the 
BRO
81
BRO
 circulation  in  the  vessels of the  head and
 neck.   The  appearance  of  a large bron-
 chocele  id of course  unsightly, although in
 those  localities  in which it prevails it is
 scarcely observed.
   Various  causes  have been  assigned  for
 the  production  of bronchocele;  but  none
 with so much  probability  as  that which
 attributes it to the regular use of water con-
 taining lime and magnesia—impregnations
 of the  fluid found coincident  with the dis-
 ease.   The use of  snow-water, as formerly
 supposed, is now proved  to have nothing to
 do with its  development.  Carrying heavy
 weights upon the  head has  been said to
 cause the disease;  it is  not probable that
 of itself the practice could  produce true
 bronchocele; but, undoubtedly, in common
 with all other  physical  efforts  or forces,
 such as cough, which tend to impede tem-
 porarily and violently the general circula-
 tion about the neck,  it will hasten its pro-
 gress.  It is certainly more common among
 the class of females who are forced to make
 strong  physical exertions.  Many different
 cures have been  proposed ; fortunately,  we
 possess one so efficacious  and certain, that
 it alone claims our attention.  Iodine exerts
 the most powerful influence.  Even before
 its discovcy, the element was used, though
 ignorantly   in  the  form of  the  lozenge
 of burnt sponge.   It is now most gene-
 rally employed  in the form of ointment.
 One  drachm of the compound of iodine and
 potash  (the  hydriodate of potash) is  rub-
 bed  up in  a mortar with  twenty  or thirty
 drops of water, and then  with an ounce of
 lard, and a  portion of this about the size of
 a small  bean rubbed well into  the tumour
 every night, intermitting the application, if
 the  skin—a3 it  often does—becomes  sore.
 Or the  tumour may be painted over every
 night  with  compound  tincture  of iodine,
 but this causes a yellow stain, [which is not
 permanent.]   Should  the tumour  resist
 either of these means after they have been
 persevered  in  for some time, they may be
 assisted by five drops of compound tincture
 of iodine taken  twice a day in water, on a
 full  stomach.  Acute  attacks  of  broncho-
 cele  require the  application of leeches and
 the use of purgatives, to  allay excited ac-
 tion, before iodine can be used with advan-
 tage.  Bronchocele ought always to be sub-
 mitted to treatment as soon as discovered.
 *f this is done  there is seldom much  diffi-
 culty in its  removal; but if it is allowed
 to gain  a large size, or if  it is of old stand-
ing, it will resist the most  persevering treat-
ment, and perhaps prove a serious cause of
inconvenience,   especially if  it  becomes
hardened,  which it not  unfrequently does
as  life  advances.  A  curious  superstitiolj
with respect to bronchocele prevails in some
of the places in  which  it is endemic.  It is
believed that a cure will be effected, if  the
tumour  is rubbed over  by the right hando'
the corpse  of a " bachelor !"
  Refer to Iodine.
  BRONCHOTOMY or TRACHEOTOMY—
Is the operation of making an artificial open-
ing in the  trachea or windpipe, in cases in
which suffocation is threatened,  from any
cause which  impedes or stops  the passage
of air into the lungs at a point nearer  the
mouth or nostrils than the site of the artifi-
cial orifice.  It  always requires educated
surgical skill for its safe performance.
  BROOM.—The common  broom is one of
our most certain and valuable diuretics,  too
much neglected; it is,  too, perfectly safe.
The infusion is  best made from  the green
tops ; a good handful—about an ounce—to
a pint of water, which should be poured upon
it boiling, and the whole allowed to stand in
a covered vessel  near a fire for some hours
—of this, a teacupful may be given twice a
day in all  cases in which it is desirable to
increase the flow of urine.  It rarely fails.  A
few juniper-berries may be added to the infu-
sion.  In cases of liver affection, the substi-
tution  of half dandelion-root  for one-half
broom is a valuable combination.   The seeds
may be  used when the tops cannot be pro-
cured.
  BROTH—Is the decoction obtained from
animal substances, and, when made for  the
sick, must, of course, be varied in strength,
according to  the state of the patient.  It is
best made by putting the article from which
it is to be formed into the requisite quantity
of cold water, and keeping the whole at a
heat somewhat  short of boiling, for many
hours : it should then be allowed  to become
cold, and  have  the  fat  skimmed off.   In
cases of diarrhoea, broth, in quantity, is  apt
to increase the tendency to looseness, but it
is at the same time extremely beneficial, if
properly managed:  in such cases, it is best
made from veal or fowl, thickened with rice
—which may be strained off—and must  be
given in small quantities only at a time.   In
Scotland,  by broth is meant the decoction
from meat, boiled with pearl barley and a
good proportion of vegetables;  it is a much-
used and  wholesome article of  diet,  and
might, with advantage, form an addition tc
the fare of all,  but especially labourers,
when economy in food is necessary.  To  bfl
wholesome  it must be thoroughly boiled.
  Refer to  Beef—Beef-Tea—Mutton—Veal.
6- 
BRO
BUR
  BROW AGUE—A name for neuralgia de-
rived from the marked periodicity of the at-
tacks of pain.
  Refer to Neuralgia.
  BRUISES  and CONTUSIONS—Are  the
effects  of external  violence applied to  the
body, and  may be  simple,  or  complicated
with wound  of the skin.   The  effects  of
bruises depend of course, greatly, upon their
situation, and the possibility of the violence
which produced them having injured import-
ant parts, this being more likely to happen
when the contusion affects the head, neck,
or trunk.   The first effect of a bruise is to
cause effusion of blood,  more or less, within
the textures injured; on the head,  this is
very evident from the large tumour which
will often rise immediately after a blow; —
a black eye renders the effused blood visible.
Blood effused, as the result of a bruise, does
not remain in one spot, but diffuses itself
through the loose surrounding textures, and
causes discolorations to appear at a distance
from the bruise, days after  the receipt of
the injury.  The changes in  colour, from
black or blue to greenish-yellow,  &c. &c,
which take place during the  recovery after
a bruise, and which are probably caused by
the mode of absorption of the effused blood,
are too well known  to  require description.
After bruises of the abdomen, particular at-
tention should be directed to detect the oc-
currence of blood,  either in the stools  or
urine:  if a medical  man is called in, it is
highly important for him to have  informa-
tion on these points.   In bruises of the sur-
face generally,  the best and most agreeable
application is lint soaked  in cold water, or
in a cold lotion made with half  an ounce of
tincture  of arnica  to  the  pint of  water.
After the lapse of five or six  hours, hot ap-
plications—poultices—will be most required.
If heat be used too soon, it may tend to in-
crease the effusion of blood, which the cold
checks.   The same  treatment  may be fol-
lowed, whether the bruise is simple, or com-
plicated with wound.  It is a frequent error,
popularly, to apply leeches immediately after
a bruise, when they cannot possibly  be  of
service;  they  cannot  remove  the  blood
which is effused, and are only useful in the
event of inflammation succeeding the injury.
After pain  and inflammation, in a bruise,
have subsided, simple water-dressing may
be substituted  for the  poultices for a few
days, and after that, should discolored swell-
ing remain, friction  with soap-liniment will
hasten its removal.   A severe  bruise may
run  on  to  the  formation of an abscess, or
end  in  mortification of the part.   In  ei-
ther case, the effect is known by the super-
vention of the usual symptoms attendant on
these processes, and must be treated accord-
ingly.  Severe bruise of a bone is liable to
be followed  by death and separation of the
injured part.
  Refer to Abscess—Concussion—Mortification
— Wounds Bruised.
  BUBO—Is the .inflammatory swelling of
a lymphatic gland, tending to suppuration.
The  term is most generally applied to the
glands of the axilla and groin, when affected,
either by venereal causes, 'or in the progress
of the plague.  The treatment of  bubo is
similar to that required in abscess generally.
  BUCK-BEAN, [Marsh Trefoil]—Is one
of the most beautiful of our marsh-plants. It
bears a trefoil leaf,  and flowers in England
in June.   [In  the United States it grows as
far south as Virginia, and flowers in May.]
The blossoms are white and feathery-looking,
with a tinge  of pink.   The leaves  of the
buck-bean are powerfully bitter, and might,
perhaps,  be  more generally used as a tonic
than they are at present.   The infusion may
be made with  an ounce of dried leaves to a
pint  of water.
  BUCK-THORN—Is a  shrub,  native  to
Britain, [but also found in New York  and
other sections of the United States; it flowers
in May, and its berries are ripe in Septem-
ber.]  A  syrup made from its berries is used
as a  purgative, but it  is apt  to gripe, and
need not be used when  there  are so many
better medicines of the same class.
  BUNION—Is the result of chronic inflam-
mation of a small bursa which is situated
over  the joint—at the ball—of the great toe,
and is  generally occasioned by the pressure
of tight shoes.  It  is a  most inconvenient
and unsightly  affection, and the more it en-
larges, the more does it become exposed to
those sources of irritation which originated
it.  A  bunion ought to  be attended to at
first, and  one or two leeches, warm fomenta-
tion, and  poultice used to allay irritation, the
offending  shoe being  at  once  discarded.
Malposition  of the  bones at the joint is a
frequent  attendant, and, perhaps, an ante-
cedent cause of bunion.  When the disease
is fully formed, the best plan is to avoid, by
the make of the shoe, &c. &c, every source
of irritant pressure.
  BURGUNDY PITCH—Is a resin obtained
from the pine tribe, but  the  real article is
seldom procurable ; that sold  for it being a
preparation made  from  common resin.  It
is used for plasters ;  they are slightly stimu-
lant.
  BURIAL.—As a general rule,  it is desir-
able  that the bodies of the dead should bo
consigned to the earth as soon as consistent 
BUR
83
BUR
 with decency and  necessary arrangement,
 more especially where, as in the  dwellings
 of the poor, space is confined and crowded.
 As an  invariable rule, some means  for the
 disengagement of  chlorine—and Collins's
 powder [or chloride of lime] is perhaps the
 best—should  be  provided in the chamber
 occupied by a corpse; it retards decomposi-
 tion, and destroys all noxious and offensive
 exhalations.
   Refer to Death.
   BURNS  and SCALDS—Are injuries in-
 flicted upon the body by heat,  the latter
 term being confined  to those cases in which
 the medium has either been liquid or vapour.
 A  burn  may vary  in intensity,  from the
 slightest scorch to complete roasting of the
 tissues; a scald is not so severe in its effects.
 There  are, perhaps, no accidents for which
 more remedies have been proposed and used
 than those resulting from  heat;  but it will
 be sufficient if the best and  most generally
 and easily applicable are kept in mind.
   In  the case of  slight burns, and of scalds
 generally, quite the  best application  is the
 cotton  wadding in sheets; it should be at
 once used  to  envelop  the  injured  parts,
 double if possible, and  bound or bandaged
 on with moderate firmness.  If this mode of
 treatment  be resorted  to within the first
 twenty  minutes  after the injury, nothing
 more need  be done; the cotton may be al-
 lowed to remain on  from twenty-four hours
 to three or four days, according  to the se-
 verity of the accident.  Under its use blis-
 tering rarely occurs,  and if it has commenced
 before  the  application,  it subsides quickly
 and painlessly.   For the  first ten minutes
 after the cotton-dressing is put on, the pain
 of the injured parts seems increased, but ere
 long  it  diminishes,  and  the inflamed skin
 appears to relieve itself by gentle perspira-
 tion.   In the cases above named, when cot-
 ton is to be procured—and no house  in the
 country ought to be without one or two
 sheets of it—it is perfectly unnecessary to
 use any other measures.
   Spirits,  whisky  or brandy,  turpentine
 and other stimulants, all  have their  advo-
 cates, but the milder methods are preferable,
 at least domestically.  A mixture of oil and
 lime-water is employed by some, but is dis-
 agreeable and dirty; it may be used  in the
 absence of a better remedy.   A lotion made
 with an ounce and a half of vinegar to a pint
 of water  may with advantage be kept con-
stantly applied to a burn if it be not extensive
—a saturated solution of carbonate of soda
has likewise been recommended. Cold water
is perhaps the most directly grateful appli-
cation to a burnt or scalded surface, and if
 continued sufficiently long, will undoubtedly
 restore the usual condition of the part, but
 it must be persevered with for many hours ;
 and when a burn or scald is extensive, this
 is a serious objection, in consequence of the
 extreme constitutional  depression which so
 often follows the accident, especially in the
 young.  And here the opportunity is taken
 of warning  parents of  the necessity of
 watching closely the effects of even slight
 injuries of this kind upon children, particu-
 larly when the chest or  abdomen are the
 seat of the accident: extreme depression—
 requiring the use of stimulants—may unex-
 pectedly come on, and death, from an appa-
 rently very slight cause, be the result.  When.
 cotton is not readily procurable, flour dredged
 over the surface is an admirable substitute,
 even in slight burns, but is more useful still in
 those severe effects of heat in which the tis-
 sues are deeply destroyed by the  action of
 fire; in  these  cases, flour applied  at  once,
 and repeated again and  again  for days to-
 gether, wherever slight moisture seems ooz-
 ing through the caked covering  it forms, is
 the most generally applicable, pleasant, and
 safest  remedy; a little  fresh sweet-oil ap-
 plied to the surface in the first instance will
 make it adhere.  [Coating the surface with
 thick white paint has  proved an  excellent
 plan of treatment.   It should be allowed to
 dry and  remain until thrown off by nature.]
 Whatever application is used in the treat-
 ment of a burn, should  be calculated to ex-
 clude the action of the external air ; it ought
 to be one, also,  which does not  require fre-
 quent changing; indeed, the more extensive
 the surface involved in  the  accident, the
 greater care  should  be  taken  not to expose
 it to atmospheric influence, which, in the
 first place,increases pain, and, in the second,
 adds to constitutional depression.   This de-
 pression must always be carefully watched,
 and combated by the use of ammonia, wine,
 or spirit, sufficient to support  without sti-
 mulating.  When paiu  is excessive, and is
 irritating the nervous system, a gentle opiate
 is required;  but  in  some of the  severest
 burns,  the sensation, not only in the injured
 part, but generally, is either wholly or par-
 tially abolished, in consequence of the shock
 to the nervous system at large.   The symp-
 tom is of most serious, and indeed  fatal im-
 port.   In the less severe forms of injury
from heat, if the cotton, the flour, or cold
 water,  have been properly used,  little after-
treatment is necessary; but when a burn
has been neglected  or  badly treated, the
blisters broken,  and  when the true  skin be-
neath is inflamed and  secreting matter, a
simple  tepid  bread and  water   poultice 
BUR
84
BUT
should, in the first place, be applied for six
or eight hours, and after it an ointment com-
posed of one drachm of liquor of lead  or
Goulard, rubbed  up with an ounce of per-
fectly fresh lard.   This ointment spread  on
linen quickly relieves the very painful con-
dition  of the  injured surface,  and is often
preferable to the lead lotion sometimes used.
  In cases  of deep burn, with destruction of
the tissues, after the flour has been applied
gome days, it begins to be pushed  off  by
the matter  formed underneath : at this time
poultices are to be continued until the caked
flour  is  separated,  and  the  surface  be-
low exposed, after which the simple  dress-
ing with tepid water will generally be the
best and safest application; or,  in a later
stage,  if healing' is slow,  the lead oint-
ment above  recommended  will  be  found
useful.
  During the  cure of burns involving con-
tiguous parts, such as the fingers, care must
always be taken to keep the surfaces asun-
der  by the  interposed  dressings:   other-
wise they  may become united.  After ex-
tensive burns or scalds, the constitution re-
quires attention—the stimulating treatment
of the first few hours or days must be drop-
ped  when feverish symptoms come on, and
mild and cooling diet, gentle aperients, and
cooling saline medicines administered:  opium
being given if requisite, to allay  pain  or
nervous irritation.   This system will again
require to  be changed  for one of stronger
nourishment—meat  soups,  meat  and wine,
or other stimuli, if  there is continued dis-
charge.  The  use of stimulating  diet, how-
ever,  requires caution, on account of the
tendency to inflammation of the lining mem-
brane  of  the  stomach  and bowels,  which
exists during convalescence from injury to
the skin by heat.
  The frequent occurrence of accidents from
burns or scalds, renders it desirable that
all should be aware of the best methods  of
managing  these  painful injuries,  which,
when slight, may be well attended to with-
out the  aid  of the surgeon;  but which,
when severe  and extensive,  and when,  in
children, the chest or abdomen are involved,
ought,  without delay, to be put under pro-
fessional care: accidents and symptoms may
arise which educated skill alone can foresee
or counteract.   Scalds of the throat are
not unusual accidents to children in conse-
quence of their  attempting to  drink from
the spout of a kettle of  boiling  water.  The
injury  is imminently dangerous,  and when
it has  occurred, whether alarming symptoms
come on at once or  not, a surgeon should be
summoned.  It may probaMy  become ne-
| cessary very speedily to open the windpipe,
 to save from death by suffocation ; and  the
 operation may be resorted to with good hope
 of success.  In the interval, before the  ar-
 rival of medical aid,  leeches, from two to
 six, according to the age of the child, should
 be  applied to the throat  externally,  and
 four grains of calomel administered at once.
 If ice is to be procured, it  should be con-
 stantly put into the  mouth in small frag-
 ments.
   In managing burns or scalds immediately
 after their occurrence, the following should
 be remembered:—
   To protect from the action of the atmo-
 sphere ; and the greater the extent injured
 the  more necessary the precaution—[hence
 the  advantage  of coating it with the white
 paint, which thus serves the  purpose of a
 scarf-skin,  and shields the  raw surface]—
 to give stimulants or opium cautiously.  The
 remedies, cotton, flour, paint, oil, and lime-
 water, vinegar and water, cold water.
   Refer to Skin— Water-dressing,  Sfc.
   BURS/E—Are small bags of membrane,
 containing an oil-like fluid.  They are placed
 in various parts of the body liable to press-
 ure  or friction.
   BUTTER—The oily constituent of milk,
 separated by the  process of churning, is one
 of the commonest, and, when properly used,
 most wholesome  articles  of food.  When
 fresh, that is, free from rancidity, it forma
 a nutritious, it might  almost be  said  in-
 stinctive, addition to farinaceous diet. Much
 has  been  said, in writings upon  diet,  re-
 specting the  unwholesomeness  of butter;
 and, undoubtedly, in  certain  states of  the
 system  and of the digestive organs, it is  so;
 but  for healthy individuals it is the reverse.
 Butter in some persons, and, if immoderately
 used, in all, gives  rise to biliary  derange-
 ment, partly, doubtless, from its  furnishing
 an excess of biliary material, but also from
 its presence in the stomach, as observed by
 Dr.  Beaumont, causing a flow, or  regurgi-
 tation of bile into that organ.   The above
 remarks apply to simple butter unspoiled
 by   cookery.   When  butter is exposed to
 gentle heat it  melts, and under this con-
 dition has obtained  a  reputation for  in-
 digestibility  which is  due  rather to  the
 quantity consumed than to its being merely
 put  in that state which it assumes when it
 is exposed to the heat of the stomach.   The
 case is very different, however, when butter
 has  been exposed, whether  alone  or com-
 bined with farinaceous articles,  to  a  high
 temperature, such as that of an  oven: it
 now becomes altered in characte", (empyreu-
 matized,) and is  rendered very indigestible 
BUT                 85               C A M
and irritating to the weak stomach.   It is
for this reason that baked pastry is so much
more indigestible than boiled,  from  the
greater  heat  to which the  former is ex-
posed.   Butter,  when  it becomes rancid,
contains various acids which are so un-
wholesome that they may almost be ranked
as poisons.
  BUTTERMILK—The thin  acid  fluid left
after the separation of the butter,  is a most
wholesome  and refreshing  article of  diet,
either in health  or sickness,  and one too
much neglected.  In diseases attended with
fever it may be  given largely with benefit.
It can  be made artificially,  by shaking  a
quantity of milk in a bottle capable of con-
taining four times  the quantity,  until the
butter (which must be strained off)  is se-
parated.  The cork of the bottle  being re-
moved  occasionally during the process, to
permit  of the renewal of the air.
  CABBAGE—As an  article  of diet, is not
only wholesome, but  extremely nutritious.
It is, however, only  suited for persons  of
good digestive powers.  [Unboiled  cabbage,
in the form of "cold-slaw,"  is more easily
digested than  that which is boiled, as the
heat  drives off the  ammonia, which,  as  a
stimulant, assists digestion.]   From the ex-
treme liability of cabbage to pass into  a
state of putrefaction,  it should always be
used as fresh as possible.
  CACHEXIA—Is a term used  to express
an  unhealthy state of the system, induced
by  causes which tend  to  depress without
causing fever, such as  deficient or  unwhole-
some nourishment.—See  Scurvy, Rickets,
§c.
  CADDIS.—Lint.
  CECUM.—The commencement of  the
large intestine.—See Alimentary  Canal.
  CiESARIAN  OPERATION—Is  the pro-
cess  of extracting the infant  by cutting
through the  walls of the  abdomen and
womb.   It  is  occasionally resorted to by
medical men, as a fearful necessity, to save
life, when delivery can  in no other way be
effected.  It derives  its name from the tra-
dition  that  Julius Csesar was brought into
the world in this manner.
  CAFFEINE—Is the characteristic princi-
ple of  coffee,  identical with  that of  tea,
"theine."   It is a compound,  nearly ap-
proaching the kreatine of animal muscle in
its constitution,—See Coffee.
  CALAMINE—Is a carbonate of zinc em-
ployed  in medicine in  the form of a  gray
powder; it is chiefly used to sprinkle upon
excoriations, chaps, &c. &c.; but there are
so many better applications  that  it might
be altogether dispensed with.  Mixed with
        II
wax and  olive-oil, it  forms the  ointment
known as " Turner's cerate."  The propor
tions are, calamine and wax, of each half a
pound, olive-oil  sixteen fluid ounces.  The
wax and oil  are melted together, and  the
powdered calamine is stirred in during  the
process of  cooking.
  CALCULUS, [Stone.]—See Gravel.
  CALOMEL.—See Mercurials.
  CALORIC—The term  used  to  distin-
guish the  cause of the sensation  of  heat,
from the sensation itself.—See Heat.
  CALUMBA, or COLUMBO, orCOLOMBA
—Are different modes of spelling the name
of the  same  root.  Columbo-root is sold in
transverse sections of various diameter and
thickness, which are covered by  a brown
wrinkled bark, are of  a grayish-yellow co-
lour, and rayed on the cut surface.   Colum-
bo is one of the  best pure bitter tonics we
possess ; it is free from astringency, and ex-
erts a  sedative  action.  In  irritable dys-
pepsia,  with vomiting,  and  particularly in
the  vomiting of pregnancy,  its effects  are
most beneficial,  especially when it is com-
bined with from five  to" fifteen grains  of
either  bicarbonate of   soda  or  of potass.
Columbo may be given  in powder, in infu-
sion, or tincture,  but never  in  decoction.
The dose of the powder is from ten  grains
to forty ; of the infusion, from a tablespoon-
ful  to  a wineglassful;  of  the tincture, one
to two teaspoonfuls in water.  The powder
of columbo may be taken in water, simple
or aromatic :  eight parts  of columbo-pow-
der, eight  parts of carbonate of soda, and
two  parts  of ginger form a most excellent
stomachic in dyspepsia, of which half a tea-
spoonful may be taken in  a wineglassful of
water once or twice a day.   An infusion of
columbo is made by pouring a pint of boil-
ing water  upon  five drachms of the sliced
root, and  macerating for a couple  of hours
in a covered vessel.  It ought to be made
fresh every day, as it quickly spoils. Tinc-
ture of columbo is better purchased.—See
Tinctures.
  CAMBOGE, or  GAMBOGE —The  well-
known pigment, is  a drastic cathartic,  too
powerful to be used alone with safety as a
domestic  remedy.  In  an overdose it  se-
riously  irritates the lining  membrane  of
the   stomach and  bowels, causing inflam-
mation of a dangerous  or fatal character.
Camboge is said  to form  a  constituent of
some of the quack purgatives;"and certainly
any compound medicines containing it can-
not  be safely adopted for  general or "uni-
versal" use, however valuable the  medicine
may be when administered in proper cases.
When simple purgative  action is required, 
C A M
                V  A M                 81

camboge csanot  be  requisite while we  pos-
sess safer and equally effective drugs ;  but
from its  property of producing free watery
evacuations from the bowels,   in cases of
dropsical swelling,  it is very serviceable.
Camboge is most safely and  advantageously
given in combination, and  the compound
camboge pill is a powerful cathartic,  adapt-
ed for those in  whom confined  bowels  ac-
company  a full  and strong habit of body.
The pill is made by mixing together, in  fine
powder,  camboge  one drachm, aloes   one
drachm and a half, ginger  half a drachm,
and beating up the whole into a mass with
two drachms of  soap.  The  dose of  the  pill
is from five to ten grains.   It is not suited
to delicate habits.
   Refer to Dropsy—Cathartics.
   CAMPHOR—Is a  white,  semi-transpa-
rent,  volatile  substance, but  resembles in
6ome  degree the volatile oils.   It is stimu-
lant,  diaphoretic,  antispasmodic, and  ano-
dyne.  Camphor is but sparingly dissolved
by water, but sufficiently so to  communicate
both taste and smell, and to form a  slightly
Btimulant  solution  or  julep,  which  may
either be  used  internally or  as a  refrige-
rant  lotion.   It  is  most simply made by
keeping  a few fragments of camphor in a
bottle of water.   In the low stages of fever,
camphor  is one of the  most  valuable  re-
medies  we possess, exerting at once a sti-
mulant and a  soothing effect.    It is some-
times  giveu  for this  purpose  in  almond
emulsion, but  quite the best vehicle  is milk.
From twenty  to thirty grains of powdered
camphor are' to  be  rubbed  up in a mortar
with  an  ounce of milk, and five ounces of
water gradually  added ;  of this mixture the
dose will be two  tablespoonfuls.  It must be
remembered  that camphor cannot  be  re-
duced to  powder, unless the  lump  is first
wetted with a  few drops of alcohol, or spirit
of some  kind.   Spirit, oil, and  acetic acid,
all dissolve camphor readily: its solution or
tincture,  in the first, is well  known  as  a
dentifrice, and  is frequently given domes-
tically,  dropped  into  water, as a stimulant,
in colic,  hysteria, &c. &c.   It is made by
dissolving one ounce of camphor  in eight
ounces of spirit. The dose is  from ten to
forty  drops, in water.  The  solution of one
ounce of camphor in  eight ounces of olive-
oil forms  the common domestic stimulant
embrocation,  camphorated  oil.  An over-
dose  of  camphor produces  giddiness, con-
fusion of sight,  and delirium :  an emetic is
the best remedy.
   Refer to Dentifrice—Embrocation.
   CANCER—Is  one  of the most  fearful,
and justly one of the most dreaded diseases
to which the human frame is liable;  and
while its  formidable  nature classes it with
those which ought at once to be placed under
proper medical care, the same reason ren-
ders it most  important that its first symp-
toms  should  be  known and  attended to,
while there is yet time to save life.  Cancer
usually commences  as a hard tumour, un-
accompanied  with inflammation, and either
painless, or the seat of intermittent shoot-
ing pain.  It more frequently  occurs in fe-
males than in males, and attacks the breast
oftener than any other organ.   In men, the
genitals are liable to be affected; and chim-
ney-sweeps particularly become the subjects
of cancer of  the  scrotum, produced, in all
probability,  from continual contact of the
soot.  The skin generally may become the
seat of cancer.   Of the internal organs, the
womb in the female, and the  stomach, are
the most frequent seats of the disease; of
these  the symptoms will be noticed under
the head of the individual organs.  Cancer
is  very rare  under thirty  years of  age.
When, from  the  nature of a  tumour, its
hardness, situation,  age of the  patient, and
particularly if there be any  hereditary bias
toward  the  disease,   incipient cancer  is
suspected, there  should be no trifling, no
leechings, or rubbing, or fomentings;  the
advice of a skilful surgeon should be sought
at once ; nnd neither  time,  distance, or ex-
pense, should stand in  the  way of procur-
ing that assistance which may  not only pre-
serve life,  but save from  a lingering and
painful death.  Should the suspicion be un-
founded, the mind is restored to peace;
should they be correct, the one remedy, ex-
cision, cannot be  too soon submitted to, be-
fore the glands adjacent to the disease, or
other textures of  the body,  become tainted.
In  any stage of  the  disease,  however, the
advice of the regular practitioner ought to
be taken.   Above all,  let  the sufferer and the
friends beware of being temp'ed by the .•'pecious
advertisements of quack remedies,  and of wasting
lime of which every day is precious.
  When, unfortunately, cancer has reached
the stage at  which hope of cure must be
given up;  when  it has become an  open,
gray-looking  ulcer,  discharging thin,  fetid
matter, the seat  of shooting  and stinging
pain,  and when the constitution is affected
it only remains to make the situation of the
sufferer as comfortable as possible.   Opium
in its various forms  is the* great  soother,
and the other anodynes, hemlock especially,
both internally and as a poultice, are all of
service.  Codliver-oil in some cases  allays
the pain and retards the   progress of the
disease; but the  regulation and administra 
CAN
87
C AO
 tion of these remedies must be committed to
 the care of the medical attendant; the do-
 mestic remedies must be the most perfect
 cleanliness and kindest consideration  for
 the comfort and irritabilities of any one who
 is the victim of cancerous disease.  Cancer
 cannot be said to be propagated by contact;
 but  this should be avoided as much as pos-
 sible—in the intimate  relations of husband
 and wife especially, whatever the organ or
 structure affected.
   The lower lip is not unfrequently the site
 of cancer in old people, especially, it is said,
 in. those who smoke much.  A painful sore
 in this situation, which will not heal, ought
 not to be neglected, but submitted to medi-
 cal examination.
   Refer to  Breast—Stomach— Womb, Sfc.
   CANCRUM  ORIS—Is  a  species of mor-
 tification,  or gangrenous inflammation, af-
 fecting the cheek and gums.   It occurs in
 children of weak, scrofulous  constitution,
 who  are ill-fed and  exposed to  the influ-
 ences of unhealthy  habitations;  and  most
 generally immediately after acute disease,
 particularly measles.    Mercury is  often
 blamed  as  the originator  of  this disease,
 and, if given too freely, it may perhaps con-
 tribute  toward its  development;  but  the
 main fault is in the constitution. The usual
 first symptom of the disease is a red, hard,
 angry-lookiug  spot  on the  cheek,  which
 quickly opens into a gangrenous fetid ulcer
 inside the  mouth,  the gums  become  af-
 fected, the teeth  drop out, the breath, as
 might be expected, is unbearably fetid, and
 the extending ulceration goes on destroying
 the  cheek  and contiguous  parts, till it is
 either stopped  or death ensues.
   As the first cause of this fearful affection
 is traceable to  poverty of constitution,  the
 first remedial measure is to nourish.   The
 strongest meat-soup—beef-tea is the best—
 must be given in small quantities frequently
 repeated ;  milk and eggs, if the little patient
 will  take them.  Wine may be allowed if
 the debility is  extreme, but scarcely, if at
 all,  should  fever  run high, and  there is
 much  heat of   skin.   The  preparations of
 chlorine are most to be relied  on as medi-
 cines.   A drachm of chlorate of potash is
 to be dissolved  in six  ounces of water, and
 to this added twenty drops of muriatic acid.
 A tablespoonful of the mixture to be given
 »o a child  of six  years of age#every four
 Hours ;  it may be slightly sweetened.  Half-
 grain doses of quinine, or an ounce of infu-
 sion  of bark, may be  given  twice or three
 times in the twenty-four hours.  A  lotion
made with  a drachm of chloric aether to the
half-pint of water is extremely serviceable
applied to the affected parts, and diminishes
the fetor;  or a drachm and a half of the
solution of the chloride of soda to the half-
pint of water may be  used for  the  same
purpose.  The case ought to be seen by a
medical man as soon as practicable.
  CANELLA  BARK—Is an aromatic tonic,
and is used as a spice.  It may be given in
powder, in doses of fifteen or twenty grains.
  CANINE  TEETH.—See Teeth.
  CANTHARIDES.—The word is the Latin
plural of Cantharis—vesicatoria, the Spanish
blistering-fly.—See Blister.  In addition to
its uses as a blistering  agent, the Spanish
fly is  used internally ; but is too hazardous
a remedy for general use.  It is sometimes
given as a poison for malicious or criminal
purposes.  When swallowed in a poisonous
dose,  cantharides quickly  produce  severe
pain  in  the  stomach and bowels, and in-
tense  inflammation;  distressing  irritation
of the urinary organs follows, with constant
desire to pass urine, which comes away in
small quantities, with or without blood, or
is entirely suppressed;  stupor and delirium
precede death.  The remedies, in a case of
poisoning by Spanish fly, must be  of the
most  soothing character.   Milk given cold
may,  as it coagulates in the stomach, enve-
lop the  irritant particles,  or it may be used
boiled with flour; white of egg, linseed-tea,
or indeed the emollient most quickly and
easily  procurable,   should  be  swallowed
largely, and  vomiting, if  not  present, pro-
moted by a  feather  in the throat, or by
ipecacuanha.  Oil is sometimes  forbidden
in such cases, from  its being a solvent of
cantharides;  but  after vomiting, or  even
before if the dose is  not 'large, one  or two
doses of castor-oil  may safely and  advan-
tageously be  given,  each in combination
with  twenty or thirty drops of  laudanum.
Clysters of starch, linseed-tea, or the  like,
with  or without  laudanum,  will allay the
irritation in  the lower bowels.   Hot appli-
cations  to the abdomen  generally should be
used,  and  if there  is much  tenderness,
leeches  freely.  Should  the patient recover,
the  state of  the alimentary canal and uri-
nary  organs  for  some  time require care,
and the mildest and most  unirritating mode
of living must be pursued.  A little can-
tharides ointment,  smeared  upon the  silk
of a seton, increases the discharge when de-
ficient.
  Refer to  Blister.
  CAOUTCHOUC, or Elastic Gum,  or In-
dia-Rubber—Is  obtained  from  different
species  of trees, both in South America and
in the East Indies.  It is interesting in me-
dicine, from being the basis of the various 
                 C A P                88

elastic mechanical contrivances  now so ex-
tensively used  in the relief  and cure  of
disease.  One of the chief inconveniences
in the use of caoutchouc was its becoming
hard when  cold;  the discovery of its com-
bination  with sulphur—vulcanized  India-
rubber—litis obviated the difficulty, and we
now have a material which remains perfectly
elastic and soft at all temperatures.   This
valuable  property has been quickly taken
advantage  of.  The water-cushion, a  bed,
is one of the most useful  applications of the
material;  it can be filled either with boiling
or with iced water, the latter a  very valu-
able resource in  fever,  for keeping—what
there is always  much difficulty  in doing—
the back of the head cool.
  Refer to  Elastic.
  CAPILLARY.—Hair-like.  The term  is
applied to the minute vessels connecting the
Arteries with the veins in the animal body;
Klso to tubes  of minute calibre.
  CAPSICUM.—Cayenne pepper is  better
known as  a condiment than as a medicine.
A product of warm climates, it is admirably
suited as a stimulant counter-agent  to  the
relaxing effects of heat.  It is extensively
used in this  country, and, when not  im-
moderately, is undoubtedly serviceable  to
persons of  languid  digestion.  In too large
quantity it will, of course, prove  an irritant
poison.   Two parts  of  cayenne, three of
compound rhubarb pill, and one  of quinine,
form an excellent dinner-pill, from three to
six  grains  of which may be taken twenty
minutes before the  meal, for a week or ten
days at a  time,  by persons of feeble habit
of body, with tendency to constipation.   Dr.
Christison recommends a strong infusion of
cayenne—a teasnuonful in  six fluid ounces
of boiling water—to be used as  a gargle in
incipient sore throat—fever being absent.
The accidental introduction of a  particle of
cayenne into the larynx is dangerous; it
has occasioned death.
  CARAWAY-SEEDS—Are the  fruit of an
umbelliferous plant, and are too familiarly
known to require description.   They are a
good carminative, may  be  given whole, in
teaspoonful doses, or in the form  of distilled
water, a wineglassful at  a  time, or may be
added to other medicines, such as senna.
  CARBON—Carbonic Acid—Carburetted
Hydrogen.—Carbon, charcoal, occurs in its
purest natural state in the  form  of the dia-
mond and  of plumbago, both of which  are
pure carbon.  It is  one  of the bodies  con-
sidered elementary, and  forms a large  pro-
portion of the matter of our globe and of its
productions.  The  most  familiar form of
carbon is  that of wood   charcoal, which is
CAR
interesting in a medical and hygienic point
of view, from its powerful antiseptic proper-
ties, and the rapidity with which it removes
the signs of, and tendency to. putrescency.
Water which has become  putrid, as it fre-
quently does at sea, is quickly restored  to
wholesomeness  by agitation with  charcoal
powder.  The powder  is frequently applied
to fetid nnd sloughing sores, either sprinkled
upon them or mixed with one of the common
poultices :  it is a good dentifrice.
  Carbon, either  in  a  fixed  or  in  a tran-
sitory condition, is an  important nnd abun-
dant constituent of organized bodies. Of the
vegetable kingdom  it  is the  characteristic
element; every leaf and  every blade  of
grass which is  exposed to the influence  of
daylight is  busy abstracting  from the at-
mosphere the carbonic acid,  which is  con-
tinually diffused through it in small propor-
tions, decomposing  it,  and rendering back
to the air the vital  oxygen, but fixing the
carbon  as  a component  of  the vegetable
solids, and putting it in that form in which,
along with  other elements, it is  fitted  to
become the nutriment of the animal.   Car-
bon, although not so characteristic a com-
ponent of the animal  as  of  the vegetable
kingdom, yet enters largely into  the  con-
stitution of  the former;  it assists to  give
permanent  form to the various tissues, and
furnishes one of the most active  material
agents, which, under the  influence of  life,
make up the sum,  and contribute  to the
varied changes and  effects which  are  ever
going on in the animated body.   We  have
every reason to believe that  carbon is the
medium by which, as it combines  with the
oxygen  inhaled by the lungs, and carried
through  the system by the blood—the ani-
mal temperature is maintained. Such being
the case, it is evident that, next to oxygen,
carbon is the element which  must be  most
regularly and sufficiently  supplied  to the
living body; the other  constituent elements
must undoubtedly be provided in food, but
their omission for a time is not so apparently
and quickly felt as  that of carbon ; if this
be not furnished from outward sources, it is
used up  from  the bodily tissues as long as
they will yield  it, even though  its use  in-
volves their destruction and the dispersion
of the other elementary bodies of which they
are composed. This actually happens in long
fevers, during which little or no  nourish-
ment is taken ;  the carbon—and hydrogen—
of the fat in the first place, nnd afterward
of the other portions of the body, is used  up
in sustaining  the animal bent—as fuel—
until  a  point is reached  when it  can  be
yielded  no longer, and when ihe patient will 
C A R
89
C AR
 actually die  of  cold, unless  there is freely j
 administered the gelatinous soups, the wine
 and spirit, with their abundant carbon and
 hydrogen, which yield their own combustible
 elements, to  maintain the heat and  to pro-
 tect the  tissues of the already exhausted
 patient.
   The discoveries of modern chemistry show
 us how  beautifully  the  Almighty, in   his
 goodness, has arranged the products of  the
 various latitudes of the globe, has disposed
 the  varied  articles  of  food  he gives to
 his creatures, to  man, in accordance with
 the various  climates, and modes of life in
 those climates, so that carbon may  be con-
 sumed in due proportion along with   the
 ither elements ; less in the watery fruits of
 the  tropics and of our own summers, more
 in the fats and oils of the cold north.
   Refer  to  Aeration—Blood—Bile—Diges-
 tion—Food—Respiration, §c.
   CARBONIC ACID GAS, or Choke-damp-
 Is a compound of one part  of carbon with
 two parts of oxygen : it  is colourless,  and
 much  heavier than  atmospheric  air, a pro-
 perty  which  gives it a dangerous tendency
 to collect at  the lower parts of any enclosed
 spaces in which it may be disengaged.  Old
 wells,  brewers' vats,  the holds of ships,   &c.
 are all liable to become the  receptacles for
 carbonic  acid gas, which,  formed from some
 decomposing vegetable matter, lies like a
 stratum of water  at the  bottom of  the  re-
 ceptacle.   Should  any  one  incautiously
 descend,  so  as to become enveloped in  the
 carbonic  acid atmosphere,  respiration is
 either instantly stopped  by  spasmodic  clo-
 sure of the chink at the  upper  portion of
 the windpipe, and  complete suffocation is
 the consequence;  or the gas, if sufficiently
 diluted with  air to  be drawn into the lungs,
 speedily manifests its narcotic effects upon
 the system, and the person quickly  falls in
 a  complete  state  of stupor.  The respira-
 tion becomes laboured, and  after  a time
 ceases ; the  countenance is livid or pale,
 and  there may be  convulsion and frothing
 at the  mouth.  In such  a case,  the body
 of the individual  must  be  removed,  if
 possible,  and  as  soon as possible, from
 the  poisonous  atmosphere,  or   the   lat-
 ter must  be  destroyed  or dispersed.  The
 many fatal accidents which  have occurred
 from  persons venturing rashly into wells,
 and  such like places, might be  a warning
for the future, and prompt  the  invariable
 employment  of the simple test of lowering j
a lighted  candle into  the  suspected place.
 If the  flame be extinguished, the atmo-
sphere is  certainly destructive to life ;  if it
burn even with a feeble and  diminished  in-
       h 2
tensity,  there  is danger.  Of the  various
modes for destroying a carbonic acid atmo-
sphere, none is more speedily effective than
the  introduction into it of newly slaked
lime, either spread  upon a board, or mixed
with  water,  and dashed into the place;
fresh lime, having  a powerful affinity for
carbonic acid, quickly absorbs it.  In  the
absence of lime, a quantity of fresh water
dashed  freely down,  so as at the same time
to absorb  the  gas  and  promote circula-
tion  of air, will  be serviceable; or large
bundles  of  combustible  material,  which
will cause currents of air, may, when blaz-
ing freely, be thrown in.  Caution in  the
first instance is the  best preservative ;  but
in the event of an  individual  dropping in
an  atmosphere  of  choke-damp, it  is per-
fectly useless for others to rush in to bring
him out;  they can no more exist in it than
he could, and in stooping to  lift a fallen
body, they become all the more thoroughly
immersed in the poisonous gas.  Instead of
rashly sacrificing life in the ill-directed  en-
deavour to rescue another, let those who  are
present dash bucket after bucket of water
or weak lime and water into the place, and
on the  fallen  person, until  the unextin-
guished flame tokens that the fatal atmo-
sphere is weakened at least; and when they
do venture in,  tie over the mouth a  cloth
soaked in lime water, in a weak solution of
caustic potash,  or of simple water, if these
cannot be obtained.
  In cases  of suffocation from immersion in
choke-damp,  cold water  should be  dashed
freely  over the  individual as  soon as  re-
moved into the open  air,  and  this measure,
succeeded  by heat  applied to the  surface,
stimulant embrocations to the chest, spine,
&c. stimulant clysters, and ammonia held
at intervals to the nostrils, while artificial
respiration  [compressing the  chest  and
allowing it to expand, or by breathing into
the patient's lungs] is  at the same  time
brought into  action, and steadily persevered
in for some hours.   [Medical advice should
also be obtained as soon as possible.]
  Carbonic acid is   produced  during  fer-
mentation, or by the  slow decomposition
of vegetable  matter, such  as  damp straw,
sawdust, wood-chips, &c.   It is the gas dis-
engaged  in effervescing liquors generally ;
it is also produced, along with other vapours
of which carbon forms a  constituent, in  the
burning of charcoal.
  Poisoning by  charcoal fumes, either by
design or accident, is not an unfrequent
occurrence.  In the  latter case, it  usually'
occurs from persons ignorantly retiring to
sleep in  a closed-up room, in  which burn- 
C A K                9U                 C A R
ing charcoal is used as a means of warmth.
The carbonic acid and  other fumes  disen-
gaged act slowly and insidiously,  and exert
so powerful a narcotizing effect, that those
exposed to the  influence are quickly  ren-
dered unable to remedy the circumstances,
and perfect insensibility ensues.   Too often
it  happens that the discovery of the acci-
dent does not  take place until  morning,
long after it is too late to remedy the fatal
effects;  the  sufferers being usually found
dead.  If living, they will probably be per-
fectly insensible ; the countenance pale and
livid.  Immediate removal  to  the open air,
and free  exposure  to  its influence  by re-
moval of  the greater  part of the clothing,
is the first proceeding, when the  treatment
recommended in  cases of  poisoning from
choke-damp should  be followed.   Carbonic
acid is  largely evolved  in  the process of
liine-burning,  and  persons who  have  in-
cautiously slept  in  the  immediate  neigh-
bourhood  of a kiln have  been destroyed by
it.   The poisonous contamination of the air
in crowded  assemblies has  already been
treated  of in  the  articles,  "Aeration,"
" Air,"  " Blood," &c.
  There is yet another  source of poisoning
by carbonic  acid, which occurs when  it is
largely given off  from  fluids taken into the
stomach in a  state of fermentation.   This
accident is said by Liebig to happen in Ger-
many in  consequence of persons drinking
wine  while  it is fermenting; the  genera-
tion of the carbonic acid is stimulated by
the heat of the stomach, and it is given off
in such quantity  as to permeate even the
lungs, causing suffocation.   The best reme-
dy is ammonia, both inhaled and taken into
the stomach.
  In  medical  practice, carbonic acid is
given in  the form of effervescing drinks.
Some mineral waters contain it naturally ;
soda-water  and  other  similar  fluids  are
mechanically impregnated  with  the  gas;
it  is, also, very frequently given as disen-
gaged from one  of  the carbonates of the
alkalies by means of an acid.  In most cases,
the action of carbonic acid, given  in this
way on  the  stomach, is  very beneficial; it
appears to be both  stimulant and sedative,
and no remedy is more generally useful in
cases of vomiting ;  it is an agreeable form
of medicine to  most persons.   When effer-
vescing drinks are given to persons confined
to bed,  they should always sit up for a few
minutes after the daught is swallowed, to
allow of the eructation of the  air, which,
not being got rid of in  an  horizontal pos-
ture, may produce uncomfortable distension.
   Refer to Effervescing.
  CARBURETTED   HYDROGEN —Coal-
gas, or fire-damp, is a compound of carbon
with hydrogen.   The fearfully destructive
explosions in the coal-mines  are the  result
of the ignition of this gas when it has col-
lected  in quantity.   Its  constnnt  use in
dwelling-houses, as a means of light, some-
times gives rise to  similar accidents;  and
occasionally  life hns been endangered by
the inhalation of it  when it  has escaped
into  an  apartment, as has  sometimes oc-
curred from persons, unused to  gas-light,
blowing  out the flame on  going to bed, in-
stead of turning  the stopcock.  In  such
cases, a  treatment very similar to that pur-
sued in poisoning by carbonic  acid may be
followed out.
  CARBUNCLE resembles a boil in many
respects, but  is larger.   It is  a  hard, in-
flamed,  intensely  painful  swelling,  of any
size  up to that of a saucer, or  even  larger.
It is flat on the  top, and contains a slough,
or mortified portion of cellular tissue, which
must be discharged before the disease can
subside.  After the inflamed swelling has ex-
isted for some days, small points of ulcera-
tion  begin to  show themselves through the
skin on its surface—they  enlarge, coalesce,
and at last form one large opening, through
which  the  slough  or core  is   discharged,
either  entire  or broken  down and  mixed
with bloody matter.  When all has been got
rid of,  the cavity begins to fill  up from the
bottom ;  and generally in the course of a few
weeks  becomes  entirely  healed.   Such is
the progress of a carbuncle, which does not
require  interference.  The treatment con-
sists, in the first place, of assiduous foment-
ation, and  poultices  of bread,  oatmeal, or
linseed meal, and, in the open  stage, yeast.
When the cavity is fairly emptied of sloughs,
the poultice  must  be exchanged for water-
dressing, which will  in all probability re-
quire no alteration  during  the  cure.  A
small carbuncle may thus,  as far  as the
sore is  concerned,  be simply and  safely
attended to,  but much more  may  be re-
quired.   Carbuncle occurs  in  two very
opposite states  of  system—in  those  of full
habit,  and in those of broken  constitution.
In  the  former, eight or  ten  leeches  may
with advantage be  applied round the  base
of a large  incipient  carbuncle,  and  free
purging, cooling saline medicines, and low
diet be resorted to.  Should a surgeon be
in attendance, he will probably make a free
crucial incision to  facilitate  the exit of the
core.  In  those of broken constitution, the
opposite treatment  will   be requisite—all
unnecessary loss of blood must b? avoided,
and while  gentle  alterative  mere-trial ape- 
CAR
91
C A R
rients are given, the system must be soothed
by  opiates, and supported by quinine  or
bark, along with strong  meat-broths, wine
or porter.   In such  constitutions,  a  car-
buncle of any size is a  serious, and  not
unfrequntly a fatal affection.  Carbuncle is
certainly indicative of a deranged state of
the system generally, and of the assimila-
tive powers in particular ; it more frequent-
ly happens, too, that a large carbuncle has
been  preceded  by two  or  three  smaller
ones,  or  boils, in  succession.   The  occur-
rence of these ought always  to be taken as
a warning; the man of full habit  should re-
duce his diet,  meat and stimuli  in particu-
lar;  take  exercise freely, and  five or six
grains of blue pill and compound colocynth
pill every night, or every second  night, for
a week or ten days, with a gentle saline ape-
rient in the morning.   A  tendency to car-
buncle in the delicate or aged should always
be  seriously  regarded,  not  only as indi-
cative of  functional  disorder  in   assimi-
lation, but from the  direct danger  arising
from  the disease itself.  On this account, it
is always  desirable that  the case  should
be early put under efficient  medical care,
so that  constitutional  treatment may, if
possible, arrest the  threatened  evil.    In
case  a  carbuncle  of any size  is  developed
in persons  advanced  in  life, or of weak
constitutional power,  it  is too dangerous
to be left to domestic management if medi-
cal assistance can  be procured.  If not, the
treatmeut should  be carried out as above
directed.
   The most frequent seat of carbuncle is the
back part  of the  body and head, the arms
and  thighs.
   CARDAMOMS—Are  the  seed-capsules
and seed of a shrub which is a native of the
islands  of  the Indian sea.  They resemble
orange-seeds  in shape, are about  half  an
inch  long,  and the covering which envelops
the seeds is brown and tough, and must be
removed.   Cardamoms  are one of the best
aromatics we possess, particularly the com-
pound tincture, in one or two teaspoonful
doses in water.  The  powder of the seeds
may be given in from ten to fifteen grains
at once.
  CARDIAC.—Belonging to the heart.
  CARDITIS.—Inflammation  of  the heart
is named pericarditis when it  affects the
membrane covering the outer surface : endo-
jarditis when the  lining  of the  cavities is
affected;  and carditis when the muscular
substance is involved.
  Acute inflammatory affections of the heart
may arise from cold, violence, &c. but in the
majority of cases they are concomitant with
rheumatism, in the progress of which they
are so apt to arise that the medical attend-
ant must be constantly on his guard to coun-
teract the slightest symptom indicative of a
tendency toward the  heart becoming  in-
volved.   This  tendency he may sometimes
detect  by means of the stethoscope, even
before the patient complains or is conscious
of any uneasiness about  the organ;  this is
of course a great advantage and strong ar-
gument, why every case of rheumatic fever,
however slight  in  appearance,  should be
placed under the care of the regular medical
practitioner.  But the symptoms of inflamed
heart,  particularly  in the above disease,
may come on suddenly—while medical aid is
hours distant.  The patient being seized with
palpitation, increased rapidity of pulse, op
pression of breathing, and sense of extreme
anxiety in the  region of the affected  organ,
(pain  may  or  may  not be present,) every
minute is of consequence.  Leeches, if pro-
curable, should be applied over the  region
of the  heart  to the number of  twelve or
eighteen, according to the condition  of the
patient.  Continued nausea should be main-
tained by the fourth or sixth of a grain of
tartar  emetic,  given  every three or four
hours, and  a pill containing three grains of
calomel and half a grain of opium given
every four hours.   Perfect quiet  and the
lowest diet must be observed.  If the rheu-
matic inflammation has suddenly deserted a
previously inflamed joint, it will be well to
apply a mustard-plaster to the place, with
the view of re-exciting  the  action  which
appears  to have been transferred to the
heart;  at the same time, it must be remem-
bered that the heart may be affected with-
out any such apparent transference.
  The  above measures judiciously carried
out will do much to retard the progress of
so serious a disease as carditis;  and there is
the advantage, that from  its  so frequently
accompanying rheumatic  fever,  an unpro-
fessional person will have less difficulty than
in many other  affections,  of making up his
mind  on the  nature of the  seizure.   In-
flammation of the  heart, whether arising
in the  progress of  rheumatic  fever  or not,
will of  course be  characterized  by  the
Bame  symptoms.   The  treatment  recom-
mended  above  is to be  resorted to irre-
spective of cause.
  CARMINATIVES—Relieve flatulence and
spasm  in the  bowels.  The principal  car-
minatives are dill, anise, caraway, lavender,
peppermint, pennyroyal, and their various
preparations;  but any stimulants and aro-
matics,  such  as nutmeg,  ginger,  spirituous
liquors, &c. &c. are carminatives. 
C A R
92
C  A S
  CAROTIDS—Are the large arteries which
pass up the neck on each side of the wind-
pipe,  to supply the head with  blood.—See
An'en/.
  CARRARA WATER—Is an artificially pre-
pared effervescing water, holding carbonate
of lime in solution by means of an excess of
carbonic acid.  It is useful in  some  forms
of dyspepsia.
  CARRAGEEN  MOSS. —The  article sold
under this name is a sea-weed. When boiled
in water it yields a vegetable jelly, or  muci-
lage,  which requires flavouring  to  make it
palatable.  It is nutritive, but probably not
more  so than other jellies.   One ounce of
carrageen, previously soaked for a  quarter
of an hour in cold quarter, is  to be boiled
in a pint and a  half of  water till it is dis-
solved.
  CARRON-OIL, [or  "Lime-water  Lini-
ment"]—Is a mixture of equal parts  of
lime-water and linseed-oil; it has been much
celebrated as an application in burns, having
first come into use at the Carron iron-works,
in Scotland.   It is certainly soothing,  but
need  scarcely be employed while there  are
other  and less  disagreeable  remedies  at
hand.  When used it  is smeared over  the
burnt part by means of a feather.
  Refer to Burns.
  CARROT—The well-known vegetable, is
nourishing, and contains a considerable pro-
portion of saccharine matter, but it is  not
easily digested by weak  stomachs,  and  re-
quires thorough  boiling  to  make it whole-
some  for any.  In the experiments of  Dr.
Beaumont, a carrot was found to take three
hours and fifteen minutes  of the  healthy
digestive process for its solution.
  CARTILAGE—ORiSTLE—Is a  white look-
ing, semi-transparent substance, closely re-
sembling gelatine in composition. It covers
the  extremities of the bones at the joints,
and also serves as a bond of union between
different bones.   Bone itself is  in the first
place  deposited in cartilage, which is abun-
dant  in the young; but as age advances,
much of the  latter substance—such as that
which connects the ribs with the breast-bone
—becomes ossified.
  CASCARILLA BARK—Is obtained from
a tree native to Jamaica  and the Bahamas.
It bears considerable resemblance to cin-
chona bark, but is more  aromatic.  In dys-
pepsia and debility generally it is useful.
The  infusion is  made by  pouring on  an
ounce and a half of bruised cnscarilla bark
a pint of boiling water, and macerating for
two hours.   The dose is from  a half to a
whole wineglassful.    The  tincture  is,  of
course,  a warmer stimulant.   One to  two
teaspoonfuls of the latter may be taken in
water, or  added to other bitter  infusions.
Cnscarilla is used in the formation of pas-
tiles.
  CASSIA PULP — Is  obtained  from  the
pod of a species of cassia by boiling.   It iH
a mild  laxative in  doses of  two or  three
ounces;  but  at  present  has fallen into
disuse.
  CASSIA.—See Cinnamon.
  CASTILE SOAP—Is a hard soap, com-
posed of soda  and olive-oil,  and is used  in
medicine for making pills, plasters, &c.   It
is sold both white  and mottled; the former
is preferable.
  CASTOR-OIL—The well-known  aperient,
is obtained  from the  seeds of the Ricinut
communis,  or castor-oil plant, by expression
either hot or cold, or  by boiling  in water.
Cold-drawn  castor-oil, or what is sold  as
such,  is most generally used  in this country.
[But  lard-oil  is often added  to  it by un-
principled dealers.   The  adulteration may
be discovered  by placing  the  suspected oil
in a cool place, when the lard will harden.]
Castor-oil is one of the most  certain and
safest of  our  aperients;  in most persons
it acts  quickly, without  pain,  clears  the
bowels effectually, leaves them with a greater
tendency to relaxation than before, and does
not  require the dose to be increased in con-
sequence of repetition.   From earliest in-
fancy to old age, castor-oil may, as  a general
rule,  be given with perfect,  safety ; but yet
there  are some persons who cannot take it.
Some  stomachs will not retain the oil, how-
ever disguised;  in a few individuals it nets
almost drastically, and produces a painfu'
sensation of piles, and occasionally it causes,
during its action, deadly faintness. These,
however, are but exceptional instances.
  In consequence of its gentle but effectual
action it is  most valuable as an  aperient,
in properly regulated doses, for persons of
weak  habit of body.   Its certain action, the
tendency to relaxation which remains after
its employment, and the circumstance that
the  dose requires rather  to be  diminished
than  increased  by  continued  use,  render
castor-oil  peculiarly adapted for  those who
suffer from habitual constipation.   In  nil
conditions of body in which it is  desirable
to clear the bowels effectually, but without
much disturbance, the oil is invaluable—in
pregnancy more particularly.  Irritation of
the mucous lining of the bowels, whether
inflammatory, or in the form of simple diar-
rhoea, is in many cases more quickly relieved
by castor-oil than by any other reme Jy.—See
Bowel Complaint, Diurrhcea, §c.
  The great objection to castor-oil, its sickly 
CAT
93
CAT
 nauseousness, has given rise to a variety of
 modes of taking it.   Floated in brandy and
 water, barley-water, or some aromatic water,
 are favourite modes with many ; others take
 it best in hot fluids, tea, coffee, or gruel, the
 heat getting rid of the feeling of oily con-
 sistency so disgusting to some.  A piece of
 orange or lemon-peel, chewed just previous
 to  taking a dose of castor-oil,  blunts the
 acuteness of the nerves of taste.   Castor-oil
 may be  taken in emulsion made with mu-
 cilage or milk;  but rubbed up with yolk  of
 egg is  the best form of mixture.  In this
 way, it is not so active an aperient as when
 uncombined; but in irritable and inflamed
 conditions of the lining membrane  of the
 bowels,  it is especially valuable when  com-
 bined with opium. Six drachms, by measure,
 of castor-oil, are to be well triturated  in a
 mortar with the yolk of one egg, and to this
 soft water  or some aromatic distilled water
 is to be added gradually to the extent of six
 ounces.   If an aromatic water is not used, a
 few drops of some essential oil, such as cin-
 namon,  may be  added  before  the  water.
 The mixture resembles  custard in consist-
 ence.   The dose an ounce—two tablespoon-
 fuls.  The usual dose of castor-oil alone is
 about half an ounce, or  one  tablespoonful.
 [When  beaten up with the froth of porter,
 the oil is perfectly disguised, and the porter,
 rising on the stomach, prevents  the eructa-
 tion of the oil from causing nausea.]
  CATALEPSY—Is a peculiar affection of the
 nervous system, caused generally by sudden
 violent mental  emotion.   Sensibility to ex-
 ternal things and,  the power  of voluntary
 movement is lost; the limbs remain flexible,
 but retain whatever position  they may  be
 placed in.  The signs of  life are in this af-
 fection occasionally  so  obscured that the
 person has been accounted dead.  Stimulants
 should  be used—as ammonia to the nostrils
 and  stimulant   enemata,  with  continued
 friction over the body, particularly down the
 spine.—See Electricity.
  Refer to Death, Signs of.
  CATAMENIA.—The female monthly dis-
 charge.   See Menstruation.
  CATAPLASM.—A poultice.  See Poultice.
  CATARACT—Is an affection of the eye
 which  produces  opacity  of  the  crystalline
 lens,  and more  or less obstructs vision, ac-
 cording to  the extent of the disease.   The
 affection is most common in persons advanced
 in life, but  may occur at any age.  An indi-
 vidual who is becoming the subject of cata-
 ract complains of seeing objects,  as it were,
covered by a mist or veil:  vision is  some-
times better in an obscure light, when the
pupil becomes dilated.  When the disease is
 a little advanced, any thing placed a little
 to one side is better distinguished than if it
 is directly in front.  The first opaque spot of
 cataract occupies the centre of the lens, or
 the axis of vision, in which situation it can
 be detected by examination.
  When cataract is in its incipient stage, its
 progress may perhaps be arrested  by judi-
 cious treatment: and for this reason the case
 should, as quickly as possible, be placed un-
 der  medical care.   In the  interim, the
 bowels  must be attended to,  stimulants
 avoided, and a blister applied to the nape of
 the  neck.   When  cataract  occupies the
 whole circle of  vision, and produces blind-
 ness, it may  be  removed by operation.  An
 oculist or surgeon  should  always be con-
 sulted on the case.
  CATARRH—Ts an inflammatory irritation
 of the mucous membrane lining the air-pas-
 sages—the nostrils and bronchi.  It usually
 commences in the former, and extends to the
 latter.  Catarrh, or "a cold," as its popular
 name implies, is generally  the result of cold
 combined with damp, but quite as frequently
 of checked perspiration, in consequence of
 the individual passing  from a heated  room
 to a current  of cold air; it is, too, not im-
 probable that the recently  discovered agent
 azone, when  it exists in excess in the atmo-
 sphere, exerts  an  irritant effect upon the
 respiratory membrane.  Catarrh commences
 with feverish symptoms more or less severe,
 shivering followed by heat.   A peculiar dry-
 ness and heat of the lining membrane of the
 nostril is followed by discharge of thin acrid
 watery fluid, " a running at the nose," and
 with this  there is intense headache between
 the eyes.  Or the throat may be first affected,
 or the chest itself may be directly attacked,
 though if not, it will quickly become so ; the
 windpipe feels as if raw; there is frequent
 cough, dry and harsh, or with thin expecto-
 ration,  and  the  breathing is  oppressed;
 there is, in fact, subacute bronchitis.
  The evil of a " neglected cold"  has become
 proverbial, and justly so as it is great.  The
 attack ought  to be checked at the first.  It has
 been recommended, that as soon as the nos-
 trils become  affected, a solution of sulphate
 of zinc—five or six  grains to the ounce of
 water—should  be  injected into  them by
 means of  a syringe; and it is said that by
 this  means, if adopted in the very first stage,
 the catarrh  may be stopped.  This cannot
 be expected, however,  to  influence in the
 least the constitutional symptoms.  The first
 measure in incipient cold is to restore and
 excite the action of the skin, to get free per-
 spiration.  This is best accomplished by the
vapour  or warm-bath; but  if these cannot 
CAT
94
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be had, the best remedies  are  hot water to
the feet, a warm bed, and hot diluent drinks,
along with diaphoretic medicine.  A draught
consisting of half an ounce of spirit of min-
dererus, one to two drachms of paregoric,
and ten to fifteen drops of ipecacuanha wine,
with  water  sufficient to  fill  a  wineglass,
should be given with five  grains of Plum-
mer's pill, on getting into bed, and about an
hour after the warm drinks; in the morning,
some  gentle  aperient, senna, or castor-oil,
or seidlitz powder, is to be  taken.  If there
is much irritation of the chest  at night,  a
bran-poultice, a mustard-plaster, or friction
with a stimulant liniment may be employed.
The treatment  above recommended  may be
followed up for two or three nights in suc-
cession ; confinement to the house, low diet,
and demulcent drinks, such as barley-water,
&c. &c. being  superadded.  When  catarrh
is not checked, it runs on to cough, in fact
to bronchitis,  more  or less  severe.—See
Bronchitis.
  Catarrh  is unquestionably the effect in
many  cases  of unavoidable   atmospheric
changes  and  influences,  but  it is  much
oftener the result of carelessness or impru-
dence—of carelessness in not guarding the
body  against the effects of our changeable
climate—for catarrh is a very common dis-
ease, nnd particularly the neglect of wearing
flannel or some woollen material next the
skin,  which is  the very best preservative.
Rooms, in the house, too warm, and exposure
to the air insufficiently clothed, are fertile
sources of catarrhal  affection, especially in
children.  Insufficient protection to the feet,
and dampness, is another.   There is, too, in
females, the exposure of  the  chest, after
heated ball-rooms, public  amusements, &c.
&c.  The use of fur round the neck "is not
unfrequently the cause of cold affecting the
throat: while close to the skin,  it produces
warmth and perspiration, but when the boa
or victorine  is thrown back, a chill  at once
ensues. It is not meant to controvert the
use of fur, so requisite in this  climate, but
to guard against the incautious and sudden
relinquishment of the protection.
  Refer to Bronchi'is—Influenza.
  CATECHU, [Terra Japonica.]—An ex-
tract obtained principally from  trees of the
acacia genus.  It  is  chiefly brought from
the East Indies  and Singapore, is powerfully
astringent, and is met with  in masses of va-
rious  sizes, either of a dark brown or of  a
pale reddish-brown colour.   It is used  both
externally and internally.   In  some forms
of diarrhoea, catechu, used either in the form
of infusion,  tincture,  or confection, is ser-
viceable, and also in the form of infusion as
a gargle in relaxed sore threat or elongated
uvula.  In  the  latter  cases, a convenient
mode of employing catechu  is to permit a
few grains to dissolve in the mouth ;  for this
purpose the pale catechu is the pleasantest.
In sponginess of the gums, powdered catechu
forms  a good dentifrice.   One of the most
valuable external applications of catechu is
in the  sore and  chapped nipples of nurses;
it must be used in the form of tincture, put
on the nipple each time after the infant has
been  nursed,  by means of a small  paint-
brush  or  feather,  nnd wiped off with  the
wetted corner of a towel before  the child is
put to  the breast.   To make the infusion of
catechu, a pint of boiling water is to be
poured upon six drachms  of the powdered
extract, along with one drachm of bruised
cinnamon,  and  the whole infused  for an
hour;  the dose  is from  two  to  four table-
spoonfuls.  The dose of the tincture  is from
one to two teaspoonfuls, and of the electuary
twenty to forty grains;  the latter is astrin-
gent and aromatic, and contains about one
grain of opium in every 193 grains.
  CATHARTICS—Are medicines which sti-
mulate the bowels to increased action.
  Refer to Purgatives.
  CATHETEH.—An instrument used bysur-
geons,  and with  slight exception to be used
by them alone, for drawing off  urine from
the bladder, which is retained in it  in con-
sequence of disease.   Some  peculiar enses
are entirely dependent upon  the use  of the
catheter for relief, and remain so for  years.
Under  this state of cireunjstances,  the pa-
tient ought  to learn to employ  the  instru-
ment for himself, and many do so;  with this
exception, it  must be used by professional
hands alone, for even in these it requires both
skill and care, and may do serious mischief.
In cases which require a catheter to be regu-
larly passed, the operation generally becomes
easier.  The  passage of the  catheter being
simply  a  mechanical  operation, requiring
tact, and a correct knowledge of the parts of
the body implicated, may of course  be ac-
quired by any one who will take  the trouble
to educate himself upon these points.
  Refer to Bladder.
  CAUL.—The omentum.—See Omentum.—
The term is also applied to a  portion  of the
uterine membranes,  which  is  sometimes
carried along with the head of the child.at
birth, and covers it.like a veil.   The caul is
frequently preserved.   Much  superstition
used to be attached both to the circumstance
and to the object itself.
  CAULIFLOWER—A vegetable of the cab- 
C AU
95
C H A
 bage tribe, agrees better  than most other
 vegetables  with those of weak digestion.
 The addition of melted butter is injurious.
   CAUSTICS—Are  substances which  de-
 stroy organized tissues by combining with
 their constituent  elements.    The  mineral
 acids, strong acetic acid, potassa, lime, ni-
 trate of silver, [burnt alum,] and  refined
 sugar, belong to this class, and may be re-
 ferred to under their respective heads.
   CAUTERY—Is  iron  applied at a  red or
 white heat to  the animal body.   It is  a
 powerful means of counter-irritation.
   CAYENNE—See  Capsicum.
   CELLULAR MEMBRANE or Tissue, or
 Areolar  Tissue—Is  the reticular mem-
 braneous web  which  connects the various
 portions of the body and fills up the inter-
 stices.   It is made up of numberless little
 fibres and  bands crossing  each other  in
 every direction, and enclosing small  spaces,
 which freely communicate throughout the
 body.  The most  familiar exemplification
 of cellular tissue,  and of its free inter-com-
 munication, is  seen in the blown-up veal of
 the butcher.  In the living body, the areo*
 lar tissue  contains  a  thin water or  serous
 fluid, which, when it accumulates in undue
 quantity, constitutes one form of  dropsy,
 finding  its way by permeation  through the
 cellular meshes to the most dependent part
 of the body.
   CERATE.—An  ointment, of which wax
 forms a component.   The  hard wax and
 fluid oil or lard, when combined, forming  a
 compouud of convenient consistence.
   Simple cerate  is  formed by melting to-
 gether equal parts of white wax  and olive-
 oil, and stirring during cooling.
   Calamine, or Turner's Cerate.—See Ca-
 lamine.
   [Cold Cream is made of one ounce of
 rose-water,  two ounces of oil  of sweet al-
 monds,  half an ounce of spermaceti, and  a
 drachm of  white wax, melted together and
 stirred till cold.]
   Lead  Cerate. — Acetate  of  lead five
 drachms, white wax eight  ounces, olive-oil
 twenty ounces.   Dissolve the wax by heat in
 eighteen ounces of the oil, rub up the acetate
 of lead finely with the remaining two ounces,
 add this gradually to  the  larger quantity,
 and stir during the cooling.
   Resin Cerate,  [Basilicon.]—Take of
 resin  five ounces,  lard eight ounces, bee's-
 wax two ounces, melt them together  with  a
gentle  heat, and  then stir   the mixture
briskly while it cools.
  Soat  Cerate—Is  sometimes  useful: it is
better procured ready prepared.
  CEREBRUM.—The brain. —See Brain.
  CEREBELLUM.—The lesser  brain.—See
Brain.
  CERUMEN—Is the watery matter of the
ear, of which the chief purpose is, probably,
the repulsion (by  its bitterness and other
qualities) of insects which might  enter or
harbour in the passage.   It sometimes ac-
cumulates to so great an extent, especially
in the aged, and in the  young, particularly
after  acute  diseases, as to cause deafness,
more  or  less complete,  which is generally
accompanied with  noises and other uneasy
sensations  in the affected organ.  The ac-
cumulated  wax  may  possibly be  detected
by examining the  ear-passage with the aid
of a candle,  [or what is  better,  a ray of
sunshine.]   In order to  remove the harden-
ed mass,  a small portion of warm olive or
almond-oil must be dropped into the ear for
two or three  nights  in succession, for the
purpose of softening and loosening the wax;
after  that has been done, the passage must
be  thoroughly  syringed  out  with warm
water, by means of a  two-ounce  syringe,
till  the wax is detached  and washed out.
Some  persons become faint and  giddy on
having the ears syringed ; in such cases the
operation is best undergone in the horizon-
tal posture.
  Refer to Ear-syringe.
  CHALK.—Carbonate of lime occurs abun-
dantly in various parts  of the world; it is
used  in medicine as an absorbent and ant-
acid.   For medicinal  purposes  it  requires
to be  levigated, by which process the finer
particles  are separated: when dried, the pre-
paration  constitutes the " prepared chalk"
of the shops.  As  a general antacid, chalk
is scarcely to be recommended;  but in cases
of diarrhoea, especially  in children,  where
much  acidity exists, it is highly useful.  For
the latter purpose, from twelve to eighteen
grains of chalk rubbed up in an ounce  and
a half of  dill-water  form  a mixture  of
which a  teaspoonful  may be  given ■ to  an
infant six weeks  old, every few hours if
requisite.
  In the  case of adults,  the ordinary chalk
mixture is an excellent preparation ; it may
be made with prepared chalk  two drachms,
powder of gum acacia two drachms, cinna-
mon water, or water simply, eight ounces;
a drachm and a half of sugar may be added,
but is quite  as well omitted ; better, if the
climate is a warm one,  as it causes fermenta-
tion.    To   the  above  mixture,  rhubarb,
laudanum, &c.  may be  added if requisite.
The dose, two or three  tablespoonfuls,  re-
peated more  or less frequently, according
to the amount of diarrhoea.   The compound
chalk-powder, (dose thirty to  sixty grains,) 
CHA                 96                  C II A
and the same powder with opium, (dose five
to twenty grains.) are both useful and easily
carried preparations,  which ought to form
part of the domestic medicine-chest of the
emigrant; or, indeed,  wherever the usual
sources for procuring efficient medicines are
far distant.  The powders ought to be  pro-
cured ready prepared.   Forty grains of that
compounded with opium contain  one grain
of the drug.  Chalk forms an ingredient  in
the aromatic confection.  The practice of
sprinkling chalk-powder upon sores, for the
purpose of absorbing discharges,  Kc. is not
to be  recommended.
  CHALK-STONE—Is the  concretion de-
posited  around  and  in the  joints of those
who suffer from chronic gout.   It consists
of the lithic acid and soda, which form a
comparatively insoluble salt.  The liability
to the formation of chalk-stone  is  a  reason
why those who are subject to gout should,
when  an antacid is required, make  use of
potassa, which,  in union  with  lithic  acid,
forms a much more  soluble salt than soda
does.
  Refer to Gout—Lithic Acid—Urine.
  CHALYI'.EATES—Are medicines contain-
ing iron.  The  term is well  known in  con-
nection  with  mineral waters.   The  most
generally used chalybeate springs in England
are those of  Tunbridge-wells, Cheltenham,
and Scarborough ; Leamington and Harrow-
gate also possess chalybeate waters, and there
are many others, including Hartfell  and
Peterhead, in Scotland, scattered throughout
the island.   [These springs are equally nu-
merous in the United  States, but  those of
Bedford. Pittsburgh, and Brandywine are the
most widely known. The springs of  Saratoga
also contain iron combined with other saline
substances.]  In chalybeate waters the iron
is generally in combination with  carbonic
acid, the taste of the water is inky, and  if it
be one of those (and they are the  most ge-
neral) in which the  metal is in combination
with  carbonic  acid, when  the water has
Btood exposed to the  air  for some time, it
lets fall a yellowish sediment.  Chalybeate
waters are, by virtue of the iron  they  con-
tain, powerful tonics,  and well adopted  as
curative agents in diseases of debility gene-
rally ; but they are not to  be  lightly and
unthinkingly used, or  without  professional
sanction.  Many persons do themselves se-
rious injury by unadvisedly  drinking mine-
ral waters, under the  idea that if they do
no good,  they  cannot do much harm.  To
persons of full  habit,  and with  any tenden
cy to head affection, even a  short course  of :
chalybeate water might be most  seriously ]
dangerous.—Refer to  Iron.                \
I   CHAMOMILE—The " .\nthemia Nobilis'
| of botanists,  is too well  known  to  require
 description.   The flowers, either fresh or
I dried, are deservedly classed amid the most
 useful, safe,  and generally employed do-
 mestic remedies.  They are often, it is true,
 wasted, in making fomentations nnd  poul-
 tices,  for which they are  no better than the
 simple water or  bran;  but their infusion
 taken internally is an aromatic bitter of un-
 doubted tonic properties,  and without nau-
 seousness. In simple debility of the stomach
 and loss of appetite, chamomile  tea, if not
 used too frequently, and for too long a time,
 is at once  a safe and a good  remedy.  Half
 an ounce  of  chamomile flowers  may be in-
 fused  like  common tea, in rather less than
 a  pint of  boiling  water, or, if time  be
 given, [twelve hours,] in  cold water, which
 makes an equally efficacious and pleasanter
 dose.  Chamomile tea taken warm is often
 employed as a gentle emetic  by itself, or to
 aid the  action  of other  medicines  of the
 class;  alone  it is  very  uncertain,  unless
 made  very strong.   From five to ten drops
 of the essential oil of chamomile, dropped
 on sugar,  is  a  useful, and not  unpleasant
 carminative.
   CHAMPAGNE.—This  well-known  wine
 contains about  12 per cent, of alcohol,  a
 much less proportional  quantity than the
 strong dry wines, such as port, sherry, ma-
 deria, &c.   When effervescing, however, it
 exerts a powerful but transient intoxicating
 effect.   Champagne  is  often  accused  of
 causing  gout, indigestion, &c. but perhaps
 these  are  more likely to  be the  results of
 the other luxuries which accompany a cham-
 pagne dinner, than of the wine itself.
   CHANCRES—Are small ulcers,  the re-
 sult of inoculation with the venereal poison.
 They commence  in  the form of  small pus-
 tules, which, after breaking, degenerate into
 yellowish gray-looking sores, around which
 the skin feels firm or  hard.  Thorough de-
 struction of the chancre in the first instance,
 by means of  nitrate of silver, (lunar  caus-
 tic,) is the only safe  measure.    When the
 disease has advanced beyond  the incipient
 stage, or indeed  in  any stage, it  cannot be
 a subject for domestic treatment,  and ought
 more  especially,  on account of the  lament-
 able results  which  may  ensue  should  the
 constitution become affected,  be intrusted
 without delay to proper medical care.
   CHAPPED HANDS—So  troublesome to
 many in  frosty  weather and during cold
 dry east winds, may  partly be  avoided by
 care  in thoroughly drying the  skin after
 washing.  The following  lotion will be found
 useful:—Take of borax two scruples, glyce- 
C H A                  97                CHE
 rine half an ounce, water seven and a half
 ounces.  This may be used  twice a day.
   CHARCOAL.—See Carbon.
   CHARPIE —The loose fibres from scraped
 linen, used  to  absorb the  discharge from
 Bores.   It is more used in  France  than  in
 this country.
   CHEESE—Is the curd or caserne of milk
 mixed  with a proportion of  butter, pressed,
 salted, and dried.  A general and nutritious
 article of diet,  it is not one suited  to weak
 stomachs.   A  meal  of  bread  and  dieese
 alone,  requires a thoroughly strong diges-
 tion to dispose of  it comfortably.   Many,
 however, who cannot eat cheese in this way,
 may take it in small quantity with impunity,
 and, when old, almost with advantage, at the
 close of a moderate meal.   Much of the
 indigestibility of cheese arises undoubtedly
 from its toughness and  the cohesion of  its
 particles:  this diminishes  as  it   verges
 toward decay; but  is much increased  by
 toasting, which renders the  article decided-
 ly unwholesome.  Cheese is said to assist
 the digestion of other articles of diet; and
 there is an old  rhyme—
         " Cheese is a peevish elf,
          Digests every thing but itself."
   Probably,  the  power  put forth  by the
 stomach for the solution of the  cheese acts
 more readily upon the less  tenacious sub-
 stances submitted to  it at the same time.
 The habitual use of old cheese in any quan-
 tity is injurious, and may occasion cutaneous
 eruptions.  In Germany a peculiar  kind  of
 decay  in cheese has  occasioned symptoms
 of irritant poisoning.
   The caseine, or curd of milk, which forms
 the  basis of cheese, very closely resembles
 albumen in composition;  its nutritive pow-
 er may be known from the fact, "that from
 caseine alone,  the chief constituent  of the
 young animal's blood, as well as its  muscu-
 lar fibres, membranes, &c. are formed in the
 first stage of its life."
   The contrast  shown between  tough indi-
 gestible cheese and the milk-curd adapted for
 easy solution in the stomachs of the young,
 is a good example of the manner in which
 an article of diet, nutritive and wholesome,
 maybe  modified as regards its digestibility,
 by preparation.   Caseine is found   in the
 vegetable kingdom, chiefly in seeds.
   Refer to Milk.
   CHELTENHAM.— The  climate  of Chel-
 tenham  is  considered particularly adapted
 to health, there being neither great extremes
 of heat  nor of  cold.   To those,  however,
 with whom a dry and bracing atmosphere
 agrees,  its climate is less  favourable than
some other localities.
       I                                  !
   " The mineral springs of Cheltenham are
 exclusively employed  for internal adminis-
 tration.  They, for the most part, resemble
 each other as to the nature of their compo-
 nent parts, yet "present considerable differ-
 ences in the relative proportions of their in-
 gredients.   They are  rich  in muriate and
 sulphate of  soda.   Several of them contain
 a small portion of iron, and iodine has been
 lately  detected in them.   They are but
 slightly gaseous, and  though two or  three
 of them have,  when  first  drawn, a slight
 odour  of  sulphuretted hydrogen, it soon
 passes  off, and  is probably dependent upon
 the springs passing through a layer of mud
 or matter in a  state of decomposition.   It
 must not, therefore, be supposed that the
 so-called sulphuretted wells are analogous in
 their action with  the class  of sulphurous
 springs.  *  *  Besides its saline springs,
 Cheltenham  possesses two chalybeate ones,
 which,  like others of the same class, have a
 disagreeable inky taste, and  are  somewhat
 dark-coloured.  From  their not containing
 much  carbonic acid,  they do not sparkle,
 and are soon  decomposed  on exposure  to
 the atmosphere.
   " There are  many diseases in which the
 Cheltenham  springs may be used with ad-
 vantage.  Persons  who have lived in India
 and other tropical  climates, who have been
 accustomed to take large doses of  mercury,
 will generally derive benefit, less  from the
 aperient than  the tonic properties of the
 waters.  For gouty patients,  also  of a ple-
 thoric or irritable habit, they are advisable.
 And in cases of amenorrhea  and  chlorosis
 they do good service, where with it a faulty
 condition of  the digestive organs exists."
   For the substance of the above  article,
 and of others similar to it, the author is in-
 debted  to the work of Mr. Edward Lee, on
 the " Watering-Places  and Mineral Springs
 of England," and those who desire further
 information  cannot do better than have re-
 course to  the publication itself.   [The ex-
 cellent works on baths and  mineral waters
 published in the United  States, especially
 that of  Dr. John Bell,  will supply  the Ame-
 rican  reader  with every item of information
 required on this subject.]
  CHERRY.—The fruit of the Prunus  cera-
sus.  Like  other stone-fruits, it is  apt to
disagree.
  CHESTNUT—Is the fruit of the Castanea
vulgaris;  it  is  nutritious,  contains  much
starch and no oil, like   many others of the
nut tribe.   It is. certainly indigestible from
its firm  and  coherent substance, but is ren-
dered much more wholesome by being con-
verted into flour, in  which state it is largely 
CHE
98
used on the  continent.   Roasted chestnuts
are more wholesome than raw, but are not
fit for weak  stomachs.
  CHEST—Or, in  medical  language, the
thorax,  is the important cavity situated be-
tween the neck and the abdomen (see fig.
xxxiii.)  which contains the heart and  large

                Fig. xxxiii.
blood-vessels and the lungs.  It is separated
from the abdomen by the diaphragm, (A,) and
is  bounded  by the breast-bone  anteriorly,
laterally by  the ribs,  and supported poste-
riorly by the spine, (fig. xxxiv.)  It is singu:
lar how much ignorance there is among the
uneducated regarding the situation of what
is called the chest: generally it  is referred
to the pit of  the  stomach ;  and what is
called  " a pain in the chest" is  in many
instances  a  pain  in the  former situation.
In ordering applications,  leeches, blisters,
and such like to the chest among the poor,
it is absolutely requisite to indicate with the
finger  the exact  spot on which  they are to
be placed  ; otherwise the  chances are, that
if  the chest  simply is named, the pit of the
stomach will be understood—a serious mis-
take in many of the acute affections of the
chest, particularly in  children.
  The  form of  the chest  itself is, or ought
to be,  that of a truncated cone, broad be-
low,  narrow above, (fig. xxxiv.)  It is true it
appears the  reverse of this, even naturally,
and  is made to do bo still more by the ab-
Burd ideas  about  small  waists:  but the
greater apparent width at the  upper part of
the chest  in the living person is due to the
shoulders and arms: when these are removed,
the contrary is seen to be the case,  and
tke cavity itself, as exemplified in fig. xxxiv.,
is evidently much more  capacious in  its
CHE
Fig. xxxiv
lower than  in  its upper part.  The princi-
pal contents of the chest are the lungs (fig
xxxiii. 2, 3,)  and the  heart (1) with  the
large vessels  immediately  connected with
it.
  When by tightly laced stays, or other con-
trivances, the  lower  part of the  chest is
compressed, the contained viscera must find
room somewhere; the  diaphragm  yields
more readily  than the  long ribs,  and is
pressed down upon the  liver, stomach, and
bowels,   disordering  their  functions, and
laying the foundation of disease, while at
the same time  the free play of both lungs
and heart are impeded.  In other words,
the possessor of that most desirable physical
conformation, a capacious chest, is doing all
that is  possible to render it otherwise; or,
should  the  cavity be naturally  small, to
make it still more deficient in size, by arti
ficial restraint, instead of every means being
used to  augment its capacity. A small chest
always  gives a greater liability to disease ;
all  tendency therefore to contraction, stoop-
ing of the shoulders, &c. ought most sedu-
lously to be watched  and attended to, par-
ticularly in young people, while  the bones
are  still soft and yielding:  disease  may be
either the cause or the  consequence.  The
spine, too, should be well examined.  Exer-
cises which, from moderate exertion,  call
for  full  expansion of the chest by i espira- 
CHE
99
C H I
 tion,  and full  play of the  arms,  are  gene-
 rally useful. The elastic "chestexpander,"
 made of vulcanized India-rubber, is a most
 excellent  contrivance   for   the  purpose.
 Some trades, particularly that of shoe-mak-
 ing,  tend  in  the  course of time to  affect
 the conformation of the cavity of the chest.
   The physical examination of the chest as
 regards measurement, the sounds elicited by
 tapping upon  it  in various ways with  the
 fingers, and heard by the application of the
 ear,  either directly, or mediately by means
 of the  stethoscope, are most important aids
 in the  investigation  of disease, and should
 never be omitted or objected to.  For  the
 purpose of facilitating  description, the ca-
 vity is mapped out by vertical and horizontal
 lines, in a similar manner to that shown on
 the abdomen.
   Refer to Abdomen—Heart—Lungs—Respi-
 ration.
   CHEST—Water in.—See  Dropsy.
   CHICKEN-POX—Is a mild eruptive dis-
 ease, which spreads by infection, and chiefly
 attacks children, occurring once during life.
 It is  preceded in most, but  not in all cases,
 by slight feverishness for one or two  days.
 The  eruption first appears in the form of
 conical pimples with a white head, on  the
 breast, shoulders, and neck, more sparingly
 on the face,  and on the  body generally.
 On the second day, the vesicles  appear like
 little globular  blisters, but with very slight
 surrounding inflammation ;  on the third and
 fourth  days the fluid they  contain becomes
 opaque or whey-like : they now either break
 or shrivel up, forming thin puckered crusts,
 which fall off piecemeal in one  or two days
 more, seven or  eight days  being  the whole
 time  occupied by the  course of the disorder.
 Little or no treatment is  required beyond a
 gentle aperient repeated once or twice, and
 care  taken that the  child does  not irritate
 by scratching.
   Chicken-pox might be  mistaken for modi-
 fied  small-pox  by the inexperienced; it is
 distinguished  by  the absence  or extreme
 mildness of premonitory fever,  and by  the
 rapid development,  course,  and different
 ?orm  of the vesicles, particularly  in  the
 ibsence of the central   depression,  which
 characterizes the true small-pox vesicle.
   CHICORY.—The  Cicorium  intybus,   the
 root of which,  when  roasted and ground,
 forms the well-known adulteration of coffee.
 Some persons  consider  the  admixture of
 chicory with coffee an improvement, and at
 ill events harmless, but the recent investi-
 gations  of the  ''Lancet  Sanitary Commis-
 sion"  tend  to show that infusion of chicory,
alone  especially, and  also when  mixed with
 coffee  in the proportion of twenty-five per
 cent., produced sense of weight at the  sto-
 mach, languor, and headache;  it has, by an
 eminent continental authority, been assigned
 as one of the exciting causes of amaurosis.
 Infusion of chicory occasionally acts  as an
 aperient, at other times as a diuretic.   In
 consequence of chicory not containing es-
 sential  oil,  it has  not, when  roasted,  the
 fragrance  of  coffee.  Its  infusion  has  a
 " sweetish  and mawkish taste, and is dark
 coloured,  thick, and  glutinous."  But, al-
 though chicory is used  as  an adulteration,
 the recent Lancet investigations go to prove
 that it is itself extensively  adulterated with
 various substances.  These are  " carrot,
 parsnip, mangel-wurzel, beans, lupin-seeds,
 wheat,  rye, dog-biscuit, burnt sugar,  red
 earth,  horse-chestnut,  acorns,  oak-bark,
 tan, mahogany sawdust, baked horse's  and
 bullock's liver,  Hamburg  powder," which
 consists of  peas  roasted and  ground,  and
 coloured with  the next article, "Venetian
 red," also  an  adulteration.  Perhaps after
 such  disclosures, few persons will prefer
 chicory in  their coffee; and, at all events,
 the moral  fraud of vending for  the pure
 article that which is mixed, ought  not to be
 suffered. When hot water has been allowed
 to stand for some time on  coffee containing
 chicory powder,  the  grains of the  latter
 lose their colour and resemble  small brown
.sago, while those of the coffee become rather
 darker than before.
  CHILD-BED.—The term may be applied,
 either to the actual labour itself,  or to the
 confinement generally, from  the first com-
 mencement of  the  symptoms  to  the com-
 pletion of convalescence.  It is in the latter
 sense it will be considered  in this article.
  The process of child-birth exhibits a series
 of the  most beautiful  adaptations  to  the
 mechanism and structural and  vital endow-
 ments of the human frame, with every pro-
 vidential provision for  the safety both of
 the mother and infant during the trying but
 important event.  When the full period of
 pregnancy is completed, the process, which
 is to  free the womb  of its contents, com-
 mences with the preparatory relaxation of
 the various  parts connected with  the pas-
 sage of the  child into the  world.  Shortly,
 the long-closed orifice,  or  "mouth" of  the
 organ  begins to open or dilate, allowing, in
 the first place, the protrusion of the mem-
 braneous bag  which contains the  fluid, or
 waters, in which the infant  floats, and which
 protrusion  forms a soft  wedge,  dilating  the
 maternal structures preparatory to the pas-
 sage of the  hard head of the infant, which
 follows  as propelled by the  expulsive efforts 
C H I
100
C  H I
af the womb.   Sooner or later, however,
this  membraneous bag gives way under the
pressure, the waters are discharged with a
gush, and the head itself becomes, in a great
measure, the dilating agent.   Although at
the commencement of labour, the head of the
infant is not in this position it should pass
at its conclusion from the mother with the
face  looking  directly backward, and in the
great majority of cases it does so, attaining
the position by a series of turns which can-
not be profitably explained to the unprofes-
sional. In some cases, however, the position
of the head is reversed, so that it passes
with the face  directed forward, causing a
more protracted and painful labour.  More-
over, the head may not come  forward, or
"present"  first, at all, but some other por-
tion  of the child will  appear, thus causing
an irregular or cross birth.
  Most women form, or endeavour to form,
a calculation as to the period at which they
may expect to be  confined, and, while some
do it with considerable apparent exactness,
others get  far wrong, much to the inconve-
nience of themselves and of those appointed
to attend upon them.  The most usual calcu-
lation as regards the duration of pregnancy,
is forty weeks from the last menstrual crisis,
and  this is generally made  the basis of the
calculation; but  as more cases fall within
the period than extend beyond it, it is safer
for expectant mothers to arrange their  pre-
parations for the  thirty-eighth  week than
later.   By  some  it is thought  that  the
duration of pregnancy in the case of a male
child is louger than  in that of a  female.
As,  however,  cases of premature confine-
ment of living children are not uncommon,
it is  always desirable that essentials be  pro-
vided as early as  possible.
  The most generally  received premonitory
Bign of approaching labour at the full period,
is "sinking," that is, from twenty-four  to
forty-eight hours before the actual process
commences, the female seems as if she were
smaller  and lighter  altogether,  the waist
especially showing a diminution in size.  At
this  time, also, there  is generally a degree
of fidgetiness, or undefined mental anxiety,
similar to  that which is observable in the
lower animals, and there frequently exists
irritability of the bowels and bladder,  call-
ing for repeated efforts at relief.  When the
bowels are very troublesome, and there is
much involuntary straining, or, as it is  call-
ed, "tenesmus," nothing relieves more than
a clyster  consisting of half a wineglassful
of gruel [or thin starch] with twenty drops
of laudanum.  At length, slight twinges of
pain are experienced,  either in the womb
 itself, or in the back, hips, and thighs, or in
 all together, and there is more or less dis-
 charge  of slimy  mucus, generally streaked
 with blood.  Shivering, with nausea or vo-
 miting,  are also  frequent concomitants of
 the first accession of labour.
   As time advances the pains become  more
 defined  and regular; and when  these, the
 " grinding" pains,  have fairly commenced,
 the first stage of labour may be considered
 as  established.   This  stage lasts, on  an
 average, from six to ' welve hours, but may,
 of course, much exceed or fall short of this
 stated period: during its continuance, the
 mouth of the womb undergoes " dilatation,"
 or full  opening.   Toward the close of the
 first or dilating stage of labour, the pains
 are  altered in character, and become ex-
 pulsive, or, as they are popularly termed,
 "bearing down;" at first slightly so, but as
 the process advances their forcing character
 is more strongly marked, and, in most  in-
 stances, the nearer the  birth of the child,
 the  more powerful and nearly connected
 are they,  until at last, the infant is expelled.
 Generally toward the middle of the expul-
 sive stage, the  "waters" are discharged;
 the sudden gush sometimes causes alarm to
 the inexperienced, who ought on this account
 to be forewarned of the circumstance.   The
 whole process of labour, in the case of first
 children,  averages from twelve to  thirty
 hours;  it is, however,  not  only as regards
 time, but in every other respect, liable to
 great variation.  Attacks of spurious  pain,
 resembling true labour, are not uncommon
 during  the last  month of pregnancy, but
 these may be known by the absence of the
 previous  sinking, and of most of the  other
 symptoms above  enumerated, as  character-
 istic of the  real  process.   The  attack is
 often the result of confined bowels, or of
 indigestion, and is removable by  a table-
 spoonful  of castor-oil  with  ten  drops of
 laudanum,  or by a  dose of rhubarb and
 magnesia.  Occasionally, active labour com-
 mences with a species of spurious spasmodic^
 pains, which want the  regularity of  the
 true ones, and only tease and exhaust  the
 patient, who is herself conscious that they
 are "doing no good."   In such a case,  the
 best  treatment is to administer five-and-
 twenty drops of  laudanum, and to keep the
 patient perfectly quiet,  so that she  may
 sleep if possible; if she does so, in all pro-
 bability she wakes in a few hours with real
 labour in full activity.  But sometimes even
 sleep does not intervene : the anodyne seems
 at once to convert the  spasmodic into the
 real useful labour  pain, and, contrary to its
; usual  effect, actually to stimulate the pro- 
C  H T
101
C  II  .
 gress  of  the  case.   Occasionally,  when
 labour has reached a certain stage, pain
 becomes suspended without obvious cause,
 and continues  so  for  a  longer  or shorter
 period:  in  such cases patience  is the best
 resource, unless the cessation of  pain ap-
 pears to be  connected with  some  of the
 complications of child-birth to be hereafter
 noticed.  The  discharge of the waters  is
 sometimes  the  first sign  of the  commence-
 ment of labour, or perhaps, more correctly,
 their  discharge from  imprudent exertions,
 such as shakes,  jumps, &c. hurry on the pro-
 cess, which, in such cases, is often lingering.
 This premature discharge not  unfrequently
 occurs when some other portion of  the child
 than the head is first in the birth.  It being
 presupposed,  that  every female in expecta-
 tion of  her confinement,  if inexperienced
 herself, will, under the advice and guidance
 of female  friends,  provide for  and  make
 those  arrangements most  suited to  her indi-
 vidual case and circumstances, as soon as
 the first symptoms of approaching  labour
 exhibit  themselves, the female  attendants
 ought certainly  to be summoned;  but should
 a medical man be engaged, it is proper, be-
 fore sending for him, to  feel assured that
 the process has   commenced  in  earnest.
 When sinking  pains,   recurring regularly
 every  ten  minutes or quarter  of an  hour,
 are accompanied with slight  "show," as
 the discharge of slimy mucus is termed, the
 medical attendant may be safely summoned,
 and he will, or  ought to, see to  all  subse-
 quent  details.
   When female attendance is  trusted to,
 these  details require  to  be carefully and
 judiciously insisted upon:
   A lying-in chamber ought to be as roomy,
 and, while free  from draughts, as well ven-
 tilated as circumstances will permit.—See
 Bed-room.    It  ought  too  to  have a fire-
 place, which  it is ascertained beforehand
 can be used  without  half  suffocating the
 patient with smoke, not an uncommon an-
 noyance.   The bed should be of such mode-
 rate  height that  an  attendant can con-
 veniently give  assistance  to the  patient.
 A mattress is always preferable to feathers,
 and curtains, as in beds generally,  are bet-
 ter dispensed with.  In addition to the ordi-
 nary furniture,  a  night-chair and  bed-pan
 should be provided ; and a vessel  of  some
 kind  which can be used  as  a bath for
 the infant.   Some waterproof material  is
 requisite for "guarding" the bed  against
 injury from moisture.  Formerly, a pre-
pared skin used  to be the  general material,
but there are  now  many waterproof arti-
cles, quite as well or better adapted for this
 purpose.   Sheet gutta-percha or India rur»-
 ber answers well, and  is cheap.  An easy
 chair, a bottle for pure water, a little bran-
 dy, a fan, and a bottle  of smelling salts,
 cups and  vessels, including a sick-feeder,
 (see  Bed-room,) for administering  either
 food  or medicine,  are all  advantageous
 additions to the numerous little  etceteras;
 these  are,  sponge,  washing-flannel,  and
 starch-powder; a little lard  without salt,
 or cold cream, soft  towels, and abundance
 of  napkins  or  doubles ;   four  ties  or
 ligatures,  each six  inches long, and com-
 posed severally of four plies of stout linen
 thread;  a  pair of  blunt-pointed  scissors
 that will cut, and a  flannel receiver for the
 infant.   A little laudanum and sal-volatile
 ought always  to be at hand;  but when a
 medical  man  is in  attendance, he more
 generally carries these  with him.
   One female friend, and no more, in  ad-
 dition to  the nurse, should  be present at
 the accouchement;  but it is  advisable to
 have another female in the house, though
 not actually present in the room, particu-
 larly if a midwife only has charge of the
 case.  Mothers ought never  to be present
 at the confinement of their daughters.
   As soon  as labour commences, the cham-
 ber should  be prepared, all  extraneous
 articles removed,  and  whatever may  be
 wanted put in order; the  guard  placed
 upon the bed, and the  latter so  arranged,
 that when the  patient lies  upon her  left
 side near the edge of it,  there may be plenty
 of room for those about her to pass and act.
 The patient herself ought to be encouraged
 to walk about, and her  mind  kept occupied
 and cheerful by conversation; light nourish-
 ment, such  as a cup of tea or gruel, being
 given as desired, in small  quantity at once;
 at  this time too,  if the bowels  are at all
 confined, they should be unloaded by a dose
 of castor-oil, or better  still, by an enema,
 consisting of a pint of thin gruel, to which
 a  tablespoonful of olive-oil is added.   As
 time advances,  and as soon as the pains ex-
 hibit signs  of "bearing  down," the patient,
 if not  previously undressed, should now be
 so, and the folded binder (see Binder) placed
 on the abdomen,  so as  to give gentle and equa-
 ble support.   The patient may still continue
 to walk about a little;  but as soon as  the
 pains become decidedly  expulsive, she must
 be  placed  in bed  upon her  left side, and
 remain so  unless raised up  for  necessary
purposes, until  the infant is born.  During
all this time the room should be kept mode-
rately cool—if regulated by a thermometer,
about 55° Fahr.  The patient, most likely,
particularly toward the end of her  labour, 
CH I
102
C H I
 will become extremely hot, and  then the
 occasional and moderate use of the fan is
 very agreeable. She should be induced, from
 time to time, to take a few spoonfuls of gru-
 el ; but the stomach is not to be overloaded,
 and above all things, the pernicious and too
 prevalent custom of giving stimulants, bran-
 dy, rum, &c. is to be avoided.  A case which
 really requires  such aids requires  also the
 presence of a medical man to sanction and
 regulate their use; if given when not re-
 quired,  feverish  heat,  headache,  thirst,
 general uncomfortableness, and, it may be,
 after bad consequences, are the only results.
 Amid the poorer, and indeed among some
 of the better classes  in  the country,  it is
 customary for patients to be "put  to-bed"
 in  their day-clothes.   Independent of the
 uncleanliness of the proceeding, it is not at
 all times free from  danger,  when, after the
 confinement is over, it becomes requisite to
 remove these clothes and  substitute  the
 bed-dress.   The usual excuse, that it is for
 the support given by  the stays, is quite in-
 admissible when the binder is used, which
 amply supplies the  place of the above un-
 desirable articles;  besides, the presence of
 the stays and clothes  may  seriously inter-
 fere with measures which must be taken
 in some particular  cases, such as  those of
 flooding.  Another  practice which  is often
 followed by midwives cannot be too strongly
 condemned:  it is  that  of delivery being
 effected with the patient kneeling on the
 floor; it is highly dangerous.  Such atten-
 tion should always  be given to the bladder,
 that it may be  duly emptied; although, in
 most instances,  the  sensations of the patient
 herself insure this point.
  When the last strong pains of labour are
 expelling the head  of the child, the mid-
 wife who has, or who  ought to have, suffi-
 cient  experience to be aware of the  pro-
 gress of the case, should elevate the upper
 knee during the occurrence of each  pain,
for the purpose of affording free space; this
 mode of proceeding is preferable to  the pil-
low placed between  the knees, which heats,
 and is always getting displaced.  A towel or
some such material is frequently attached to
the bedpost or some fixed  point, and many
women appear to derive comfort from hold-
ing it during the paroxysm of pain: it may
be permitted, if it  does not encourage  too
great efforts  at straining.   The feet  must
be kept  warm; cold  feet may retard the
frequency and force of the pains.
  It cannot be too strongly impressed upon
 the minds of all, that child-birth is  a natu-
 ral process, and that nature is fully compe-
 tent in all ordinary  cases—and in more ex- j
 traordinary ones than might be imagined—
 to accomplish its end safely and unassisted.
 And  it must and  ought to  be completed
 without assistance, or any attempt at assist-
 ance,  as  far as female  attendance is  con-
 cerned.
   As soon as the head of the infant is born,
 the  attendant  midwife  ought to pass her
 fingers around its neck, to  ascertain, as
 sometimes occurs, that the navel-cord is not
 twisted around it;  should it be so, she must
 endeavour gently to slip it over the head,
 otherwise the neck may be so  strongly com-
 pressed as to occasion fatal strangulation.
 The cord may be  coiled once, or  two or
 three times around  the neck.   At this period
 also, the mouth and nostrils of the child—
 if there is any delay in  the passage of the
 body—should  be kept as free as  possible
 from the  surrounding  discharges,  which
 may be drawn in by the efforts to breathe.
 Neither ought the body,  or even the legs of
 the infant, to be drawn from  the mother;
 their expulsion  should  be left to the natural
 efforts  of  the womb;  for if too  suddenly
 emptied, its  natural  action  becomes  em-
 barrassed, and irregular contraction, accom-
 panied with unnecessary pain and discharge,
 may be the consequence.  The infant being
 fully born, the  navel-cord must be tied by
 the ligatures, which have  been ready pro-
 vided ;  the first being placed about three
 fingers' breadth from  the body of the child,
 and  the other  about  an inch and  a half
 further; the  intervening portion of cord
 being divided by the scissors.   The infant
 now  separated  from  the  mother is  to be
 placed  in the flannel, in the  arms of  the
 nurse, and put in a moderately warm situ-
 ation.—See Children.
  In  tying  the  navel-cord,  one  or  two
 cautions are  requisite.  The  first ligature
 must not  be  placed nearer the body than
 the distance  above-named,  and before  the
 second  is put  on,  it  is well—to  prevent
 spurting—to  squeeze the blood up toward
 the body of the mother,  out  of the  inter-
 vening  portion.   For cutting the  cord, a
 pair of blunt-pointed scissors  should  be
 used, and care taken at the  moment that
 no other  portion of the child is  intruded
 between the  blades;  it  has  occurred that
 a finger or toe  has been  lopped off by a
 careless attendant.  After the cord is  cut
 through,  the  cut  extremity  attached to  the
 child must be carefully examined, to  make
 certain that it does not  bleed, particularly
if the cord be thicker  than usual, in which
case the tying must be most carefully per-
formed.  From careless tying and neglect,
infants  have  bled to death from the  navel 
C H I
103
C H I
 vessels  immediately  after birth.   Should
 the infant not appear to breathe as soon as
 born, it is well to  delay the severance  of
 the cord for a minute or two, while at the
 same time the mouth  and nostrils are freed
 from  all adhering  mucus, and efforts are
 made to rouse, by blowing upon the face, or
 by  two or three smart taps on the  back.
 As soon as the infant  is separated from the
 mother, it is proper to ascertain by the hand
 placed upon the abdomen that there is not a
 twin child;  if there be, the remaining bulk
 will  indicate it in a way that  can scarcely
 be mistaken;  and should it  prove so, the
 recurrence of the pain which is  to  effect
 the  expulsion  of the  second child, must
 be quietly waited for,  unless hemorrhage, or
 some other occurrence,  dictates a different
 course.   In  most cases of  twin children,
 the second is quickly  and easily born, after
 pain sets in.
   When labour is completed,  the binder must
 be tightened up, so as to give gentle and com-
 fortable support  to the now  lax abdomen,
 and the patient left quiet until the accession
 of pain gives signal of the throwing off of the
 afterbirth.—See Afterbirth.    AVhen this is
 effected, the binder will again require slight
 tightening,  and  a warm  napkin, sprinkled
 with  brandy,  should be  applied  to  the
 mother.  At this time, chilliness, succeeding
 the profuse perspiration, is often complained
 of, and should be counteracted by some ad-
 ditional covering.  The female must now be
 allowed to  remain quiet, but not left  alone,
 and so far attended to  that  any symptoms
 of faintness or undue discharge of  blood—
 flooding—may be detected.  If all goes well,
 a cupful of gruel or arrow-root maybe given,
 if desired,  in the course of  half an hour;
 in the course of  another  half-hour, a dry,
 warm, open, flannel skirt, and  dry napkins
 should be  substituted for those which have
 become wet;  but by  this time every thing
 ought to be arranged  and quiet for the pa-
 tient's repose.
   Such  are the incidents  of natural and
 regular labour; and could we  calculate upon
 the process following undeviatingly the same
 course in all cases, it might safely and  at all
 times be left to the care  of judicious and in-
 structed females.  But,  as too well  known,
 accidents and difficulties of the most formi-
 dable  nature will arise, which tax to the
 utmost the skill and nerve of the well-edu-
 cated  practitioner;  and with  some, this  is
 an argument why every case of confinement
 should be attended  by a medical man—in
 many situations, at least, a physical impos-
sibility.  As, therefore, many  cases must be
left to female care, the foregoing directions
 will,  it is  trusted, lead to their safer and
 better management, while those which are
 to follow are intended to point out what cases
 ought never to be trusted to a female attendant,
 and what symptoms occurring in a case un-
 der female care, indicate the  approach of
 such  difficulty or danger as requires the at-
 tendance of the male accoucheur.
   As a general  rule, in a first confinement,
 it is always desirable to have the attendance
 of  a medical practitioner, and especially so
 should the female be the subject of any de-
 formity, such  as curvature of the  spine,
 should she in early life  have suffered from
 any tendency to rickets,  or been the subject
 of epileptic fits at any period of life.   Also,
 if there exists any suspicion of heart or other
 organic disease.   If a previous confinement
 has in any way been irregular, or has re-
 quired instrumental or artificial delivery of
 any kind;  if convulsions have occurred; or
 if there has been flooding, either from diffi-
 culty  with  the afterbirth,  or any  other
 cause, the  woman ought never to trust her-
 self in the  hands of a female.
   AVhen a midwife, either professed or other-
 wise, is in attendance upon a case, fainting
 coming on at any period, any  symptoms of
 wandering or delirium, or of convulsion, any
 unusual  discharge of blood while  the pro-
 cess is going on, should at once be the sig-
 nal for summoning medical assistance; also,
 should the labour be more than usually pro-
 tracted, without obvious cause, provided the
 pains  are regular, sufficiently numerous, or
 forcible; should the navel-cord, or any thing
 unusual, such as the infant's hand, be felt
 protruding externally;  and lastly, if, after
 the child is born, there is any difficulty with
 the afterbirth, (see  Afterbirth,) either with
 or without flooding.
   In the interval which must or may elapse
 in many cases before medical assistance can
 be  obtained, should fainting come on, the
 female must be  laid on the bed with the
 head  on a level with the  body, air should be
 freely admitted around  her, and  smelling-
 salts  used  to the  nostrils, while brandy or
 sal-volatile is administered by the mouth.
 It ought to be  ascertained whether there
 is any discharge  of blood externally, and
 if so,  cloths dipped in   cold or iced-water
 are to be freely used to the lower part of the
 bowels.  Wandering or delirium, or convul-
 sion, must  be soothed by the most perfect
 quiet,  and  by the  free use of cold applica-
 tions  to the head, and mustard-plasters to
 the calves of the legs ;  while if the person be
of fall habit, and if the face is full and flushed,
from six to a dozen leeches are to be applied
to the temples.   In all cases of unusual dis- 
CHI                104                CHI
charge of blood, the measures recommended
under the article "Abortion" are to be em-
ployed; and it must be borne in mind, that
if the accident occurs after the birth of the
child, firm pads composed of folded napkins
must be kept firmly bound over the situation
of the womb—in other words, one  or two
inches below  the navel—and  kept  there
while cold is used to the external parts.   In
a case of sudden and profuse outward flood-
ing after the birth of the child, occurring in
a thin  individual, much may be done to ar-
rest it, by some one instantly pressing the
hand firmly and steadily upon the belly—at
the navel—until the pulsation  of the great
main artery, or aorta, is felt, and felt, as ar-
rested  by the  pressure,  to beat up to the
hand, but not  beyond it.
  It must,  however, be kept in mind that
alarming, and even fatal loss of blood—in-
ternal  hemorrhage, as it is  called—may be
going on within the womb, and yet be unma-
nifested by any outward flow, the first signal
of the  mischief probably being faintness;
and if the abdomen is now examined, it will
be found to have enlarged more or less since
the birth of the child.  This dangerous con-
dition requires the most energetic and well-
directed  efforts  of a  medical  man to save
life, and not one moment should be lost in
procuring his assistance.  In  the  interval,
the binder well spread over  the bowels, and
two or three folded napkins placed  under-
neath it to assist  the pressure,  is  to  be
tightened well  up, and in addition, firm
pressure must be exercised with  the  ex-
panded hands  of an attendant on the outside
of the binder.   By this method, the ordinary
attendants will do more to retard the further
filling of the womb with blood;  at the same
time cold is to be used to the lower part of
the bowels, and stimulants given sparingly.
The medical man, on  his arrival, will take
much more active measures which could not
properly be employed by others.  The above
dangerous accident of the lying-in  chamber
will sometimes occur in spite of every care,
but it frequently results  from bad  manage-
ment, such as  too sudden emptying of the
womb by abstracting  the child, instead  of
allowing the  natural  efforts to accomplish
the entire process; by impatience  with the
afterbirth, neglect in putting on the binder
insufficiently, or not at all, or by moving too
Boon after delivery.  The existence of cough
has a tendency to promote  its  occurrence.
The occurrence of internal flooding is some-
times indicated by continued pain complained
of in the bowels or back, different  from the
usual intermittent after-pain.
  Lastly, whatever accident may occur in the
 lying-in room, it should be the endeavour of
 those around to avoid the excited hurrying,
 which too often seeks to do every thing, and
 does every thing but what is right. This is one
 reason at least why it is proper to exclude all
 but the necessary attendants, and especially
 mothers, from the scene ;  they communicate
 their own alarm to the patient, and  aggra-
 vate the danger, if it exists, by so doing.
   When a female has  enjoyed a few hours'
 repose after her delivery, if the bladder has
 not been relieved, it  should now be so [but
 the patient  should use a sheet or  bed-pan,
 and not  be allowed to rise or even  sit up in
 bed]; a  little light  nourishment, such  as
 gruel, may then be taken, and the infant ap-
 plied to the breast, whether it appears to  contain
 milk or not.—See Breast.  If the confinement
 be a first one, the afterpains will scarcely give
 trouble.   When they are severe, twenty drops
 of laudanum may be  given in a little water.
 —See Afterpain.  Perfect quietude is to be
 observed.
   It is not probable that the bowels will act
 of themselves, particularly if opium has been
 given ; it is  therefore right on the morning
 of the third day after confinement to give an
 aperient.  Castor-oil is almost universally
 prescribed;  but when the person is  of full
 habit, and if there exists any tendency  to
 fever, a common black draught is preferable.
 After the bowels have been moved, the pa-
 tient, if going on well, is to be  allowed an
 improved  diet; a little meat-soup, or light
 pudding;  and now, provided it can be done
 without  putting the person in the erect pos-
 ture, the bed may be made, and the night-
 clothes changed.  After the fourth day, ac-
 cording  to the state  of the  patient, a little
 solid animal food is  to be allowed ; but sti-
 mulants, whether immediately after the con-
 finement, or during the period of convales-
 cence, should never be taken unless for some
 special reason, such  as great debility.  At
 the end of the week,  if all goes on  well, the
 female may get on the sofa, toward the tenth
 day begin to get her  feet to the ground, and
 gradually return to her usual  mode of life.
 During the whole of the convalescence, there
 is no greater comfort, or more salutary prac-
 tice, than the free use of tepid water, so as
 to preserve the strictest cleanliness.   By the
 use of gutta-percha  sheeting, drawn  under
 the patient, it may be fully employed with-
 out wetting  the bed.
   AVhen a confinement has been a moderately
 favourable one, if the foregoing directions
[ are attended to, there are few cases that will
 not progress regularly to  complete  conva-
 lescence :  it is true, that among the poor,
 some of the  means and conveniences cannot 
                  C H I

be carried out or procured as fully as could
be wished ;  but the most essential, fresh air
and cleanliness,  are mostly at  command,
and might  be more freely taken  advantage
of than they are ; and in all cases something
like moderate care ought  to be observed—
which is too often not the case.  As regards
comforts and conveniences, in no way can the
charity of the more fortunate be  applied to
the relief of their poorer sisters, than in the
provision both of  linen and diet  suitable to
a  time of trial,  when  poverty is often so
severely felt.
  But  recovery after chUd-birth does not
always preserve the smooth course.   The
accession of the milk may be  accompanied
with  feverish excitement.   This,  if not ex-
treme, is to be allayed by means of aperients,
as castor-oil, black draught, or seidlitz pow-
der, and effervescing saline draughts, to each
of which may be added five grains of nitrate
of potassa.  AVithin the first few hours or
days  after delivery, the woman, if attacked
with shivering, or rather shaking, so severe
as to shake the bed, succeeded  by heat of
skin,  thirst, delirium, with or without severe
pain  in the bowels, may be attacked with
child-bed fever, and cannot be too quickly
seen by a medical  man; in the mean time,
the diet must  be kept at the lowest ebb.  If
time  must  elapse  before  efficient aid can
be got,  there should at  once be given a pill
composed of  one grain of  opium and  five
grains of calomel, and  this repeated regu-
larly  every  six hours;  if pain is severe, a
dozen of leeches at least, if they can be pro-
cured, must be put on the abdomen, and if
not, light  hot  bran-poultices continually ap-
plied.   If the bowels have not been moved,
they must be  opened  by an enema of gruel
and castor or  olive-oil, and the thirst be re-
lieved by toast-water freely allowed.   But
the above active measures are not to be the
substitutes  for  a medical  attendant;  the
attack  threatens life, and may require all
that skill can do for its removal; if only a
few hours are likely to elapse before aid is
procured, the poultices,  a single dose of
calomel with  opium, and the enema, should
only be resorted to.
  If a woman, at  any time during the first
few weeks after her  confinement, becomes
excited and talkative, if she wanders slightly,
if the eye becomes restless and wild-looking,
and if sleep is absent, she  requires imme-
diate  attention, for an  attack  of child-bed
mania is  probably impending.   A medical
man should be immediately summoned.  In
the mean while, the most perfect quiet is to
be preserved around the patient, who. should
be placed in bed,  in a room with the  light
15                CHI

 slightly  shaded;  cloths dipped in cold or
 iced-water be applied to the head, the feet
 kept perfectly warm, and the bowels, if con-
 fined, opened  by a gentle aperient, but not
 purged.   This, perhaps, is all that it is de-
 sirable should be done before the case is seen
 by a professional  man; but on an emergency
 it may be requisite, without this aid, to re-
 sort to the use of opium—Battley's sedative
 solution is the best—of that ten drops, or of
 laudanum fifteen  drops, along with a grain
 of ipecacuanha powder,  should be given in a
 little water, every half-hour, till quiet sleep
 is procured, or till at  least four doses of
 either of the above have been administered.
   Occasionally,  shortly after  labour,  the
 skin of  the patient becomes covered  with a
 "miliary" eruption, consisting of number-
 less points resembling minute blisters. This
 is generally the  result of overheating or
 stimulating, and was much more frequently
 met with in former times than now, that a
 more cooling and rational system  has been
 adopted.
   The principles to be kept in mind in the
 domestic  management  of  child-birth,  by
 those in attendance,  are:—To have every
 thing in order and ready at hand;  to ex-
 clude all  useless attendance; to encourage
 the  mind of the patient;  to  preserve  the
 moderate temperature of  the room, and  its
 free ventilation;  to  abstain  from  giving
 stimulants,  and from loading the stomach
 with  food;  to have the  bowels clear;  to
 avoid all meddling interference ; to summon
 medical  assistance on the first appearance
 of any thing unusual; lastly, let the patient
 be  assured,  that the  process,  though  a
 painful, is a natural one, and He, who  has
 ordered  its  marvellous  arrangement  and
 adaptations, will be present in the hour of
 travail.
   CHILD. — Infancy. —Childhood.—The
 period of childhood, including infancy, may
 be  said  to extend from birth  to  the thir-
 teenth or fourteenth year; and truly may it
 be said  that the child  is the father of the
 man; for upon the original constitution, and
 upon the physical and  mental training of
 this most important epoch of human life, de-
 pends in great measure the usefulness,  and
 consequently the happiness—it may be the
 eternal welfare—of the  future man and wo-
 man.  The subject of the management of
 childhood, all-important as it is, can, how-
 ever, be but briefly treated of in a work like
 the present;  and the reader who wishes fur-
 ther information than is to be found  under
 the  head of this article, is referred to the
 admirable work of the  late  Dr. Andrew
 Combe.
1( 
                 CHI                1<

  Infancy.—Continued from  Child-birth.—
When an infant is born, should it, in conse-
quence of protracted labour or some other
cause, not draw breath, and appear purple
on the surface,  it is advisable in the first
place to pass the end of the finger,  covered
with a piece of thin calico or linen,  into the
mouth, for the purpose of clearing away the
stringy mucus which not unfrequently ob-
structs the passage  of air into the lungs.
If, under these  circumstances, the navel-
cord continues to pulsate, it should not be
tied for at least two or three minutes, during
which efforts are to be made to rouse the
child, by blowing sharply on the face, or by
one or two slight slaps on the back; at the
same time an attendant ought to be getting
a warm  bath—temperature  98° Fahr.—in
readiness.  If, after  the lapse of time above
mentioned, animation still seems suspended,
the cord should be tied without  further de-
lay,  and the infant at once removed and
placed  in the warm  water up to the neck,
the  body being  well  supported,  and  the
mouth and nostrils carefully kept from being
accidentally submerged.  The mouth and
throat having been cleared from obstructing
mucus as above directed, some one, while the
nostrils of the infant are closed, should, by
placing their mouth  over that of the child,
endeavour  to  inflate the  lungs with their
breath, and then withdrawing the mouth, to
empty them by pressure exerted upon the
abdomen and sides of the chest.  The direct
effort to  inflate  the  lungs having been re-
peated a few times, the artificial respiratory
movements—alternately pressing upon the
ribs  and  abdomen,  and  allowing  them to
recover by means of their own resiliency—
Bhould  be persevered in  for a considerable
period.   In these cases of suspended anima-
tion  in infants, electricity is  unquestionably
a powerful  restorative; but hitherto the
difficulties  attending its ready  application
just  at the moment have rendered it almost
unavailable;  now, however,  the newly in-
vented electric chains of Pulvermacher will
probably place in the  hands of the accou-
cheur,  and, from their simplicity,  even of
others, a readily applicable  source of the
above powerful stimulant.—See Electricity.
  When an infant exhibiting full signs of
life is separated from the mother, and placed
in the flannel receiver, it must not be covered
up too closely—the caution is not superflu-
ous,  for infants  have  actually been smo-
thered  in this  way by the extra carefulness
of the nurse; it must,  too, be placed where
it will be warm.  As soon as the child can
be attended to, it ought to be examined all
over, to  ascertain whether  it be perfectly
                 C H I

formed;  and  the tying of the navel-cord
should be seen to be secure.  Washing with
warm  soft water—temperature W3—soap,
and  soft  flannel, is  the next requisition.
The skin of a newly-born infant is covered
with a white unctuous matter, which is to
be removed.   This  may  be best  accom-
plished by greasing the skin thoroughly with
lard or oil before washing it, and then rub-
bing it as gently and effectually as possi-
ble, without fraying the skin, the arm-pits
and other folds of the body being particu-
larly attended  to.   The child, after being
washed,  is often  dried upon  the  receiver,
placed on the nurse's  knees ;  a better plan
is  to have placed on the lap a moderately
soft pillow, covered with two or three large
warm napkins, on which to  lay  the child.
The drying, which  should  be done  in cold
weather  at a moderate distance from a fire,
having been effected gently, without scrub-
bing, a little starch-powder should be dusted
into the folds of the groins and arm-pits, but
not  elsewhere,  unless  the  skin  appears
frayed.   The portion of the navel-cord re-
maining  attached to the child is now to be
wrapped in a piece of soft linen, which is
kept in place by a binder of fine flannel, five
inches wide, and  long enough to pass twice
round  the body of  the child, so as  to give
support without  pressure,  and fastened by
needle and thread—not by pins : if too firmly
applied, the respiration  of the  infant is inter-
fered with.  The  remainder of an infant's
clothing is so much regulated by custom and
other considerations, that it is unnecessary
to mention it here, further than to impress
the rule that it should be perfectly loose and
easy, and fastened entirely by tying or sew-
ing.  A cap should never be placed  upon a
child's head, which is  naturally hot enough
to do without artificial covering.   [This is
the general practice of the present day, and
is  chiefly adopted  by mothers  as saving
trouble;  but it is doubtful whether the cases
of deafness  and gatherings in the head,
snuffles, and sore eyes, now so common among
children, may not arise from this departure
from the habits of our forefathers.   A thin
cap is a protection from sudden changes of
temperature, and upon the bare head of an
infant  cannot do harm.  Few adults  even
with a full  head of hair Bleep comfortably
without covering  the head.]  When  the in-
fant  has been dressed, it should be  laid to
rest in the cradle, or place prepared for it,
perhaps beside its mother, but at all events
where  it will be  sufficiently warm.  It will
probably sleep for some hours.  It ought not
to be fed  for the  first few hours after birth.
As too  frequently practised, the unfortunate
)6 
                  C H I

baby is dos»d with " rue tea,"  " sugar and
butter," or some such mess, or stuffed with
soaked bread or gruel, and the first founda-
tion laid of the  disordered  bowels,  wind,
screamings,  &c.  &c.  which  are so general
in young infants.  AVhen  the infant wakes
from its first sleep, or,  at  all events, in the
course of four or five hours  after birth, it
should be put to the breast; even  should
there  not be sufficient  secretion of milk  to
satisfy the  child, it is well both  for it and
the  mother that  it should be thus early in-
duced to  take the nipple.  If, as may occur,
the  milk-flow is delayed, it will be necessary
to give the infant the  artificial support  of
cow's  milk, unskimmed,  but diluted  with
nearly half water, and very slightly sweet-
ened : this may be given, either from a com-
mon nursing-bottle, or by means of a spoon,
but the former is preferable.   On no account
should any thing like bread, gruel,  or the
like, be allowed to pass the lips of a newly-
born infant, unless under the  pressure  of
extreme necessity, such as might happen  on
board ship,  and  then the powder of  grated
biscuit, or of twice-baked bread, softened  in
water, is the least hurtful substitute.  The
first milk of the mother is thin  and serous,
and is generally considered to exert an ape-
rient action upon  the  infant's bowels, by
which the slimy olive-green discharge named
"meconium," which first occurs from them,
is carried off.   Should the bowels not act
within twenty-four hours after birth, from six
to eight drops of castor-oil should be given,
mixed with a small quantity of moist  sugar.
Should this  have no effect,  it  may  be re-
peated ;  but should  the infant appear  to
make  the straining  effort to  relieve the
bowels, without its being  effected, the vent
ought to be carefully examined by a medical
man, as it may happen that  closure of the
bowel, complete or partial, exists,  but which
may,  nevertheless,   be  remediable.   The
case is not common, but its possibility is not
to be forgotten.
   The  majority of mothers are able, and ought,
as a sacred duty, to nurse their own infants;
but  cases occur in which,  from illness suc-
ceeding  the confinement,  or from  general
weakness of constitution, a female is unable
to do so, either with benefit to herself or the
child.   When she cannot, it  becomes a se-
rious question, whether the duty of nursing
is to be devolved  upon  another, or whether
the  infant  is to  be brought up by hand.
The  general voice says the former—the au-
thor confidently  asserts that  the latter  is
preferable.   In the first place, it is  requi-
site to provide a nurse whose  own infant  is
of the  age, or nearly so, of the infant to be
)7                CHI

 wet-nursed; it.will  not do to put a  young
 infant to the breast which has been nursing
 for many weeks or months. This is the first
 but the lightest difficulty.  [Children have
 often done perfectly well upon  breast-milk
 eighteen months old, though that nearer the
 age of the child is certainly the best.] But
 there is a much more serious consideration.
 We have  yet  to learn  the  full  measure of
 influence, both physical and mental, which
 may be exerted upon the child by the pecu-
 liar physical and mental constitution of the
 foster-mother from which it draws  its first
 nourishment.   It is  true the physical de-
 velopment is generally rigorously  scruti-
 nized,  but how are  passions  and  mental
 tendencies to be measured ?  And we do know
 that  the  class from  which  wet-nurses are
 often selected are certainly not in the habit
 of controlling their appetites and passions ;
 and further we  know, that the physical
 qualities at least of the milk are very liable
 to be affected by the mental emotions of the
 nurse:  here at least is one source of danger,
 were we sure, which we are not, that there
 is no deeper, more lasting, life-felt influence
 exerted. And withal, it is quite possible that
 some physical taint, venereal perhaps,  (it
 has happened and may happen,) has escaped
 the searching examination  of the selecting
 physician.  These are all  serious consider-
 ations for a mother before  she submits her
 child to draw its first nourishment from the
 body of a stranger; one too, who must either
 be  suffering  from the  intense grief  which
 every mother feels who loses her infant from
 her breast, and whose milk must be affected
 by that grief, or who must have  been com-
 pelled by poverty, and  all its physical evils,
 to undertake the task;  or one whose mental
 constitution is  so unscrupulous, that, with-
 out necessity, she will  consent, for gain, to
 cast aside her own infant, and, at the risk
 of its welfare, give its birthright to a stranger.
 Are any  of these the  qualifications which
 a mother will  choose  for  the nurse  of hei
 child, even if she  has  the selfishness to
 tempt another to desert her own legitimate
 offspring?   Medical men often  witness the
 painful sight of one infant declining away,
 while the mother is nourishing another into
 strength.   The system and importance of
 wet-nursing  has  been  much  overrated;
 for  it is  perfectly possible, if the care and
 trouble  requisite will be incurred,  to bring up
 a child by hand, as well and healthily as at
 the  breast  of a foster-mother.   Care and
 trouble it does involve; but if these are
 grudged, the child had  better go to its grave
 at once.
  In bringing up  a child  by  hand, milk
II 
               CHI                  1*

must  be  its only nourishment for  the  first
three  or four months.   Ass's milk  or goat's
milk may be employed, but more generally
cow's  milk  will be used, either  with or
without the cream  removed,  according to
its richness, and according (as the first few
days'  experience  will  show)  to  its effect
upon the infant.  The milk is to be diluted
with one-third water, and just perceptibly
sweetened.  It is not to be given by spoon,
but by means of a common nursing-bottle,
which should always be of glass.  (See fig.
Fig. xxxv.
xxxv.) Of these bottles there should be two,
both on account of accidents, and also, that
unvarying  and essential  cleanliness  may
be observed.  AVithout the most scrupulous
care, (and on  this depends the success  of
bringing a child up by hand,) the purity and
wholesomeness of the food  cannot be  pre-
served.   The  milk  and water should  be
mixed fresh, at least twice  a  day, and, in
summer, kept  in vessels  immersed  in  cold
water;  it is to be  given to the  child  at
nearly the temperature of the  body, about
96°.   The food is  to  be sucked from the
bottle, and  much care  is requisite in the
management of the artificial " sucks" which
are used for the purpose, and which  are  of
great variety:  they are  made of  silver,
caoutchouc,  prepared teats, wash-leather,
parchment,  linen,  muslin, &c.   Whichever
material is  preferred,  it  should, without
being too impervious,  occasion the infant
some exertion to draw the milk through  it,
if it  does not,  the  child is apt to overfill
the stomach, and loses  the exercise which
it has when-it draws its nourishment from
the breast of  the mother.   Silver is gene-
rally too hard for the gums.  India-rubber
sucks of excellent quality are now made;  or
wash-leather, or parchment, or double linen,
or muslin will  be found  convenient, accord-
ing to the strength  of the  infant.   Which-
ever  is used, it must be made up into the
form of a cone, or like a small jelly-bag,  with
a piece of sponge about the size of a large
pea,  to give a little substance, fastened inside
by one or two stitches passed through.  The
suck must then be firmly tied to the end of
the feeding-bottle, and will require  changing
every day, otherwise  it becomes sour-smell-
ing  nnd unwholesome;  independent  of
which, wash-leather  thickens and  becomes
s                  C II I

impervious,  and the other materials are apt
to wear through.  Again it is repeated, that
the most thorough cleanliness,  in milk-can,
bottle, and suck, is to be observed, and must,
except  in  rare  instances, be a mother's care.
Another caution is  requisite.   In  feeding
children from  the bottle, careless  nurses
may frequently be observed  to incline it
the wrong way, so that the infant  goes  on
for a time  sucking  wind.   For the first
three or four months   this milk-and-water
food is all that  is requisite, with the addi-
tion,  if at any  time the bowels should  be
too much relaxed, of a  portion  of isinglass,
from  one to  two small  teaspoonfuls dis-
solved in the half-pint of fluid.  About the
fourth or fifth month,  a small portion  of
arrow-root or wheat-flour may  be boiled in
the water before  it  is  added to the  milk;
and about the seventh or eighth month, the
spoon may be used to give some of the more
solid  milk and farinaceous preparations.  In
bringing up  by hand, the  child will, as at
the breast,  require  feeding about six  or
seven times in  the four-and-twenty hours,
for the first  three months at least—about six
tablespoonfuls, or one ounce  and a  half,  on
the average, being given at  once,  at first,
and the amount gradually increased.  Small,
delicate  children, however,  will scarcely
take  half  the  amount above  stated, and
great care must be taken, both with them
and others,  not to allow the  stomach to be
overloaded.   If an infant is habitually sick,
[or has diarrhoea,] the  quantity allowed at
once must be reduced ;  for, though  happily
the infant stomach relieves itself easily of
superfluous  food, it  is  better  to avoid the
superfluity than trust to the sickness, not-
withstanding the popular fallacy that sick-
ness is a sign of infant  health.
   The system of rearing by  hand is much
more  prevalent in some parts  of Germany
than  in  this country.   The following pas-
sage from the work of  Dr. Andrew  Combe,
the substance of which he says he derived
from  the German work  of Dr. Von Ammon,
is so  full of practical  instruction, that the
author makes no apology for quoting it at
length:—
   " In  some constitutions, however, cow's
milk  does not  agree  when merely diluted
and sweetened ; but  answers perfectly well
when a  large  proportion  of  water and a
small quantity  of any well-prepared fari-
naceous  substance is added.  In this case,
it is  a common  custom in some parts of
Germany to dilute the milk with  a weak
infusion  of  any  light  aromatic, such  as
linden-tree flowers, instead of  pure water.
But after  the   first month or two,  where 
                  C HI

 diluted milk  does not agree,  a  small  pro-
 portion  of well-boiled  arrow-root,  grated
 Dutch rusk, or well-baked or toasted bread,
 sometimes  forms  a  very  useful  addition
 wherewith to thicken the  milk to the  con-
 sistence of thin gruel.   Briand,  indeed, re-
 marks that milk diluted  and boiled for a
 length  of time with  any  light farinaceous
 substance, is  more easily digested by some
 infants than pure milk ; and that when the
 use of milk alone is  followed  by white and
 curdy evacuations,  a  change to a  bouilli,
 made of milk  and  farina, often restores
 them to  a healthy colour and consistence.
 For  this reason  he  recommends panada,
 made by boiling  for a length of time  in
 water,  or milk  and water, thin slices  of
 bread,  previously well  dried  in  the oven.
 Another, of which he speaks highly, is the
 crcme de pain, made  by infusing in water
 for several hours well-baked  bread, previ-
 ously dried in the oven  in slices, and boil-
 ing ,it gently for  some hours  more,  adding
 water from time  to  time to prevent it be-
 coming too thick.   It is then  strained and
 sweetened,  and  a few drops  of orange-
 flower  water  are  added.    For  infants a
 few months old, arrow-root,  sago, or semo-
 lina may be  used in the  same  way.  The
 bouilli in  common use  in France,  as  the
 first  food of infants,  is  made  by  gently'
 roasting  the  best wheat-flour in an oven,
 then  boiling  it for  a  considerable time,
 either in water  or in milk and  water, and
 adding sugar  to it.   AVhen carefully made,
 not too  thick, and free from knots, it is
 considered  an  excellent  food,  especially
 where the use of milk excites a tendency to
 diarrhoea, or  colicky pains.  .On changing
 to the bouilli,  the digestion immediately im-
 proves, and the  evacuations become healthy
 and unattended  by pain.
   "In some  instances, especially when  the
 bowels  are sluggish, barley-water or  thin
 gruel, with or without the addition of weak
 chicken-tea or beef-tea, answers best;  and
 the grand rule  ought to be to follow what
 seems best suited to  the individual  consti-
 tution.  In soft,  flabby children, the chicken
 or  beef-tea is often most  useful; while  in
 thin, active, and irritable infants, the  milder
 nilk  and  farinaceous  diet  answers best.
 But in  trying the effect of any alteration
 we must  not  be too  rash, and, because no
 advantage is apparent within a day or two,
 conclude  that therefore it will  not  agree.
 In many instances, the effects of a partial
change  of diet show  themselves  so  gradu-
ally, that it is sometimes  only after an in-
terval of a week or two, or  even longer, that
19                CHI

 we can  tell  positively whether benefit will
 result from it or not."
   AVhen the  infant is to be nursed at the
 breast of its mother, it  ought, as above di-
 rected, to be put to it, unless  some cogent
 reason forbids, within six hours after birth,
 and from that time it will require it exery
 three or four hours for the first few months.
 It may be requisite, either from weakness of
 the child, or some other cause, (see Breast,)
 to have  the  nipple drawn  out either by a
 stronger or  older infant, or by some other
 means.  Should the mother not be able to
 nurse  her infant entirely, the extra feeding
 must be conducted upon the rules laid down
 for bringing  up by hand.
   The first few weeks of an infant's life are
 spent  principally in sleeping and taking
 nourishment;  movement is but  little in-
 dulged in, and consequently the  power of
 sustaining the animal  temperature is but
 slight; for this reason  care is always re-
 quisite that sufficient  heat be preserved,
 both of clothing and of situation, during the
 day,  and by the  infant sleeping with  its
 mother or nurse during the night, for the
 first few weeks of its life at least.   Equally
 important with temperature, nay, even more
 so, is the purity of the atmosphere which a
 young child breathes; errors in this respect
 have  led to the  most  deplorable loss of
 infant life.   One instance is  sufficient to
 illustrate the point: it is  the well-known
 one of the Lying-in Hospital of Dublin, in
 which, at one period, one child out of every
 six died within  the first fortnight of exist-
 ence ;  but by the adoption of proper means
 of ventilation, this very great mortality was
 at once reduced to one death for every nine-
 teen or twenty children born.   It is unne-
 cessary here  to repeat what has been said
 in the  article, " Bed-room," upon the means
 of ventilation,  &c, and  to  that article the
 reader is referred.   The cradle or bassinet
 in which an  infant  sleeps  should  not be
 smothered up with curtains; and  it is bet-
 ter, for some time at least, without sheets,
 light blankets only being used.
   The mattress should  be hair if possible;
 but where economy is requisite, cotton-wool
 will answer the purpose; it should be pro-
 tected from  wet by means  of waterproof
 material of some kind.  A pillow too large
 and soft is not advisable, for, by allowing the
 head to sink into it, an injurious amount
 of heat and  perspiration is promoted, and
 the child rendered susceptible  of cold when
 taken up.  The skin  of  an  infant requires
 the most scrupulous care;  by its powerful
 agency it frees the body from matter which
II
£ 
CHI                 HO                CHI
must  be n-ixious if retained,  and which is
especially upt to act injuriously upon the
susceptible  infant  nervous system.   The
skin ought to be washed with tepid  water
and  soap,  night and morning, and,  after
each washing, reaction  promoted by gentle
friction with the hand  for  a  few minutes.
Care must  always be taken  that  the  situa-
tion for washing is sufficiently warm, but
not, as  too often the case, before a scorch-
ing fire; draughts  of air are especially to
be guarded  against.   Before leaving this
subject, it  is requisite  to notice the filthy
custom, prevalent among the poor, of allow-
ing the scurf, the  oily secretion, and the
dirt,  to cake upon  the skin  of  the  head,
under the idea that it preserves  from cold.
The habit is not only disgusting, but is pro-
ductive of disease—perfect cleanliness is as
requisite here as elsewhere.
  In  fat children the  creases or folds in
the skin require extra  attention, from the
liability of the opposed surfaces to become
inflamed,  and  to  pour  out  an  irritating
moisture;  dusting with starch-powder, or
the intervention of a  piece  of  soft linen
spread  with  simple cerate, may either of
them  be used as a  remedy.    The portion of
navel-cord which is left attached to the child,
will require attention.  This separates by a
kind  of moist decay; it may come  off en-
tirely by the fourth day, or  take a fortnight
to do so; it must never be hurried.   Gene-
rally, when the navel separates, it leaves the
puckered closing of the skin perfectly com-
plete.   It sometimes, however, occurs, that
bleeding or inflammation and ulceration take
place at the time of separation; such cases
ought at once to be  placed under medical
care.    AVhen actual  bleeding occurs, the
condition is all but  hopeless.   When the
opening at the  navel does  not thoroughly
close  at birth, protrusion of  a portion of
the bowel takes place when the child cries.
This  stote  of things,  apt to occur when the
cord has been of more  than average  thick-
ness,  requires much attention, as the com-
fort and safety of  the individual, especially
of a female, in after life,  may be considerably
interfered with if the malformation is not,
as  it may be, cured in childhood.   The
belly-band,  or binder,  has  of course con-
siderable  power in preventing the protru-
sion through the navel opening: but in these
cases it is  not sufficient; and for the first
few weeks,  one or two graduated compresses,
made of folded litien, should be placed over
the navel underneath the binder; and when
the child is  a month or six weeks old, the
following apparatus must be  used :—From
a cork,  the diameter of  which is about half
as large again  as  that  of  the  protrusion,
a slice the  eighth of an  inch  thick is to be
cut, flatly padded, covered  with  linen, and
affixed  to  two  cross-pieces of plaster by
stitching.   (See  fig. xxxvi.)   The plasters,
Fi,^. xxxvi.
 being warmed before application, are  used
 to retain the padded cork directly over the
 opening of  the  navel; above all the binder
 is applied.   The plasters will probably re-
 quire renewal every few days.   It is better
 to trust to the linen  pads alone, ns long as
 any  tendency to inflammation  of the  skin
 exists,  using at the  same time a plaster of
 simple  cerate or goldbeater's leaf next the
 skin.   Instead  of either linen or cork  pad,
 one of  vulcanized  India-rubber, filled  with
 air, might  be substituted.  The  treatment
 of  navel protrusion, or hernia,  in  infants,
 and  the management of the  apparatus, in-
 volves  some  amount of care and  trouble,
 but not more than  the necessity and im-
 portance of the evil demands for its rectifi-
 cation.    In such cases the infant should be
 kept from  crying by all reasonable means,
 the best preventive being the careful atten-
 tion to  the  rules of health laid down in this
 article.
   Rupture  at the  groin may occur in chil-
 dren at  birth, and may be suspected to
 exist when  unusual fulness  or  swelling is
 observed in this situation ; and if the fulness
 and tension is increased when the child cries,
 the case should at once be seen by a medi-
 cal  man.
   Any  malformation with which an infant
 is born, ought as soon as possible to be sub-
 mitted  to the judgment of the surgeon, so
 that he may have full opportunity of fixing
 the appropriate time for its rectification or
 removal.  The operations for hare-lip, dis-
 torted  joints, such  as  club-feet,  are  now
 performed  at a much earlier period  than
 they used to be formerly.  In the case of
 vascular najvus,   or mother-mark, which
 often increases rapidly from a mere percep-
 tible point  to a large size, surgical interfe-
 rence as early as possible is most important
| These ntevi are composed of  so twick a net- 
                  CHI                1

 work of capillary vessels as to be  almost
 spongy,  and, should they  be accidentally
 wounded, bleed  freely,  and if of any size,
 dangerously;  they vary in colour from
 bright red to purple;  if the finger be pressed
 upon a ns8vus, it becomes emptied of blood,
 and pale; but the instant  the  pressure is
 removed  the blood,  and consequently  the
 colour, instantly return.  There  are various
 methods employed for their removal;  but
 the one used in each case must depend upon
 the surgeon.    A simple, painless, and fre-
 quently  successful mode of cure,  is vacci-
 nating upon the  nsevus,  which  is cured by
 the inflammation which takes place in  the
 progress  of the  cow-pox.  The  possibility
'of this being  done is an additional  reason
 why the disease should be seen  as early as
 possible by a medical  man.  The continued
 use of the compound tincture of iodine to a
 naevus, the surface being painted over with
 it night and morning, will, sometimes, ifper-
 severingly adhered to, be successful in remov-
 ing it; the  application being intermitted for
 a few days  should the skin become sore.
   Tongue-tying in infants  is not  uncom-
 mon ; it depends on too great prolongation
 of the "fraenum," or bridle which retains
 the tongue in place.   It is easily rectified
 by a snip  of  the surgeon's blunt-pointed
 scissors.
   The time at which an infant may first be
 taken out of doors after birth must depend,
 of course, greatly upon  the time of year;  in
 fine warm summer weather, in  the  course
 of ten days or a fortnight, it will be  safe to
 make the change ; in winter it can scarcely
 be prudent to do so for a month or six weeks,
 and then only on a fine  day.  In either case,
 free exposure  in  the house  should  first be
 practised, the first airing should  not  extend
 longer than twenty minutes, and the eyes,
 especially at first, must be shaded from  the
 glare of  the sunlight: of course, either  the
 chill  of  morning or  the damp  of evening
 must be avoided.  A young infant  should
 not be taken out  during the prevalence of
 an east wind.
   The principal  ailments,  likely to  come
 under  domestic management, to which  in-
 fants are liable, are thrush, red gum, colicky
 pains in  the bowels,  and diarrhoea.  For
the first—thrush—the  reader  is referred
to the article " Aphtha."  Red gum is a mild
species of  "papular"  eruption, to  which
many children are subject soon after birth.
It is quite devoid of danger, and requires
no  treatment if the  bowels  are in  good
order; if not, a  dose  or two of castor-oil
may be  given.   The  usual friction  after
washing must be  moderate during its con- |
LI                CHI

 tinuance.   Inflammatory  swelling  of the
 breasts in infants  is not unfrequent.—See
 Breast.  Most infants are troubled, more or
 less,  with wind, or  colicky  pains  in the
 bowels, and not unfrequently with diarrhoea,
 but these are much aggravated by errors in
 feeding  so universally prevalent,  particu-
 larly among the poorer classes : sometimes,
 when  the child  is nursed entirely at the
 breast, particularly of a wet-nurse, they arc
 caused by the nurse's transgressions in diet.
 Attention  to the  rules already laid  down
 under the head of  feeding will greatly pre-
 vent the above ailments ;  but when they do
 occur they must be rectified as simply as
 possible,  but never by the dangerous and
 baneful  quack carminatives so  extensively
 sold and used.   Pain and wind in the bow-
 els  in children  are  generally  connected
 with   superabundant  acidity; for  the cor-
 rection of the cause  and its  consequences,
 either of the two following mixtures may
 be used moderately, both with safety and
 good effect.  No. 1.—Take of calcined mag-
 nesia  twelve grains,  dill  [or  anise-seed]
 water one ounce  and a half.   No. 2 —Take
 of prepared  chalk ten grains,  dill-water
 one ounce and  a  half.   Of either of the
 above mixtures, a small teaspoonful may be
 given, and repeated if requisite.  The first,
 No. 1, is  to  be selected, should the bowels
 be at all confined;  the second, No. 2, should
 they be too relaxed.  It is not recommended
 that  either of these  medicines, simple as
 they are, or any  others, are to be  given too
 freely to infants, and on every slight occa-
 sion;  but it is better  to give them than to
 allow  a child to suffer;  they, or something
 similar,  ought to be the substitutes  in  every
 nursery for the secret quack nostrums.  It is
 true  they will not either as quickly stop
 pain  or put a child to sleep as mixtures
 which contain opium or poppy syrup; but
 they cannot, like them, either put it into its
 last long  sleep by an overdose, or injure
 not less fatally, when frequently used, even
 in small doses, by gradually disordering the
 brain and nervous system.   When either of
 tHe mixtures above recommended are given
 to children,  or indeed  whenever magnesia
 or  chalk is  given  habitually, it is  always
 prudent to j,-ive an occasional dose of castor-
 oil, as cases have occurred in which concre-
 tions  of the above antacids have accumulat-
 ed in  the intestines.   The dose of castor-oil
 for a young infant may be from ten drops to
 half a teaspoonful.   In cases of diarrhoea,
 should the affection be slight, and the infant
 be a hand-nursed one, the  addition of isin-
 glass  to  the  milk food  will, in most cases,
 stop the tendency  at  once, particularly if
1 
f'H I
111)
C  H I
assisted by a  few doses of mixture  No. 2,
and by a warm bath for five or six minutes,
at a temperature of '■ ^°. regulated by a ther-
mometer.   Should the  affection  be  more
severe, the emulsion of  castor-oil with yolk
of egg (see Castor-oil) must  be given.   To
one ounce and a half of the emulsion, made
with a teaspoonful or drachm of castor-oil,
two drops of laudanum are to be adyded, and
one teaspoonful, or twelfth part, given once
in six hours.   And here the opportunity is
taken  to  warn the reader  respecting  the
administration of opiates to children.  They
are most susceptible of  the influence of  the
drug, and accidents are continually occur-
ring—more frequently  perhaps than comes
to light—from its  effects: a single drop of
laudanum has been known to prove fatal to
a young infant.   The above  treatment is
given,  not as  an   inducement for parents,
who  can readily  procure medical  aid,  to
take the  treatment of their  children, when
ill, into their own hands, but it is because it
may be of service in situations when  skilled
assistance is not readily procurable.  Many
of the diseases of children commence  in-
sidiously,  but  after  attaining  a  certain
Btage, run their course rapidly.   No parent,
therefore, who either  values his child's  life
or his own peace of mind, should delay pro-
curing medical assistance when real illness
shows itself; but at the  same time, the very
same  reason  ought to  induce every  parent
to inform himself upon the  nature  of  the
symptoms which  most  generally usher in
real  illness in children, and  also how and
by  what  means  the   illness  which  these
symptoms indicate is  to be most effectually
retarded and  obviated.   More upon  this
head  will be  given when the diseases  of
childhood generally  are  touched  upon.
Within the first five months of an infant's life,
vaccination ought to be  performed, that  is,
before the constitution is  liable to suffer
from the irritation of  teething.—See Vacci-
nation
  The period of teething varies extremely,
and not less so in the  manner in which it
affects children.   For information upon  the
mode in which the teeth are developed,  the
reader is  referred to  the article " Teeth."
Some children cut the  two  front  teeth  of
the lower jaw—which always  appear first
 -as early as  the fourth or fifth  month,
while  others, apparently  equally strong,
do not  have  them developed  within  the
year.    The usual and popularly received
sign of  approaching tooth-cutting is water-
ing of the mouth; but this  may continue
for many weeks  before the  teeth  appear.
Before the teeth  come  through, the gums
flatten on  the top, look semi-transparent
and  full,  and  are  sometimes  extremely
swelled and inflamed.   The constitution of
the child always  sympathizes more or less
with the cutting of the teeth—most simply
and beneficially so by the occurrence of mild
diarrhoea, which  is always—unless it goes
to an  undue extent—a  safeguard,  and is
better not interfered with.   When the gums
ore much swollen and  inflamed, and must
be very painful,  the susceptible  brain and
nervous system of the child is strongly and
injuriously affected by the irritation.  The
little  sufferer is  fevered,  flushed  in  the
cheeks, and  peevish;  sleep  is  disturbed
with moaning and starting, and the fingers
are constantly in the  mouth, or the lower'
jaw is moved from side to side.   In such
cases,  lancing the  gums thoroughly,  warm
baths, and aperients if the bowels are  not
relaxed, are the remedies, the first especially,
without which the  others are useless  or
nearly so.   The  popular idea,  that lancing
the  gums  is  beneficial, by assisting  the
passage of the teeth through them, is quite
erroneous,  and may lead to an  erroneous
method of  performing  this   simple little
operation, which  every  parent  who lives at
a distance from medical assistance, and par-
ticularly in emigrant life, ought to know
how to do.   The real benefit is derived from
the relief which  the incisions afford  to the
tense  and   distended gum,  and from  the
slight  flow of blood which follows;  and on
this account it is advisable, not only to cut
the upper surface, but also the side of the
gum, so as to divide the vessels  freely.  The
operation is most conveniently and  safely
done by a " gum  lancet" made for the pur-
pose, (see fig. xxxvii.,) but a  common pen-

                 Fig, xxxvii.
knife  may be  employed on emergency,  the
blade being wrapped with a piece of linen,
to within a short  distance of the point, to
prevent any chance cut to the lips.  It is
superfluous  to describe this simple proceed-
ing: it should be seen done ovce, or at least
the method shown.  It is not recommended,
of course, that the gums are to  be lanced
for every slight  irritation of teething;  but
when the child  exhibits the  graver symp-
toms above  described, it ought to be done at
once, and, if requisite, repeated  again  and
again.  In addition to lancing the gums, a
warm  bath for  ten minutes will be founfl 
CHI
113
C H I
 eminently  serviceable in soothing the irri-
 tated system, and aperients should be given—
 a couple of grains of gray powder at night,
 followed by a  small  teaspoonful of castor-
 oil in the morning ; or if stronger action be
 thought requisite, a powder composed of
 one  grain of calomel to two  of powdered
 scammony is  to be given at bedtime to a
 child of six or eight months old.   If the
 irritation  attendant  on  teething produces
 convulsion, medical aid must be had as soon
 as possible, and,  in  the mean time,  those
 remedies employed which are suitable.—See
 Convulsion.
  In judging of the diseases of children, it
 ought to be borne in  mind that the pulse of
 an  infant  is always quick,  averaging from
 120  to 130 in  the minute, and  that at the
 end  of the first year its average is still con-
 siderably above 100.—See Pulse.
   The  regulation  of  the exercise of young
 children  is of  much  importance.  At first
 the mere respiratory  movements, occasional
 crying, and the effort of sucking, are exer-
 cise  sufficient,  if gentle nursing movements
 be  employed :  but gentle they  must be;
 the  system so often  adopted  of jerking
 infants about  is  much  to be condemned,
 and  may  be   extremely hurtful.   In the
 course of a few weeks after birth, the infant
 begins to show signs of increased power of
 movement, and evidently experiences phy-
 sical pleasure  in  the exercise of its  limbs.
 As time  goes on, its next effort is to sit up
 in the  nurse's arms, till,  if a vigorous
 healthy  child,  at about fourteen months,
 it generally tries to walk.  All these move-
 ments will come spontaneously to the child,
 when its frame and  muscular powers are
 adequate to the exertion, but they should
 never be forced.  It is astonishing what  an
 amount of practical ignorance prevails  on
 the above  point; children are put to sit in
 chairs, held upon their  feet, or  put in go-
 carts of various construction, long  before
 the bones  are  fit  to  bear  the weight—and
 curved  spines  and distorted legs are the
 consequences.   Again it is repeated, every
 advance of the child toward walking and
 the upright posture can only be safe when
 spontaneous.   AVhen a child first commences
 to walk it must get  falls,  but  it is sur-
 prising how little material injury the head,
 which  most  generally  suffers,   seems  to
receive.  At the same time, in families in
which  a tendency to  head affection exists,
extra care  must be taken; a padded band
round the head is a useful protection, and
one frequently  employed.
  AVhen a child begins to walk, and  to at-
tempt to talk, the period of infancy may be
       k 2                                i
considered as ended, and childhood begun
Many  of the  directions  applicable  to  the
former are equally so, in a modified degree,
to the latter,  and vice versQ,; but "child-
hood" requires further remark.   When  dis-
tinct nursing is no longer requisite, the child
becomes more truly  the  inhabitant of the
nursery, and  much  of its health and hap-
piness  for the  next few years of  its  life
will depend upon the proper regulation of
this important department of the household.
  Whatever is said respecting the necessity
for pure air and proper ventilation, either
in this article  or  in any other, such  as
"Bed-room,"  applies of course to the nur-
sery, or rather nurseries ; for every parent,
whose  means  will admit, should  provide a
night and a day nursery for his children,
in neither of which should such operations
as washing clothes,  cooking, &c. &c. ever
be carried on.   The double room will allow
all  necessary airings, washings of floors,
&c.  to be  perfectly carried out  without
the health or comfort of the  children being
interfered  with.  Should  one nursery only
be available, the children should be  taken
out of it in the morning as soon as possible
after rising, the windows thrown wide open,
and all necessary cleaning performed before
they again enter it;  and, both now, and at
every period of the  day, all kinds of slops
should be removed.    Should  any action of
the bowels take place during  the night,
the receptacle  should be put  out of  the
room at once.   The observations respecting
the sanitary regulation of the nursery  are
more  particularly applicable in the case
of the  middle classes, who want the  abun-
dant accommodation of the wealthy,  and
whose  children, in towns  at least,  do  not
have the  same free  access to the open air
as those of their poorer  neighbours.   The
situation of a nursery in the house is import-
ant ; it must,  if possible,  be in the upper
stories, it should have a south aspect,  and
be  abundantly  supplied  with light:  the
latter  is  a most necessary consideration.
A guarded open fire-place is the best means
of warmth,  and the heat,  regulated by a
thermometer, should  be kept as near 60° as
possible.
  But  however  salubrious the nursery ar-
rangements, children must  have as much
open air as possible ;  and when the exercise
can be taken as play, in  summer, upon the
grass, or otherwise, it is  certainly the most
beneficial.   When weather and  other con-
siderations forbid, and walking is  had re-
course  to, it must not go to the extent of
real fatigue.   At all  times it adds much to
the beneficiul effect of exercise, if the mind 
                 CHI                1

ne  engaged  pleasurably in it, and there-
fore all active plays, either in doors or out,
are preferable to the mere walk,  which few
children enjoy.   The  clothing during the
whole  period of childhood, in a changeable
climate, requires much attention ;  woollen
textures next the skin, both winter and  sum-
mer, is indispensable  for  health.  During
the former season, it should cover the chest
and  abdomen, and come at least  halfway
down the thighs ;  but in the latter, it may
be a lighter material, and not  extend so far
over the chest.   Woollen stockings extend-
ing over the knees ought always to  be  worn
in winter; and at all times should  the entire
clothing  be such as will keep the  surface
of the skin comfortably warm.  There  is no
greater or more fatal error than that which
exposes children  lightly clad to the influences
of a variable climate, with the view  of hard-
ening them.
  Thorough  purification  of the skin  must
be maintained.   A child  should be  washed
all over with soap and water at least  once
a day.   In the case of strong children the
water  may  be cold, in the weaker, tepid,
and  in both friction with a tolerably rough
towel should be used after the bath, both to
cleanse and to promote reaction.  If a  child
continues chilled and  cold-looking,  and ap-
pears languid after a cold bath, it is a sign
it does  not agree, and the temperature  of
the  water should be  raised, or the washing
Bhould  first be performed  in  tepid  water:
and then just at the last, a little cold water
dashed over the body.
  The food in childhood claims  care, equally
with air, clothing, exercise, and cleanliness ;
its regulation in infancy has already  been
sufficiently  noticed.    For strong  healthy
children, particularly those inclined to full
or gross habits,  the milk and farinaceous
diet, such as rice, sago,  bread, &c. cannot
be exchanged for a better, for the first  four-
teen months at  least; but  if  children are
delicate, and incline to the  lymphatic  con-
stitution, the use of animal broths ought to
be commenced even as  early as  the  sixth
month.   The broth made from fowl,  mut-
ton, beef, or veal, should not be too strong,
should  be   free from  fat,  and  is better
thickened with  arrow-root  or sago for  a
young  child, or with rice or bread crumb
for  an  older one.   Toward   the  twelfth
month, a lightly boiled egg may  be given ;
but the best method of giving the powerful
nutriment  of egg to children is to break
the raw egg into  some one  of the  milk
preparations, while the latter is  quite hot,
and  to beat  up together.   In  this  way,
the albumen is  sufficiently cooked  but not
                  C II  I

hardened.   AVhen the teeth of a  child are
sufficiently  advanced to masticate it,  ani-
mal  food  in the solid  form may be given,
but  the quantity  and frequency  must en-
tirely  depend upon  the constitution of the
child.   Strong ruddy children  are  better
with it only twice  or three times a week,
weaker children  should have it once a day
at least, and in the more  advanced  stages
of childhood, perhaps twice;  but this is a
point which should  be settled by a medico!
adviser.   Potatoes,  and  the  more  whole-
some vegetables, ripe fruits in their season,
may all be allowed  to children,  in modera-
tion, after  the first eighteen months, and
particularly should there be a tendency to
costiveness,  or to  eruptions on the skin, and
other affections depending  upon gross habit
of body ; weaker children may also partake
of them, but more moderately, and provided
they do not become substituted  for more
indispensably nourishing  food.   Children
at any  age are better without baked pastry
of any kind, but boiled paste puddings are
not unwholesome ; cheese, and all sorts of
spiced  and seasoned  dishes, are quite objec-
tionable.   A healthy child  should  never
have an alcoholic stimulant within its lips;
and tea or coffee, if allowed, should be very
weak, and made with much milk:  but there
are  some  delicate  children,  nay  infants,
who may derive much benefit from a portion
of alcoholic stimulant, carefully given  as
medicine,  and  as  medicine  requiring so
much care and consideration, that it should
only be employed when and as  advised by
a  medical man.   Children should  not be
made to wait long  without some nourish-
ment in the morning:  the rapid  changes
which  go  on in their systems render them
peculiarly sensitive to any, even temporary,
want of nourishment.   Regularity in meals
is important even from  the earliest  period
of existence;  it  is  always advisable that
the principal meal be taken early in the day.
   Physical training,  however, and the closest
attention  to physical regulations, require
the addition of mental training to carry out
thoroughly even  the physical education of
a child.   For the infant a cheerful nurse
is most valuable.  As childhood advances,
whatever  may depress  or frighten ought
especially to be  guarded  against, and all
threats or practices  which excite undefined
terror  especially avoided.  Affection  of the
brain may be the  result.   Undue precocity
in a child should always be regarded, if not
with alarm, at least with suspicion.  Many
scrofulous children are unusually precocious;
and  as a general rule in such instances, the
brain is more prone to disease, which  may
14 
C II I
115
CHI
 end life, or predispose to mental  affection.
 In such cases it is of the highest importance
 not only to avoid every  thing which  can
 stimulate to mental effort, but  to  excite
 them to such moderate and regular physical
 exertion as will in  some  degree  draw off
 from the brain itself both  the  activity of
 the circulation  and the nervous energy.
   There are  some diseases which  are more
 particularly considered as  those  of child-
 hood ;  such are   measles,  hooping-cough,
 scarlet fever, small-pox at times, and chick-
 en-pox ; not that they do not occur  in adults,
 but being  most generally passed through
 only once, it is  in  the  earlier years of  life.
 In addition to the  above, such affections of
 the brain as acute inflammation ending in
 effusion of  water, convulsive disease, croup,
 inflammation of the lungs, and diarrhoea,
 are the  most common  acute affections of
 children.   They and other diseases may be
 referred to  under  their   proper  heads.
 Children quickly exhibit the general  symp-
 toms of illness, but  it often requires  much
 more tact and  discrimination to  make out
 its exact seat and nature than it does in the
 case of  adults;  it  is, therefore, always de-
 sirable to place them under proper medical
 care as quickly as possible.  At  the same
 time, the following ought to be some  guide
 as to the site  of the affection,  and to its
 provisional treatment.
   When in a child complaining of illness,
 or appearing ill, the eyes look heavy,  and
 are wholly  or partially closed against the
 light, if the brow is  contracted, and if with
 these symptoms there is general fever, some
 acute.affection of the head is to be dreaded,
 and the indications should not be neglected
 for an hour ;  if sickness is present with the
 above, so much  the worse. Oppression of the
 breathing, along with general appearance of
 depression, is often the forerunner  of severe
 inflammatory affection of the chest,  which
 may be considered as established, if heat of
 skin, general fever, rapid  breathing,  and
 cough succeed.   In  the chest affections of
 children, the  movements of  the nostrils are
 much  affected.   Constipation, which  can
 scarcely be classed as  a  disease, is almost
 natural to some children, but requires cor-
 rection,  and this should be effected if possi-
 ble by food.  Coarse bread should always be
 employed, and fruits, either cooked or ripe,
 such as roasted apples, given in moderation;
 honey or treacle are useful, but  nothing is
more so than the daily useof pprridge made
from Scotch or other oatmeal.  AVhen the ten-
dency to constipation in children cannot be
overcome by diet, the next best remedy is
the use  of a small  enema  of gruel simply,
 or medicated with  castor-oil, senn?,, or anj
 simple aperient, or made with soap-water,
 but  the simple gruel ought always to be
 tried first.   Dr.  Marshall  Hall considers,
 that in children especially, the use of warm
 enemas exerts  a peculiarly  beneficial effect
 in stimulating  the  liver.  An  enema for a
 child of six  years old should not  exceed
 twelve ounces, and  ought to  be administered
 slowly.   When medicine  must be given, as
 general aperients,  castor-oil or infusion of
 senna are most useful:  caution must, how-
 ever, be exerted in forcing  the former  me-
 dicine (as sometimes must  be  the case)
 upon very young children ;  death has been
 occasioned from its getting  into the wind-
 pipe.  Rhubarb  is a most excellent  and
 safe aperient for children, but its bulk  and
 nauseousness frequently make it difficult to
 get  it taken satisfactorily  ;   magnesia is
 easily given  in milk, and  may be  useful
 either in the  solid or  fluid  form  where
 active effects  are  not required, but  the
 former especially ought not to be long con-
 tinued.   Calomel and  gray  powder,  alone,
 are  too much  employed for their aperient
 action;  they should not be  administered
 except under medical sanction.
  As a general rule, in giving medicine to
 children, deception  should not be practised;
 but while the child knows that it is medi-
 cine which it takes, it ought to have  it in as
 palatable a form as may be, without inter-
 fering with the efficacy of the drug.
  Refer  to  Bed-room—Breast—Clothing—
 Diet—Electricity—Exercise—Milk—Rupture—
 Skin — Teeth— Vaccination— Ventilation—and
 to the articles on diseases and medicines gene-
 rally.
  CHILBLAIN.—A chilblain  is an  inflam-
 matory affection of the skin, more particu-
 larly of the fingers  or toes, caused by alter-
 nations of cold and heat, and is characterized
 rather by irritating and troublesome  itching
 than by pain.  Persons of fine skin,  scrofu-
 lous constitution, or languid circulation  are
 most liable to suffer from chilblains, and old
 people and children more than those of mid-
 dle life.  The sudden exposure of the skin
 when very cold to a high  temperature is
 generally  and  justly considered to  be an
 exciting  cause  of  the  affection; but  one
 quite as frequent is keeping the  surface in
 a state  of  artificial warmth  by the use of
 sleeping-socks and  hot applications in bed,
 or of fur-lined shoes and foot-warmers in the
 day time.   All  these applications keep the
skin  in a continual  state of  unnatural per-
spiration, weaken its tone, and so render it
more susceptible of the effects  of cold when
exposed to ii.  To prevent chilblains, in the 
C II 1                 110                C II L
predisposed, the feet ought to be regularly
bathed with cold, or,(in the case of the aged,)
tepid water,  or  salt water, every morning,
and  afterward well rubbed with a rough
towel, exercise being employed to preserve
the warmth of the extremities rather than ar-
tificial heat.   When chilblains have formed
and the skin is unbroken, stimulating appli-
cations are requisite; many different ones are
used; spirit,  such  as brandy, camphorated
spirit, paregoric, or  turpentine, will any of
them  be of service, applied by means  of a
piece of  linen, or gently rubbed on.  When
the skin of a chilblain breaks, an ulcer is the
consequence,  which discharges a thin  slimy
fluid, and is often  difficult to heal.  In this
case,  the inflammation should  be subdued
in the first place by means of a poultice, and
afterward an ointment used, made either
with forty drops of  Goulard, or ten grains
of red precipitate,  to the ounce of lard.  Of
course all friction  or pressure from boots or
shoes must be guarded against.
  CHIMNEY.—A chimney, by intention the
channel through which  the smoke and fumes
of fire  are conveyed  away, also performs
the no less  important  but slightly (until
of late)  estimated office of a vensilator.—
In former times, when  the chimney formed
almost a separate chamber, in which  per-
sons sat round the  fire, or  indeed as long as
it retained its ample dimensions, the people
enjoyed  an  efficient means of ventilation,
although in ignorance  of the benefit.   By
change  of fashion, the chimney  has been
gradually contracted and lowered to the mo-
del of the present modern fire-place.  While
this has been done, from ignorance of the
necessity for pure air, no provision has been
made to supply the loss of the efficient ven-
tilating power of the old-fashioned construc-
tion, and health must consequently have
suffered and does suffer materially from the
omission; although it is to be hoped that the
diffusion of popular knowledge  upon this
and other points of sanitary regulation will
not allow such to be the case much longer.
The chimney, however,  is a notable instance
of society enjoying ignorantly an  arrange-
ment  conducive to health;  and that  igno-
rance,  while  making alterations more con-
sistent with comfort and convenience, doing
away with one great advantage, of which it
remains for science to point out both the loss
and the means of reparation.  As whatever
goes up, or ought to go up, the chimney, are
vapours  and  gases  which  cannot remain
down without injury to health, it is a matter
of importance that the chimneys of a house
draw well—more  especially those  of  bed-
rooms in which fire is used.   As a means of
ventilation simply, independent of the fire, the
importance  of a  chimney is so great, that
rooms in this climate which are destitute of
one cannot be considered  healthy, although
it must  be  confessed that this  secondary
office appended to the original .intention is
rather a  clumsy method of effecting so im-
portant an end. It is one, however, of which
it is requisite to make the most, and there-
fore chimneys ought to have a thorough
draught for smoke, ought never to be stopped
up when not in use, unless other means of
efficient ventilation are possessed, and, when
possible, should be fitted with some efficient
mechanical contrivance for  increasing their
ventilating  power.—See Bed-room,  Ventila-
tion, $c.
  CHIN-COUGH.—See Hoopino-Cough.
  CHLORINE—Is a gas of  a  green colour
It is an  important  agent  in manufactures,
on account of its  bleaching  properties; and
its powers as a disinfectant, or destroyer of
the noxious emanations from  decomposing
bodies, whether vegetable  or animal, render
it a most valuable assistant in sanitary ar-
rangements.   AVhen undiluted, it exerts an
extremely irritating effect upon the lining
membrane of the respiratory organs; and as
serious and even fatal accidents have occur-
red from this cause, caution is requisite in
its use.   A small  proportion of chrorine gaa
diffused through the atmosphere, very quick-
ly and  thoroughly  destroys  not only the
smell, but the injurious properties of float-
ing emanations, which are capable of engen
dering disease.   Chlorine  gas is obtained
in various ways, but the great magazine for
its supply is common salt, which is composed
of chlorine and sodium.  For sanitary pur-
poses,  various preparations  calculated to
yield chlorine simply and  easily have been
used; of  these the chloride of lime is the
best known.  This and most of the prepara-
tions, however, have the  disadvantage of,
when alone, yielding the gas too slowly and
sparingly to be of much service, and, when
mixed with  an acid, of pouring it out in
quantity so great as to affect disagreeably or
injuriously any persons exposed to its influ-
ence,  particularly the sick.  Other prepara-
tions  require sprinkling about the place to
be purified;  and as this  is often  done in
ignorance of its  colour-destroying  powers,
much damage is  done to furniture, &c.  A
late preparation—Collins's disinfecting pow-
der—seems to be  free from the above objec-
tions ; when a portion of it is exposed to the
atmosphere, it keeps up a certain but suffi-
cient  exhalation of chlorine for some days,
as it continues to  absorb moisture.   It is the
best, most effective, and agreeable method 
OHL
117
CHL
for employing chlorine in the chambers of the
sick which the author has met with.  In no
case of continued sickness,  whether of an in-
fectious character or not, ought chlorine
fumigation to be neglected.
   The principal preparations used in medi-
cine into the composition of which chlorine
enters are chloride of sodium or common salt,
(see Soda,) chlorate of potass, (see Potassa,)
chloride of zinc, (see Zinc,) and hydro-chloric
acid.  Hydro-chloric acid is a gaseous com-
pound of chlorine with hydrogen gas, but is
usually met with in solution of a yellow co-
lour, when  it  is generally called  muriatic
acid or spirit of salt.  It is of course a pow-
erful corrosive poison when swallowed alone;
its antidotes are the carbonates of potassa,
chalk, or magnesia in any form, or milk, or
white of egg, whichever is first at hand,  un-
til the antacids are procured.  In  the  ab-
sence of any of these, soap-water may be
given ; but, in  poisoning with any  acid, it
should be remembered that mortar or white-
wash, rubbed  up finely with water or milk,
may be used on emergency as an  antidote;
the lime neutralizing the acid.  Of course
the  other antacids, particularly magnesia,
are to  be employed if procurable at once.
Of the  latter,  a dessertspoonful  may be
given  every ten minutes, and repeated  ac-
cording to the effect and  probable  amount
of acid swallowed.
   Muriatic acid is used  in medicine as an
unstimulating tonic, particularly in diseases
such  as malignant scarlatina, which are ac-
companied with tendency to putrescency; it
is also used  as a  mouth-wash  or gargle in
the same disease.   Muriatic acid is given in
doses often drops, in  a wineglassful  of wa-
ter sweetened with sugar ;  or it may, if pre-
ferred, be taken much more largely diluted,
and then forms a pleasant drink.   It may be
used  as a gargle, in the proportion  of two
drachms to the pint of water.   As  in  the
case  of  acids generally,  unless largely di-
luted, the doses should be sucked through a
quill  or glass  tube, to preserve  the teeth
from corrosion; and  it is likewise a useful
precaution,  for the  same  purpose, to rinse
the mouth with a diluted solution of carbon-
ate of soda.   In the absence of means  for
procuring chlorine, if fumigation is required,
muriatic acid  gas may be  used as a substi-
tute,  as it is disengaged  by  mixing equal
weights of common salt and oil of vitriol,
(sulphuric  acid,) care being taken  against
inhaling its  irritating  fumes in too concen-
trated a state.
  CHLOROFORM—Is a fluid; it is transpa-
rent,  heavy,  colourless,  and  possesses  an
agreeable etherial smell.   Its power of pro-
ducing  "anaesthesia,"  or insensibility ti
pain, when  inhaled, is now too  universally
known to  require comment..  It is, however,
too potent an agent to be trusted in unpro-
fessional  hands, except, indeed, under di-
rect medical sanction and direction in each
particular case.  In  the more painful and
larger operations  of surgery it is one of
the greatest boons conferred upon suffering
humanity, and its use tends to diminish the
average mortality after them.   In the case
of minor operations, however, such as tooth-
drawing,  it  becomes a question whether its
employment is advisable.   Fatal cases have
followed its inhalation ; and although these
have been  in  very small  proportion  com-
pared with the numbers in which it is daily
and hourly administered,  still the fact of
their having occurred is  sufficient to make
us pause before incurring  even  the remote
chance  of so  serious a result, for the  sake
of avoiding a momentary though  sharp pain,
[especially when ether is as good an anaes-
thetic, and is perfectly safe in the hands of
a medical man.]  In  some cases very  disa-
greeable effects, such  as headache, sickness,
hysteria, &c. &c. have succeeded the use of
chloroform.   No one should, therefore, ever
be  tempted to inhale this agent, without
being certain beforehand that no tendency
to organic disease  exists,  especially of the
heart or lungs.
  Although not suited for domestic use as
inhaled, chloroform may be employed  with
perfect  safety and  much  advantage as an
external application in painful affections, of
the nerves especially, such as neuralgia and
toothache.  For this purpose  a piece of
linen or lint, of a size proportioned to the
part affected, is to be soaked in the fluid, ap-
plied to the skin, and then covered with some
material, such as oiled silk, to prevent quick
evaporation.  It destroys the silk; and in
the course of a few seconds produces an in-
tense but scarcely disagreeable burning sen-
sation, which continues until the fluid is all
dispersed.  In  many cases  the  neuralgic
pain disappears at  once.   AVhen the cover-
ing is removed, the  portion of skin to which
the chloroform has been  applied is found
much reddened, sometimes slightly blistered.
A  small portion of  cotton wool soaked in
chloroform will, if placed in the cavity, some-
times allay  the pain of toothache.   Chlo
roform,  taken  into  the stomach, has  been
found useful in spasmodic diseases, as asth-
ma,  hysteria,  &c.  and  might be adminis-
tered, in the absence of other remedies, in
doses of from six to ten drops, along with a
teaspoonful  of brandy in three tablespoon-
fuls of water. 
C II L
118
C HO
   CHLOROSIS—See Anemia.
   CHOCOLATE —See Cocoa.
   CHOKE-DAMP.—See Carhontc Acid.
   CHOLERA—Asiatic or  Malignant.—
The modern pestilence which first visited
England in the year 1832, and again in 1849,
in which latter visitation it carried off, in
London alone, 15,000 people, and in the en-
tire kingdom,  not less perhaps than 8O,o()0.
At present, we know  the disease but in its
symptoms;  its true nature  and seat, not-
withstanding  numerous investigations  and
hypotheses, are still  undetermined, and as
regards the best mode of treatment there is
nearly equal uncertainty.   Happily, such is
not the case with respect to those conditions
of body, and still  more with respect to the
external circumstances,  which  favour  the
attacks of the scourge and foster it into
activity.   Dirt, bad  air, bad water,  bad
food, insufficient clothing, and irregular and
vicious habits, are all the favourers of cho-
lera;  and were it not for these,  singly or
combined, it would, in all probability, pass
comparatively lightly over  our  land.   AVe
know not how, in future times, the Almighty
may order the mysterious agency of Asiatic
cholera to fulfil his own good purposes; but
we have every reason to calculate, that by
a more diligent observance of those organic
laws with which he has linked our material
existence, we  may be enabled to break the
force  of another,  it may be more fearful
visitation than the last.   If the compara-
tively healthy  homes,  the habits of cleanli-
ness, the sufficient food and clothing of the
higher classes have hitherto protected them
from the sweeping virulence of the disease,
as it has been shown  in the less  advantage-
ously  placed families of the poor, it gives
confidence to suppose that  the elevation of
the sanitary status of the whole mass of the
people will have an equally good effect.   It
is not supposition—it is certainty—that such
would be the case; certainty, that, whatever
the virulence  or the  mildness of  the  next
visitation of Asiatic cholera, the  suffering
will be proportionally commensurate  with
the sanitary condition of the people when
it  comes.  And yet  this was equally well
known  after the warning of  1832  as  it is
now; and, after a respite of seventeen years,
the pestilence  came again and found us un-
prej ared  as regards our  own  safety,  but
prepared to nourish  and  foster its myste-
rious  germs in  the  l'u-tid,  stagnant air of
city, town,  and village, unventilated  and
undrained,  half supplied  in water or not
supplied at all, or tainted  with  decomposi-
tion of every kind, from  human excrement
upward; and  such will be  the case again,
 unless the people themselves stir—and to
 them  this is addressed.  Governments cer-
 tainly may do much, vastly more than they
1 now do. but they cannot do all; the people
 themselves must be fully awakened to the
 necessity of observing the laws of  health,
 now so well ascertained—awakened to  the
 sin  before  God  of neglecting  them.  The
 teachers  of the  people,  and  especially the
 clergy nnd the higher orders, must be more
 conversant with  the laws which regulate the
 existence, and on which  depend the health
 of their own bodies and of those of their
 less favoured brethren—must be able to de-
 tect and point out those sanitary deficiencies
 which  must so often come before them, and
 which they have  it in their power to rectify.
 While  resignation  to the will  of God is re-
 quired from  all, surely it is not true resig-
 nation, but sinful ignorance and apathy, to
 submit the mind, while  the cause remains,
 to the  loss of husband or child carried  off
 by cholera or by  fever, generated  by the
 unhealthy habitation or  the stagnant pool.
 For, whether  it  be cholera or fever—and
 they both inhabit  the  same  localities—or
 the  slow undermining of the health, or scro-
 fula, or consumption,  they are  too often
 looked upon as the direct visitations of God,
 when  they  are due to the sinful neglect of
 those laws with  which he has connected the
 health and  soundness of  our material body,
 the healthy and happy working of our minds,
 both for our own good  and that of our fel-
 low-men.  This  may perhaps be  deemed a
 digression  from  the main subject of thia
 article, but the  subject itself  is one which
 arrests men's attention,  and will do so still
 more  should  the pestilence again threaten
 our shores; it has,  therefore,  been seized
 as another opportunity for reiterating  the
 advantage, the necessity, the religious duty
 of-attention to sanitary regulation,  to sup-
 plies of light, pure air,  and pure water in
 abundance; to regular and temperate habits,
 and to their usual attendants  in  this hind,
 good food  and sufficient clothing.   It is a
 privilege to be able to afford relief to sick-
 ness and  suffering in the hour of need—and
 to further  that  end  the  present work is in
 part devoted; but  more important still is
 the  enforcement of  those  measures which
 will, under Providence, ward off  or  modify
 disease.
   The first commencement of Asiatic cholera
 is traced to the year 1817,  when it took iti
 rise in a swampy district  at the mouth of the
 Ganges, from  whence it spread over India
 to various  parts of Asia and  Europe,  and
 finally reached England  in the  year \S'->\.
 where it continued till  the end of 1832,  d.s- 
" C HO
119
CHO
 appeared  for  seventeen  years, and re-ap-
 peared, in a more virulent form than before,
 in the year 1849. [In Canada and the United
 States cholera first appeared in  1832, and
 again in 1850.  It  has also prevailed along
 the Mississippi and other rivers  since that
 period.]   The mode of propagation of cho-
 lera is undetermined;  it exhibits the most
 apparent  capriciousness in  the  course it
 follows ; but one thing is certain,  that those
 unhealthy  external conditions already al-
 luded to, almost, as it were, seem to attract
 the disease.
   The violence of  its symptoms, and  the
 fearful rapidity with which it often termi-
 nates life, render  cholera one of our most
 alarming diseases.   Occasionally, but more
 frequently in  hot climates than in temperate
 ones, persons are, as it were,  prostrated at
 once by the cholera-poison, and die,  perhaps
 within  an hour of the first attack,  without
 any other symptom  than total collapse  of
 the  powers of life.   More  generally  the
 seizure is not so sudden: probably there has
 been slight diarrhoea, or rumbling move-
 ments of the bowels, with sinking sensation
 at the stomach, for some days previously;
 or, at all events, the person has felt unwell.
 When the -disease  sets in earnestly, which
 in the  larger proportion of  cases  it does
 during the 'hight, the patient  vomits, and is
 purged with  more  or less frequency and
 violence, the evacuations quickly  coming to
 resemble  thin gruel or rice-water;  cramps
 of the limbs  succeed, the surface becomes
 cold, blue, bathed in sweat, and  has, par-
 ticularly  the  fingers,  a peculiar  shrunken,
 sodden appearance; the tongue is cold, the
 pulse imperceptible; the urine is suppressed,
 and the voice  acquires a peculiar pitch of
 tone.  Many die in this,  the  collapse stage
 of the disease; but if it  is passed through,
 reaction comes on, the surface gets warm,
 the thirst continues, the quick  pulse becomes
 perceptible, the tongue is dry and  brown,
 and  delirium  is present; in short,  fever is
 established, and may end either in recovery
 or death.
  During the prevalence of cholera, many
 err in making  material changes in their or-
 dinary modes  of living, and, by so disorder-
 ing  the  regularity of the functions, lay
 themselves open to  attacks of the disease.
 Of course, if  a man  is  aware that he  is
 habitually indulging in practices injurious to
 health, such as intemperance, debauchery,
 &c. &c.  he only acts wisely as regards his
physical  safety in  changing  those  habits;
but it is hazardous to alter regular modes
of living, which have  hitherto been found
compatible with good  health—it being un-
derstood that whatever tends to lower the
standard of health favours the attack of the
disease.   There is, however, one important
precaution which ought  to  be observed, at
all times indeed,  but  more particularly
during the epidemic of cholera:  the perfect
purity of the drinking-water should be ascer-
tained, and its freedom from all decomposing
organic matters made certain.  Care is also
to be observed not to take active purgatives,
particularly salines, which produce  watery
evacuation; if aperient medicine is required,
it ought to be of a warm character,  such as
magnesia and rhubarb, with some aromatic;
for whatever produces  free action of the
bowels  apparently increases  the  suscepti-
bility to attack.  For this reason,  too,  the
slightest tendency to diarrhoea should at once be
arrested by the aromatic confection or chalk-
mixture, repeated as often as requisite, with
the addition of from five  to ten drops of lau-
danum  [and tincture of camphor] to each
dose, and the use of milk, and  farinaceous
preparations containing gelatine, for food.
The speedy adoption  of  these measures, in
places distant from medical assistance, and
their enforcement, by the clergyman or some
intelligent  individual, might do  much  to
check the disease.  Should the ^astringents
above recommended fail,  three or four doses
of acetate of lead and opium might be given
by a careful person.
   AVith regard  to  the actual treatment of
the  disease  itself, when  fully established,
many different methods have been proposed
and practised,  and few  of them, perhaps,
without apparent advantage in some cases  ;
but as yet no treatment which can be called
decidedly successful (a cure) has been dis-
covered.  Of course, in so formidable a dis-
ease, proper medical assistance ought to be
obtained as quickly as possible ; but as far
as our  present knowledge extends, those
around  the patient would be fully justified
in using every possible method of hot ap-
plication to  maintain  the  temperature  of
the body, and in permitting the gratification
of the intense thirst  to  the  full,  by cold
water, alone, or containing  one  drachm of
common salt, one drachm of carbonate of
soda, and twenty grains  of  chlorate of po-
tassa, in every quart.   In doing this there
will  be at  least the  consolation  that the
comfort of the patient is promoted; every
thing further must be  left to medical judg-
ment.   We  must live  in  hope,  that before
the scourge  again  visits us, which it  pro-
bably will do,  particularly if the present
sanitary evils are permitted to remain, me- 
C HO
120
C  I R
dical  science will have some  more efficient
method of cure to offer than we at present
possess.
  The consecutive fever of cholera requires
the treatment of fever generally.
  CHOLERA, BRITISH.—See Bilious Cho-
lera.
  CHOLERA.—See St. Vitus's'Dance.
  CHRONIC.—A term applied to diseases
of slow  progress,  in  contradistinction  to
" Acute."—See Acute.
  CHYLE—Is the  milk-like fluid which is
separated from the chyme, or digested food
mass, after it has passed from the stomach
and become  mixed in the small intestines
with  the bile and pancreatic fluid.   The
vessels by which  the chyle is  absorbed
from  the  intestine have  been named lac-
teal, from the milk-like or  white  appear-
ance  of this  fluid,  which  they  contain
abundantly after a full  meal; the charac-
teristic whiteness being more particularly
apparent if the  food  has contained  much
fat.
  Refer to Absorbents—Chyme—Digestion—
Pancreas.
  CHYLOPOIETIC—Ts a  term  applied to
the viscera which assist in the formation of
the chyle.
  CHYME—Is the pultaceous, gray-looking
acid substance, to which  food is reduced  by
digestion in the stomach,  before it passes—
in the healthy state at least—into the small
intestines.
  CICATRIX—Is  .the scar  or  mark left
upon  the skin or upon an internal organ, at
the place where  separation  of  substance,
either from violence or ulceration,  has been
healed.
  CIDER.—The well-known fermented drink
made  from apples.  Its characteristic prin-
ciple  is malic  acid.  It contains  but little
alcohol, not  above 9 per cent., and is  gene-
rally considered wholesome;  but to its use
has sometimes  been attributed  a form  of
dry belly-ache, resembling painter's  colic,
which occurs in cider districts.  There ap-
pears, however, to be some doubt whether
this is not owing to accidental impregnation
with lead, which readily combines with the
malic  acid of the  cider.
  CINNAMON—The well-known spice,  is
the bark  of  a tree.   It  is  brought  from
Ceylon and the islands of  the Indian Archi-
pelago.   It is largely used in medicine  for
the same purposes as other  stimulant aro-
matics ; chiefly as  an addition  to correct
the nauseant, or add to the stimulant pro-
perties of other more active medicines. The
distilled water is  well known.  In conse-
quence of the high price of true cinnamon,
a coarser  description,  the  cassia  bark, is
very generally sold in place of it  in this
country,  and, though not. so fine  in  flavour
as the true bark, is equally well adapted for
medicinal use.  True cinnamon  is thinner,
lighter in colour, nnd consists of more quills
one within another, than cassia bark.
  CIRCOCELE.—An enlargement or vari-
cose condition of  the veins of the testicle.
  CIRCULATION  OF  THE  BLOOD.—By
this 4s understood the entire course  of that
fluid from its leaving the heart to its return
to that organ. In man, and in warm-blood-
ed animals generally, including birds, there
are  two  complete  systems of  circulation,
(see fig. xxxviii.,)  the one through the body
Fig. xxxviii.
at large, the other through the lungs; and
this double circulation involves the presence
of a double propelling organ, that is, a heart
consisting of four cavities.
  The structure and requirements of our
animated  bodies, as  they have been consti-
tuted by the Creator, depend for their main-
tenance in  healthy  existence and action
upon  the continual passage of arterial blood
throughout  every portion of their structure
—for this the circulation  provides.  The
heart, which is muscular, consists of four
cavities, two auricles and two ventricles;  of
these, the  left ventricle, (G.)  which  gives
the first propulsion to the arterial wave of
blood, is  considerably the  most powerful.
When it contracts, the blood contained with-
in it  at the moment is forcibly propelled 
CIT
121
CLE
into the aorta (A) or main blood-vessel of
the body, from which it diverges into  the
secondary  branches,  until at last, by  the
division and subdivision of the vessel, it is
conducted into the capillaries, (C,) in which
it comes into more intimate connection with
the elementary components of the body,  and
undergoes such chemical change  that when
it emerges  it is an altered fluid;  instead of
the bright red arterial, it is the dark black-
looking venous blood, unfit for the mainte-
nance of the vital functions.   It is now  col-
lected by the veins (V)  and conducted back
to  the heart, the right  auricle of which it
enters; from this cavity it passes  into the
right  ventricle, (D,)  and is propelled  by its
muscular power  into the  pulmonary artery
(B) and through  the  lungs;  in its passage
through which it is brought into contact
with atmospheric air, casts off the carbonic
acid with which it has been  laden, absorbs
oxygen,  and, being  chemically changed, is
once more  the bright arterial fluid, which,
returning through the  pulmonary vein (E)
up  to the  left auricle of the heart, (H) is
transmitted by it to the left ventricle, to be
sent once more upon its mission of life.
  Although the forces which circulate  the
blood,  namely,  the  muscular   propelling
power of the heart, the muscular and elastic
contractility of the arterial  coats, and  the
suction power exerted within the chest, are
sufficient of themselves, during  health, to
maintain the vital current, which flows, and
must flow, from the first moment of life until
death,—their power  and efficiency is  much
assisted by the muscular movements of the
body by  exercise,  which, quickening  the
respiration  and  the  action  of  the heart,
sends  the  blood  with increased  force  and
frequency throughout the frame, and stimu-
lates every  function to increased action.
Thus provision has been made by the Crea-
tor, that while the powers which circulate
the blood can, of themselves, carry on that
necessary  process  sufficiently  to preserve
life, high health and vigour can  only be at-
tained by the active exercise .of our limbs.
In  the  aged,  and  in those  exhausted by
disease, who are long confined to a horizon-
tal  posture, the circulating powers become
too feeble to overcome the force of gravity,
and the  blood tends to accumulate,  more
particularly  in the  lungs, in the most de-
pendent part;  for  this reason,  change of
posture is advisable.—See Bed.
  Refer to Artery—Blood—Heart—Respira-
tion, <Sfc.
  CITRATE OF  IRON—Is a compound of
iron and citric acid, introduced into medical
practice within the last few years.  It is an
elegant and pleasant form, and may be given
in solution in water  in  one or two grain
doses.   It becomes  moist if  exposed to the
action of the air.
  CITRATE OF QUININE AND IRON—Is
a compound of iron, citric acid, and quinine,
and is an elegant and highly useful form of
tonic;  it may be given in a similar way, and
in doses similar to the above.
  CITRINE OINTMENT—Is  a mercurial
preparation much used by some in  skin dis-
eases.  [It is also often employed in the form
of sore eyes attended by redness of the edges
of the  lids, and by a  disposition in them to
stick together in the morning.  It should be
applied at the roots of the eyelashes at night,
so that it cannot get into the eye,  and the
part should be  washed in the morning with
warm water.  An application every other
night is sufficient to create  a change in the
action of the part, and thus cure the com-
plaint.]  In its ordinary form the ointment
is too strong, and should be mixed with once
or twice its weight of lard.   Iron utensils or
spatulas must not be used in its manipula-
tion.  It is an ointment which very quickly
spoils,  [as may be told by its decided green
colour or hardened condition.]
  CLARET—Is one of the most wholesome
of the  light wines.   It contains 15-10 per
cent, of  alcohol.   In convalescence from
acute febrile  disease in  which  wine is ad-
missible, but where there exists  a tendency
to febrile action from  slight causes, claret is
most useful, and  preferable  to the  stronger
and heavier wines.   In diabetes, claret has
been  recommended  as  superior to every
other form of stimulant.
  CLAVICLE.—The Collar-bone—extends
from the upper part of the breast-bone to the
point of the shoulder. It is particularly liable
to fracture from falls upon the shoulder: the
accident is easily detected.—See Fracture.
  CLERGYMAN'S  SORE-THROAT—Is  a
peculiar affection of the  throat and organs
of voice to which  public speakers are liable.
According  to  Mr.  Macready, actors,  who
have to assume feigned tones, are more liable
to it from that  cause.  The  seat of the dis-
ease is the mucous follicles  scattered over
the membrane of the throat,  larynx, &c.
being extended to the latter from the former.
The commencement of the disease is insidi-
ous ; it begins with an uneasy sensation, as
if there was something in the throat which
required to be hawked  up or swallowed
down;  at the same time the mucus secre-
tion is viscid.  As  the larynx  becomes af-
fected the voice is changed, becomes hoarse,
unequal in tone, or quite extinguished; there
may be slight pain about the parts, but not 
C L I                122                 C L I
much cough in the earlier stage of the dis-
ease.  All the symptoms become aggravated
by cold,  by vicissitudes of temperature, or
by exertion of the voice in reading, speak-
ing, &c.  The above sources of aggravation
are of course  to be guarded against, and
the general health attended to;  but the cure
of the disease, which  consists chiefly in the
repeated  application of a strong solution of
lunar caustic to  the  parts  affected, must
only be intrusted to the medical man.   Dr.
Green, of New York, has the credit of first
accurately describing  the disease,  and  of
prescribing the treatment above mentioned,
which is very successful.
  CLIFTON —Lies within a mile of Bristol.
Sir James Clark speaks highly of its climate.
"In its local advantages  and geographical
position it yields, perhaps, to no place in the
kingdom  us a residence for a large class of
invalids.   Within its own limits it affords a
sheltered winter,  and an  open airy summer
residence; while  it is surrounded by nume-
rous places of agreeable  resort in  the fine
season, suited  to  the various classes of per-
sons who may seek its shelter during  the
winter. Compared with the south and south-
west coasts, the  spring is the period of the
year in which this climate  appears to  the
greatest  advantage.   For consumptive  pa-
tients, and those  labouring under irritable
affections of the  bronchial membrane,  the
softer and  more humid air of Devon will be
found more soothing, while for invalids whose
constitutions  have suffered from  long-con-
tinued derangement of the digestive organs,
or a  congested state  of  the  mucous mem-
brane, with copious  secretion,  and also for
young scrofulous persons, and those of re-
laxed habits of body, generally, Clifton will
prove a preferable climate."
  " The spring termed Hotwell rises at the
base of the lofty  St. Vincent's Rock, and is
said to  yield as  much  as forty gallons  of
water in  a minute.  *  *  *   The temper-
ature of  the water is 76° Fahr.   Like the
springs of Bath and Buxton, the salts of lime
predominate.  The following table will ex-
hibit the proportion of the saline constituents
in a gallon of water :—
                                Grains.
    Muriate of magnesia............   7-25
    Muriate of lime..................   3*80
    Sulphate of lime..................   7;5
    Sulphate of soda.......;.........;  16-15
    Carbonate of lime........i..a...  13-5

                                47-30
  " A gallon also contains, according to Dr.
Carrick, thirty cubic inches of carbonic acid
  " The water emits a few gas bubbles when
drawn into  a .glass.   Taken  internally,  it
generally acts upon the kidneys, and occa-
sionally produces vertigo and headache.   It
is recommended in various states of deranged
health.  The baths are not much used. The
internal use of the water is considered to be
very efficacious in cases of dyspepsia with
acidity, in affections of the kidneys, as dia-
betes, gravel,  and tendency to stone."
  CLIMACTERIC DISEASE—Is a  sudden
giving way of the vital powers in persons of
advanced life, without any definite  disease
to  account for the change.   The affection
seldom occurs before fifty years of age, and
is more common in men than women; for one
reason, probably, that its most frequent ex-
citing cause is over-work and anxiety of the
mind  in business.  The  person  who is be-
coming  the  subject of climacteric  disease,
complains of weakness coming on gradually,
the appetite gives way, sleep is deficient, the
bowels sluggish,  the  pulse quick,  and the
tongue furred ; the flesh falls away, and the
altered  countenance assumes  an  aged look
in  a short period: in other words, the "con-
stitution is breaking up," and the individual's
friends  remark that  "he ages very fast."
Swelling of the limbs, eruptions of the skin,
and mental apathy are further concomitants
of the disease, which,  if unchecked, may run
on to a speedy, fatal termination;  while  it
also renders the patient liable to sink easily
under any attack of acute illness, even of  a
common cold, which too, it may be observed,
is  often the first traceable  commencement
of  the attack of climacteric.   Another very
frequent cause is grief  caused by  the lo?3
of friends or relatives, who have been much
mingled in  the affections and habits of daily
life.
  When an  aged person  exhibits  the symp-
toms  described above, they should imme-
diately be attended to : the case must be put
under medical management, and will require
tonic  treatment,  generous living, complete
relaxation  from the cares and  anxiety  of.
business, and, if possible, change of climate.
  CLIMATE—Is the condition of the atmo-
sphere which generally prevails over any
particular tract of country, a condition which
is  of  course  regulated  and  modified by  a
great variety of circumstances.  The lati-
tude,  the  elevation,  the proximity to  or
distance from the sea; the soil, the absence
or presence of water, including  the drain-
age, the amount of wood, and the shelter or
otherwise  from prevailing winds, all exert
important influences upon the characteristic
climate of any locality, and have to be con-
sidered in   the  recommendation given,  oi 
CLI
123
CLO
 plan of action resorted to by invalids.  The
 subject is quite too extensive  to admit  of
 profitable  consideration in this work; and
 the  decision respecting the climate, resort
 to which  is likely to benefit each individual
 case, is so much matter of judgment, and is
 really so  important,  that  medical  opinion
 ought always to be taken when change  of
 air  or climate is seriously sought as a re-
 medy in illness.  Very much precious time
 is often lost, and real injury inflicted, from
 want of due care upon  this head, and from
 persons  acting upon their own ideas,  or
 upon insufficient advice.  Those who desire
 to get for  themselves  the most  complete in-
 formation upon the subject of  climate, will
 find  it in the  valuable work of Sir James
 Clark.
   There are few diseases, perhaps, which do
 not  derive either temporary or permanent
 relief from change  of air and  climate, but
 some  are  more strikingly benefited than
 others ; they are particularly diseases of a
 neuralgic, intermittent, or spasmodic cha-
 racter, of  which hooping-cough and asthma
 are  good  examples.  Chronic rheumatism,
 scrofula, weakness of the constitution gene-
 rally, including pulmonary consumption and
 dyspepsia,  may also  be mentioned.   As a
 general rule, benefit appears to result from
 change to a climate presenting characters
 which contrast with  those  of  the  one  in
 which the individual is or has been gene-
 rally resident;  the dyspeptic or consumptive
 patient will derive  advantage by removing
 from the  colder to  the mere genial  region;
 the  fever-stricken   resident of the  sultry
 or vaporous plain will  regain  health  and
 strength in the bracing air of the hills;  and
 even the  country child, in whose constitu-
 tion  hooping-cough  lingers, will probably
 lose it if  transferred to  city air for  a short
 period.  Perhaps no  air  exerts such uni-
 versally tonic effects as that of  the sea, but
 to some it is too stimulating in some particu-
 lar localities, though not so in others; but,
 in fact, the differences  in  climate,  and  its
 effects, are so numerous and varied that it
 is impossible here to  pass beyond the general
 consideration of the subject.   Unquestion-
 ably some amount of the beneficial influence
 of the change of climate  is due to the stimu-
 lant  effect  upon the  mind which excitement
 and  change of  scene  produce, this being
 more particularly the  case if the condition
 of the individual permits  or calls for the
continued change of  travelling from place  to
place.
  The error is  frequently committed of re-
sorting to  the  change of climate as a last
resource, which, if earlier had recourse to,
 might have proved of essential or real ser-
 vice.  Another  error is trusting  too much
 to the curative power of climate ;  and inva-
 lids, by throwing aside the restraints of the
 regimen to which they have been previously
 subjected,  and  neglecting the other  acces-
 sory adjuncts to recovery, fail  to derive the
 full measure  of benefit  which they ought;
 and this more especially if they do not  con-
 sider and endeavour to accommodate them-
 selves to the  modes  of living  and other
 requirements  adapted  to  the climate in
 which they are resident for the time.
   Sir James Clark divides the "mild region
 of England" into four districts or groups of
 climate; that of the south coast, compre-
 hending the tract of coast between Hastings
 and Portland Island; the south-west coast,
 from the latter  point to Cornwall; the dis-
 trict  of  the Land's End;  and the western
 group.   In  Scotland,  the  island of Bute,
 situated in the  Frith of Clyde on the west
 coast,  is a remarkable instance  of climate
 modified by situation:  surrounded by  sea-
 water and sheltered by lofty hills,  its cli-
 mate is  remarkably mild and equable—so
 much so, that snow rarely lies above a few
 hours.   It  is much to be regretted that the
 beneficial effects of change of air are so little
 attainable  by the poor,  particularly in re-
 covery from  acute illness,  when  it  is  fre-
 quently all that is requisite to re-establish
 firm health, and to  hasten an otherwise lin-
 gering  convalescence.   The establishment
 and support of convalescent stations  for the
 poor would constitute a truly useful end for
 charitable support.
  Refer to Atmosphere—Convalescence, $c.
  CLOTHING.—The protection of the body
 from the influences of climate,  by means of
 clothing, is most intimately connected with
 health, more especially in any climate sub-
 ject to the numerous and sudden vicissitudes
 of temperature,  moisture, &c.   The form of
 clothing  must ever vary with fashion;  the
 principle ought always to continue the same,
 that is, it should involve complete and tho-
 rough protection of the surface of the body,
 and especially of the cavities of the chest and
 abdomen, from cold or sudden chill.   This is
 best insured by a covering of woollen mate-
rial next the skin; the habit should be com-
menced from the earliest childhood, and con-
tinue through  life in  every season  of  the
year, varying only the thickness of the flan
nel, or other  woollen  texture, according to
the  average   temperature.    No  outward
clothing  can be  so uniformly efficacious as
the inner one of wool, as a protection against
a variable climate ; and yet very many there
are who, both  in their own  persons  and in 
C LO
124
C L Y
those   f  their children, neglect this real
preservative of health, and therefore this real
economy, although the cost at first may seem
much to the poor.   In addition to the inner
clothing, the outer ought of course to be suf-
ficient,  and, in winter, an addition made on
going from the warmth of the house into the
open air.  In this respect, men are generally
better provided, under all circumstances,
than  women and  children.  Women,  from
the nature of their dress, and from the per-
nicious  custom of occasionally exposing the
chest and arms—which would be less hurt-
ful if constantly done—suffer much  from
errors in clothing; they subject themselves
to the extremes of fur and  thick shawls in
the morning, and of thin dresses at  night;
added  to which  there is often  exposure to
currents of  air  when heated, and without
any protection against  their effects.   Any
article of clothing, such as  fur, which keeps
up a more than average degree of heat, and
even  induces  perspiration, and which  is
liable to be thrown off or put on easily and
as fancy dictates,  is  hazardous and inju-
rious.   Children are  in many cases most
insufficiently protected  from the weather;
numbers are  without  a single article  of
woollen under-clothing, either in consequence
of carelessness, or from the erroneous  idea
of rendering them hardy;  a system which
may answer in the offspring of hardy pa-
rents, whose children  are  hardy in every
other respect,  but which can only be  pro-
ductive  of  injury to  health  in  those who
spend most of their time in warm, perhaps
too warm, rooms and nurseries.   The surface
of a child, from the neck downward, ought to be
kept warm by clothing; exposed chests,  bare legs,
and thin insufficient coverings, are synonymous
with croup, inflammation of the lungs,  and scro-
fula.   For the same reason that boas, &c.
are unsafe articles of dress  for women, com-
forters and woollen  neck-wrappers are not
advisable, except under particular circum-
stances, for boys: they heat the neck, and,
if thrown off carelessly, predispose to cold
or bronchitic affection.
  The clothing of the feet is a matter of the
highest importance to all;  dryness and
warmth must  be attended  to by those who
value health.  On the other hand,  the head
is often, especially in infants and children,
kept too hot [by wadded caps, &c]
   CLOA'ES—Are the undeveloped  flower-
buds of a tree  originally a native of the Mo-
lucca Islands, but which is now cultivated
in various parts of the tropics.  They are
well known as a spice, and  used as a stimu-
lant aromatic  in medicine, their properties
depending upon  the volatile oil, which is in-
tensely acrid.  Cloves  are rarely used vn
medicine alone.
  CLUB-FOOT.—See Deformity.
  CLYSTER, Enema, or Injection—Are nil
names for the same useful  adjunct to medi-
cal treatment—the mechanical injection of
fluid into the bowels hy the fundament and
rectum.  Clysters are most commonly em-
ployed as aperients, but they are  also used
as anodynes, or antispasmodics, for the pur-
pose of dispelling wind, or as internal fo-
mentations,  or as styptics.   In illness they
are generally administered to the patient by
others, but  instruments  are constructed to
facilitate their self-administration, which is
of course preferable when,  as frequently
occurs, they are often required in ordinary
health.
  The  mechanical means used for the ad-
ministration of clysters  are very numerous ;
the most useful are the self-injecting syringe,
(fig. xxxix.,) and thevulcanized India-rubber
Fig. xxxix.
Fig. xl.
bag, (fig. xl.)  The pipe and bladder, which
was formerly the only method used, is still
employed in country districts, and  though
clumsy, may be had reoourse to on an emer-
gency.
  The injection-syringe, or pump, is most
useful when the clyster to be administered
much exceeds half a pint in quantity, when
it is used as an aperient, and requires to be
forcibly  injected.   When the clyster does
not exceed  half a pint, as in the case of chil-
dren, or when used as  an anodyne or styp-
tic, the vulcanized India-rubber bag (fig. xl.)
is quite the  most  convenient  mechanical
agent, from its simplicity, and the ease with
which any one may use it.   Either instru-
ment may be procured good  from  any  re- 
                  c l  y

spectable maker of surgical instruments, and
directions  are, or ought  to be, given with
them.   AVhen a clyster is administered to
the sick, the patient  may either be laid on
the face or on the left side, near the edge
of the bed, with  the knees drawn up.   The
metal or bone pipe which is introduced into
the bowel  should be well  oiled or greased,
and its introduction should be effected with
perfect gentleness, not  straight up, but in a
direction slightly inclined toward the back
bone, care being taken that no abrasion or
scratching of the parts be occasioned:  this
is a most necessary caution in all cases, but
more especially in those in which repeated
use of the remedy will probably be required.
Even with  the greatest care,  the parts are
liable  to become  sore,  causing the patient
both  to dread and suffer each time the in-
strument is used, and even to be unable to
bear a continuance of the practice.   In all
cases a clyster should be given slowly and
gently, and care taken that air is not thrown
up into the bowel as well as fluid; with the
syringe, this is to be avoided by pumping it
full of fluid before it is applied to the pa-
tient, and  by not continuing  the operation
when the fluid used gets so low in the basin
as to allow air to be drawn in;  with the bag
care should be  taken that the pipe-end is
always held the lowest.  AVhen the bag is
used, air is less  likely  to be  introduced if
the patient is laid on the face.  When the
syringe is  used,  if the flexible tubes have
been kept  bent in one position, they should
be slightly warmed before any attempt is
made to straighten them for use ;  otherwise,
especially in cold weather, they are apt to
crack.  If an instrument has been used for
any thing but simple water, it ought always
to be well  washed out with warm water be-
fore putting by.   When taken to pieces it
must always be unscrewed by the hand hold-
ing the metal mountings.
   Clysters can  only  be conveniently self-
administered by means of the syringe,  (fig.
xxxix.)
  Aperient clysters may be simply mecha-
nical, of water,  gruel,  and the like,  either
cold, tepid, or warm, or they  may be medi-
cinal.   There is an objection  to clysters of
simple water, that in some cases they are apt
to wash off the natural  protecting mucus of
the bowel,  and therefore it is perhaps better
as a general rule, and where the remedy is
often or habitually used, to employ a demul-
cent, such  as gruel or  barley-water.   Cold
clysters, though  sometimes  useful,  ought
never to be resorted to except by medical
direction;  the fluid about the temperature
of 90° will  generally be found most appro-
       l2
5                C L Y

priate, and when used simply, about a quart
thrown up slowly, but with sufficient force,
be found a suitable amount for the generali-
ty of adults.  Some use a much larger quan-
tity, as  much  as  two or three quarts; this,
in certain cases of illness, may be a useful
measure, but as an habitual thing it is bad;
the frequent over-distension with so large a
quantity of warm fluid produces want of
tone, which aggravates the torpid tendency
of the bowels, and favours faecal accumula-
tion.  For a child six years of age, half a
pint of simple gruel clyster is ample.  These
simple clysters act by stimulating the bowel
by their mechanical bulk; when a medicinal
clyster is used, the object is in some degree
to avoid this, so that the medical agent may
not be expelled before it has time to  exert
its  peculiar agency.  The medical clyster
ought, therefore, as a general rule, not to ex-
ceed one-half the quantity of the simple one.
  The simplest and readiest medicinal clys-
ter is made, either with a tablespoonful of
common  salt in a pint of gruel, or with a
piece of brown soap, the size of a hazel-nut,
rubbed down into a pint of warm water; or
instead of these,  from half an ounce  to an
ounce of Epsom salts, or two ounces of olive-
oil, or half that  quantity  of castor-oil; or
infusion of senna, half an ounce of leaves to
the pint, may be employed.  Stronger clys-
ters, with  turpentine, croton-oil, &c. are
also used by medical men.
  Anodyne clysters ought always  to be so
small in bulk-—not  exceeding  three fluid
ounces—as not to stimulate the bowel to
expel them, which from the  nature  of the
cases in  which they are usually given, it is
apt to do.   In all cases,  anodyne clysters
are  most  conveniently   administered  by
means of the vulcanized bag, and the best
form is from fifteen to twenty-five drops of
laudanum in three [or two] ounces of mode-
rately thin starch.  This clyster is of course
to be retained in the bowel if possible. One of
the most useful clysters for dispersing flatu-
lence is made with two drachms of tincture
of  assafoetida to half a pint of gruel, to
which, if there is much pain, ten or fifteen
drops of laudanum may be  added: or the
same quantity of assafoetida  tincture may,
if required, be added to an aperient clyster.
A useful domestic clyster, in the country, for
the same purpose, is  half a  pint  to a pint
of strong " rue tea," or infusion of rue.
  Clysters used for the purposes of iLternal
fomentation, may be  given to the amount
of a quart,  and  of  a temperature o»'  98°
or 100° Fahr.
  In haemorrhage from  the lower  bowel,
when it  is proper  to interfere  with it, a two
11 
                C 0  A                 11

or three-ounce cold styptic clyster may be
used, made with sulphate of zinc four grains,
or sulphate of iron one grain, to the ounce
of fluid.
  COAGULATION—Is the conversion of the
whole of a fluid, or of some of its constitu-
ents, into a solid.  The solidification of the
white of  an egg by heat is an instance of
the former ; that of the clot in blood,  or of
the curd in milk, of the latter.  The coagu-
lating power of the blood  is the great safe-
guard in bleeding, which could not be per-
manently stopped by any appliances, without
this property  of the  vital  fluid; and  it  is
the loss  of this property that gives rise
to the occasional cases of  danger or death
from  bleeding,  in consequence  of  com-
paratively slight  wounds,  such as  those
from leech bites, or from the extraction of a
tooth.
  COAL-GAS.—See Carburetled Hydrogen.
  COB-WEB—Employed as  a  styptic,  to
arrest  bleeding  from  simple flesh-wounds
or  from  leech-bites,  is often used in the
country.   The web  of the  black spider,
which  builds in  out-houses,  &c.  has  been
used with much  success as  a medicine  in
ague, given in doses  of ten grains, in the
form of pills, every two hours, commencing
six  hours before the return of the paroxysm.
The fact  is worthy of  remembrance.—Refer
to Ague.
  COCCULUS INDICUS—Is the fruit of an
East Indian  tree.  It  resembles  a  large
brown  shrivelled pea in outward  appear-
ance.   The kernel is  intensely bitter, and
on this account  is sometimes used fraudu-
lently in the manufacture  of beer, instead
of the hop; also  with the view of increasing
the intoxicating power of the beverage.  In
some districts, a  deleterious, but rapidly in-
toxicating  ale, named  "tear-brain,"  sup-
posed to contain cocculus indicus, is, or used
to be,  consumed by  regular drinkers, on
account of the smaller quantity of  it, com-
pared with ordinary  ale,  which  produces
intoxication, or rather stupefaction.   This
power of stupefying has occasioned coccu-
lus  indicus to be  popularly used as a fish
poison.
  COCHINEAL—An insect which yields the
well-known  colouring matter carmine,  is
brought from Mexico, being  gathered from
various species of cacti, on which it feeds.
It is used chiefly as a colouring agent; but
has been employed especially as a domestic
remedy in hooping-cough.    Its powers are
very doubtful.
  Refer to Hooping-cough.
  COCOA—CHOCOLATE.— Cocoa  is  pre-
pared from the  seeds or beans of a tree—
                   C 0 c

the Theobroma cacao—cultivated chiefly is
the West Indies and South  America.  The
beans  are  roasted to develop  the nroma
and  free them from the husks, which  are
comparatively innutritious, though frequent-
ly mixed up with the prepared  cocoas  of
commerce.    Cocoa, when genuine and pro-
perly prepared, is a wholesome and nutri-
tious article of diet;  it contains a consi-
derable quantity of oily  or fatty matter,
starch,  &c.  &c.  and a  peculiar  principle,
"the obromine," which, according to Liebig,
nearly   approaches theine  and  caffeine—
the  characteristic principles  of  tea and
coffee—in composition;  cocoa  does  not,
however, affect the nervous  system in  the
same manner as these  beverages, and may
therefore be taken in cases when they are
inadmissible.  Cocoa, as  a beverage,  ought
to be prepared only from the crushed beans
themselves,  or "nibs," as  they are called,
for there  is no certainty  as regards  the
purity  of the various artificial preparations
sold  under the names  of "flake," "rock,"
"granulated," "homoeopathic" cocoa, &c.
&c. &c.  In the recent investigations of the
"Lancet Sanitary  Commission," more espe-
cially,  these  often  puffed-off compounds
have been found to be made up of cocoa,
sugar,  starch or flour, husks of  the  cocoa
bean, &c. &c.  and sometimes with fats and
oils of various kinds, and earthy and colour-
ing matters.
  Chocolate is professedly a manufactured
article, and should be made with the kernels
of the cocoa bean, perfectly free from husks
and reduced to a smooth uniform paste with
sugar,  and  starch  of some  kind, such  as
arrow-root;  vanilla or cinnamon being used
to impart flavour.  Such a  preparation  as
chocolate is  of course liable to many adul-
terations,  of which the  most deleterious
are those  with ochre,  red lead, vermilion,
sulphate' of  lime, chalk, &c.  &c.;  tallow is
sometimes used in the preparation of the
cheap forms.  It need scarcely be said that
those who  make  use  of chocolate  ought
always to  procure it from dealers on whom
they can depend.  That of French make ia
generally to be preferred.  As an article of
diet, chocolate is extremely.nutritious, but,
on account of the  oil it contains, is apt to
disagree with weak stomachs, particularly
if too  great heat be  used  in preparing;
moreover, the addition of vanilla is apt still
more to increase its  indigestibility, and,
according to Dr.  Paris, to occasion iiervoun
disorder.
   COCOA-NUT—The  well-known  fruit of
the palm, is, in its ordinary state, extremely
indigestible, from the same cause that mosl
>6 
C 0 C                127                C 0 F
 other nut-kernels are so—the solidity of the
 structure  and the oily constitution, a com-
 bination which strongly resists the digestive
 powers.  The reduction  into paste or flour
 probably remedies the objection.
   CODLIVER-OIL—Is obtained  from  the
 liver of the common codfish and other allied
 species ; it was formerly employed in medi-
 cine in this  country, fell  into disuse, was
 revived as a remedy in Germany, and again
 brought into public notice in  Britain, by
 Dr. Hughes Bennett, of Edinburgh, in 1841,
 since which time  it has advanced rapidly
 and  deservedly  in the  estimation  both of
 the  profession  and  of the public.   It had
 never, however, been entirely abandoned as
 a  domestic  remedy in  rheumatism; and
 among the sailors, particularly  those con-
 nected  with the northern  fisheries, had been
 regularly  used  both internally  and exter-
 nally in the above disease.   Now, however,
 it  is principally  employed and  celebrated
 for its curative powers,  especially in pul-
 monary consumption, in  scrofula,  and in
 all diseases  connected with the  scrofulous
 constitution,  or  depending on general de-
 bility.  In the  atrophy  or wasting of the
 flesh in young  children,  connected  with
 enlarged glands in the belly, which is tumid
 and hard, feels knotty, and with the veins of
 the surface  enlarged, codliver-oil, given
 internally, a teaspoonful twice  a day, and
 well  rubbed into the skin of the  belly two
 or  three times  a day, will in many  cases
 cure, in a way  which no other  remedy we
 are acquainted with could do.
   For some  time,  the dark,  heavy, strong
 oil was considered to be the most efficacious;
 but  now,  especially since  more  care has
 been bestowed  on  the   manufacture, the
 purer and  lighter oil, of the colour of light
 mahogany, is as good  as any that can be
 used.   The dose for an adult is  generally
 one  tablespoonful twice  or three -times a
 day; it is however by some given much
 more largely.  It  is always advisable at
 first  to begin  with  smaller, such as tea-
 spoonful doses,  till  the  patient  and  the
 stomach become accustomed to the remedy,
 which even children quickly do, although
 sickness is sometimes  produced at  first.
 Tastes differ much  as to the best  method of
 taking codliver-oil;  floated  in a little bitter
 beer  [or beat up with the  froth  of porter]
 answers well, or the dose may be  shaken up
 with  half the quantity of syrup  of  marsh-
 mallow, and swallowed at once,  or  it may
 be  taken  in  water,  simple  or  aromatic.
 With  many, codliver-oil acts  slightly upon
 the bowels.  In  some cases of chest affec-
tion,  the   breathing is certainly apt  to
 become more difficult for the first few days
 of its use,  and it has been said to induce
 spitting of blood.  There cannot be stronger
 eVidence  of the nutritious power of cod-
 liver-oil. than the  way in which its omission
 is felt by patients who have taken it regu-
 larly for some time: neither wine nor any-
 thing else appears to be a sufficient substi-
 tute.
   Refer to Scrofula,  Sfc.
   COFFEE.—Active principle, Caffeine.
 —Coffee is the berry of a  shrub, the  Coffea
 arabica,  indigenous  to  Arabia,  and  now
 cultivated in the  East and West Indies, in
 America, &c. &c.   It  contains a  consider-
 able amount of essential oil, and a  peculiar
 principle, caffeine, which is identical  with
 " theine," the characteristic principle of tea.
 The berry requires  roasting to develop the
 well-known  fragrant aroma.
   As an article of diet, coffee is for  most
 persons  wholesome  and  stimulating,  but
 when there  exists  any tendency to   head
 affection,  or when the biliary secretion is
 apt to be  over-abundant, it  ought  not to be
 used.   Dr.  Paris  remarks that coffee, "if
 taken after a meal,- is  not found to  cause
 that disturbance in its digestion which has
 been  noticed as the  occasional consequence
 of tea ;  that, on the contrary, it accelerates
 the  operations  of the  stomach."  When
 strong,  it most undoubtedly exerts  much
 influence  over the brain and nervous sys-
 tem, producing  watchfulness  nnd  feverish
 symptoms;  it is thought, too, to affect the
 skin,  and the sallow hue of the Parisians
 has been  ascribed to the excessive use of
 coffee.  The nutrient power of coffee is con-
 sidered  greater  than that  of tea,  although
 this cannot be great in either, irrespective
 of the characteristic  principles—theine and
 caffeine—above mentioned, which, probably,
 are peculiarly beneficial to those who, either
 from necessity or inclination, consume much
 non-azotized, or vegetable  food.  In  such
 individuals,  who are often of sedentary ha-
 bits, a deficient consumption of animal diet,
 and inactivity together, render the biliary
 secretion  deficient, and these principles of
 tea and  coffee are,  according to Liebig, " in
 virtue of their composition, better adapted"
 to supply the otherwise  deficient  "biliary
 azotized  principles  than  all other nitro-
 genized  vegetable  principles."  It is sin-
 gular that the above is supported by what
 we  might almost  call  an instinctive  habit
 among many of the poor in our own country
who are unable to procure animal, that is
azotized food, but who will make ev.ery effort
to procure tea  and  coffee; the custom is,
and is no doubt felt to be, salutary  Coffee 
COL                 128                 COL
is  more suitable, for most persons, for the
morning meal than tea, which is more likely
to  affect  the nervous functions.   A cup of
strong coffee, taken immediately after rising,
is  considered a  good protective  from the
effects of malaria.  In poisoning by opium,
coffee is  one of the most useful antidotes,
but in this case ought to  be/rwA, pure, and
strong, and taken without milk or sugar.
The infusion of one ounce, taken every twen-
ty  minutes, is considered a suitable dose.
  Coffee  should  always  be  infused, never
boiled; when made  with half milk,  it  is
more  nutritious  for the weak, if  it agrees
with the  stomach in this form.  The adul-
terations of coffee are numerous;  for  that
with chicory, which is  the most  prevalent,
the reader  is referred to the article "chi-
cory." According to the "Lancet," roasted
wheat-flour,  and   beans,  mangel-wurzel,
acorns, potato-flour, and a "coffee colourer,"
made with coarse burnt sugar, are likewise
used.   From what has been said respecting
the properties of pure coffee,  it  is evident
that none of the above additions or adulte-
rations, although  they may give  the ap-
pearance of it, can add real strength to the
infusion,  or be  in any way substitutes for
coffee  itself;  indeed,  it would  be much
cheaper,  and more  nutritious and whole-
Bome, for the poor to make and drink good
toast-water, than to  spend their money on
coffee so called, which in reality is half, or
more than half chicory, or something worse;
for the chicory itself is very  greatly adul-
terated.  Coffee  sold in  " air-tight"  canis-
ters  is always to be suspected.   The  only
real  security at present is  for persons to
grind their own  coffee, not  too much at
once, and to preserve both the whole berry
nnd  the powder  in  canisters,  or wide-
mouthed, well-closed bottles.   In the West
Indies an infusion of raw coffee is used by
the negroes, and  found serviceable in  pro-
moting the  flow of urine.
  Refer to  Diet—Tea, $c.
  COLCHICUM.—Colchicum   autumnale  is
the botanical name for the " autumnal cro-
cus," found wild in many parts of England
south of the Trent.   The root  and bulb and
the seeds are both used in medicine,  par-
ticularly in gout  and rheumatism; but the
drug  requires too much care, and its im-
proper use is too  liable to  produce  evil
consequences, to  make  it a  safe domestic
remedy,  unless  previously  sanctioned by
medical authority.   In  some  persons  par-
ticularly, it acts  most powerfully upon the
bowels, even in  small doses.   The prepa-
rations  chiefly  used are  the  tincture, the
wine, and  the vinegar.   According  to Dr.
 Christison,  two drachms,  or tenspoonfuls,
 of the wine of colchicum has proved a fatal
 dose.  The symptoms produced by an over-
 dose  of  colchicum  are vomiting, purging,
 colic, heat in the  throat and abdomen, ge-
 neral depression,  headache, and stupor or
 delirium.  The remedies to be used until
 medical assistance is procured are diluents,
 such  as barley-water,  linseed-tea, or thin
 gruel, and  laudanum  or  opium in some
 form.
  Refer to Opium.
  COLD—Is generally considered  to be  a
 negative result of the absence of heat rather
 than  an  active principle;  in consequence,
 however, of its energetic influence upon the
 living body, either in health or disease, it is
 usually spoken of  as an active agent.  The
 animated human frame is endowed with the
 power of maintaining a certain average tem-
 perature, which—except in  rare instances
 —is higher than  that  of  the  surrounding
 medium, and this  power is adequate to re-
 sist  all ordinary impressions of cold;  but
 when, from great intensity, or long continu-
 ance, and  especially when combined  with
 moisture, the  depressing  action of cold is
 much  augmented, the powers  of life sink,
 and disease or death is  the consequence.
 This power of the  living body to resist cold,
 is in great  measure dependent upon  the
 supply and proper  assimilation of a suffi-
 ciency of nourishment; the  ill-fed  and the
 dyspeptic always suffer most from the effects
 of cold.  But in order that full benefit may
 be derived from the power of food to protect
 against low temperature, particularly when
 at all severe or long continued, it is requisite
 that more or less muscular exercise—accord-
 ing to circumstances—be engaged in, for the
 purpose  of quickening the functions  of re-
 spiration,  circulation,  and  metamorphosis
 of tissue; in other words, for the purpose of
 increasing the  supply of oxygen taken into
 the system, and thereby facilitating the con-
 sumption of the internal  fuel, (see Animal
 Heat,) either obtained directly from the food,
 or from the  compounds carbon and hydro-
 gen already existing in the body.   This is
 no more than common  experience testifies;
 for all  know that, of two  men exposed to a
 continued  degree of intense cold, even  if
 equal in other respects, should one  perse-
 vere  in  muscular exertion, and the other
 give way to indolence  or torpor, the former
 will  be  much  more likely to  survive the
 effects  than the  latter.   And  even under
I exposure to cold  not  so  immediately dan-
 gerous to  life,  and especially if combined
| with moisture, the most ignorant are aware
j that  " as  long as they keep moving" there 
COL
129
COL
is  comparatively little danger of  those bad
consequences  which  almost invariably re-
sult  if rest is indulged in.  In fact, as long
as the muscular movement is  kept up, the
circulation, respiration, and change of tissue
goes on with sufficient activity to maintain
temperature  adequate to resist  the  cold,
which, however, prevails  as  soon as inac-
tivity permits the cessation of the  resisting
forces.   Thus we have a point of every-day
experience confirmed  and its rationale ex-
plained by the researches of m6dern science.
  In northern latitudes, however,  the inter-
nal  means of  resisting cold  are  of them-
selves insufficient  for  the  purpose,  and,
therefore, clothing, shelter, or  habitations,
and  the production of artificial heat, are re-
sorted to, and these, indeed in some degree,
stand in the  place of  nourishment; for the
man who is sufficiently well protected from
the  effects of cold certainly requires a less
supply of food to maintain health than he
who is not.  As regards food,  habitations,
and  fuel, most who have it in  their power
are  inclined  to use their  protecting influ-
ences sufficiently.   It is in clothing that the
chief errors  and negligences  are  met with,
and  the  reader is referred to the subject
itself for their exposition.  There may", cer-
tainly, be such over-precaution in guarding
against cold, that it  is impossible to  keep
up the protection on all  occasions, so that
an  accidental  omission in dress,  or expo-
sure, after being  habituated  to air of too
high  a temperature,  at once  gives rise to
disease.   But the abuse is no argument for
the  non-employment of sufficient rational
protection against the influences of weather,
especially in latitudes like our own, in which
a low temperature frequently prevails, and
that, too, combined with moisture, while, at
the same time, the vicissitudes from heat to
cold are  often extreme and violent.  It may
safely be asserted that  a large proportion
of the diseases to which the inhabitants of
this  country are liable are, either  directly
or indirectly,  the  result of cold.   It is suf-
ficient to  mention  inflammatory attacks,
general and  local, apoplexy and  paralysis,
rheumatism  and  neuralgia,  scrofula  with
its long  train of disease, and consumption,
as diseases, among many others,  traceable
to the  influences  of  low temperature, to
convince the most careless of the necessity
of due protection against an agent so potent
for evil.   In  many warm climates the prin-
cipal danger from cold is incurred by ex-
posure to the  chill  dew*s  of evening, after
hot days.
  The effect  of extremely low temperature
acting upon a limited portion  of the body is
rigidity of the muscles, blistering of the skin,
particularly from  grasping  metallic bodies
with the bare, hand, and frost-bite or death
of the part affected.   The general effect of
extreme  continued cold is  depression  of
the nervous system, of the functions of the
respiratory organs and skin,  deterioration of
the blood,  torpor, insuperable drowsiness,
and death.  In case of frost-bite, as of the
fingers or toes, although the part may ap-
pear quite lifeless, pale, and  shrivelled, it
may often be  saved by proper  treatment;
and the principal thing to  be attended to
is, that the temperature be not suddenly
raised; circulation,  nervous  power, and
heat,  must be very gradually restored ; and
probably the method  followed in countries
in which this  accident  is common, will  be
found  safest and  best, that is,  continued
friction of the part affected with snow, till
reaction is established : at all events,friction
should be  used;  after inflammation may be
soothed by tepid poultices.
  When, in consequence of long exposure to
external  cold,  drowsiness comes on,  both
mind  and  body must  be exerted te keep off
the influence ;  to indulge it  is death ; mus-
cular motion must be kept up:  if the in-
dividual is alone, and has a  supply  of alco-
holic  stimulant,  brandy or  wine, it ought
to be  resorted to when it is felt that other-
wise  the  powers  must give way;  then,
it may give strength to reach  safety and
shelter; but the greatest caution is requisite
before those who are  exposed to severe cen-
tinued cold have  recourse  to these stimu-
lants : as  a last resource they are  invalu-
able, but their aid must be unsought as long
as possible, for if  resorted to too soon, the
after  depression adds fatal facility to the
further depressing power of a low tempera-
ture.   Experience proves  that those who
are likely to be exposed to  great continued
cold should provide abundant nourishment,
particularly of a fat or oily character ; they
should never be without a flask  of spirits,
but never have recourse to  it except  as a
last resource.   The sudden  application of
cold,  even if it be not intense, may be very
serious, in case the nervous powers are at
all exhausted.  Of this, the  cramp to which
bathers are subject is an example, and like-
wise the fatal  accidents so frequent during
harvest, from persons  drinking largely of
cold  water.   The fatal  effect is  usually
ascribed  to the heated  state of the body,
but much  is also due  to the shock  commu-
nicated to the stomach and its numerous
nervous connections, while the system gene-
rally is exhausted.   The effect of cold, not
extreme, bu* long continued, especially if 
COL
130
COL
combined with moisture, is one of the most
fertile sources  of diseases,  some  of  which
have been already enumerated*  The young
and  the aged are more peculiarly liable to
suffer, and for this reason require  especial
protection.  The partial application of cold,
particularly by  a moving current of  air,
most  generally  produces  disease of a neu-
ralgic or rheumatic character, partial para-
lysis, especially  of the  face, or erysipelas.
All  these  injurious  influences are  more
readily exerted if the body is at the time in
a state of heated excitement, combined with
nervous exhaustion, the result of previous
exertion, and at rest.
  The  partial application of cold and  wet
may produce  inflammatory action in  the
immediate vicinity of the  part  exposed, or,
as in the case of wet feet, in some distant
organ.
  The most effectual remedy for the effects
of " a chill," is warmth with  moisture, in
the form of bath, vapour or  warm,  or of
hot bran bags,  and the free  use of  warm
diluent drinks, such as  tea, gruel, &c. and,
in case of much  depression,  warm  wine and
water.
  The  use  of cold as an hygienic  agent, or
in the  treatment  of disease, is invaluable.
AVhen, either as  cold air or cold water, it is
adapted  in intensity and continuance  to
the resisting power of the constitution, it is
a  most admirable tonic.   AVhen used to
subdue certain forms of excited and inflam-
matory  action,  the temperature  must  of
course be suited to the case, but ice-cold is
most  generally useful—care being  taken,
in the  application of ice itself,  that  the
part  is  not,  as  has happened,  actually
frozen or  killed.  Various forms of evapo-
rating  lotions,   made with  spirit,  &c.  are
employed,  but  as the additions are  made
simply to increase the  cold  by increasing
the evaporation, if a sufficient  supply of
sufficiently cold  water can be procured, ii is
all that is requisite.  The best mode of ap-
plication is by  cloths dipped  in  the cold
fluid,  and  renewed again  and again by  a
careful nurse.   When, from circumstances,
this cannot be done, the  next best method is
to keep  up  a continued system  of irrigation,
by means of a vessel of cold water placed a
little higher than the part to be cooled, the
fluid being conducted from the  vessel  to the
part by bundles  of woollen  thread, or thin
strips of flannel—care being taken,  by means
of waterproof material of some kind placed
underneath, to  carry off the superfluous
water;  in  this way the head  or a broken
limb may be kept  constantly under the in-
fluence  of  a  stream of  eold water, without
the necessity for constant attendance.  Ther«
has always  been considerable difficulty in
the application of cold  to  the back of the
head  in a  person confined to bed;  this is
now completely removed by the u-=e of the
vulcanized  [India-rubber]  cushions,  which
can be filled and refilled with ice-cold water
as often as required, without disturbing the
patient.
  Refer to  Animal Heat.
  COLD  IN  THE  HEAD, or Coryza—Is
an inflammatory affection of the membrane
lining the nostrils; it is accompanied with
more  or  less fever.   It commences  with a
sense  of dry fulness or obstruction of one or
both  nostrils, which  is  quickly  succeeded
by watery discharge of  an  acrid character,
and there is frequent  sneezing.  The mem-
brane of the eyes and their lids, being con-
tinuous with that of the nose, is also affected;
and, from a similar cause,  extension of the
irritation to the membrane  lining the frontal
sinus, there is  more  or less  headache.  If
simple cold in the head  be  not  renewed,
which it is  extremely  apt to be, it gradually
subsides within the week;  more  generally,
however, as it leaves  the nostrils, it  travels
downward  into the lungs,  and ends in ca-
tarrh, cough, &c. &c.  Coryza is a concomi-
tant of some other diseases, such as measles
and influenza.
  From its  tendency  to recur, and  also to
produce and keep up irritation of the lungs,
coryza is not  only not to be neglected, but
should be checked at first, if possible, and
for this purpose various methods  of treat-
ment are recommended.  The injection of a
solution of sulphate  of zinc,  five  grains to
the ounce, into the nostrils, at the very com-
mencement of the disorder,  has been  said to
stop it without fail. A dose of opium, either
in the form of a large teaspoonful of pare-
goric,  of six  or  eight  grains  of Dover's
powder, or quarter of a grain of muriate of
morphia, when taken at bedtime, will often
check a cold in the head at  once; and the
usual  system of hot foot-baths, confinement
to bed, low diet, and  diluent  drinks, along
with diaphoretic  medicines,  such as spirit
of mindererus, antimonial  wine, &c. &c, is
certainly calculated to mitigate the disorder,
and may be followed with  advantage.  The
following mode of treatment  comes  recom-
mended by the high  authority of Dr. C. J.
B. AVilliams.   He  says, "It is the common
practice to drink  copiously of tea, gruel, or
some  other diluent,during a cold; as long
as this promotes  perspiration it is of some
utility, and although it  augments the flow
from  the pituitary or  nasal  membrane, it
has the effect of diminishing its  acrimony 
COL
131
C O I
 by dilution.   It is the acrimony of this dis-
 charge which  reacting  on the membrane,
 keeps up the inflammation, and its accompa-
 nying disagreeable symptoms.   On this cir-
 cumstance depends the efficacy of a measure
 directly opposed to that just noticed, but to
 the success  of which we can bear  decided
 testimony—we mean a total abstinence from
 liquids.  To  those who have the resolution
 to  bear the  feelings of thirst for  thirty-six
 or forty-eight  hours, we  can promise a
 pretty certain  and  complete  riddance  of
 their  colds,  and what is, perhaps, more im-
 portant, a prevention of those coughs which
 commonly succeed to them.  Nor is  the suf-
 fering from  thirst nearly so great as might
 be expected.   This method of cure operates
 by diminishing the mass of fluid in the body
 to such a degree that it will no longer supply
 the diseased secretion.  Any thing that will
 contribute to reduce the quantity of fluid in
 the body will assist in the plan of cure and
 shorten the time necessary for. it  to take
 effect.  It is, therefore, expedient to begin
 the treatment with an aperient, followed by
 a diaphoretic,  as is  usual,  and  this  is
 the more necessary when any fever attends;
 but beyond  this  no  further  care need be
 taken, and  the  individual can devote him-
 self to his  usual employments with much
 greater impunity than under the ordinary
 treatment.   The coryza  begins to be dried
 up  about  twelve hours after  leaving  off
 liquids ; from that time the flowing to the
 eyes and fulness in  the head become less
 and less troublesome;  the secretion becomes
 gelatinous,  and  between the  thirtieth  and
 the thirty-sixth hour ceases altogether: the
 whole period of abstinence need  scarcely
 ever to exceed  forty-eight hours.    It  is
 then as well to return to the  moderate use
 of liquids, as the first indulgence is apt to
 be excessive.  It is not  necessary to limit
 the solid food  any more than to that which
 is plain and simple, except where  there is
 an acceleration of the pulse, or gastric irri-
 tation, in which  cases animal food should
 be proscribed.   For the sake of comfort  in
 mastication,  the  food  should not  be of the
 driest kind.  Thick puddings and vegetables,
 with or without meat, will be the  best din-
 ner;  and toasted bread or biscuit  merely
 moistened with tea or other  liquid  for other
 meals.  A single cup of  tea is sufficient to
 bring  back  the  coryza  immediately, after
 twelve  hours' abstinence has  removed  it.
 We doubt not that it will be said  that  this
 plan of cure is worse than the disease, and
 so it may be  in some instances.  It  may be
called  always a  choice of evils; but we do
not  believe  that any one who  is liable  to
severe colds,  after once  experiencing  the
amount of good and evil resulting from thifi
method, would hesitate between them, and
it is for them that we make it known.
  "We have never witnessed any evil from
this abstinence  from liquids for the time
prescribed;  but  it is not unlikely  that it
may do harm  in persons with irritable sto-
machs, or in those liable to urinary disor-
ders.  Moderation in liquid food, which may
be  assumed as a corollary from what has
been  already said, is one of the best  pre-
ventives against the bad effects of exposure
to cold.  AVhen there is a large quantity of
liquid in the system there must be increased
perspiration, and therefore greater risk from
the effects of cold."
  If coryza  be not in itself a disease of im-
portance,  its tendency to frequent renewal,
and, as often as it is renewed, to the repro-
duction of irritation in the lungs, renders it
really a disease of consequence, and one not
to be neglected. Moreover, those individuals
who are most susceptible to repeated attacks
of coryza are those who are  most likely to
suffer from frequent or continued irritation
within the chest.
  Refer to Catarrh—Cold, Sfc.
  COLD  CREAM—Is a  pleasant  cooling
ointment,  made by melting four ounces  of
white wax  in  a  pound of almond-oil,  by
means of  gentle  heat, and mixing  gradu-
ally with  a  pint  of  rose-water in a warm
mortar.
  COLIC—Is  the painful spasmodic  con-
traction of the muscular fibres of the bowels,
particularly of the colon, occasioned by the
presence of  an undue amount of wind, or of
some  irritating matter, such as accumulated
faeces, undigested food, acrid bile, over-doses
of strong purgatives, or poison; it may also
be  brought  on by exposure  to  cold.  The
pain of colic comes on and goes off suddenly,
is of  a rolling or twisting character, is  re-
ferred chiefly to the umbilical or navel region,
and is relieved by pressure; there may or
may not  be vomiting.   In some  cases  of
colic,  the spasmodic contraction of the bowel
is so complete and permanent, that inverted
action takes place, and the  faecal contents
are vomited ; to this form the name of ileus,
or iliac passion, has been given.  The above
symptoms distinguish colic from inflamma-
tion, the pain of which is of a more persist-
ent, burning character, and  is aggravated
rather than relieved by  pressure;  in  the
latter case, too, febrile symptoms are present
from  the  commencement.  The distinction
is,  of course,  requisite for active medical
treatment, but many remedies which  may
be used safely and effectually to relieve the 
COL
132
C O M
 one wit1 also be beneficial in the other, and,
 indeed, in other spasmodic or inflammatory
 attacks within  the abdomen, which  might
 be mistaken for colic.
   The  sudden  accession of an  attack  of
 colic,  its peculiarly painful character, and
 the danger that, if continued, it may pass on
 to one of inflammation,  renders immediate
 relief imperative.   The first remedy is heat,
 either locally to the abdomen  by bran-bags
 or similar applications, as hot as they can be
 borne, or by the hot bath of the temperature
 of 100°, if not undesirable on other accounts.
 The use of heat, if promptly and effectually
 oarried out, will often of itself relieve  the
 attack at once, particularly if it is the result
 of cold;  but even should it do so, it will  be
 well to give a dose of castor-oil, or  rhubarb
 and magnesia, to insure the freedom of the
 bowels from irritating matter; a few drops
 of laudanum being added to either medicine
 should the spasm show a tendency to return.
 Should the pain  not be relieved  by the
 employment  of external  heat,  as  recom-
 mended, a warm clj'ster, temperature 102°,
 should be administered, and a cup of tea  or
 of  some unstimulating fluid taken as hot  as
 it can  be swallowed.   If the pain  still  re-
 mains, ten drops of laudanum must now  be
 given,  and repeated  every  quarter of  an
 hour until relief is obtained, or until forty
 drops,  or even more, have been administered.
 If the  case is violent, a  clyster containing
 twenty drops of laudanum  may be given.
 These means, if thoroughly carried out, will
 scarcely fail to afford relief until the arrival
 of medical assistance, which should always
 be  procured, if the  case is at all severe
 or  continued;   it  may depend on causes
 which a medical man alone can discover  or
remove.   Alcoholic stimulants are scarcely
to be recommended for use in non-medical
hands, not because they are not serviceable
in colic,  but  because, should the case   be
mistaken, and prove  one of  inflammation,
they would prove most injurious, which the
remedies above prescribed could not.  Still,
in a case  in which  no doubt could  exist, a
tablespoonful of undiluted tincture  of rhu-
barb, or  a glass *of hot brandy and water,
with or without laudanum, are  either  of
them good remedies.
  Painter's colic, or dry belly-ache, is  a dis-
ease to which persons are subject who work
much among lead;  it is said also to be oc-
casioned by new cider, &c. &c.  It is severe
colic, accompanied with obstinate constipa-
 tion.   The disease, either in itself  or from
concomitant constitutional affection, may
prove fatal, and should always be  treated
 by h medical man if possible.  The treatment
 is much the same as that for common colic as
 far as allaying pain goes, but  the obstinate
 constipation  which accompanies it, requires
 the  laudanum and other means to be com-
 bined with  active  purgatives,  castor-oil,
 senna, compound colocynth pill, &c.  Alum
 has been strongly recommended as a remedy
 in painter's colic.   Much might be done by
 those  engaged  in  employments  connected
 with  lead, to avoid not only this, but other
 bad  effects, by due attention to cleanliness,
 particularly  of the hands at meal-times.
 The use of lemonade, acidulated slightly with
 sulphuric  acid, or of  aromatic  sulphuric
 acid, in water, would probably be additional
 protection.   Lead colic has been induced in
 whole families,  by the use of water which
 acted strongly upon leaden pipes or cisterns.
   Those  who have once suffered from  an
 attack of  colic should pay particular atten-
 tion  to the bowels.  A pill composed of one
 grain of extract of henbane,  with two of
 compound colocynth and rhubarb pill,  will
 be found a most suitable aperient.
   Refer to Alum—Lead— Water—Sulphuric
 Acid, §c.
  COLLAPSE.—The term applied to a state
 of sinking or prostration of the powers of
 life.
  COLLAR-BONE.—See Clavicle.
  COLLIQUATIVE.—A term applied to any
 profuse exhausting evacuation, more par-
 ticularly the  diarrhoea and perspirations of
pulmonary consumption.
  COLLYR1UM.—A lotion  for the eyes.—
 See Eye.
  COLOCYNTH,  or Bitter Apple—Is the
fruit of a  creeping plant, and is brought to
 this country chiefly from the shores of the
 Mediterranean.  An extract made from the
dried pulp is  used in  medicine.  It is  a
powerful  irritating purgative, never used
alone, and only likely to be employed domes-
tically in  its  well-known combination,  the
compound  colocynth pill, one  of the most
universally useful purgatives we possess,
of which the dose is from five to ten grains.
Refer to Pill.
  COLON.— The  large  bowel.—Sec Ali-
mentary Canal.
  COMA.—A  state of insensibility, resem-
bling sound  sleep,  from which the  person
either cannot be roused at all, or only to
partial  consciousness.   The  condition  is
generally the result of pressure on the brain,
either from injury to the skull, or from effu-
sion  of blood or watery fluid, or of matter,
within the head.   In  apoplexy,  poisoning
by narcotic drugs, and  complete  alcoholic
intoxication, the comatose condition exists;
it  may also be owing to exhaustion of the 
                  COM

 brain.   Jn coma the action of the heart con-
 tinues sufficiently perceptible ; in fainting it
 does not.—Refer to Apoplexy, §c.
   COMPLEXION.—The  hue  of  the face.
 Much information may  frequently  be ob-
 tained of the existing constitutional condi-
 tion,  by observation of the complexion;  but
 in judging, it is  requisite to consider the
 original temperament and the family descent
 of the individual.   In fair races, such as the
 Anglo-Saxon, a certain amount of  colour is
 usually associated  with our ideas of health,
 and in some respects truly so ;  the reverse,
 a perfectly pallid face, can scarcely be con-
 sistent with a sound bodily condition.   But
 colour may be too high at all times ; and the
 capillary vessels of the face, partaking of the
 fulness of those of the body generally, may
 indicate that from some cause, such as over-
 feeding, or indolence, combined with good
 digestive powers, the system of the individual
 is too full of blood; for the colour is  not
 confined to the parts naturally tinged, but
 is diffused over the face generally,  and even
 the white of the eye is covered with distended
 vessels.   Such a state is  one of danger : it
 is often  accompanied with headache, giddi-
 ness,  confusion  of thought, sleepiness;  and
 when these occur, apoplexy maybe  dreaded.
 A high or brilliant colour may also accom-
 pany the consumptive constitution ;  but in
 this it is very generally  associated with a
 fine skin, and  often with light or red hair,
 with  freckles,  and also  with  a pearly  or
 bluish appearance  of the white of  the  eye.
 This appearance of high health is apt to de-
 ceive the inexperienced;  but the colour is
 generally not equal or persistent.   It varies
 much, being  easily heightened by excite-
 ment,  or depressed by the  reverse,  and it
 continues  to  add beauty even to  the last
 stages of the hectic of consumption.  In the
 dark-haired, and dark-complexioned, colour
 is less commonly developed.   The complex-
 ion of disorder or disease is very varied ; it
 may be muddy, pallid, pasty, white, sallow,
 cachectic,  yellowish-green, and purple.
  The muddy complexion  may be the natural
 one of the skin, but it frequently accompanies
 dyspeptic  ailments, and is directly depend-
 ent on depressed nervous  power and languid
 circulation of  blood:  it  is  most  strongly
 marked in the dark depressions underneath
 the eyes.   Whatever lowers or exhausts the
 nervous power will  produce this complexion,
 which may be  seen in perfection when  the
 right of morning shines in, either upon  the
-otaries of a too protracted  dance, or upon
tne weary watcher  beside the  bed  of sick-
ness.   Sleep is the  best restorer of the  ex-
haustion of nervous power indicated by this
       M
;3                CON

 condition of complexion; but if rest is im-
 possible, it is one  of/those cases in which
 stimulants, hot tea or coffee first, and then
 alcoholic stimulants, is  perfectly  requisite
 The pallid complexion is often the result of
 too  close  confinement to the house,  and
 especially of deficient exposure to diffused
 daylight—it is well marked in miners.  The
 pastj' complexion accompanies the lymphatic
 constitution, and general laxity of the solids.
 The subjects of it require a good allowance
 of animal food, in  preference to milk and
 grain preparations,  puddings, &c, of which
 they are often too  fond.  They  almost in-
 variably  derive benefit from  preparations
 of iron.   A marked white complexion not
 natural to the individual  is often  indica-
 tive  of serious disease, probably  of the
 kidneys or  heart,  and when  it appears
 in persons advanced in life, the case ought
 most certainly to be investigated  by a medi-
 cal  man.   The sallow  complexion  is very
 generally  a natural  one.   The  cachectic
 accompanies a diseased state of the  system,
 and often  of the  abdominal organs ; it is
 muddy, and accompanies emaciation of the
 features.   The yellow complexion may be
 the  bright hue  of jaundice, or the muddy
 yellow  associated with  malignant disease,
 especially  cancer.   In the greenish-yellow
 skin of chlorosis or green sickness, there is
 also extreme pallor of parts usually coloured
 —such as  the lips.   A purple complexion is
 indicative  of deficient oxygenation  of the
 blood, either from  disease  of  the heart or
 lungs ;  generally of the former.
   Refer to Skin, Countenance, Sfc.
   CONCRETION—Is a term applied to the
 unusual aggregation  of any substance or
 substances within the body—most generally
 to intestinal concretions.  Persons who have
 been in the habit  of  taking large and re-
 peated  doses of magnesia have  not unfre-
 quently suffered  from its  concretion  into
 hard lumps or balls in the stomach or in-
 testines.   Any  substance  which  possesses
 the  power of felting  or matting together
 is liable to form a concretion in the bowels.
 One has been found of ends of thread matted
 together, which a female  had been  in the
 habit of biting off and swallowing when at
 work ;  but perhaps  the most common cause
 of the intestinal concretion is the felting of
 the bran of the oatmeal, as used in Scotland,
 when too exclusively employed as food, and
 in too  dry a state.   Good  boiling and di-
 luting,  or  the mingling of other  articles of
 food, particularly those of an oily nature, is
 the best preventive.
   CONCUSSION.—A term applied in medi-
 cine to  the effects of a severe blow over some
li 
C O X
134
CON
 of the  m irt important organs of the body,
 or on the body generally.
   For Concussion of the Brain, see Brain.
   Severe concussion  of the  chest affecting
 the heart,  or  over the region of the  sto-
 mach,  may prove  fatal immediately, or at
 least produce much alarming faintness and
 collapse. In the latter case the use of stimu-
 lants, such as ammonia or spirit internally,
 or stimulant clysters, and the dashing of a
 jug of  cold water  over the chest and face,
 immediately following it by hot applications,
 mustard, &c, would be the most appropriate
 treatment.
   CONDIMENTS—Are substances which are
 not of themselves nourishing, but which are
 taken along with food as seasoning, and to
 promote its digestion.   Salt  is the most ex-
 tensively used, and  also  the most whole-
 some condiment.   To civilized man its use is
 second nature, and very many of the lower
 animals are not only fond of  it, but seek it
 instinctively as a necessity, and  improve in
 health  and appearance when they have ac-
 cess to it. The vegetable acids, vinegar, &c.
 are useful  and wholesome  in moderation,
 particularly with oil}'  food.   The aromatics
 and spices, such as cayenne, white or black
 pepper, ginger, &c, can  scarcely be called
 injurious to healthy  individuals,  if used in
 moderation; in debility of the stomach they
(are often of  service,  and they seem espe-
 cially adapted  to counteract  the effects of
 a warm climate  upon the digestive organs,
 and  also to the  constitution, acquired or
 otherwise, of the  inhabitants.   They are,
 however, generally used along  with vege-
 table productions
   Refer to Salt—Vinegar—Aromatics, Sfc.
   CONDYLE.—The extended extremity of a
 bone which forms the joint.
   CONFECTION.—A  term applied  to  me-
 dicinal  preparations  generally made with
 sugar.   The most useful are almond confec-
 tion, aromatic confection, cassia, rose, and
 senna confections.   Of these, the aromatic
 confection is the  most useful  and generally
 used preparation.  It is thus made:—Take
 of cinnamon,  nutmeg, saffron, of each  two
 ounces; cloves one ounce, cardamons half
 an ounce: prepared  chalk  sixteen ounces.
 Reduce these materials, when dry, to a fine
 powder, and keep  them in a close vessel.
 Sugar,  to the extent  of six ounces, may or
 may not be added to the preparation.
   Refer to Almond—Rose—Senna, jfc.
   CONFECTIONARY—Literally,'  " things
 made up,"—is not necessarily unwholesome,
 if used in moderation;  it is, however, too
 often deleterious  if made with much butter,
 or when made of bad materials, or mingled
with poisonous ingredients.   Baked confec
tionary,  in which the butter or grease is
rendered  empyreumatic and  acrid  by the
heat employed in its preparation, is  always
liable to disagree, and especially so when,
as often happens, bad materials are em-
ployed and  disguised with  flavours  of va-
rious kinds, which are often in  themselves
unwholesome, particularly those so largely
used, such as the oil of bitter almond, peach-
kernel,  and  laurel flavouring,  which  are
actual  poisons, when taken  even in  not
very large quantity.  Another flavouring in-
gredient, recently introduced, but already
largely  used,  called  "jargonelle pear," is
not devoid of danger, and  has been  known
to produce dangerous head symptoms in a
child.  It is  made from the fussel-oil  ob-
tained  in distillation  from grain, potatoes,
&c.  But perhaps the most numerous cases
of injury have arisen  from  coloured confec-
tionary and sweetmeats, a large proportion
of which are  tinged  with deleterious  sub-
stances;  the greens with arsenite of copper
or Scheele's green, verdigris, or a mixture
of chrome  and prussian blue;  the yellows
by chromate of lead ; the reds by  vermi-
lion, a compound  of  mercury, or by oxide
of iron;  and the whites by carbonate of
lead,  oxide  or carbonate  of zinc,  chalk,
or sulphate  of baryta.   The  frosting of
cakes and the white-sugar comfits often con-
tain  a large percentage of plaster of Paris,
These facts ought to  be sufficient to make
people very  cautious  in  the use of such
articles, particularly with children ; and, in
case of sudden unaccountable illnesses, they
should not  forget the  possibility of such
causes.   The  colour of a sweetmeat would
afford some clue to the nature of the poison,
and  reference to the  proper article  in this
work will show the measures proper to be
adopted in  the  interval  of procuring medi-
cal assistance.
  CONGESTION.—A  morbid accumulation
of fluid,  such as blood, in its  own  proper
vessels.
  CONJUNCTIVA—Ts the membrane which
lines the eyelids, and is folded  from them
upon the forepart of the eyeball, which it
covers, extending over both  the white and
the clear portion, or cornea. In its ordinary
healthy condition the conjunctiva is a trans-
parent membrane, with, perhaps, one or two
tortuous vessels seen upon it.
  Refer to  Cornea—Eye, #c.
  CONSERVE—Is  a  compound  of some
fresh vegetable substance with sugar.  The
conserves are  now classed with  the con-
fections.
  CONSTIPATION.—See Costivknkss. 
CON
135
COiN
   CONSUMPTION,  or  Pulmonary  Con-
 sumption—As its name implies, is a disease
 of the lungs, or  at  least one in which the
 lungs are  more  prominently affected than
 any  other  organ.   In Britain  [and in the
 United  States] its  fatality and frequency
 render it but too familiar, as year by year
 it numbers  for its  victims  the young, the
 good, and the fairest in the land.
   Consumption is a portion only of a con-
 stitutional  malady,  which very  frequently
 develops its intensity in the organs of respi-
 ration, but  may do  so in other modes  and
 in other organs of the body.   Its constitu-
 tional nature requires to be impressed upon
 the mind of people in general; for, regarded
 only as  a disease  of  the lungs, alarm is not
 taken, nor  are  remedies generally resorted
 to, until its effects   upon these organs be-
 come manifest;  the antecedent  period, in
 which  the   constitution  is  giving way, is
 overlooked,  and that time is lost in which
 the first indications of disease might  have
 been successfully attended to.
   The causes  of pulmonary consumption
 are all  those which  occasion debility gene-
 rally, not excepting the most frequent of all,
 hereditary predisposition, or that tendency
 to the disease which exists  so  strongly in
 some families, that no care or precaution can
 ward it off, nor prevent it seizing in  succes-
 sion  member after member of a household.
 Fortunately,  this  intensity  of  hereditary
 transmission is not  so very frequent,  but
 there  are few  families in this  country in
 which the  tendency does  not more  or less
 exist; there are few which cannot number
 amid their  deceased relatives some victim
 of  consumption.  AVith a susceptibility so
 widely diffused, it becomes a serious  con-
 sideration with  all by what this tendency is
 encouraged, and how it may be diminished.
 The first consideration that presents is mar-
 riage.  There can be no question, that from
 errors in the contraction of this great en-
 gagement of life, much  of  the hereditary
 tendency to  consumption is  developed, and
 especially when the union is betwen  parties
 nearly related by blood; doubly so if  the
 predisposition already  exists in the family.
 Delicacy  of  either parent,  particularly of
 the father, is very apt to entail consumptive
 tendencies upon the children ; and the same
 follows if the parents are either too young,
 or if the  father be advanced in life.  The
 mistake is a very common one,  that mar-
riage and child-bearing act as a check upon
the progress of  consumption, and  the step
is often advised even to the comparatively
young with this view.   The error is a serious
one; nothing can be  more trying even to a
 healthy female, in this country, than having
 a family before the constitution is formed ;
 and most certainly it is so to the weak.   It
 is true, apparent temporary amendment of
 consumptive symptoms sometimes occurs,
 but the powers  of life are  sapped by the
 too  early call  on their exertions.  In the
 management of  the  children of  even the
 most healthy parents—doubly so  of those
 who are the reverse—much  may  be  done
 either to weaken or to  fortify the constitu-
 tion, to pull down the  one to the level of
 the  scrofulous diathesis which  ripens into
 consumption, or to infuse into  the other
 such strength and vigour that it may resist
 during a long life any development of the
 disease.  For  information respecting the
 management of children, the reader is re-
 ferred to the article itself.
   As  the  period of puberty approaches,
 care is required with  all,  but doubly  so in
 the  case of  those who  have displayed any
 scrofulous  or consumptive  tendency.  The
 development of the body which is going on
 requires a full  supply of the most nutriticus
 food, animal food particularly.  The secre-
 tions should, if possible, be kept in healthy
 activity, and,  more especially,  all sources
 of exhaustion most strictly  avoided. Youths
 especially must be warned  against the evil
 of prolonged physical exertion ; and not'less
 so against the mental  efforts, which those
 especially,  who partake of  the nervous and
 excitable constitution of the hereditary con-
 sumptive, are apt to give way to, in compe-
 titions at school or college.
  At any period of life, mental anxiety or
 over-exertion, intemperance or dissipation,
 the habitual  breathing  of vitiated  air, low
 damp  situation,  insufficient  clothing, and
 exposure to the weather, or peculiarity of
 employment, particularly that which neces-
 sitates the  inhalation of irritating matters,
 or any continued drain upon the powers of
 the constitution, such as suckling, may any
 of them develop or induce consumption.
  Two very opposite conditions of physical
 development  are found  to exist along  with
 the consumptive tendency.  In the one, there
 is the fair fine skin  and  bright red com-
 plexion, the fair hair, the light eye, with its
 pearly  looking  white,  and  the  tapering
 fingers; in  the other,  the  dark  hair and
 skin, the latter almost dirty-looking, and the
 swollen looking  upper  lip.   Consumption
 varies  much  in its initiatory stage; some-
 times it steals upon the  patient most slowly
 and  imperceptibly;  at  others, developed
probably by  some acute attack, it  appears
 to start at once  into activity.  Generally,
for  a considerable period  before  marked 
C 0 N                 130                CO N
symptoms—or  at  Inst   symptoms  which
attract general attention—show themselves,
the person  has felt weak,  languid, and com-
plained much of cold, probably has sunk in
flesh, and a short dry cough has come on,
apparently without  cause, or  there  has
been continued dyspepsia.  If the patient is
a female, the monthly discharge has become
irregular, or stopped. It may be that these
symptoms  have  been  aggravated during
winter, and disappeared partially or entire-
ly with the advent of warm weather.   Such
symptoms may go on for a longer or shorter
period, ebbing and flowing, but still gaining
ground, or  they may progress more unre-
mittingly,  though still  slowly, or become
suddenly aggravated by some adventitious
circumstance, such  as  taking cold,  some
unusual fatigue, or the like.   The emacia-
tion becomes too evident to escape notice,
the cough is unabated and becomes trouble-
some, the voice assumes  a peculiar hollow
sound, the  breathing is  quickened, and it
may be that spitting of blood, profuse  night
perspirations, or even diarrhoea, have set in
before the patient's condition excites either
alarm in their own mind  or in that of their
friends.  Indeed it very frequently happens
that the patient is  the   last  to take the
alarm, the  last  to entertain the idea of the
fatality of  the disease, of which this hope-
fulness of recovery is a well-marked symp-
tom.
  Threatened consumption is no disease for
domestic treatment.   On the first suspicion
of its presence, the  person  should at once
be examined  medically.   The  above symp-
toms may  excite alarm,  may afford  most
grave ground for suspicion, not only to the
friends,  but also in the mind of any medical
man, but their certainty cannot possibly be
pronounced upon without the physical  exa-
mination of the chest, which well-educated
medical practitioners only  can conduct.   By
that,  the case may  very  generally be de-
cided, groundless  fears  dispelled, or  just
apprehensions confirmed  and  acted  upon,
while yet there is time to save or prolong
life.
  As regards the prospect of recovery from
consumption—for recovery  does  undoubt-
edly take  place—much depends  upon the
original  and  existing  constitution   and
the habits, past or  present,  of  the  indi-
vidual, and the  worldly  means within his
power.
  If the disease has  become established  in
an individual of strong hereditary tendency
to it, or in one who has  broken down his
constitution by dissipation or intemperance,
or who  is  the subject of  some other  debi-
litating disease, hope of amendment can be
but small.  If, on the contrary, the affection
is more probably induced, and rather acci-
dental than the  result of original constitu-
tional tendency,  the  probability is thnt
under proper management, and with the aid
of the great curative powers  of cod-liver-
oil,  not  only amendment,  but permanent
recovery, may be obtained.  When consump-
tion  has  advanced beyond its first stage, all
the  symptoms  already  mentioned are in-
creased,  the  cough and  perspiration  parti-
cularly become more distressing, and the ten-
dency to diarrhoea, (frequently with severe
spasmodic  pain  in  the bowels,) notably in-
creased ;   expectoration  is often difficult,
either from weakness, or from viscidity of
the expectorated matter ; the  hair falls off,
progressive emaciation continues, and be-
fore  death  the  skin of the most  prominent
portions  of the back is apt to become  ulcer-
ated.  The disease, however, may be termi-
nated earlier by sudden  bleeding from the
lungs, by an acute  inflammatory attack, or
by giving way of a weak constitution.  Its
ordinary duration  is  about  nine months.
Amid the other symptoms of advanced con-
sumption,  a peculiar broadening—" club-
bing"—of the extremities of the fingers, with
incurvature of the nails, is often observable;
and recent observations  have  been directed
to the occurrence of a peculiar pink-looking
marginal line at the junction of the  gums
with the teeth, which occurs in some cases.
  The prevention of so  fatal a disease as
consumption is a more important subject, in
a.work like the present, than its treatment;
and  in those predisposed, the preventive
or "prophylactic" system must be continued
life  through, even into  old  age.  It is a
popular error, that by the time middle  life is
reached  the liability to consumption is  over.
Such is not the case, for even the "three
score and ten"  is sometimes terminated by
the  disease.  According  to the  tables of
Sir James Clark,  it  appears  "that  the
greatest  number of  deaths  from phthisis
(consumption) happens between the ages of
20 and 30; the next greatest  number from
30 to 40; the next from 40 to 50, and many
even  up  to 70 years  of age ;  more women
than  men,  on the average, dying from the
disease.   It has  already been  remarked
what a potent influence hereditary predispo-
sition toward consumption exerts, and how
strongly this predisposition  may be deve-
loped or  increased in a family  by marriage
union.  People will marry, whatever  their
constitutional predisposition ;  but if either
their own constitution or  that of their family
generally is at  all consumptive, it  ought 
                  CON

 to be  a very  weighty consideration with
 them  that  the  union should be  with one
 as  little  inclined  toward  the  disease as
 possible.   When the children in  a family
 evidently inherit or display consumptive
 tendencies,  in addition to the precautionary
 measures already enumerated in the article
 " Children," it  should  become  a  question,
 how far permanent removal to a  more genial
 and dryer climate might be desirable.  To
 the  rich, who  have it  in their  power to
 change their  residence  as and when they
 may,  the consideration is perhaps of less
 immediate consequence ; but to the labourer,
 the mechanic, or the man of small income,
 it must be a question of paramount import-
 ance,  whether, by emigration  to such a
 climate  as  that of Australia, he may not
 only  save  himself the  constant  sorrow,
 actual and  anticipated, of seeing his family
 drop one by one into their early graves, but
 also save the constant pull-back upon his
 exertions  and  drain  upon  his resources
 which  a sickly family necessarily entails.
 But, indeed, in any condition  of life, the
 question of tendency or not to consumptive
 disease should  always influence the choice
 of field for exertion, and not only of field,
 but also of the nature of the business of life.
 Any occupation which  renders  the inhala-
 tion of irritating substances unavoidable, is
 to be  eschewed by the  consumptively  in-
 clined  man; and not less so,  that  which
 involves confinement in a constrained  posi-
 tion or in  a close  room.   Of  the former
 class,  grinding or  polishing of  metal or
 stone,  especially if  dry, flour-grinding, &c.
 are examples;  of the latter, the occupation
 of the  tailor, the shoemaker, the  seamstress,
 or the compositor.  The  most eligible em-
 ployments are those which require muscular
 exertion of not  too  exhausting  a kind, and
 without too great exposure to the weather ;
 the  gardener,  the carpenter, the butcher,
 the farm-servant, are all less likely to be the
 victims of the disease.  In whatever  situa-
 tion or grade of life, however, a person may
 be placed who is  predisposed to consump-
 tion, much may  be done to keep up the
 powers of resistance, by keeping up the ge-
 neral health to the highest possible standard,
 by diet,  early hours, attention to the skin,
 [by thorough and daily washing of the whole
 body,] and avoidance of all kinds of  dissi-
 pation  and intemperance.   Smoking tobacco
 should be shunned as particularly injurious.
 Regular exercise is to be taken—[especially
in the  open  air,  when the weather is not too
damp.  A distinguished  physician of Phila-
delphia prolonged his life thirty years by con-
stant  exercise,  though at one  period ad-
       *r 2
17               C O N

vanced in consumption.   He never remained
in-doors except when it rained.]  The chest
and  shoulders  should  be  bathed  every
morning with cold salt-water, and rubbed
afterward to promote reaction.   Cheerful-
ness of mind and moderate mental exertion
are important, while perfect temperance in
the use of alcoholic stimuli is indispensable;
but any change to their total disuse cannot
be made in many cases without danger. All
the  usual sources  from which "cold is
taken" are to be shunned, particularly wet
feet, sitting in damp clothes, crowded  ball-
rooms, and public assemblies; and, lastly,
when exposure to cold air, especially to east
winds, or to the foggy atmosphere of night,
is unavoidable, the protection of a respirator
of some description should be resorted to.
  The question is often mooted with respect
to the communicability of consumption from
one person to another.  That it  is not ge-
nerally communicable is certain;  that it
has been thought to be so  under  circum-
stances of predisposition, and when there has
been close communication between two per-
sons, should  be sufficient to caution  other
members of  a consumptive family  from
hanging too  much over one  affected  with
the disease; and certainly, in any case, for-
bid the occupation of the  same bed.
  With respect to the treatment of consump-
tion, little remains to be said. Itcan never be
an emergency, and the first suspicious symp-
toms should be the signal for obtaining pro-
per medical advice; if the disease is really
threatened,  the well-conducted  treatment
of a competent medical man can alone  be
trusted to.   In the progress of consump-
tion, however, there are many painful symp-
toms which may be alleviated by measures
independent  of the  treatment of the  dis-
ease properly so called.
  As regards  diet,  there is the  greatest
variation, some patients  being  most  com-
fortable with  a  milk or farinaceous diet
alone, while others require the constant use
of stimuli, wine or porter, and consume ani-
mal food in good quantity.   For allaying the
troublesome  cough,  demulcents  of various
kinds  may be tried, with or without the ad-
dition  of small doses of morphia, laudanum,
paregoric,  or  Battley's  sedative solution.
When a tendency to perspiration exists, and
there is no diarrhoea, the following is a very
useful and palatable mixture, which  allays
both nervous irritability and cough:—Take
of muriatic  acid  thirty drops, muriate of
morphia  one  grain,  refined  sugar  two
drachms, water six ounces;  of this mixture,
a tablespoonful may  be given  every few
hours.  In the later stages,  when the  couph
1: 
C 0 N                 13S                C O N
is parti;,  spasmodic, and expectoration diffi-
cult, miich relief is often experienced by the
inhalation of steam,  along with the vapour
from  a few drops of sulphuric ether put in
the boiling water.   The perspirations may
be kept  in check  by fifteen-drop doses  of
dilute sulphuric acid  in a wineglassful  of
water ; but when diarrhoea is present, this
cannot be persevered in.   To relieve  diar-
rhoea, the abundant use of isinglass or gela-
tine  will be  found  serviceable,  also  chalk
mixture with opium ; five-grain doses of the
oxide of bismuth, with a quarter of a grain
of powdered opium, is often a useful remedy.
Acetate of lead,  gallic acid,  &c. are also
used, but scarcely likely to be so domestic-
ally.  In case of sudden bleeding from the
lungs, refer  to Hemorrhage.
  Refer to Chest—Children—Lungs—Respira-
tion—Respirator—Scrofula—Temperament, <yc.
  CONTAGION—Is sometimes  used to ex-
press the actual agent by which  disease is
propagated;  but more generally the propa-
gation itself.  Properly speaking,  the  term
ought to  be  confined to the  propagation of
disease by actual contact, in contra-distinc-
tion to infection;  but it is now used in the
more extended sense  of  "infection"  like-
wise.  Contagious diseases may be commu-
nicated only by actual contact of individuals,
as in the case of itch, &c.;  by inoculation,
as in the case of cow-pox; or in addition to
both or either of these modes of transmis-
sion,  through the  atmosphere by infection,
as in the case of small-pox, &c.
  This power of propagation through the
atmosphere, however, does not, independent
of epidemic and endemic influences, extend
far from the patient.  Certain circumstances
influence the extent of contagious diffusion.
Of these, the most distinctly ascertained are
atmospheric  impurities; for  it is ever ob-
served, and  we believe it may be predicated
of every disease possessing the property of
remote contagion, that its contagious matter
is propagated to greater distances in a dirty,
crowded,and ill-ventilated apartment,than in
one of which the air is pure.   The same prin-
ciple applies to articles of dress and  furni-
ture ;  those which  are contaminated  by
animal secretions  and effluvia being  much
more readi'y impregnated with contagious
matter than those which are clean.  Peculiar
atmospheric  conditions certainly,  also  fa-
vour the propagation  of disease by conta-
gion ; sometimes these conditions  are inap-
preciable, at others they are evidently con-
nected with  a superabundance of warmth
and moisture:  and also, we have good rea-
son  to  conclude, with certain  states  of
electrical disturbance.  The discovery of
the new agent, or modification of the known
existing  agent oxygen—named ozone—may
probably shed some new light upon the sub-
ject of contagion.  Actual contact, however,
or  even  immediate  vicinage, to  a person
labouring under a contagious disease, is not
requisite for its propagation to others.  Tlu>
may be effected by means of substances to
which the contagious matter clings.  These
substances, which go by the name of fomites,
are more generally clothing and stuff furni-
ture  which  have  been about or  near the
bodies of those labouring under the disorder.
These fomites are apt to be impregnated
with the  poison in a very concentrated con-
dition, and are capable, not only of retain-
ing it for a long period, but of transporting
it from place  to place.  A sofa on  which a
patient labouring under  scarlet fever had
lain  has  been  known to  propagate the
disease six  months afterward; and clothe9
which have been  about the  sick  are con-
stantly ascertained to have been the media
of conveying fever, &c. to distant localities.
Wool and cotton  seem particularly apt to
attract and retain contagious emanations;
but, indeed, all loose textures appear to have
the  property; while  on  the other hand,
polished  and  hard surfaces and substances
are much less likely  to act as fomites, if
they do so at all.  Every thing of  unneces-
sary drapery or clothing should be removed
from the chambers of those sick of contagious
maladies, or  indeed of any malady;  for a
sick  chamber  must always, in a lesser or
greater degree, have  an  atmosphere con-
taining unhealthy emanations, which it is
expedient, both for the good of the patient
and of others, should  find no unnecessary
attractions or lodgments.   Further,  it  is
advisable to have the furniture as  much as
possible  of hard and  polished substances;
and the dresses of those in attendance upon
the sick,  especially if habitually  so, might
with  advantage be made with a glazed sur-
face.   Those  substances which have neces-
sarily become  the  fomites  of  contagious
matter ought to be scrupulously freed from
it by complete and lengthened exposure to
the open air,  by washing,  or by exposure to
the fumes of chlorine in a close apartment;
or by all three, the chlorine fumigation  be-
ing first  resorted to.   Indeed  those persons
under whose  management a  case of conta-
gious disease has  occurred, ought, as  a
Christian duty, to make sure that  every ar-
ticle of stuff, furniture, clothing, &c. has been
fully and carefully  purified  before others,
either in the way of  social  intercourse or
in occupation, particularly that of the wash-
erwoman, come in contact with them.  Tin 
C 0 N                139                C 0 N
 foUowing systematic course of action should
 be pursued when the generation of contagious
 matter has  ceased in  an apartment, either
 by  the death  or recovery of the  patient,
 premising, of course,  that throughout  the
 illness measures have been (or ought to have
 been) resorted to to preserve purity.  During
 the  day, the door being shut, the windows
 should be open to their full extent,  and  the
 infected articles freely exposed to  the air;
 during the night, the windows and door be-
 ing closed, chlorine should be well  diffused
 through the apartment. This having  been re-
 peated, if possible, for two days and nights,
 all textile fabrics and the like should be re-
 moved; those that are capable  of being wash-
 ed put into cold water, and the others placed
 in the open air.  All articles of furniture left
 in the room, also the  floor and oil-painted
 wood-work, should be well scoured.   If  the
 chamber be a white-washed or coloured one,
 it should be "re-done;" if papered, it is
 only a safe precaution to repaper it.   The
 bed  requires the greatest  amount of care;
 if of wool, it is better destroyed altogether;
 if of hair or feathers, these should be exposed
 to the  heat of rebaking, that  is, at least to
' a temperature of 210° Fahr.;  and the tick-
 ing either thoroughly fumigated and washed,
 or entirely renewed.  These directions may
 appear minute and  troublesome,  but they
 are far from being too  much so when put in
 somparison  with  the fearful  scourge of a
 contagious disease  which  has  established
 itself in a  household or  community,  and
 which  perhaps might have been checked at
 the  outset by the adoption of prompt and
 vigorous  measures.   The poor  and  the
 ignorant cannot or will not adopt, in most
 instances, effective precautions ; it remains
 for the rich, for the well-informed, to point
 out  their necessity, and lend a helping hand
 to their  fulfilment,  not only  as  an act of
 Christian charity, but  as a means of safety
 for themselves. The disease which takes its
 origin  in the cellar of Lazarus, not unfre-
 quently ends by establishing itself in the
 mansion  of Dives.   It is not a necessary
 character of contagious disease  that it has
 itself sprung from contagion; some of the
 most virulent and  spreading fevers,  such as
 those of the ship, or of the old jails,  had no
 such commencement, but had their origin
 in the  decomposing emanations from  the
 bodies  of numbers of  individuals confined
 in unventilated  and insufficient spaces.   In
 addition to the disinfectants  already men-
 tioned,  air, water, and chlorine, many others
 are and have been used, such as the vapour of
 vinegar, of pitch, or  of tobacco or camphor,
 [or roasved coffee] ;  large fires also used to
 be a favourite method; but none of these last-
 mentioned  are  to be solely depended upon.
 The vapour of muriatic acid and the absorb-
 ing properties of newly slaked lime may be
 resorted to, in the absence of chlorine, with
 advantage.  In many instances, particularly
 in  the  case  of  clothes and  other  textures
 which will not wash, heat might be used more
 extensively than it is at present as a disinfect-
 ant.  The experiments of the late Dr. Henry.
 of  Manchester, proved that while the various
 textile fabrics might be exposed to a heat of
 at  least 215°Fahr. without injury,their power
 as  fomites,  or  of propagating contagious
 disease, after having absorbed the emana-
 tions, is destroyed by the high temperature.
   Refer to Air—Bed-room—Chlorine, Src.
   CONTUSION.—See Bruise and Concus-
 sion.
   CONVALESCENCE—Is the transition pe-
 riod between the cure or cessation of severe
 disease, whether acute  or  chronic, and  the
 re-establishment of health.  The commence-
 ment of convalescence, or the point at which
 the characteristic symptoms of disease cease,
 is sometimes  distinctly marked, more espe-
 cially after acute disorders; frequently, how-
 ever,  the tendency toward health, particularly
 after  chronic disease, is much more insen-
 sibly  established.  In the latter case, too,
 the progress of  the convalescence is slower
 than it is in the former.  Its rapidity or pro-
 traction,  moreover,  is  much  influenced by
 age,  and  the  nature and treatment  of the
 previous  malady.  Children  convalesce ra-
 pidly, old people the reverse ;  but in all cases
 the natural power of resiliency of the consti-
 tution exerts much effect.  In no case, per-
 haps, is convalescence  more  tardy and un-
 satisfactory than after illness in which much
 loss of blood, or of its constituents, has taken
 place, either as a consequence of the disease
 or  of blood-letting in the treatment of it.
 Since, however,  the  practice  of abstracting
 blood in a large quantity by the lancet has
 been  modified, there are fewer cases of pro-
 tracted convalescence from this cause.
  AVhen convalescence  from  acute  disease
 commences, the  previously quick pulse falls
 to the natural standard, the  tongue begins
 to clear, the skin becomes  cool, sleep is re-
 freshing, the mind acquires a  more healthy
 and hopeful tone, and the person looks better.
 There is nothing which more  assures a me-
 dical  man of the condition  of his patient
 than the look, the expression of the counte-
 nance, to which the first glance, as he enters
 the room of sickness, is almost instinctively
directed.  The look of convalescence is tran-
quil and placid, not the heightened colour :*nd
bright eye of hectic, which so often  deceives 
C 0 X
111)
C 0 X
 the  inexperienced  with  delusive   hopes.
 AVhen  the brain has  been  much  affected,
 howev*er,  the condition of the mind,  and
 consequently the countenance,  assumes its
 natural look more slowly.
   The management of convalescence is ex-
 tremely important.  Errors in this  respect
 frequently expose  the  already weakened
 patient to attacks of other disorders, or in-
 duce relapses to  the diseased actions which
 had just been cast off.  The  convalescence
 after some particular diseases is more liable
 to such accidents than it is in others.  That
 after fever is peculiarly so ; and after scarlet
 fever,  the tendency to  cold  and its  conse-
 quences,  dropsical swelling,  and  affection
 of the kidneys,  is  so very common, and so
 frequently fatal, that the greatest  possible
 care is  requisite.   During   convalescence
 from  acute disease, and  especially of an
 eruptive character, many of the disorders
 characteristic of the scrofulous constitution
 show themselves :  the  eyes become the seat
 of chronic inflammation, purulent discharge
from the ears occurs, and chronic eruptions
 show themselves upon the skin, of the head
especially.  Moreover, these disorders, now,
perhaps, for the first time apparent, are apt
to continue even after convalescence,  pro-
perly  so called,  is  over.   Further,  relapse
in convalescence often occurs from  too soon
 employing  actively the previously  affected
organ; the liability to  this mishap  must be
evident to the common sense of every  one.
 In the case of the  eye, it is  evident to the
senses, after inflammation of that organ, its
undue  exercise, or even its exposure to full
daylight, will often be followed by a return
of the  disease.  Such is the case elsewhere;
and whether  it be the  eye, or the brain, or
 the stomach which has  been affected, re
turn to the  ordinary exertions of health
must be made with the greatest caution.
  The  clothing of a convalescent patient re-
 quires  particular attention ;  there  is much
 susceptibility  to  cold  and to  atmospheric
 vicissitudes.   For  the  requisite  informa-
 tion  the reader is referred  to  the article
 "Clothing."   General   exercise  is  to  be
 resumed cautiously, and should never be
 carried to the extent of fatigue.  Diet, how-
 ever, is the great source both of error  and
 mischief—the greatest  difficulty which the
 medical man has to contend with ;  that is,
 in getting it properly  attended to, and his
 orders properly  carried  out,  particularly
 among the poor.  AVhile a disease is in  pro-
 gress and alarm is felt, directions are tole-
 rably well, or indeed strictly, obeyed; but
 no  sooner does the patient  begin to get
 Setter, than irregularities commence.   The
j popular idea seems to be that convalescence
 must advance in proportion  to the amount,
 and  often to the stimulant qualities, of the
 food given ;  and many a hopeful  case sinks
 back into  fatal relapse from  the wilful  and
 injudicious  kindness  of  friends.  The  point
 is one which requires  to  be  strongly  en-
 forced, not only on the minds of the poorer
 and  more ignorant, but on those  of people
 generally, that in diet, as in every thing else,
 convalescence must  be gradual,  and  that
 nothing is more  dangerous,  more likely to
 induce relapse, than  the injudicious use of
 solid animal  food or of stimulants.  .Milk,
 and  the various farinaceous preparations
 with which it is  usually combined, such  as
 arrow-root, sago, rice, bread, &c. is perhaps
 the most  generally useful  article  of diet in
 convalescence ; next come  the  broths made
 from  fowl, mutton, veal, or  beef,  alone, or
 mixed with some of the farinacea ; next in
 succession, are  eggs lightly boiled; and,
 lastly, solid  meats, of which tender mutton
 is probably  the  best, are to be permitted.
 Ripe fruits in their  season, if not  contra-
 indicated  by the nature  of the  previous
 disease, and  if they  do not occasion flatu-
 lence or diarrhoea, are  both grateful  and *
 serviceable.   If  alcoholic stimulants can be
 dispensed  with,  it  is the  safer plan,  and
 when requisite,  the  time of their employ-
 ment, and the kind  used, is best  left to a
 medical attendant.   A good  deal  must  de-
 pend upon the previous habits of the person.
 Gin, in cases in which the urinary  secre-
 tion is deficient, is most suitable;  or light
 sherry, if  the circulation is excitable f nnd
 port  wine or porter in extreme debility.
 One  of the   most useful of the  alcoholic
 stimuli, in convalescence, is the bitter India
 beer  or pale  ale;  the amount of alcohol it
 contains  is not  large,  its  bitter  exerts a
 beneficial  tonic  effect upon the  stomach,
 while the narcotic  principle of  the  hop
 tranquillizes  the  nervous  system,  often  so
 painfully irritable.  In whatever form nour-
 ishment is given to  the  convalescent, it
 should be in small quantity at a time, but as
 frequently repeated as the  natural appetite
 requires.  The atmospheric  purity of  the
 chambers  occupied  by persons recovering
 from  sickness  requires   great  attention,
 and the temperature ought  to  be  kept as
 nearly as possible about 58° Fahr.   Lastly,
 when convalescence has reached  a certain
 point, there  is no remedy which  so surely
 promotes  perfect recovery  and   confirms
 health as  change  of  air.   Almost  nny
 change  is  beneficial, but  in  many cases
j much more  advantage would be derived if
; persons thus seeking  health  acted  upon 
CON
141
CON
  competent medical advice.  It is to be re-
  gretted, that  so  many of  the  accessories
  which  promote speedy and certain conva-
  lescence have hitherto been  unattainable
  by the  poorer classes in this country.   Care
  and good  nursing and the highest medical
  skill in the country are bestowed upon the
  poor inmate of the hospital up to a certain
  point,  and convalescence  is  barely  esta-
  blished, when  too often the patient has, in
  order to make room for others, to leave the
  comfortable home of his  sickness, with all
  its  nourishing food  and its comforts, and
  return  to  scanty  nourishment, exposure to
  weather, and to an unhealthy home.   In  a
  climate like that of Britain, [as  well as in
  the United States,] the point is  one which
  requires more attention than it has hitherto
  received.  Proposals for  the establishment
  of convalescent villages have certainly  been
  made, and some  steps  have been taken to-
  ward providing convalescent  stations; but
  an immense deal requires to be done before
  the want is supplied, and charitable bequests
  and donations might be worse  directed  than
  into such a channel.'
    Refer to  Air—Bed-room—Clothing—Cook-
  ery—Diet,  $c.
    CONVULSION—Is  a state of alternate
  violent contraction and  relaxation  of the
  muscles, independent of the influence of the
  will; those under its direct control are  most
  frequently  affected, but  not invariably so.
  The muscular fibres  of the  stomach  and
  other  involuntary muscles are  often  the
  seat of convulsion, but in this  case the  term
  spasm is generally applied to the disorder.
  Convulsions are classed by medical men as
  "tonic," or those in which the state of con-
  traction is maintained for  a considerable
  period  without alternation with relaxation,
  and as " clonic," or those in which the two
  states succeed one another with more or less
  rapidity.  When  the relaxations and  con-
  tractions are very slight and very rapid, the
  condition is tremour.  The first of these, or
  the tonic convulsion, occurs in lock-jaw in
  its most perfect form ; the second, or clonic,
  in hysteria ; the third is seen in the persons
  of hard drinkers when not  tender the in-
  fluence of their stimulant.
    Convulsions may  be either general  or
  partial, affecting  only the. muscles  of the
  eyes or eyelids, of the face, or of one of the
  extremities, or of one  side of the body;  or
  they may shake the whole frame  in convul-
  sive agitation, such  as occur in epilepsy.
  Some of the most characteristic  local  con-
«  vulsive  actions occur in the muscles of the
  fac;, causing squinting, &c. &c. or the pecu-
  'iar "sardonic smile,"or grin,which is caused ;
by forcible retraction of the corners of the
mouth, exposing the teeth.
  Sometimes an attack of general convulsion
is prewarned by a local  affection, the ey«
is unnaturally turned, or the  thumbs, as
often occurs in children, drawn  across the
palm of the hand; or hiccup, which is  a
convulsive affection of the diaphragm, pre-
cedes the more  widely  diffused  affection.
In partial convulsion, the mind is probably
unaffected ;  but when the affection is widely
distributed, or general, there is  frequently
no outward sign of consciousness, and when
the  convulsion ceases,  and  consciousness
does return, there is  no  recollection of the
past paroxysm.
  An attack  of  convulsion  may come  on
suddenly, without  any  previous warning,
but more generally it is  preceded by symp-
toms.  If in a child, there has  probably
been disturbed and moaning sleep, starting,
screaming, grating of the teeth, peevishness.
heaviness about the eyes, or squinting, or
rolling of the ball in sleep, and a disordered
condition of the  bowels.  If  in  an adult,
dreaming and unsettled sleep have occurred,
headache, noises  in the ears, disturbed and
clouded  vision,  giddiness, nervous fears,
loss  of memory,  and confusion  of mind,
have accompanied disorder of the digestive
organs; a tendency to vomit without obvious
cause, or colicky pains in  the bowels, hic-
cup, and cramps in the hands or feet,  have
been the  premonitors, and, just before tho
accession of the paroxysm, a creeping sen-
sation  or " aura" is  often felt  to extend
gradually from an extremity up to the head.
In one of the most terrible and protracted
successions of convulsive attacks the author
ever witnessed, each paroxysm could be dis-
tinctly traced, commencing in one toe, gra
dually extending up  the limb and  trunk,
until the whole frame was fearfully agitated.
In such cases the convulsive movements of
the limbs and the distortion of the features
are truly terrible  to witness; but there is
every reason to suppose that in many in-
stances, and it is a great consolation to do so,
the trial  is to the spectators, and that the
cerebral  disorder which causes such violent
commotion of the body extinguishes for the
time any consciousness  of suffering.   Of
course, when the mind is unaffected, as it is
in lock-jaw or tetanus,  or in hydrophobia
and  other cases, the pain of the convulsion
is severely felt.   The length of time a con-
vulsion  continues  may  vary from  a few
minutes  to  many  hours, but  generally the
period  is short,  the  paroxysms  returning
after intervals of cessation.   The fit of con-
vulsions may terminate in apoplectic stupor 
CON
142
CO N
in a state of extreme nervous exhaustion, in
lethargy,  or in prolonged sleep.   For some
time after, there is  usually much languor,
both physical and  mental, and  the faculties
of the  mind are confused and  incapable of
being  exerted.   There may remain  perma-
nent lesion of the nervous functions,  such as
paralysis,  or  disordered  nervous  action,
such as St. Aritus's dance : a  squint  often
dates from an attack of convulsions in child-
hood.  In some cases bleeding from the nose
or ears, or vomiting or diarrhoea appear to
terminate the attack.
  Convulsions are the  result of a great va-
riety of causes.   The brain itself may be the
organ primarily affected ; there may be dis-
ease of its structure, or pressure or irrita-
tion exerted upon it, by disease or accident;
there  may be  too great  determination  of
blood to the head, or the reverse  condition
may exist, and the supply of stimulant blood
to the  brain may be inadequate.   But con-
vulsions quite as frequently arise from irri-
tation of distant organs affecting the brain
and spinal cord.  In childhood, the irritation
of teething is a  most prolific source  of con-
vulsions—and perhaps not less  so, irritation
of the  stomach  and bowels; causes which
might,  in the adult, produce transient head-
ache, in the susceptible  nervous system of
the child may cause convulsion. In females,
irritation  connected  with  the generative
system is a frequent source of convulsive
action; and, indeed, one of the most formida-
ble phages of the disorder occurs in the pro-
cess of childbirth.  Strong mental emotion
of any kind, such  as joy, fear,  &c. &c  , are
apt  to cause  convulsion.  Suppression  of
accustomed discharges likewise  is  often
followed   by an  attack  of the malady.
Worms in  the intestinal canal cause it; and
the onset of acute disease, small-pox in par-
ticular, but also  febrile disease  of any kind,
is, in many instances, heralded by an attack.
In  fact,  with those who  are  susceptible,
there is scarcely an agent, from a carious
tooth or the scent of a flower upward, which
has not the power of exciting convulsive ac-
tion—or something nearly approaching it—
of the human frame.
  Some persons  are much more liable to be
affected than  others,  and children, as a
general rule, especially so; it  is therefore
very important that the premonitory symp-
toms, either  in  them or in individuals  of
excitable temperament, should  be carefully
noted  and attended to,  and  the exciting
cause,  if possible,  discovered and removed.
In children, the state  of the gums and  of
the secretions from the bowels  are espe-
cially to be watched ; the first  may require
lancing, or the second clearing out by nn
active purgative, such as calomel and scani-
mony.  But when, from the occurrence of
warning symptoms,  and  especially if  the
child, or any  other  member of the family,
have previously suffered  fi»om convulsions,
an  attack is  supposed to  be impending,
medical advice  should  be procured.   A
point of great importance to be determined
is whether the disordered  condition is con-
nected with excess  or deficienc}- of circula-
tion in the vessels  of the  head and spine;
for if the former, it is evident that the low-
ering treatment which  it requires  must bo
injurious should the latter condition prevail,
for this must be corrected by tonic medi-
cines, or even by the exhibition of stimulants,
such  as sal-volatile, or brandy in  minute
quantitj'.   It  must  be clear to all  how im-
portant it is, either in the prophylactic or in
the actual treatment of convulsions, whether
in children or adults, that  this  point should
be  clearly  ascertained.  And as it is one
which sometimes requires  considerable me-
dical acumen  and experience satisfactorily
to determine, it must be equally clear that
it must render non-professional interference
in such cases a matter of hazard,  nnd not
lightly to be undertaken. At the same time,
the sudden and alarming nature of convul-
sive attacks renders it necessary that some
means of discrimination and some safe rules
of treatment should be known to all who are '
likely to be appealed to in such cases, par-
ticularly if resident in places  far removed
from immediate medical assistance;  and it is
reiterated that the two opposite states must
be kept in mind, the one arising  from excess,
the other from deficiency of circulation, and
the treatment modified accordingly.
  If convulsion be threatened in a child of
full habit,  with firm flesh and good colour;
if teething is  going  on,  the  gums must
be looked  to,  and lanced  if requisite,  the
bowels  may be freely purged with  calomel
and  scammony, or  with  gray  powder  at
night,  followed  by  senna  in the morning,
the diet being at the same time reduced : and
should there be much  heat about the head,
and the symptpms remain unabnted, leeches
—one, two, or more, according to age—may
be applied  to the temples, and cold to the
head  generally.  If,  on the contrary, the
child, even though fat, be pale, and the flesh
loose, and if it is of feeble habit, any thing
like  lowering  must  be avoided; the gums
ought, of course, to  be attended to, and if
the bowels  are disordered,  the  secretions
must be gradually corrected by a couple of
grains of gray powder, given every night al
bedtime, and,  if requisite, a small  dove ot 
CON
143
COO
castar-oil in the morning; likewise, in either
of tho above cases, an antacid will probably
be of service, such as three or four drops of
solution of potash, or a teaspoonful of fluid
magnesia,  in the  milk food, given  twice a
day.  In judging of the energy or weakness
of the  cerebral circulation in infancy, as
long as the opening of the head is unclosed,
it affords  a guide to judgment.  AVhen at
this point, the scalp and sub-jacent parts ap-
pear depressed, the condition is one in which
any thing  like lowering measures are inad-
missible.   Keeping the already given  cautions
in view,  and remembering how often, both in child
and adult, convulsion is threatened in consequence
of irritation, not in the brain or spine, but at a
distance from them, when it is suspected  that
an attack  is impending, and when  medical
assistance cannot be  at once procured, at-
tention should be  directed to  any possible
source  of irritation, and should any such be
found,  its removal  should, if  possible, be
effected.  If no appreciable source of irrita-
tion is discovered, to which  symptoms of
threatened convulsion can  be referred, and
if the brain itself be suspected to be in fault,
the same cautions respecting excess or  defi-
ciency  of vascular  action must  still be
remembered.   If  plethora  is  undoubted, if
the individual  is  of full  habit,  florid,  and
with.a  strong pulse, leeches and  cold to the
head, and free purging,  with  low diet,  may
•be resorted to with every prospect of advan-
tage.  On the contrary, if the habit is feeble,
the more negative system will be most safely
pursued;  the bowels must be regulated but
not purged,the diet attended to as regards di-
gestibility but not lowered, and every source
of nervous exhaustion, either fatigue of body
or mind, or of a sexual character, most scru-
pulously  avoided.   If the extremities  are
cold, as they often are,  their warmth must
be preserved;  if the head is hot, the mode-
rate  use  of cold will allay nervous excite-
ment, as well as vascular action.  Provision-
al measures like the above will, if used  with
judgment, be most valuable even in unpro-
fessional  hands, but they are not to super-
sede  medical examination, which  must be
submitted to.
   In the treatment of an attack of convulsion
the above directions must  equally be borne
in mind and acted upon.   When a child is
seized  with convulsions, the most generally
available remedy is the warm bath, and if
used with  judgment  it is a good one.  The
temperature  should be 98°; if the child is
strong  and plethoric, it  should not be im-
mersed above the  waist, and, while in  the
bath, cold should be applied to the head;  if
the child is weak, it may be put in the water
above  the shoulders;   in  either  case the
immersion is  to be continued  for  twenty
minutes.  The  gums are  to  be lanced if
requisite, and leeches  applied to  the  he:id
under the cautions  already given as to the
abstraction of blood ; and  under the  same
cautions purgatives are to  be resorted  to,
either the more powerful ones of calomel and
scammony, or calomel  and jalap, or senna,
or indeed the first efficient medicines of C.c
class at hand, or  the milder agency of castor-
oil ; in addition, an aperient clyster may be
administered with  advantage.  AVhen the
child is taken out of the bath, it should at
once be wrapped up in warm  blankets, and
laid in its cradle, or in bed, and cold  used
to the  head, or  not, as thought well;  and
if the  fits still  continue, mustard-plasters
made with half  oatmeal may  be applied to
the legs, but must  be  removed  as  soon as
the skin is well reddened.
  AVhen an adult is  seized with convulsions,
the treatment,  conducted  upon the  same
principles, must be very  similar  to  that
recommended for a  child, with exception of
the bath, which cannot  be  conveniently
used ;  in its stead,  a  warm  bed,  with hot
applications to the feet, limbs, &c. must be
substituted, and mustard-plasters  may be
used more freely.   If there is  much heat or
excited action about the head, it should be
shaved, or the hair cut close off,  and cold
or iced applications freely employed.  In
following out these  directions, the  non-pro-
fessional  will be doing much,  and indeed
all they  can  legitimately  do  during the
longer or shorter interval that must neces-
sarily  elapse before the case is seen  by a
medical man.   Lastly,  it must be borne in
mind  that convulsions  are  not  unfrequent
in extreme intoxication, and also in poison-
ing from narcotics, such as  opium:  their
occurrence from such causes would of course
materially modify the  treatment.   In  chil-
dren particularly, they are unquestionably
the frequent result  of the administration of
laudanum, and more frequently still of quack
soothing  and  carminative  medicines  and
elixirs.
  Refer to Apoplexy—Bath—Children—Clys-
ter— Croup— Spasmodic— Head—Lockjaw —
Spasm—Teeth—Worms, §c.
  COOKERY—For  the sick and convales-
cent.—The best methods of preparing suit-
able nourishment for the sick is  a matter of
so much  consequence, that its  consideration
here cannot be  out of place.   Its import-
ance is, perhaps, scarce sufficiently appre-
ciated  by any class; and among the  poor,
almost total ignorance  prevails respecting
it.  Even when the needful  materials are 
COO
144
C 0 o
 lbundnntly provided,  still things are pre-
pared  in such a barbarous and uninviting
fashion, that the fastidious appetite of an
invalid turns  loathing  from  them;   and
this simply from lack of knowledge or of
attention in preparing.  Constantly is  the
medical man told, " 1  could eat, but I can-
not fancy such food as we have here"—and
this, when  material is  amply provided,  but
nicety  wanting.
  The  reader is  referred  to  the  separate
articles which treat of  the various forms of
food for further information ; but the follow-
ing recipes are a few of those  most directly
useful.
  Sick-room Articles of Diet.—And here
it  may just be  hinted that  neatness in
serving up,  as well as  care and perfect
cleanliness in preparing,  makes  sick-room
cookery more likely to be  attractive to an
easily  offended appetite.
  Arrow-Root.—Not quite a tablespoonful
of arrow-root powder is to be  mixed slowly
and smoothly in a basin with a little cold
water—and when  done,  a pint of boiling
water  added; it should then  be sweetened
to taste, and put on the fire to boil for  five
minutes, stirring well  the whole  time.   If
wine is permitted,  it should be  put  in
after the  arrow-root  is  poured  into  the
bowl.  The  same quantity of arrow-root is
a proper one, when it is prepared  with milk
instead of water.
  Oatmeal Gruel.—A dessertspoonful  of
meal must  be mixed smoothly with two of
cold water—a pint of boiling water poured
on,  and the whole boiled on the fire for ten
minutes, well stirring for the  time—sugar,
or pepper and salt, being added, as may be
agreeable to or proper  for the sick  person.
  Sago requires thorough  washing in cold
water to take away its earthy taste ; after
doing so—(a tablespoonful will be a suita-
ble  quantity)—put it in a pint of  milk,  and
boil it  slowly till it  is quite  soft and  has
thickened the milk—ten minutes or a quarter
of an hour is sufficient  time—sweeten to the
taste, and add wine, or flavour with lemon-
peel, according to circumstances.   Some in-
valids  prefer tapioca  to sago.  It is pre-
pared in the same quantity as the other, but
does not require the  previous  washing,  and
takes  only half the  time for softening on
the fire.
  In all preparations  for the sick, let  the
constant stirring while on  the fire be at-
tended to,  whether  directed  or not.   The
least  tendency to burning  renders sick-
cookery perfectly abominable.
  Ground-Rice  Milk.—A tablespoonful of
ground rice, a pint and a half of  milk,  and
 half an ounce of candied lemon-peel.   Mix
 the rice very smoothly with the milk, then
 add the  lemon-peel   cut  into  very small
 pieces; boil lor half an hour; and strain as
 soon  as  off the  tire.   [Furina is to  be pre-
 pared in the same manner, and  flavoured
 to suit the taste.]
   This is an excellent nutritious beverage
 for the  sick, or for  early  convalescence,
 when strict abstinence is not required.
   Simplk Bkeau Panada.— Put a moderate
 quantity of grated  or soft stale bread into
 enough boiling water  to form a  moderately
 thick pulp ; cover it up, and leave it to soak
 for an hour—then  beat it  up with  two or
 three tablespoonfuls of milk, and fine sugar
 to sweeten—boil the whole for ten minutes.
 This preparation is occasionally acceptable
 to the invalid,  when milk diet alone is  re-
 jected.
   Carkac-een Moss.—One ounce of it boil-
 ed  in a  pint and a half of  nter is suffi-
 cient to form a  semi-transparent, moderate-
 ly consistent, nearly tastelcs- jelly, which,
 when sweetened and  acidulated,  or when
 mixed with milk, forms an excellent diet  for
 invalids  who require  to have the strength
 supported.
  The Gelatine,  now so conimonly used, is a
 very palatable  preparation  combined  with
 either water or milk, and may be taken dis-
 solved in tea, coffee, or broth, without  im-
 pairing the flavour of  one or the other.
  Jelly  from Gelatine.—To rather more
 than an ounce of gelatine add half a pint of
 cold water to soften it, then pour over it a
 pint of boiling water,  and stir till  the gela-
 tine is dissolved ; pare wvy thinly the rind
 of one lemon, and  add, with the juice  of
 three or  four—if acids are  permitted—one
 pound of loaf-sugar, the whites and shells
 of  three  or four  eggs, thoroughly  well
 whisked  together,  and  stirred  into   the
 whole ;  let it come  to  the boil upon  the fire
 without  more  stirring,—if wine is  ordered
 with it, it should be added after coming off the
fire; pour  it through  a thick flannel jelly-
 bag,—what runs through  nt  first will not
 be  clear, and should be returned to the bag
 again; let it stand still cold, and you will
 have a clear, sparkling jelly, which  few  in-
 valids will refuse.
  Gelatine with MrLK.—An ounce of gela-
 tine is to be soaked in half a pint  of cold
 milk;  when softened, a  pint  of  boiling
 milk stirred well with  it,  till  it is quite
 dissolved;  it may  be sweetened  to taste,
 and put upon the fire  to boil up altogether.
 It may be flavoured with lemon-peel, or cin-
 namon, or brandy, as is rno«f liked,  or m-M
 suitable.   It will be quite solid  when cold. 
COO                145                 COP
   White Wine AVhey.—Boil a pint of milk;
 add to it one or two glasses of sherry wine,
 and sugar enough to sweeten; let it boil till
 the curd has separated,  then strain through
 muslin.   If the wine   does  not  possess
 sufficient acid to turn the milk, a little  ren-
 net,  or a  teaspoonful  of  lemon-juice, or
 three or four grains of tartaric acid may be
 added.
   Barley-Water.—See Barley.
   Lemonade.—The  juice of  two lemons,
 the rind of one added to a quart of boiling
 water, sweetened moderately, and kept  in a
 covered jar,  or jug, is  a useful  drink for
 those suffering from cold or slight fever.
   Toast-Water.—This  simple beverage is
 seldom well  prepared.   Let the water with
 which it is made have been boiled and be-
 come cold.   Toast thoroughly of a fine deep
 brown, but not black color, half a slice  of a
 stale  loaf;  put it into  a jug, and  pour  a
 quart of the water over it; let it stand  two
 hours, and decant the water from the bread.
 A small piece of either orange or lemon-peel
 added with the bread is an improvement to
 toast-water.
   Linseed [Flaxseed] Tea.—One ounce of
 flaxseed, not bruited, two  drachms of liquo-
 rice-root, bruised;  pour over  one pint of
 boiling water; place the jug (covered jugs
 with  perforated  spouts  should always be
 used  for  drinks for sick people) near  the
 fire for three or four  hours, then strain off.
 When flaxseed-tea is ordered to be continu-
 ed, it should be made fresh every day.
   " Milk  and Soda-AVater.—Heat, nearly
 to  boiling, a teacupful of milk ; dissolve in
 it a teaspoonful of fine sugar, put it  into a
 targe tumbler, and  pour  over it  two-thirds
 of a bottle of soda-water.  This is an excel-
 lent mode of taking milk when the stomach
 is charged with acid, and consequently feels
 oppressed by milk alone.
   "Rick and Gravy.—Let the rich  gravy
 from  a leg of roasted mutton or sirloin of
 beef  stand till the fat forms a cake on the
 surface, remove  it,  and heat the  gravy
 with  as much well-boiled rice as  will make
 it thick.   A  teacupful  of  this is very
 strengthening in the early convalescence of
 delicate children."—Dr. A. T. Thomson.
   ["Biscuit  Jelly.—White  biscuit, four
 ounces;  water, four pints.  Boil down  one
 half, strain and evaporate to one pint.  Add
 one pound of white  sugar, four  ounces of
 red wine, and a teaspoonful of cinnamon or
 peach-water.
  "Almond Jelly—Blanc Mange.—Sweet
almonds bleached, one ounce;  white sugar,
six  drachms;  Water,  four  ounces.  Rub
into an  emulsion in a mortar; strain,  and
      N                                  1
 add  isinglass  or  hartshorn jelly, eight
 ounces ; orange-flower  water, one drachm:
 essence of lemon, three drops.
   " Rice Jelly.—Rice, picked and washed,
 four ounces;  loaf-sugar, half  a pound,
 water sufficient to cover it.   Boil till it be-
 comes a glutinous mass, then  strain and
 and season to the taste.
   "Indian or Corn-meal  Gruel.—Three
 tablespoonfuls of corn-meal  sifted; water,
 one quart.  Wash several times with fresh
 water, turning off the  water as  the meal
 settles; then  boil for twenty minutes, stir-
 ring  all the  time; add a little salt;  then
 strain and sweeten, adding a little  butter,
 wine, and Dutnieg, if proper.
   " Oatmeal  Gruel—Is made in the same
 manner.
   " Vegetable Soup.—One potato, one tur-
 nip, one onion, one carrot, (if liked,) and a
 little celery.   Slice, and boil in one quart
 of water for an hour ; add salt to the taste,
 and cut up toast to soak in it.
   " Mutton Broth.—Lean  of mutton, one
 pound; water, one quart;  a little salt, pars-
 ley, and crust of bread.   Boil slowly for
 two or three hours, skimming  carefully.
 Vegetables, rice,  or barley may be added.
   " Chicken  Water.—Half a chicken, free
 from fat; break the bones, add half a gal-
 lon of water,  season with  salt,  and boil
 half an hour.
   " Suet Drink.—Sheep suet, two ounces ;
 milk, one pint; starch, half an ounce.  Boil
 slowly for half an hour.  An excellent drink
 in dysentery."—American  Medical  Formula-
 ry, by Dr. J.  J. Reese.~\
   COPAIBA,  or  Copaiva,  or  Balsam  of
 Copaiva—Is  a fluid  resin  obtained from
 trees native  of Brazil.   It is principally
 used in treatment of chest and venereal dis-
 eases.— See Balsam.
   COPPER.—This  well-known  metal  is
 used in medicine, principally in the form of
 its sulphate, better known by the name  of
 "blue vitriol," which occurs in crystals  of
 a  beautiful blue  colour.  It can never  be
 employed as a domestic medicine internally,
 and scarcely, if at all, as an external appli-
 cation, with much  benefit.   In the latter
 form, indeed, mischief is often done, by the
 popular practice  of sprinkling " powdered
 blue  stone"  upon  sores  and  ulcers ;  its
 injudicious and copious application giving
 much unnecessary pain, producing slough-
 ing or mortification of the surface to which
it  is used,  and thus retarding,  instead  of
hastening the cure.
  All the salts of copper are poisonous, but
 those which are most generally known and
used as poisons are blue vitriol  and ver li- 
COP
116
COP
gris.   Another combination, the arsenlt* of
copper—a compound of arsenic and copper
—also known as Scheele's green, a deadly
poison, has already been noticed under the
head of arsenic.  In addition to the above,
poisoning  by copper frequently  occurs  in
consequence of the use of copper vessels in
cooking, &c.
  Blue vitriol is sometimes taken to procure
abortion ; its  strong metallic taste, however,
would prevent its being administered with-
out the knowledge of the person taking it.
It has been taken for the purpose of suicide,
and the author has  witnessed  one case of
the kind which proved fatal in ten hours, to
a woman above seventy  years of age, who
swallowed a  large dose  in order  to commit
self-destruction.   The poison produces, in
the first instance, violent vomiting, and  in
this way life  may be  saved by the emetic
action of the salt itself;  purging succeeds,
followed by extreme depression of the vital
powers, cramps in the limbs and severe pain
in the bowels ; occasionally jaundice has
occurred.   The  matters ejected are tinged
with  the blue  colour of the poison.  In a
case of poisoning by a  salt of  copper,  the
object must of course be to get the stomach
freed  from it as quickly as  possible.  Its
own  emetic  action should be  assisted by
warm  drinks,  warm  water, or   milk,  or
mucilaginous  drinks of  some  kind,  such
as linseed-tea,  or barley-water;  sugar has
been found useful in these cases as an anti-
dote, and should be added in good quantity to
the fluids which are administered.   After the
stomach has been well cleared by the vomit-
ing, raw eggs should be given largely; and
if sickness does not recur, which it proba-
bly will, it  should be reinduced  by putting
a feather down the throat, or by  the admi-
nistration of  a scruple of white vitriol in a
little water.   Of course, medical assistance
should be obtained, but the above measures
may be advantageously had recourse to in
the interval.  AVhen poisoning  by copper
occurs in consequence of its presence in food
which has been prepared improperly, or in
badly cleaned  copper vessels, the amount
of the poison may not be sufficient to occa-
sion death, but it produces  severe  symp-
toms,  similar to those above detailed.   Cop-
per vessels, unless protected by tinning, and
even then, unless the protection is in  a per-
fect state, cannot be considered desirable
cooking utensils; and when they are  used,
the strictest cleanliness  is requisite  for
safety.  Even if water is allowed to  stand
in a copper  pan for  any length  of time, a
poisonous salt is formed.  But if the water
contains an acid of any  kind, such as vine-
 gar, if it holds common salt in solution, 01
 if  there  be oily  or fatty  matter present,
 poisonous compounds are  quickly formed.
 Consequently, food  which contains any  of
 these ingredients  should  never be prepared
 in copper vessels.   The same  objection, of
 course, holds  good as regards  preserving
 fruits, which all contain  more or less acid,
 and are therefore liable to act upon copper
 There is, however,  less danger  as long  a*
 the active  operations of  cooking are going
 on, than  there is from  allowing the articles
 above enumerated to stand for any  length
 of  time in a  copper utensil freely exposed
 to the air.  German silver, which contains
 a more or less considerable  proportion  of
 copper, is in some  degree  open  to similar
 objections; and those  who have used this
 material  for  any purposes, must have  no-
 ticed the green stains which form upon its
 surface, and which are owing to decomposi-
 tion of the copper it contains.   Many of the
 cheaper green pickles contain copper, which
 is added to them to  make the colour appear
 finer.   The  adulteration  may be  detected
 by introducing a perfectly clean  plate  of
 iron—a table-knife—into  the suspected arti-
 cle ; if copper is  present, it will be depo-
 sited upon the surface of the former  metal,
 in the form of a fine  metallic film  or coating.
 It has been the practice, on  the continent, to
 add a small proportion of  sulphate of copper
 to dough in the making of  bread; the practice
 is not  known to  be followed  in England.
 Copper has been detected in mussels which
 have caused symptoms of poisoning, but it
 is not considered to be the invariable cause
 of  the injurious results which occasionally
 follow the use of this  shell-fish as food.   It
 should be remembered  that the majority of
 i ie green colouring matters and pigments
 it present in general use are compounds of
 o >pper; and, therefore, care should  be  ob-
 served in  permitting children to have access
 to  them.   A child has been poisoned by a
 cake of green paint  from  a toy colour-box.
   Copper coins are sometimes swallowed by,
 children,  and may pass away  by stool with-
 out any  apparent bad consequences;  but
 this is not always the case, and  severe epi-
 leptic fits have ensued in  consequence of the
 accident.    In  the event  of a child being
 known to have swallowed a piece of copper,
 salt, acids, and fatty matters should  be ex-
 cluded from its food, which ought to consist
 of  thick milky preparations, such as hasty
 pudding  and the  like, well sweetened with
 sugar; gentle doses of aperients being  ad-
| ministered.   The thickened food  should  be
 given as  soon as possible after the accident
   Refer to Arseni'e of Copper. 
COR
147
COS
   CORDIALS—Are stimulants generally of
 *n alcoholic nature;  the name is  derived
 from the old idea that they " strengthened
 the  heart."   They  certainly stimulate  the
 circulation, and are useful in cases of  de-
 pression from anjr  cause,  where such  an
 effect is required.   Brandy is, perhaps, as
 good and as generally attainable a cordial
 as any; the compound tincture of  carda-
 mon  and the  aromatic spirit of ammonia
 constitute two of the best medicinal cordials.
   Refer to Excitants.
   CORIANDER SEEDS—Are produced  by
 a plant, a  native of Southern  Europe; it
 now  grows wild  in Britain.   They are a
 pleasant and powerful carminative, the pro-
 perty depending upon the volatile oil which
 they  contain.   In  medicine, coriander is
 principally used  to correct the griping pro-
 perties of senna.
   CORN.—A corn is a thickened state of  the
 epidermis, or  outer or scarf skin, caused by
 irritation, such as pressure or friction, act-
 ing  upon the  true or sensitive  skin, which
 causes an increased growth of the flattened
 cells of which  the  epidermis is composed.
 The  corn,  produced  in  the first place  by
 external pressure or friction, soon becomes
 in itself an additional source of irritation,
 and,  by its  hardness, increases  proportion-
 ally the inflamed and sensitive condition of
 the true skin underneath.  If the causes  are
 removed, the disease gets well, as any one
 who has suffered from corns can testify, after
 having been confined by illness for any time.
 Tight  shoes   are  undoubtedly the most
 general originators of  corns;   but badly
 made, ill-fitting ones  also give rise  to  the
 affection, not  by pressure,  but  by friction.
 Soft corns generally form between the toes,
 and are very troublesome and painful: they
 are kept soft by the continued perspiration
 of the part.
   The  most efficient cure for corns is,  of
 course, to get quit of the cause—the offend-
 ing  boot or shoe—but as some persons  are
 so liable to  the affection, or have their feet
 so formed,  that if they wear boots or shoes
 at all they must suffer from corns, the best
 palliative is keeping the hardened mass well
 pared down in the  centre.   Vinegar,  or
 strong acetic acid, applied  to a corn every
 evening will sometimes effect a cure, a little
 olive-oil being smeared over every morning.
 Various corn-plasters are used; the most
 effective aud rational  are those which  are
 made  thick, and  have a hole  cut  in  the
 centre for the corn, which is thus preserved
from pressure.  [A piece of buckskin spread
with  adhesive  plaster, cut to the size of a
sixpence, and with a hole in its centre large |
 enough to permit the corn to come through,
 serves the same purpose.] Soft corns should
 be cut with scissors, a piece of linen should
 be worn between the toes, and the strictest
 cleanliness  observed.    [Soaking  the feet
 in strong oak-bark  tea will do much toward
 hardening  the skin and  checking excessive
 perspiration.]  A peculiar kind of corn oc-
 casionally forms  under  the corner  of the
 nail of the great toe, and causes much pain
 and irritation ; if discovered by slightly ele-
 vating the nail, the thickened mass may be
 turned out.
   Refer  to Skin.
   CORN.—See Grain.
   CORNEA.—The  transparent,  glass-like
 portion of the eye.—See  Eye.
   CORROSION.—The term, when applied
 to the living  body, means the gradual de-
 struction of any of its tissues by  chemical
 action.
   CORROSIVE  SUBLIMATE.—See  Mer-
 cury.
   COSMETICS—Are external applications
 used to improve the appearance of the skin,
 as regards whiteness, &c.  Their employ-
 ment is always to be condemned; moreover,
 they frequently contain deleterious matters,
 such as corrosive  sublimate of mercury,
 salts of  lead,  &c. &c.  Indirectly  they are
 injurious, by leading the mind from the only
 true cosmetics, obedience to  the laws for the
 maintenance of physical health, which the
 Almighty has linked with our existence—
 Cleanliness, temperance,  abundant fresh air
 and exercise, and early hours, and the cheer-
 fulness which results from the healthful oc-
 cupation of the mind in legitimate pursuits,
 are  cosmetics which no  art can imitate  or
 supplv.
   COSTIVENESS,   or   Constipation —Is
 undue  retention of the faecal contents of the
 bowels, and their evacuation in a harder and
 drier condition than natural.  The state is one
 in a great degree dependent upon habit and
 constitution; for  that which would be con-
 sidered constipation  In  one person, would
 not be so in another, and vice versa-.   As a
 general rule, however, the bowels  ought to
 relieve themselves  thoroughly once in  the
 twenty-four hours;  when such is not  the
 case, the condition may be said to be one of
 costiveness.
  AVith some individuals,  a single evacuation
 of the bowels once every  three or four days,
 and  even less often, seems to  be sufficient,
 and  perfectly  compatible with their  enjoy-
ment of perfect health; and when such is the
case, it is of course superfluous to endeavour
to correct  it, and  it is  better to  let well
alone.   If,   however, in  conjunction with 
C 0 s
J 48
COS
this condition of the bowels, the person suf-
fers from headache, from languor, from dis-
tension  of  the  abdomen,  if the  breath is
disagreeable, and  the tongue  furred,  the
state  is  not  compatible with health, and
should be corrected.
  The causes of costiveness are very nume-
rous.  The nature of the food, as might be ex-
pected, exerts considerable influence ; bread
badly made, and especially if alum be mixed
with it, cheese, milk with some persons, fari-
naceous  articles,  such  as arrow-root  or
ground rice, and food of too concentrated a
character, all tend to constipate.  Deficient
exercise, particularly if combined with much
exertion of mind;  any drain upon the sys-
tem, as in suckling, abundant perspirations,
loss of nervous power, and old age, have the
same  effects.  Pregnancy,  and tumours in
the abdomen, constipate by mechanical ob-
struction, and in the same way contraction
of any portion of the alimentary canal.  The
colon  or large bowel  is very frequently the
seat of the  constipation;  it  loses  tone,
allows itself to be distended, sometimes to an
enormous extent, or contracts to a very nar-
row calibre in  some portion of its course.
Lastly, a very  common inducing cause  of
costiveness, particularly in females, is inat-
tention to the intimation of nature to relieve
the bowels.
  As, except in the case of a few persons of
constitutional peculiarity,  confined bowels
cannot be compatible with health, comfort,
or activity  of either mind or body, the state
must be rectified, and that in a proper man-
ner, not as it is usually attempted.   Perhaps
there  is no  ailment to which the human body
is  subject  which  is more frequently mis-
managed than  constipation.  Every effort
should be made to correct the disorder with-
out the aid of  medicine.   In the food, all
those  articles which have been enumerated,
or which are known to constipate, must  be
avoided.   The bread  used should  be made
of coarse flour [or bran] ; if vegetables and
fruits agree in  other respects, they may be
freely consumed, and cocoa substituted  for
tea or coffee:  food is not to be taken in a
state of too great concentration, but so that
by the bulk of its  refuse it may afford sub-
stance to stimulate the action of the bowels.
In addition,  there are  various articles  of
Het which exert  an  aperient effect,  and
which may be used or not, according to the
taste  of the person : such as Scotch  oatmeal
in the form of porridge, honey, prunes, &c.
Exercise,  whether on foot or horseback,
is  another valuable  aid in the removal of
the costive state; it  not  only quickens  all
the  functions,   but  it  assists  defecation
by the mechanical motion  it communicates
to the intestines.  A similar  effect  may in
some  cases be   produced  by  friction  or
kneading  the abdomen with the hand ;  the
practice is scarcely  so much resorted to as
it might be.  Another very important point
is  regularity in  the  time of evacuating the
bowels; not waiting for the urgent sensa-
tion, but retiring for the purpose at  one set
period of  the day, when time can be given.
[Soon  after breakfast is the  most natural
time,  as digestion is perfected during the
night.] Persons who are liable to costive-
ness should give themselves at least a quar-
ter of an hour, or even longer, for the daily
evacuation of the bowels.   Lastly, as con-
stipation is so frequent an  attendant upon
the sedentary life of  the student, and upon
the anxious-minded man of business, a holi-
day both from books  or  desk, and change of
air and scene, is both a good  and pleasant
remedy.
  When neither diet  nor regimen will effect
the cure, other means must be had recourse
to.  If there is simple  costiveness, without
disorder of the digestive functions, the best
remedy will  be  the regular  use of some
simple clyster: if, on the other hand, furred
tongue, with acidity of stomach, flatulence,
pain between the  shoulders, headache, &c.
betoken deranged digestion, medicine will
be required, at  all  events  in  the first in-
stance : the liver is  probably at  fault, and
five or six  grains of blue pill, or of com-
pound colocynth  and calomel  pill, followed
in the morning by the black draught, or  by
castor-oil,  will be requisite to commence the
treatment.
  When the stomach, liver, and upper bow-
els  have  been well  cleared  by the above
medicines, it is requisite to keep the  bowels
open;  otherwise a few days will  see all the
symptoms  returned—and,  in fact, such is
too often  the case.   Persons  are content
with taking a dose of strong opening medi-
cine  every few  days,  or once a week,  as
the case  may  be, and rest  content  with,
thus,  as it is called,  having a good clearing
out—albeit they are  under the necessity of
increasing the strength of the doses.  The
practice  is one  incompatible with sound
health, and is most injurious to the stomach
and bowels themselves: many cases of ob-
struction,  and  even inflammation  of  the
bowels are produced by it.  The principle
to be proceeded upon  in  the treatment of
costiveness is, that  it is more easy  to keep
the bowels in  action  than to excite them
to  it  when they  have  become thoroughly
torpid, and therefore the individual should
not rest content without the  daily evacua- 
COS
149
COT
 non.   As has been  said above, if simple
 constipation,  depending  upon  inaction of
 the  lower bowel,  exists, the  use of the
 clyster will in all probability be sufficient;
 but  medicine may be  required,  perhaps
 daily,  for some time, or it  may  be  used
 alternately with the clyster.  Some medi-
 cines are better adapted  than others to the
 treatment of  habitual costiveness, and  of
 these castor-oil,  aloes alone or in its com-
 binations, senna, and ipecacuanha are the
 principal; their  great advantage is not los-
 ing  their  effect  by continued use.   AVhen
 castor-oil  can be taken regularly, in  most
 cases it  answers  extremely  well;  and  if
 taken  regularly, the  dose  requires rather
 diminution than increase.  It is a medicine,
 moreover, which never seems to injure the
 tone or the mucous coat of the bowels.  In
 the  constipation of pregnancy, castor-oil  is
 so well  known as the best and safest aperi-
 ent that it scarcely requires mention. Aloes
 is peculiarly well adapted to relieve certain
 forms of costiveness,  particularly that of
 the sedentary, and may be taken in the form
 of pill,  in  combination  with soap, in the
 compound rhubarb pill, or compound  colo-
 cynth pill: any of these  are most excellent
 combinations.   If  there  is  debility of sto-
 mach, the addition of a  quarter or half a
 grain of quinine to each  pill  increases the
 efficiency of the medicine and gives tone to
 the stomach.  The quinine must not be con-
 tinued for more than a fortnight at a time.
 The  dose  of  aloes when regularly taken
 does not  require to be augmented.  When
 quicker  action is required, the  compound
 decoction  of aloes  may be  taken with ad-
 vantage  instead of pills.   The  principal
 contra-indication to the use of aloes is the
 occurrence of piles, which,  if inflamed, or
 if the dose be too strong,  are  apt to be ag-
 gravated by the medicine; in this case cas-
 tor-oil,  or infusion of senna, or the clyster,
 should be substituted for a time at least. In
 some cases, on  the other hand,  when the
 piles are not inflamed, aloes  taken regularly
 in small doses,  seems to  exert  a beneficial
 and  curative  action upon them ; probably
 in consequence of keeping  the intestinal
 veins from becoming overloaded with blood.
 Senna, either  in infusion  or electuary, is  a
 medicine well  adapted for the relief of cos-
 tiveness ;  it is perfectly safe,  and does not
 seem soon to  lose its effect.   Ipecacuanha,
 not alone, but in quarter or half grain doses,
especially when  added to the aloetic pills,
exerts a  most beneficial  effect in cases of
habitually  confined bowels.   A  weak solu-
 tion of Epsom salts, a drachm to the half pint
of water, with  or without the addition of five
      n 2
or ten drops of dilute sulphuric acid, when
taken  on first rising in the morning,  will
prove  effectual with  some, and forms  a
change from the use of  the other aperients.
[A quarter of a pound of salts in a pint of
water, and a  wineglassful  taken  at bed-
time, is  also a useful and easy method of
taking it.]  Again it is repeated, keep the
bowels free, by food, by exercise, by  habit,
if possible,  by clysters  or  medicine  if ne-
cessary,  but do not let them become costive.
  In some individuals in whom the walls of
the  abdomen  are very  flaccid, and do  not
afford  sufficient tonic support to the con-
tained bowels,  costiveness frequently exists,
and  is much  remedied by the use  of an
elastic or other belt, worn  to  support  the
entire  belly.
  Refer  to  Alimentary Canal—Aloes—Clys-
ter—Digestion—Laxatives, Sfc.
  COTTON—Is a soft downy fibre obtained
from the  seed  capsules of the cotton-plant,
a species of gossypium.  In  its manufac-
tured state, as calico, it is useful for  many
purposes, such as bandages, &c. in medical
practice.   The use of cotton cloth [muslin]
in the treatment of sores is generally  consi-
dered to be more likely to irritate than  linen,
but the difference, if  there is much, is  great-
ly exaggerated.  The cause has been said to
be in the different form of the constituent
fibre ;  that  of the cotton, as seen under the
microscope, being  flat—that   of  the  lint
round.    Much of  the  manufactured  lint
consists of cotton alone or mixed with flax,
It has been thought that the flat sharp (?)
edges of  the cotton fibre were the irritating
agents.   The use of  the sheet cotton,  in the
form as used for wadding dresses, is a most
invaluable application in burns.  It is also
sometimes used to dress blisters.
  Refer to Lint—Burns, $c.
  COTYLEDON  UMBILICUS, or  Wall
Pennywort—Is a native of Britain,  and is
found  growing on old walls, chiefly in  the
south of  England.   The whole plant is suc-
culent,  and its leaves,  which  are round,
spring directly from' the soil, or nearly so ;
from their centre there  is sent up a  round
stem about  nine inches high, which bears a
number of yellowish-green,  drooping flow-
ers.  The plant is remarkable from its juice
having lately come  prominently into  notice
as a  remedy for epilepsy.  It was introduced
by Dr.  Salter,  of Poole : and the author  can
from his own professional experience testify
to its marked  good effects in this most in-
tractable and distressing malady. Of course,
in those neighbourhoods  in which the plant
grows, the  fresh expressed juice may be
used ; but most efficient extracts are  made 
cou
K><|
COl
from it by various of the  London chemists.
The dose of the fresh juice is one ounce
twice a day.
  COUCHING—Is an  operation performed
upon  the eye,  by which  the lens, when it
has become opaque from  disease, is shifted
or depressed to another part of the interior
of the eye-ball, and  thus  removed from the
axis of vision, which it obstructs.
  Refer to Eye.
  COUGH—Consists in the violent  expul-
sion of air from the  lungs through the air-
passages.   In  most cases  it  must be  re-
garded rather as a symptom of disease than
as a disease itself.   Cough  may arise from
a great variety  of causes.   From direct ir-
ritation of the air-tubes themselves, by  the
inhalation of cold and  damp air, or of irri-
tating  vapours,  by the mechanical irritation
of foreign substance  accidentally introduced
into them, by the  pressure  of  tumours, or
by irritation of the throat and  fauces, par-
ticularly when  there is  relaxation  of the
uvula,  and also in consequence of disease,
inflammatory or  otherwise,  of the  lungs
themselves.  Further, cough  may be sympa-
thetic with disorder in the  stomach, or liver,
or with irritation in  the bowels, occasioned
by worms or other irritant agents, or it may
be the  result of nervous derangement, such
as  hysteria, or be  spasmodic, like hoop-
ing-cough.   So  numerous  are  the ailments
and diseases of which cough is a symptom,
that it frequently requires considerable dis-
crimination  to  determine  the real cause of
the irritation.  Many of the acting causes
are undoubtedly trivial, but many are deep-
ly seated and fatal diseases; and therefore,
whenever an  individual becomes the subject
of cough which cannot be readily account-
ed for  by cold or some other direct cause, a
medical examination  ought to be submitted
to.  And even if the  cough  has been in  the
first instance the result of cold,  should it
continue "hanging about" a person, without
obvious reason, medical advice ought to be
taken;  mischief may be  brewing, and be
the cause of the irritation, or the cough ex-
cited by some  trivial and easily remedied
cause,  may itself be  causing disease in the
lungs of a predisposed person.
  Cough is spoken of  both  medically  and
popularly as  dry and moist.   A dry cough
may be the result of  direct temporary irri-
tation  of the air-passages, but  more gene-
rally it is symptomatic, either  of incipient
disease connected with the chest, or of sym-
pathetic nervous irritation, probably con-
nected with  the abdominal viscera.  Moist
cough  is generally  connected  with  direct
affections of the chest,  such  as  common
catarrh, and with  inflammatory affections,
or with asthma or consumption.
  It  has  already been said that a  cough
should never be allowed to continue for any
length of time without the cause being ascer-
tained by medical examination; till this is
done, it can  scarcely be expected that the
proper remedy can be applied.   In the first
instance, however, simple remedies may be
tried.   If the cough be clearly traceable to
cold or catarrh, it may be treated according
to the directions  given under these heads;
if it be very dry, demulcent medicines, such
as the mucilage and tolu-mixture, or barley-
water, or  linseed-tea, may be taken freely,
with from five to ten drops of ipecacuanha
wine  two  or  three  times a day, to which
may be added  fifteen  or twenty drops of
tincture  of henbane  to  allay irritation.
Opium and its  preparations  are  not  gene-
rally desirable in dry cough—unless, indeed,
it be spasmodic—as the drug itself exerts a
drying effect upon  the  mucous membrane
of the lungs.  The  inhalation of the steam
from boiling water is sometimes highly be-
neficial.  In dry, and also in moist cough,
counter-irritation, by blisters, on the  ante-
rior part  of  the  chest, or between  the
shoulders, is  often of much  service.   'The
surface of the chest should be  well  pro-
tected by flannel next the skin, by a dressed
hare-skin, or by a warm plaster, either in
front  or behind.   In   moist coughs,  the
amount of fluids and of  demulcents  must
be  somewhat more restricted than in  the
above.  The preparations of  opium may be
given in small quantity,  either  alone  or in
cough-mixtures, but none answers  better
than  paregoric, taken in one  or two tea-
spoonful doses,  in  water; this allays  the
irritation  and  teasing  frequency of  the
cough ; and to each  dose, if expectoration is
difficult, five or ten  drops of  ipecacuanha
wine, and the  same of- tincture of  squill
may be added.   The author  has  found  the
following  pill most extensively  useful in
coughs  depending  upon  irritation  in  the
bronchi or air-passages:—Take of powdered
opium five grains, of powdered squill sixteen
grains,  of powdered  ipecacuanha  twelve
grains,of powdered camphor eighteen grains,
of  powdered  gum-ammoniac  twenty-four
grains, of powdered rhubarb twelve grains :
make into amass with syrup, and divide into
thirty pills : of these, one or two may be
taken for a dose.
  The  foregoing  remarks   apply  only to
chronic or continued cough ; of course the
treatment of the affection  as  iv  arises in
connection with other disease, either  acute,
such as inflammation of  the lungs, or jhro- 
cue
151
COD
 nic, falls under the general management of
 these disorders.   AVhen feverish symptoms
 occur  along  with cough,  all stimulation,
 either in diet or by stimulant expectorants,
 is to be  avoided ;  indeed, as a general rule,
 when  cough exists, the  diet should be as
 little stimulating as circumstances will per-
 mit, and the usual allowance of animal food
 curtailed; but in  old people, and those who
 have lived freely,  the lowering system must
 not be carried too far ; it may be  requisite
 even, at times, to  stimulate, and to support
 strength by strong meat-soups.
   Again, it is repeated,  a cough ought not
 to be allowed to continue.   If not relieved
 by some of the simple  remedies mentioned
 above, medical  advice  should be  sought—
 particularly in the case of the aged—and if
 there  is much secretion  of  phlegm or mu-
 cus, the least continued  impediment to the
 expectoration  of  which,  in  an  old person,
 may rapidly induce dangerous or fatal em-
 barrassment of the lungs, often most unex-
 pectedly.
   The possibility  of a relaxed or elongated
 uvula being the cause of cough must not be
 forgotten.  An examination of the throat will
 detect it, and the state may be relived by the
 use of some astringent gargle, by a small
 fragment of catechu allowed to  dissolve in
 the mouth, or by touching the uvula once or
 twice a day with a camel's-hair brush dipped
 in "tincture of steel."
   Refer  to Catarrh—Cold—Counter-irritation
 —Expectorants—Lungs, Sfc.
   COUNTER-IRRITATION—Is irritation or
 excited  action in  one portion of  the body,
 which counteracts or withdraws analogous
 action going on in another portion.  It  may
 be naturally or artificially established, and
 it  may  be  called into  action  within  the
 body, as well as without; but the term is
 now generally  applied  solely to  counter-
 irritant  action artificially excited upon the
 skin.  There are many various modes of ex-
 citing counter-irritation :  some may be and
 are used  popularly with  perfect safety ;
 others are only admissible in medical hands.
   Counter-irritants may simply produce red-
 dening of the skin, or  they may blister, or
 they may cause discharge of purulent mat-
 ter,  or  even mortification  of the  surface.
 Heat, according to the temperature at which
 it is used, may give rise to any or all of
 these effects :  mustard will redden  smartly,
 and may blister; ammonia will do the same,
 according to strength ; camphor in solution,
 either in spirit or oil, will redden.
   Of the  blistering counter-irritants  the
Spanish fly is  the  best,  and almost univer-
sally employed.  Boiling water, or its steam,
or metal heated in boiling water, have al
been used for the purpose, and might be, on
emergency.   Counter-irritation  by tartar
emetic,  or tartarized antimony,  takes  the
form of pustules or pimples.  The salt is
applied  either in the form of ointment, or
as a Saturated solution, used as hot as  can
be  borne, and  rubbed  upon the skin by
means of  a piece of flannel.   The pustules
formed by the latter mode are said to heal
speedily, and to leave no scar, which some-
times happens  after the  ointment.  When
a common blister is irritated, " kept open,"
secretion of purulent matter takes place;
but the system  is  a bad one, and is pro-
ductive of much unnecessary pain and irri-
tation.
  Issues and setons cause discharge of mat-
ter.  Counter-irritation by means of galvanio
agency has recently attracted notice.
  Iron heated to a red or white-heat, moxas,
and other applications  which  destroy  the
texture to which they are applied, fall under
the head of cauterants,  and can  never be
used as domestic remedies.  There is, how-
ever, one application of the hot iron, intro-
duced by  Dr. Corrigan,  of Dublin,  which
might safely be used by the non-professional,
and, as the instrument can be made by  any
blacksmith, might prove a valuable resource
in remote  districts, for the relief of nervous
and rheumatic  pains,  such  as lumbago,
sciatica, &c.  &c, in which it  is  often of
essential service.
  The instrument (fig. xli.) consists of an
iron portion  (1)  about  four  inches and a
half long, which ends in a disc (2) half an
                 Fig. xli.
 
cou
152
C O W
inch in diameter, and  a quarter of an inch
thick, and a wooden handle, (3.)   When  it
is used,  it is  grasped  so  that the point of
the forefinger may  rest upon the bend at 4.
The disc is then to be introduced  into the
flame of a spirit-lamp, or  a piece of burning
paper,  and held till the metal (at 4) be-
comes uncomfortably hot;  the handle is
then to  be grasped, and the disc applied
lightly, and momentarily, and  at  short in-
tervals to the skin over  the affected  part.
Each touch of the disc produces a shining
mark on the skin, and very shortly the whole
surface  becomes reddened  and slightly in-
flamed.
  As regards the  use of counter-irritants
generally, it  is often  serviceable  to  excite
the  skin by  friction or  heat before using
them.   When fever is present and  inflamma-
tion goiny on,  non-professional  persons will
do quite as much, if not more good, and be
much less likely to do harm, by using the
mild counter-irritation of moist heat than
by applying blisters, mustard, &c, particu-
larly close upon the seat of  the disease.  If
a blister is put  on  in these cases, it should
be  a large one.  For  further  information
respecting  the counter-irritants  individu-
ally, the reader is referred to  the various
articles—Antimony—Blister—Mustard, Sec.
  COUNTENANCE.—The  expression  and
aspect  of the  human face is much  and
peculiarly affected by the various  diseases
which affect the body;  and  the first view of
a countenance often conveys to a physician,
who has  studied  the  subject, immediate,
valuable, and certain prescience as to the
nature of the disease for which his patient
is about to ask advice.  The indications are
partly due to the  changes of  complexion
which are associated with different forms of
disease;  but  expression  is equally signifi-
cant. The physiognomical evidences have
been classed  by a writer,  Mr. Corfe, who,
enjoying abundant scope for such observa-
tions, has made them  an object of special
attention.
  The following is  a summary of Mr. Corfe's
arrangement:—
     Countenance in—
A.—Brain Affections.
     1.  Lethargic,  in disease causing insen-
          sibility.
         Examp.:  Apoplexy.
     2. Livid, in   disease causing  deficient
          change  in the  blood.
         Examp.: Suffocation  and Coma.
     3. Distressed, in disease causing men-
          tal disturbance.
         Examp.: Paralysis and  Fever.
B. — Chest Affections.
     1. Dusky, in disease  interfering wit!
          blood changes.
         Examp.  : Bronchitis.
     2. Anxious,  in disease impeding respi
          ration.
         Examp.: Croup.
C.—Abdominal Affections.
     1. Pinched, in painful seizures.
         Examp.: Colic and Cholera.
D. — Nutrition   Affected. — Emaciation
          General.
     1. AVan, in diseases  of debility.
         Examp.  : Consumption and Cancer.
     2. Hue  peculiar, in diseases  affecting
          the blood.
         Examp.  : Heart disease and Jaun-
          dice.
E.—Enlargement of Organs, Glands, &c.
     1. Disturbed, in diseases causing con-
          tinued uneasiness.
         Examp.: Sore-throat,   Rheuma
          tism, &c.
F.—Vascular Disturbance.
     1. Flushed, in febrile disease.
         Examp.: Inflammatory fever
     2. Pale and languid.
         Examp.  : Hemorrage, &c.
  Refer to Complexion, Src.
  COUP DE SOLEIL, or  Sun-stroke.—See
Heat, effects of.
  COW-POX—Is  the disease affecting the
cow, which, transferred to  the  human sub-
ject, confers in the majority of cases immu-
nity from attacks of small-pox ; and in those
in which it does  not  give complete protec-
tion, renders  the attack of  that usually
virulent disease comparatively mttd.
  Cow-pox shows itself upon the teats  of
the cow in the  form  of  bluish  or livid-
looking vesicles,  surrounded by  a ring  of
inflammation, while  at the  same  time the
animals are  feverish and the milk dimi-
nished.   At first  the vesicles contain clear
fluid,  but ultimately become pustular,  or
filled  with matter.  The cow  is  liable  to
other forms of pustular disease affecting the
teats, but  they  do  not  present  the  same
characters nor follow  the same  course  as
the genuine cow-pox: which is, moreover, a
constitutional disease, sometimes extremely
severe,  and even fatal to  the animals.
  The name of Dr. Jenner, who discovered
this inestimable  boon  and introduced the
practice  of  vaccination—as  the inocula-
tion of cow-pox  matter is  termed—must
be  known  to  all.  His   attention  was first
directed to the  subject  from  the  known
circumstance, that when  the cow-pox had
prevailed among the cows of a  particular 
c o \v
153
COW
 district  or farm, many  of  those  connected
 with the management of the animals, like-
 wise became affected with  the  disease, and
 therefrom a certain number were protected
 against  small-pox.   The value of this cir-
 cumstance seemed at first  to be materially
 impaired  by the fact  that the protection
 was neither universal nor certain, until the
 investigations of Dr. Jenner made  it  clear
 that the  protection or non-protection de-
 pended upon the stage which the disease had
 attained  in the animal at the time it was
 contracted by the human attendant; that is
 to say, if  the vaccine disease advanced into
 the  stage  of maturation, or that in which
 the  contents of the vesicle, which forms  its
 outward   manifestation, had become  con-
 verted from a  limpid-looking  fluid  into
 matter,  although sores were produced  upon
 the  hands of the milkers, that certain pro-
 tection was not afforded which ensued when
 the  sores  were  produced by the fluid  from
 the  vesicle in an earlier stage.
   Following up his investigations, Dr. Jen-
 ner  clearly demonstrated, that when the human
 subject was properly inoculated with virus  taken
from the cow-pox vesicle, at the proper stage  of
 its progress, and  when in consequence of that
 inoculation  the disease was regularly produced
 and  went through its proper stages, both locally
 and  constitutionally, the individual thus affected
 was  thenceforth all but certainly protected  from
 the  contagion of small-pox.   These circum-
 stances call for particular  attention at the
 present time, when the value of vaccination
 and  its protective power is becoming  much
 disputed.   It is unquestionable, that within
 the  last few years, small-pox has prevailed
 much more extensively, and  been more fatal,
 than was  the case some time  previously ;
 also, that  many persons who had been vac-
 cinated  have taken the disease, and that a
 certain proportion of that number have died
 from it.   As regards  the complete protec-
 tion  of every individual who is vaccinated,
 against the contagion of small-pox, it could
never be expected—for the simple  reason,
that one attack of small-pox is  not in every
 case a security that the  disease may not  be
contracted  a second time; for,  although,  in
the  eruptive fevers  generally,  as well  as in
small-pox, the general  rule is one attack in
a lifetime,  it by  no  means  invariably holds
good; and it is unreasonable to  look for
more from cow-pox than  we  find in the
analogous cases already  alluded to.  Admit-
ting, then,  that certain exceptional instances
may  fairly be expected in which  the  most
perfectly developed cow-pox will not  pro-
tect against small-pox even in its most fatal
form, it becomes a question  how far its  pro-
tection  really extends, and whether, from
some cause or other, its influence  has not
become diminished since  the early days of
its introduction.   Many are inclined to this
opinion, on account of the recent epidemics
of small-pox which have prevailed in various
districts; but it will require much  stronger
evidence of the fact than  has ever  yet been
produced to justify, as some would have it,
the  abandonment of vaccination  and  the
recurrence  to  inoculation for small-pox.
One  thing is  certain,  that  Dr.  Jenner,
strongly  alive  to  the circumstance  that
milkers  inoculated with the  genuine cow-
pox were not protected by it if the disease
had passed a certain stage, both practised
and insisted upon the practice as  a  condi-
tion necessary  for success, that the same
law  should be had regard to in the  trans-
ference of the matter from one  human sub-
ject to another.   It must  be asked, has this
precaution  been  observed in the  cases of
those who  have  proved to be insufficiently
protected.   It may  or may not have been
the case; but there is some reason to expect,
that among the thousands and millions who
have undergone vaccination, a certain pro-
portion have thus been lulled by the sem-
blance of protection which was no protection
at all.  Again, it is an ascertained fact, that
the  presence of other disorders materially
interferes  with  the regular  progress  and
perfect  development of cow-pox ; and thus
there is  introduced  another  element  of
fallacy and of failure.  And, lastly, are there
not  those who have been vaccinated;  but in
whom the disease, owing  to  constitutional
peculiarity, or insufficient  performance of
the  vaccinating  process,   has either been
irregularly developed or not at all,  but who
nevertheless rank  among the  vaccinated?
With all these sources of failure, it cannot
be matter of surprise, that a proceeding to
which is confided the protection of millions
against so active an enemy as small-pox,
should in a certain proportion of instances
fail.  Still less so when it is reflected, that
amid the various hands to which  its per-
formance  is intrusted, some  will  prove
careless; nay, that  it is  not unfrequently
performed by those who are ignorant of the
distinctive characters  of  the  true  cow-pox
disease.   This is  not said  in  condemnation
of the performance of vaccination  by non-
professional persons, under peculiar circum-
stances ; for in many cases it has proved and
must prove of the most essential benefit; but
still  they cannot  be expected  to distinguish
accurately  an irregular development from
one which is the reverse.
  The most interesting recent fact connected 
C O \V                154                 COW
with  the  history of  vaccination,  and  one
which throws light upon its constitutional
influence, has been elicited by  the  experi-
ments of Mr. Ceely, of Aylesbury,  which
prove the  identity of  the two diseases, cow-
pox and small-pox,  and that their  apparent
difference depends  upon their modification
by the animal constitution. In other words,
that by taking the matter from a  patient
labouring under  small-pox,  and therewith
inoculating a cow, the genuine cow-pox was
produced; and  thus, that by its  passage
through  the  constitution of  the  cow, the
former virulent disease is deprived  of its
virulent and fatal character,  and converted
into a mild and perfectly safe disorder, and,
equally important,  deprived of its contagious
property, otherwise than as it can be communi-
cated from one person to another  by direct
introduction of its  tangible virus into the
blood.  Connected with this fact is  the
occurrence of the  grease on the  heels of
horses, which was  at one  time considered
identical  with  cow-pox, but  must now be
considered as the same virus, but modified
by the equine constitution.
  The next point is one intimately connected
with the prejudices  of the public, and espe-
cially of the poor—the possibility of other
diseases, or a tendency to them, being in-
troduced  along  with  the  cow-pox  virus,
taken  from  persons  who  either  had  the
dreaded disease, or a tendency thereto.  The
idea is not without  apparent  foundation, but
the state of the case  is one which most
parents are unwilling to admit.  Any medi-
cal man who  has had much  to do with  vac-
cination, and who  has watched its  effects,
must  have known  cases in which  children,
previously apparently healthy,  have,  after
passing through cow-pox, become liable to
cutaneous eruptions, discharges from  the
ears or eyes, and even abscess : some of these
are of course  adventitious circumstances,
but they  occur too often  and too closely fol-
lowing vaccination,  to be entirely so ; more-
over,  they are  precisely analogous to what
is witnessed every  day of the  effect of
eruptive  febrile diseases, such  as measles
and  scarlatina,  upon children of  weakly
and scrofulous constitution.   That the virus
itself introduces other than its own  specific
disease is not to be  believed, but that the
peculiar  disturbance  it occasions  in  the
constitution,  stirs up, as it were, the latent
tendencies to disease above  named, cannot
be doubted.  It is  proper that the  public
should be rightly informed upon this point,
for it  is one on which much misconception
prevails, and it is the chief ground  of  pre-
judice and even of resistance to vaccination,
especially among  the poor.  The medicai
man  is  constantly met with  objections,
on  the  score  of  the liability to the intro-
duction of  other  diseases  along with the
cow-pox, and  when  a reluctant  consent  is
yielded, it  is always guarded  with strict
injunctions as to the selection of the matter
from a "healthy child,"each  person consider-
ing their own  offspring as unexceptionable.
It certainly is not a pleasant admission for
parents, either to themselves or to  others,
that their children  have bad  or  scrofulous
constitutions; but the fact still stands, that
vaccination, as well as  the other eruptive
fevers, may  in them give the  first impetus
to latent disease.   A parent may decide not
to subject  a  child  to the  chance,  but in
doing so, it is exposed to the much greater
hazard of an attack of  small-pox,  in the
first place  as a disease,  and in  the second
as  an  excitement of  other diseases, still
more powerful than vaccination.   Further,
however, as  a proper   concession  to  the
opinions of the public, a  medical man ought
to take the  vaccine  virus  from  perfectly
healthy children only; and it  may be said,
if we find such a powerful  modification of
the constitutional effects  of  the  disease by
its  passage  through  the body of  the  cow,
there may be some influence, to us unappre-
ciable, exerted in the passage through  the
varied constitutions  of  mankind.  At all
events, the simple supposition is  sufficient
to dictate care in the selection of those from
whom the vaccination lymph is taken.
  The best period of life for the performance
of vaccination, is infancy, between the third
and fifth months, before the  constitution be-
comes disturbed by the process of teething ;
it may,, however, be performed at any time,
from immediately after  birth, should  cir-
cumstances, such as exposure to the conta-
gion of small-pox, render it advisable, and
of  course at  any period of after life.   A
child ought  to be free from  illness or disor-
der at the time of vaccination ;  any tend-
ency to fever, to  diarrhoea,  kc.  &c.  or any
eruption, should be removed before the pro-
cess is undergone.  It is always preferable
to vaccinate from the fresh arm if possible.
AVhen this  cannot be done, vaccine virus or
lymph is used, which has been preserved for
the purpose, either dried on ivory  points, or
between  two small squares of glass, or li-
quid, in small glass tubes.  In these cases
it ought to be as fresh as possible, otherwise
it is  liable to fail; but if well preserved
from the air by means of oiled silk  or me-
tallic leaf wrapping, and kept in as cool a
place as possible, it will keep its efficiency
far longer,  and  is  thus sent or taken  tc 
c o \v
155
COW
 warm climates.    The hermetically sealed
 tubes are said to be peculiarly well adapted
 for the above purposes, and sugar  has also
 been  used as a medium  for preserving the
 lymph for a lengthened period.  The scabs,
 also, dried and kept from the air, are capable
 of producing the disease  after  keeping;
 they  require to be [powdered and] rubbed
 down with  a little water when used.
    The part of the body on which  vaccina-
 tion is usually performed  is the arm, about
 halfway between the shoulder and elbow;
 a  point not of  very great importance  in
 males, but  to be attended to iu  females,
 who  may wear low dresses or short sleeves,
 and who will not thank the doctor for a scar
 upon  a visible part.   Some vaccinate upon
 both  arms; others consider three, or  even
 two well-developed vesicles upon  one arm
 sufficient.   In choosing the arm in a child,
 it  should be done with reference to the arm
• on which  the nurse  or mother habitually
 nurses it;   attention  to  this simple  point
 may save the child some uneasiness, or even
 from  failure of  the entire process, by the
 vesicles being rubbed or broken.
    All that  is requisite for the process  of
 vaccination is the  contact of the virus with
 the surface of the true skin, which of course
 is  done  by  piercing  through the upper  or
 scarf  skin;  this  may be  effected  without
 pain sufficient to  make an infant cry,  by a
 series of  scratches  crossing  one another,
 continued till the slightest  exudation  of
 coloured serum takes  place. A small quan-
 tity of  the vaccine  is now to be placed
 upon the abraded spot, and the thing is done.
   If the lymph has been dried, it is advisable
 to  rub it into the exuded serum  with the
 point  of the instrument used.   The points
 of insertion should be placed  about  three
 quarters of an  inch asunder.   Of course
 any thing which will abrade the skin in the
 manner  described above, and  apply the
 virus, may  be used as a vaccinating instru-
 ment; a large  needle will do, if nothing
 better is at hand, but a lancet, not over sharp,
 is perfectly convenient for the purpose ;  or
 the vaccinator of Dr. Graham Weir (fig. xiii.)
 which is furnished with a  series of  metallic
 points (1) at one end of the instrument, for
 the abrasion of the cuticle, and  a small knife
 (2) at the other, for the collection and appli-
 cation of the virus.  AVhen ivory [or glass]
 "points" (fig. xliii.) are used  to vaccinate
 from,  the charged extremity (1) may either
 be  well rubbed on the scratched surface  of
 the skin, or the  virus may be  scraped off
 and applied  with the lancet, or,  a deeper in-
 cision  being made with the lancet,  in place
 of  the scratches,  the extremity of the point
Fig. xiii.


 i
Fig. xliii.
is to be pressed into it for twelve or flfteeu
seconds.
  The course of the vaccine disease is gene-
rally a regular one.  About the third day
after  the  insertion of the lymph, the spots
appear slightly elevated  and inflamed, like
small pimples ; on the fifth,  each has a per-
ceptible  vesicle upon  it, which continues
enlarging,  until,  about the eighth day, it
assumes  its perfectly developed character-
istic form, (fig. xliv.,) that of  a  circular
                  Fig. xliv.
vesicle with depression in the centre.   At
thisperiod it contains a transparent ''lymph"
and it is surrounded by a perceptible blush,
or " areola," the vesicle itself looking pearly
or yellowish.  By the tenth day, the lymph
has become changed into matter, and the
vesicle looks more opaque and darker ; the
areola  of inflammation  has much extended, 
COW
15(5
C R A
the affected skin feels  hot  and hard, and
is  sometimes covered with minute blisters.
After the eleventh  day, the areola  begins
to  fade,  the vesicle  darkens still more  in
colour, becomes dryer and  shrivelled, and*
finally assumes the  form of a dark  choco-
late-brown scab, which separates somewhere
about the twenty-first day, leaving the skin
healed, but  permanently marked with the
impression of the vesicle, and with a num-
ber of little  pits.  Occasionally  the process
does  not  go on quite so regularly; four,
five, or six  days  may  elapse  before the
points of insertion inflame;  and it  may  be
the tenth or eleventh  before the vesicle  is
fully  formed.   On the other hand, it may
advance so quickly as to be  well formed  by
the seventh  day.    These   differences are
chiefly due  to  constitution.   In a weakly
child  the process is  apt  to  be delayed, and
rice  versa.  The constitutional symptoms
also vary, but generally  are palpable about
the  eighth  day; the  child is  fretful and
feverish, and continues so, more or less, for
three or four days.   Without the evidence
of constitutional disturbance, the protection
cannot be calculated on as complete.
   The management during   the  progress  of
the vaccine disease is very simple, the prin-
cipal  being  the protection  of  the  vesicles
from  injury, either by  rubbing or  by the
dress.   A piece of soft linen should  be
placed upon them on the fifth day.   If the
inflammation of the  arm is severe, as some-
times happens, a oold poultice of bread and
water should be applied.  A little Goulard
water will  allay the   after-irritation,  if
troublesome.  A dose of some simple aperi-
ent, castor-oil or senna,  should  be given  on
the  tenth or  eleventh  day. and  repeated
once  or twice afterward.   Care should  be
taken that  the scabs are   not  forcibly de-
tached, otherwise a sore, sometimes difficult
to heal,  may  be the consequence.   Some-
times this will happen  in spite of  all pre-
caution,  in children of a scrofulous  habit,
and a troublesome  ulcer form.   It may be
dressed with cold cream, or simple water-
dressing,  or may require a weak astringent
lotion, such  as two grains of the sulphate of
zinc to the ounce of  water.
   Occasionally, an eruption of vaccine vesi-
cles comes out all over the body; it is not a
circumstance of importance, and makes no
difference in the treatment.
   When matter is taken from the cow-pox
vesicle  for the purpose  of  propagating the
affection, it  is  requisite to puncture the
vesicle all round; for, in consequence of its
being divided  into  separate  cells  by par-
titions radiating from the  centre—such as
we see in the section of an orange—if on»
cell only is  opened,  the amount of lymph
which exudes is comparatively small.  The
ivory  points  may simply  be  dipped in the
exuded  lymph and dried;  or the square of
glass, if glass is used, gently applied to the
vesicle.   The "points," when dry,  should
be enveloped  in  some material which will
exclude the air, such as  goldbeater's  leaf,
or they  may be  kept in  a  bottle.  AVhen
glass  is used,  the  two squares  should  be
put together before  the lymph is quite dry,
and if likely to be kept long before using,
they also should be wrapped up from the
air;  if to be used at once,  paper  is suffi-
cient.
  The question  of  revaccination  is much
mooted.  If the process has been properly
passed through in early life, there can be no
possible necessity for its  repetition before
puberty; but after that period, during which
the  constitution  undergoes  considerable
change,  it is an  expedient  precautionary
measure which ought  to be  resorted  to.
The  process of a second vaccination is very
different from that of a first, being irregular
in everyway, sometimes causing the slightest
degree  of irritation, at other times giving
rise  to  rapid, almost erysipelatous  inflam-
mation  of the arm.   When it takes effect, it
usually occasions slight feverish symptoms,
loss of  appetite, and headache, for a day or
two.  A dose or  two of aperient  medicine
should be taken when these symptoms are
passing away.  The  virus of a second vacci-
nation is quite inefficient, and  should never
be taken.
  [In many of the large towns of the United
States,  physicians  are  appointed to vacci-
nate the people without charge.   Their re-
sidences may usually be learned'at the city
halls.]
  Refer to Skin—Small-pox.
  CRAB—The well-known shell-fish, is an
article  of diet unsuited  to  those of  weak
digestion.   In some constitutions it causes
griping when eaten, and  in  others  a  cuta-
neous eruption.
  CRAB'S-EYES—Formerly used in medi-
cine  as antacid remedies,  particularly  in
cases of gravel, are concretions which form
in the stomach of the craw-fish.
  CRAMP—Is  a spasmodic,  involuntary,
and painful  contraction  of  the  muscular
fibres.   The term  is  generally applied to
the  affection of the voluntary muscles,  in
contradistinction to spasm,  applied to that
of the  involuntary.  Any muscles may be-
come affected with cramp, but those of the
legs and arms, of the former especially, ire
most liable  to  do  so,  doubtless  from  the 
C R A
157
CHE
  greater liability of the nerves supplying the
  lower extremities, to irritation and  pres-
  sure, two great exciting causes of the dis-
  order.  The cramp may be confined  to one
  or two muscles, such as  those of the  calves
  of  the  legs, or  may be more  general, as
  happens in  cholera.  The affected fibres are
-  drawn  in   hard   knotty contractions.,  and
  maintain  this condition  for a longer or
  shorter time.   The most frequent causes of
  cramp are the  presence of indigestible food
  in the stomach, or of acid in the bowels, or
  the pressure exerted  on the nerves by over-
  loaded bowels.   The weight and  pressure of
  the child, acts  in a similar manner in preg-
  nancy and labour, and occasions painful and
  troublesome cramp.   The disorder is also
  often associated with the presence of worms.
  AVhen cramp affects  the arms and fingers,
  it may be  connected with disease  of the
  heart and great blood-vessels of the  chest.
  The power of the application of  sudden and
  prolonged cold  in producing cramp is often
  sadly exemplified  in  the case  of bathers.
  The best  immediate  remedy  for cramp is
 friction  with the  hand, or better still, with
 the soap and  opium  liniment.  AVhen  the
 legs are affected, it is always expedient to
 take medicine,  rhubarb and magnesia, with
 a teaspoonful of sal-volatile, or fifteen grains
 of carbonate of soda, with sal-volatile or a
 little  ginger;  and  afterward  to clear out
 the bowels with some active aperient, such
 as castor-oil, especially if there is any exist-
 ing constipation,  or a possibility of their
 being loaded.   Any other disorder of the
 digestive organs ought, of course, to be at-
 tended to.   Some persons find relief from the
 immediate attack  of cramp, by tying a band
 of some kind  tightly round  the limb, be-
 tween the affected part and the body,  while
 others are in  the  habit  of standing, upon
 some cold substance.   The first process is
perfectly safe, and may be tried;  the second
certainly is often effectual, but it is not devoid
of danger.   Active friction is quite the best
temporary remedy.   Cramp  affecting the
arms is always  to  be  regarded with  suspi-
cion ; if  it recurs, a medical opinion should
be taken.
   Refer to Convulsion—Spasm, SfC
   CRANIUM.—The skull  containing the
brain.
   CRADLE—The  old  form of child's bed,
ts now nearly superseded  by the  more con-
venient bassinet.  Either, if well  arranged,
should have a tolerably firm mattrass, afirn
villow, a piece of protective waterproof cloth
over the mattrass,  and soft blankets, but no
curtains, which are quite incompatible wUii
the health of the child.  Rockers beneath,
 if they allow  only very gentle motion, are
 admissible, but not otherwise.
    Refer to Children.
    CREAM—Is that  bland,  oily portion of
 the milk which separates  and floats on the
 top ; its  composition is vevy nearly that of
 fat.  It is a constituent of the  milk of all
 animals.  As the amount of cream, contained
 in cows'  milk especially,  varies consider-
 ably, the proportion  may be ascertained by
 allowing the milk to  repose in tall cylindri-
 cal glasses.  Zinc pans have been recom-
 mended for use in dairies, as exerting some
 chemical action upon the milk, and causing
 the more abundant   separation of cream.
 If there  is chemical action, there must be
 danger of impregnation from the metal, and
 though it  may be slight, it is better avoided.
   Cream is  nourishing,  but not suited for
 weak  stomachs, except in  small  quantity,
 mixed with other articles of diet, such  as
 arrow-root mucilage, when it may  some-
 times be  advantageously substituted  for a
 larger proportion of milk.
   Refer to Milk.
   CREAM OF TARTAR, or Bitartrate
 of Potash.—See Potash.
   CREATINE, or Kreatine—Is a crystal-
 lizable  substance, existing  in the  flesh of
 animals.
   CREASOTE—Obtains  its  name  from its
 powerful antiseptic properties. When pure,
 it is a  colourless  fluid,  of  a strong  pene-
 trating  odour,  which is  known to  most
 persons from its being extensively used as
 a  palliative  in  toothache.    It is obtained
 from tar,  and, for that reason,  is sometimes
 called  "spirit  of  tar."   For  allaying the
 pain of toothache its power is superior to
 that of any other remedy.   A single drop
 of creasote, rubbed up with a little sugar or
 gum, in an ounce of water, will often  allay
 obstinate  vomiting.
   It can be made into pill very nicely with
 crumb of bread ; but  the piils should not be
 kept for more  than three or four days. It
 may also be given with spirit of juniper, or
 with acetic acid, (vinegar,) which dissolves
 it.  It disgusts some patients, but others
 like the smoky  flavour, and  in such cases it
 is  a itpecific against sea-sickness,  and rarely
 fail*, in  the vomiting of pregnancy.   It is
 an  admirable ingredient  for pomades for
 oMlblains,  threatening, incipient, or ulcer-
 ated, five  or six  drops  being rubbed  up
with the  ounce of lard.  Dr. Cormack, in
his treatise on creasote—Edinburgh, 183b"—
brought forward many arguments and facts
to  prove that the Egyptian  mummies owed
their preservation,  as well  as their medical
virtues to creasote; and upon the occasion 
C RE
158
C RO
of the unrolling of an Egyptian mummy in
1850, the same author addressed a very in-
teresting communication to the Atheiuvum,
of June 15th, 1850,  in  which he seems  to
establish beyond  doubt  that the essential
part of the mummifying process  was the
application  of heat  to   bodies filled with
bitumen.  He shows, upon the authority  of
Royer, &c. &c. that large quantities of bitu-
minous  substances were always introduced
into the body, and that the strong heat was
then always  applied.
  CRESSES—In the various  forms of land
and  water-cresses, are  wholesome  salads,
but, like other vegetables which are eaten
uncooked, are not likely to agree with those
of weak digestion.  Water-cresses, so famed
popularly, for their effect "in purifying the
blood," probably owe their beneficial influ-
ence to  the  presence of a small portion  of
iodine.
  CRETINS—Are individuals in whom de-
ficient development of the brain, and of the
body  generally, is associated with  mental
imbecility.   Cretins are  met with in various
quarters of the world,  and  even in  this
country,  but their peculiar  location  is  in
the dark, deep valleys of Switzerland.   The
condition is  often  associated with the exist-
ence of bronchocele,  nnd the two diseases
have been considered as connected, but it is
probably not more than coincidence of ex-
citing cause.
  The most characteristic features of cre-
tinism are, the stunted stature, which seldom
exceeds four and  a half feet, the deformed
head, large  belly, and distorted limbs, the
countenance being an index of the imbecile
or idiotic condition of the mind.  There are,
of course, various grades of cretinism.   The
malady is instructive in  showing how strong
an influence is exerted  upon the  develop-
ment of the  human frame, by  circumstances
such  as surround these unfortunate beings
in their childhood ;  deficiency of light, and
deficient change of the  damp malarious  at-
mosphere of the deep valley.   It is also to
be feared  that it exemplifies the  power
exerted  by the habits of the parents upon
their  offspring; and that drunkenness and
debauchery  of the former often entail cre-
tinism upon the latter.  There is no chance
of amelioration, either physical  or mental,
unless the cretin is removed from his native
home to the free air of the mountains above,
The  endeavour to improve the condition of
these unfortunates is now being made in an
establishment situated  on one of the  Swiss
mountains, under the care of a philanthropic
physician—Dr. Guggenbuhl—who  is   de-
voting his  life to the object.  The  results
obtained, both mental and physical, are said
to be encouraging.
  CRISIS—In  disease,  means  a sudden
change, tending either to recovery or death.
Much more importance used formerly to  bo
attached to the critical  periods of diseases
than there is  at present, although, in  some,
undoubted periodical changes do take place,
but not with  sufficient certainty or  regu-
larity  to  admit  of  much calculation.  A
crisis has generally  been considered  to  be
denoted by some well-marked circumstance,
such as profuse perspiration, discharge  of
blood,  cutaneous eruptions, boils,  abscesses,
or the like, or by the appearance  of copious
deposites or sediment in the urine; and there
can  be no  question  that decided and per-
sistent improvement in the  character of a
disease does  often follow immediately upon
the occurrence of these " critical" ejections.
  Refer to Fever, £c.
  CROTON-OIL—Is obtained  by pressure
from the seeds of a shrub,  the Croton  tig-
Hum, a native of Hindostan,  Ceylon,  &c.
The > oil, when good, should be  of a pale
amber colour, about  as thick  as  castor-oil.
It is very acrid, and so powerfully cathartic
as to be a very unsafe  remedy for domestic
use  internally;  and,  indeed,  should  never
be resorted to,  except  in the  one case  of
apoplectic seizure, when medical  assistance
is at a distance.   In such a case, a single
drop  of croton-oil—if  it is  procurable—
mingled with a little sugar, might be placed
on the tongue.
   As a counter-irritant, croton-oil  is  ex-
tremely useful.   It  may  be  made into a
liniment, with equal parts  of the  strong
solution of ammonia and water,  or it may
be used alone.  It  brings out a  thick crop
of pustules,  when  rubbed  on the skin in
small  quantity.  It  sometimes,  however,
affects not only the  part to  which it is ap-
plied, but causes a general cutaneous erup-
tion, with  swelling  of the   eyelids.   It
occasionally  exerts  the latter  effect upon
persons who happen to be near while the oil
is used. It is not improbable that what are
said to  be  concentrated preparations  of
castor-oil contain croton-oil.
   CROUP—Is an inflammatory affection of
the  larynx  and  upper portions  of the  air
passages.  It is peculiar to children—males
are more liable to it than females—and when
one  in a family suffers from the disease,  the
rest almost certainly have a tendency to it.
The malady seldom occurs during the first
year of life, but is most frequent  in  the
second ; at puberty the tendeuc y to it ceases,
although  cases  of  genuine croup have oc-
curred after that period.  The ra/ydity witk1 
C R 0               159                 C R 0
 which croup at times progresses  to a fatal
 termination, and  the distressing  character
 of the malady, always render it adreaded dis-
 ease.  Fortunately, it is one which, if taken
 in time,  is greatly under the control of well-
 directed treatment.  Its dangerous nature
 must ever  make  proper medical advice a
 necessity, but the importance  of early active
 remedial measures  renders it at  the  same
 time highly desirable that treatment should
 be resorted to without  the slightest delay.
 Moreover,  the  well-marked  characters of
 the  disease render it easily distinguishable
 by the unprofessional—doubly so by  those
 who have once witnessed  it, or  heard its
 peculiar cough.  The great danger in croup
 arises not only from the possibility of the
 narrow chink in the larynx through which the
 air  passes becoming closed by swelling; but
 also from the remarkable product of  a pe-
 culiar inflammation which is  formed upon,
 or  thrown  out by,  the lining membrane
 of the trachea and larynx.  This formation,
 " false membrane" as it is named, resembles
 thin leather of an ash colour.  It  takes the
 form of the tube which* it lines, and indeed is
 sometimes coughed  up in perfectly tubular
 portions.  More  generally, however, when
 this  false  membrane forms,  death  is the
 result,  from its  clogging  up the narrow
 chink of the larynx, and preventing the
 ingress of  air to  the lungs.  Croup  may
 begin very suddenly.   A child goes to
 bed  to all appearance perfectly well, and in
 the  course of two or three hours comes a
 cough, which  strikes even  the most  unob-
 servant as peculiar, which falling  upon the
 ear  of  the anxious  parent, who  has ever
 heard it before, tells at  once of danger.
 The child  seems as  if it coughed through
 a brazen tube.  Perhaps at first  the  little
 invalid is not awakened,  and if now visited,
 is  found  flushed  and  fevered,  moaning
 slightly,  perhaps, and restless, the breath-
 ing  slightly quickened;  the  cough comes
 again, the child awakes or is awakened; if
 it speaks, the voice is hoarse; if it  cries,
 hoarser still.  Should the disease be neglect-
 ed at this  time, or go on uncontrolled, the
 cough, still retaining its peculiar character,
 becomes more frequeut; the breathing quick-
 ened, is also accompanied by the character-
 istic dry  wheezing occasioned  by narrowing
 of the passage  through  which the air is
 drawn; the head  is thrown  back in  the
 efforts to  breathe,  respiration is insuffi-
ciently performed,  and   the  blood  being
insufficiently changed, begins  to evince its
deteriorated  character in  the blue  colour
of the lips,  the dusky coldness of  the skin,
and  the affection of the  brain which  gives
 rise to  partial  insensibility or  delirium.
 The pulse,  previously quick, becomes stil!
 quicker, but at the  same time feebler, and
 at  last the child dies in a state of almost
 unconscious suffocation.  There may,  how-
 ever, in  the  progress  of the disease,  be
 intervals  of comparative ease,  alternating
 with paroxysms of spasmodic obstruction
 to  the  breathing, threatening,  and some-
 times causing  immediate suffocation.  The
 average duration of a fatal attack of croup
 is from three to four days, but it may, and
 does, terminate much more speedily. When
 under  proper  treatment, the  disease  is
 checked,  the  first best  sign  is the cough
 beginning to  "loosen,"  the  breathing  at
 the same  time becoming tranquil, and the
 skin moist; the pulse changes from its  hard
 quick  beat  to one of a softer and a slower
 character.  Croup does  not,  however, in-
 variably  begin suddenly;  frequently the
 child has been suffering, apparently,  from
 common cold in the head, and the attack of
 croup seems to be a consequence of the in-
 flammatory affection of the membrane  of
 the  nose  and  throat  extending  into  the
 trachea, and taking on the peculiar charac-
 ter of the  more fatal  disease.  At other
 times there has been slight drowsiness for
 some days  previously, but  not  sufficiently
 well marked to attract attention,  although
 at the same time, from hoarseness not being
 common  among children,  its  occurrence
 should  always  rouse  suspicion, especially
 if the child itself, or any  of the family,  have
 suffered from  croup.  Sometimes  a child
 will have a croupy  cough for some nights
 in succession before  the  attack of the real
 formed  disease; and parents are apt to  be
 lulled  into  security  by the fact,  that  in
 children  susceptible  of  croup,  any cough
 partakes  more or less of the shrill croupy
 intonation.  Another, and highly dangerous
 form of croup, is that in which the inflam-
 mation  commences  on the throat, the  ton-
 sils  and  soft  palate,  and  uvula, which
 quickly become covered  with an  ash-co-
 loured  membrane.   At  first  the  child  is
 supposed  to  be merely suffering from  sore
 throat, for there may be little or no cough,
 or embarrassment of breathing, but the in-
 flammation extends downward into the air
 passages,  and the croupy symptoms become
 developed ; by the time this stage is reached
 the case is  all but hopeless.  Fortunately
 this dreaded  disease,  the most distressing,
 perhaps,  by which  a parent  can  lose a
 child, is, in every form but the Inst, amen-
 able to proper remedies if adopted at once.
 So strikingly, indeed, is this the case, that it
is very common to find parents taking the 
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160
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matter in their own hands  after they have
3een a child treated for the disease once or
twice, keeping, as they ought to do, a supply
of the proper medicines constantly at hand.
and by  their prompt application,  nipping
the incipient attack in the bud ; the medical
attendant is either not sent for, or if he is,
It is only to find  that the proper treatment
has been followed and the disease checked.
   The remedy,  in incipient croup, is  tartar
emetic given in  tolerably full  doses, either
in the form of solution  in water, or rubbed
up with  sugar,  but never as antimonial
wine.  The  form  of a powder, one or two
grains of sugar with the appropriate dose of
the remedy, is the best form for keeping, as
the solution decomposes and becomes inert,
but the  latter is perhaps the  most quickly
efficient form of administration.  In a house
which contains a child  liable  to croup, six
or eight of the powders ought  to be ready
at all times, and also bran-bags.  To a child
of two years of age, the eighth of a grain is
to be  given at once, to one of four years the
sixth; anil this dose to  be repeated every
ten minutes or quarter of an hour, till full
free vomiting is produced.  [A much  safer
and often more certain emetic is a drachm
of powdered alum.]  At the  same  time  a
warm bath may be got ready, into which the
child  is to be immersed  for  a quarter of an
hour as soon as possible, or what will in the
author's  opinion  answer equally well, large
poultices of hot moist bran should be placed
over the  upper part of  the  chest and  fore-
part of the throat, while the child is kept in
a sufficiently warm situation.  In the habita-
tions of the poor,  especially, the latter mode
of treatment is certainly preferable to the
bath, which cannot always be procured with-
out delay, nor managed  without  danger of
after-chill.  An hour after the vomiting, the
dose of tartar emetic [or alum] is to be re-
peated, and  vomiting again excited, nnd its
subsequent repetition at the end of one, two,
three, or more hours, must depend upon the
continuance and urgeucy of the symptoms ;
the bran poultices  being  continued.  The
child  may be allowed  to  drink  freely  of
toast or barley water, or thin gruel, but not
tea—which decomposes  the  tartar emetic—
unless the infusion is extremely weak.  If
a case of incipient croup be thus treated, it
will, in all probability, and may be subdued
without  medical  assistance—though it is
certainly safer to have it; but  if the fever
is extremely high, and if the breathing has
any approach to  a crowing sound, medical
attendance must be procured if possible, and
with the  shortest  possible delay.  If it can-
not be procured, and if the attack does not
seem to yield after the second or third dose
of tartar emetic, leeches must be used—one,
as a general rule, for each year of the child's
life—not on the throat itself, but over the
upper part of the breast-bone, in which situ-
ation a blister must also be placed,  if it be
tried, as it may be, later in the  disease   If,
after tartar emetic has been used for four or
five  hours, the disease  progresses, the  fre-
quency with which the remedy is given must
now be  diminished,  and  sickening doses
given at longer  intervals, otherwise there
may be danger of depressing too much ;  but
calomel must be commenced  with, and to a
child of two years of age, a grain is to  be
administered every four hours. The strength,
if it seems  to fail, should be supported with
weak animal broth—that made from veal or
fowl is  the most  suitable—given in small
quantity and  at  short intervals.  Later iu
the  disease, when weakness  increases,  the
strength of the broth must be increased, the
tartar emetic entirely stopped, and solution
of acetate of ammonia given instead, a tea-
spoonful every two or three hours to a child
of three years old.  Of if symptoms of sink-
ing, cold or blue surface, and weak pulse,
seem to  demand  it, five  to ten drops of sal-
volatile,  or the  same  quantity  of brandy,
must be given in a little water,  or the car-
bonate of ammonia resorted to; eight grains
should be dissolved in an ounce and a half
of water, and of this, two teaspoonfuls given
during one hour.  A little  white-wine whey
may  also  be  given.   Such  must  be  the
general  outline of treatment  to  be pursued
in a case of confirmed croup, should it fall
to be treated without the presence of a medi-
cal man.  But again it is reiterated, the first
twelve, nay the first eight hours, are the all-
important period, which, if lost, can scarcely
be recovered; for, though children do recover
when the disease has advanced into its second
stage, and even sometimes  from  such despe-
rate circumstances as  to  make it  a duty
never to despair of saving life,  the chances
are but small compared with those which
the first few hours hold  out, that  period,
which in some situations must elapse before
medical assistance can  be procured, and
which thus places the life of the  child in the
hands of a parent or guardian.   If it is
croup, even if it is suspected to be, let there
be  no temporizing, but let  the treatment
now laid down be  promptly, actively,  un-
sparingly carried out.  If the antimonials act
strongly  on  the bowels,  they  should  be
checked with one or two drops of laudanum.
Bleeding from the  arm  is  practised  by
medical men in croup, but cannot be a safe
proceeding for the  unprofessional.  In the 
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161
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 last stage, opening  the windpipe  holds out
 the last, and that but a faint hope of saving
 life.  Of course a surgeon is required for
 its performance, if the parent consents  to it.
   In that fatal form of croup which com-
 mences  in the  fauces,  an unprofessional
 person can do  but  little with hope of suc-
 sess ;  if discovered in time, medical aid
 should be procured. The local application
 of the solution of caustic to the whole sur-
 face within sight, and to the interior of the
 larynx,  may  be  successful.   If  croupy
 symptoms have come on, one or two emetics
 of ipecacuanha may give relief; but the case
 is so desperate that it is a question whether,
 in the  absence  of a medical man, it is not
 better left entirely alone.   If, however, the
 life  of  one child cannot  be saved, the possi-
 bility of this form of the disease  extending
"to the others  of a  family by  contagion,
 should be known, and  guarded against by
 timely and effectual separation.  But should
 another child become affected, the disease
 being thus discovered at once, a solution of
 lunar caustic (nitrate  of silver) should be
 made, in the proportion of twenty grains to
 the tablespoonful of rain-water, and the in-
 flamed  throat thoroughly brushed over with
 it, with  a hair pencil, and the process re-
 peated  in eight or  ten hours.  If fever is
 present, small doses of tartar emetic, the
 twelfth of a grain,  should be given every
 three or four hours  to a child of  six years
 of age, and two  grains of calomel  every
 eight  hours,  and an  aperient  given  if
 required.   These measures are to be fol-
 lowed out  until medical assistance is pro-
 cured.
   The causes of croup are almost invariably
 connected with cold  and moisture, and par-
 ticularly during east winds; hence, on the
 east side of  Britain  the disease is con-
 sidered to be more  prevalent  than on the
 other;  but it may  also  be occasioned by
 the removal of wrappings from the throat,
and  exposure to a cool air when  a child is
heated.  Children liable to croup are still
more so after attacks of acute or debilitating
disease.
   The prevention of croup is,  of course, of
the highest importance, and, therefore, the
causes  of  it,  just  enumerated,  must  be
avoided in every way.  Slight colds should
never be neglected in children or families
uredisposed, but should  be treated by con-
finement to the house, or to bed if requisite,
by milk diet, diluent drinks, and by the
tolu and mucilage cough mixture,  with the
addition of ipecacuanha wine;  paregoric
should also  be given to allay troublesome
cough, and, in fact, those measures recom-
      o2                                 V
mended  in  Cold  carried  out.   The  sus-
ceptibility may also be  lessened  by  not
clothing the throat too warmly, and by the
regular practice of bathing the throat  and
chest well with cold water every morning
rubbing afterward with  a rough towel till
thorough reaction ensues.  This  practice
is,  of course, better commenced  in  warm
weather, and  not  too soon after an attack
of the disease.  Flannel should always be
worn next the skin, and care taken particu-
larly that bed-chambers, and  rooms  chil-
dren habitually live in, are not too warm, and
never occupied while  the floors  are  wet
after washing.   A residence  at a  distance
from water is to be preferred.
  Refer to Antimony—Children—Larynx—
Trachea, Sec.
  CROUP—Spasmodic, or Child-crowing
—Is  a  species of convulsive or spasmodic
affection  of  the  muscles  of  the  larynx,
which, by narrowing and  closing the chink
in that  organ, through which the air passes,
occasions the sound of the breathing to re-
semble  that of the  true inflammatory  dis-
ease.   This   spurious  croup  is often  an
alarming, and sometimes a fatal disease;  it
generally occurs before the end of the third
year of life,  and in consequence of irrita-
tions acting more or less at a distance from
the affected larynx, which receives the im-
pressions through  its nerves.  Enlargement
of the glands  of the neck,  affections such
as eruptions of the scalp, the irritation of
teething more especially, or the presence of
irritating matter in the bowels, may any of
them give rise to the affection.  It comes on
suddenly, the  child  is seized in a moment
with  " catching at the breath," struggles,
the face change's colour, and the veins  are
full.  If the spasm be not relaxed, after a
few ineffectual efforts at breathing, the child
must die; but if the spasm gives way,  the
air  is drawn  into  the chest with a crowing,
croupy  sound.   It is of much  importance
that this spasmodic  disease should be dis-
tinguished from real inflammatory croup,
on account of the very different treatment
required ; it  may  be known by the  absence
of fever, the  stopping of the breath being
much more  instantaneous  than that which
occurs in the real  disease.   In an affection
presenting symptoms so  sudden  and  so
alarming, immediate remedies must be used ;
a little cold water  should be dashed on the
face at  once, and, as recommended by  Dr.
Watson, a sponge dipped in hot water  ap-
plied to the  forepart of the  throat—medi-
cal  assistance  being, of  course, procured
quickly.   In this disease, a child, even when
apparently dead, might  be saved by open- 
CRU
ltW
c  u r
ing ;he windpipe.  After one of these at-1
tacks have occurred, the strictest examina- |
lion as to the probable cause should be in-
stituted  by a  medical man.    The  gums
lanced if requisite, the bowels cleared with
a purgative,  and  the glands of the  neck
specially observed, and,  if  enlarged,  the
cause ascertained and removed.
  Refer to Convulsion—Glands, Src.
  CRUSTA-LACTEA.—An eruptive disease
affecting the head and face.—See Skin, dis-
eases of.
  CRY  OF  CHILDREN.—The  principal
distinctive difference in the cry  of  children
is, whether it be that of expiration from, or
inspiration into the lungs.   The  cry of a
strong child, suffering  pain, is more of the
expiratory; that of a weak, exhausted child,
of the inspiratory or sobbing character.
  CRYSTAL LENS.—See Eye.
  CUBEBS, or Cubeb Pepper—Is  the fruit
of a climbing plant, a native of the islands
of the Indian Ocean.   It is used in affec-
tions of the urinary organs.  The dose from
a half to a whole teaspoonful.
  CUCUMBER—A pleasant article of diet
for the strong,  but a very unwholesome one
for invalids.
  CUMIN—is the fruit of an  umbelliferous
plant, a  native of Greece and Egypt.   The
Beeds contain an aromatic volatile oil.  Cu-
min  plaster  is stimulant to the skin, and
useful in cases in which very active excitant
action is uncalled for.
  CUPPING—Is  a process of blood-letting,
by which blood is drawn from wounds made
for the purpose,  by the agency of suction,
exerted by a cup or other vessel exhausted
of air, or nearly so.  It is a very old surgi-
cal expedient, and  in  former times it was,
and, indeed,  among uncivilized nations at
the present time, it is still effected by the
primitive agency of a sharp flint  or knife,
and a cow's horn with the tip removed, suc-
tion being made by the  mouth of the opera-
tor.   In  modern surgery,  cupping, when well
performed, is  at once one of the most ele-
gant  and most useful  of our methods of
treatment.  For the purpose  of wounding
the skin, a metallic box, containing a set
of lancets, varying in number, is provided.
In this box, (fig. xiv.,) which is  called the
scarificator, the lancets are so fixed as to
be discharged,  when set or cocked,  by a
trigger (1) and spring, which causes them
to pass rapidly  through the skin in a semi-
circular  sweep—so rapidly indeed,  that the
usual sensation of cutting is not felt.  The
most convenient number of lancets is twelve,
ind  the depth of  the wound made by them
can be increased or diminished  by turning
Kig. xIt.
the screw, (2 ;)  this  must  be done  while
they are fixed at half-cock, and  protruding
from  the  instrument.   The  only other es-
sentials for cupping are a vessel from which
the air can be exhausted, and kept so when
it is applied to the skin, and flame of some
kind, or some others means, for  exhausting
the air.  There  are, however, sundry other
little requisites convenient for the operation,
to be mentionod hereafter.
  Cupping is applicable  in  most instances
where local  abstraction of  blood is called
for, and may often be substituted for leeches,
and even  for  general bleeding;  it is a
safe operation when  used in proper situa-
tions, and most may be taught its perform-
ance by a few practical lessons.  It is, more-
over, a most useful accomplishment for per-
sons who are far removed from medical as-
sistance.  It is hoped that the following de-
tails may be sufficiently clear to enable even
those who have never seen cupping perform-
ed, to effect it in case of need ;  but by all
means let every one who contemplates the
possibility of such a requirement get prac-
tical  instruction, which  there can be  no
difficulty in doing.
  Cupping-glasses of various kinds are and
have been used,  but the most general is the
bell-shaped form, (fig.xlvi.,) of various sizes,
Fig. xlvi.
some of these are made with brass fittings
at the top, for  the  attachment of an ex-
hausting syringe.  But the most useful form
of all,  and  that most easily applicable by
an unpractised or an unprofessional hand, is
the leech cupping-glass,  (fig. xlvii.,.) which is
the invention of  Dr.  Fox,  of Derby.   When
this is  used, the  next instrument, the  lamp
or torch, (fig. xlviii.,) is not required as it is
for the application of the bell-shaped glass • 
CUP
Fig. xlvli.
Fig. xlix.
this torch is simply a lamp made for  burn-
ing spirits of wine,  by means of a wick
which will afford a large flame.
   Cupping maybe performed in most situa-
 tions on  which it is possible to fix a glass,
 by a proficient; but the range of the un-
 professional  operator must  be much  more
 limited, partly on the  score of safety, but
 also for the reason, that in some situations
 they are not likely to draw blood  sufficient
 to  effect  any  good  object.  As  a general
 definition, an unprofessional person may cup
 anywhere upon the back of the trunk of the
 body,  from  and including the nape of the
 neck, to the bottom of the spine, and also
 on the forepart of the chest.   In selecting
 a place  within the  above  limit it should
 always be ascertained that there is room for
 the rim of the  glass  to  be in  contact with
 the  skin  throughout its  entire circle.   It
 being pre-supposed that the  abstraction of
 blood is called for,  and it being  also pre-
 supposed  that the intending operator is pro-
 vided with the necessary instruments, he
 should also have some warm  water, a good-
 sized piece  of  sponge, or, in lieu of  it,  a
 piece of flannel, a light, and some plaster.
  The  person  to be  operated upon  being
 conveniently  placed, and  the skin bared,  it
 should be moistened with warm water, or
 the circulation  of the  part excited by means
 of hot water  fomentation applied  for some
time ; an  exhausted glass is  then to be ap-
plied for a few minutes; removed, the scari-
3                 CUP

ficator  placed upon  the portion of  skin
which had been drawn up by the  glass, am
the lancets, which have been  put on ful.
cock,  discharged.   The scarificator  being
removed, the exhausted glass is again to  be
applied over  the wounds made by the lan-
cets, (fig.xlix.) Thebloodought immediately
((L
to commence flowing.   If the bell-shaped
glass is used, when applied, one edge should
be made to rest upon the  skin, (fig. 1.,) the

                   Fig. 1.
flame of  the  spirit torch  passed rapidly
under  it  and  withdrawn, and  the  glass at
the  same instant  pressed entirely  down
upon the skin.  This is the point of the opera-
tion most  difficult  to perform well and effi-
ciently by the unpractised, for if  the  ex-
haustion is incomplete, suction, and conse-
quently the abstraction of blood, are  so
likewise ;  and in endeavouring to make the
movements  quickly, there  is a  liability of
burning the skin.   Fortunately,  an  indivi-
dual can practise the manoeuvre upon the skin
of his own thigh at any time.  Much of this
is avoided by the use of the leech cupping-
glass, from which  the  air is exhausted by
simply putting into it a small  fragment of
paper,  half an inch  square, dipped in spirits
of wine,  or spirit of  some sort.  A short
piece of wire (fig. xlvii. 1) with  a small por-
tion of tow tied to the end of it and dipped in
the spirit, is used to ignite  the paper in  the
glass, the  latter being applied  to the skin
the  moment this  is  done, and the wire
withdrawn; the confined air extinguishes the
lighted paper  in the cupping-glass at once.
  In addition  to simplicity  in  application,
the leech-glass has also the advantage of
taking  at  once a considerably larger quan
tity of  blood than the other form, and thus
Fig. xlviii.
 
C C P
164
C U R
of requiring to be less frequently reapplied;
moreover, the blood, as it  flows, gravitates
to the bottom  of the glass, and does not clot
over  the wounds, as it does with the bell-
shaped instrument.  These  remarks do not
refer to the  quick, elegant,  and  efficient
manipulation  of a professed cupper, but as
the operation  must be in the  hands of the
unskilled.  AVhen an applied  cupping-glass
is to be  removed, it must be done by press-
ing down a portion of  the  skin  at its  edge
with the point of the finger, so as  to admit
the air, which enters with a hiss.  If,  after
a cupping-glass has been on some time, the
blood does not  flow freely, but clots  upon
the wounds, and  it is  desirable that  more
blood be drawn, the glass  should be taken
off,  and—when the  wounds  have  been
cleansed with warm water—reapplied.  AVhen
the operation  is concluded, it  is only neces-
sary to  cleanse the wounds, which will not
continue to bleed in the situations indicated
for cupping in this article, and  to put a
little  adhesive plaster  upon  them, [or  a
greased rag will suffice.]
  Such  is the  operation,  under  the  pre-
supposition  that the operator is provided
with the requisite instruments; but in the
absence of these, very good substitutes may
often be  made.   To make the incisions,
which should be about  the eighth of an inch
in depth, any  sharp instrument will suffice;
for the cup, a  tumbler,  or wineglass,  or any
similar vessel  with a uniform rim will do;
and to exhaust the air, whatever will blaze
freely.  In cases of poisoned wounds, the
application of  a cupping-glass, where it can
be done, either with or without enlargement
of the original wound, is a good precaution,
and will retard the absorption  of the poison,
during the interval of procuring medical
assistance.
  Dry cupping is a most  useful remedy,
perhaps too little used;  it is the application
of the cupping-glass for from  ten to twenty
minutes,  without any previous scarification.
The blood is thus withdrawn from parts in
the vicinity of that operated on, and relief
afforded  without weakening by actual ab-
straction of blood.   In  local congestions of
blood, in local  pain, &c. it is often of much
service.   The  principle  of dry cupping has
been brought forward as a remedial measure
on a large scale by M. Junot, who, by means
of vessels capable of being  exhausted  after
the manner of a cupping-glass, and which
are made sufficiently large to include a whole
limb,  thus draws temporarily  a great mass
of blood—from  three to four  pounds—out
of the current of the  general circulation,
and produces the effect of a large bleeding,
without its weakening results.   The methc J
is said to be successlul, but it has not been
much employed in this country.
   Cupping is certainly a most useful accom-
plishment for  the emigrant.   It  is a  safe
method,  and, when once practised, an easy
one of blood-letting;  but, by all means, let
it be  practically  learned  if possible,  and
then the  above, though  meant  for all, will
be more  certainly useful in bringing  back
to the  memory the minutiae which so aptly
escape it.  The chief inconveniences of the
leech cupping-glass are its greater bulk and
liability  to  fracture  than the  bell-shaped
form.
   CURD.—See Cheese.
   CURRANTS—The well-known fruit, either
black,  red,  or  white, are extremely whole-
some,  disagree with few, and are particu-
larly well adapted, either fresh or cooked,
to form part of the cooling diet requisite for
health in very hot weather.  Moreover, the
mechanical action of their seeds has a most
beneficial  effect in  exciting  the  bowels.
Some bilious persons say they find  benefit
from eating a few ripe red currants a short
time before breakfast, and that  the practice
tends to  keep off the increased liability to
bilious attacks during the hot weather, when
currants  are in season.
   The  black currant possesses more astrin-
gency  than  the other varieties, and when
preserved, is  much domestically  used  in
sore  throats,  &c.;  it also  acts upon  the
bowels.   Boiling water poured upon a por-
tion of currant preserve, and the infusion
allowed to cool, forms one of the  pleasantest
and  most useful  of  our fever beverages.
Black  currant  leaves are used  in infusion
as a domestic diuretic.   What usually goes
by the  name of the  dried  black currant is
no currant  at  all,  but a species  of small
grape.   It is brought almost solely from the
islands of the Levant.  It is a favourite do-
mestic  aperient—particularly in the lying-in
chamber—mixed with gruel.   It  probably
acts mechanically.
  CURRY—Is  food of  any kind  prepared
with the  well-known condiment  curry-pow-
der, which is composed of turmeric, cayenne,
and  black peppers, mustard,  ginger, and
other spices.
  The  preparation is not adapted for inva-
lids, and  should only be used sparingly by
those in health, especially if they have any
tendency  to irritation of the stomach and
bowels, or to  head  affections.   It is  pro
bably better adapted, as regards  wholesome-
ness, to give requisite stimulating power to
the rice  and other foods of hot  climates
than as an addition to an animal diet. 
CUT
165
DAK
  CUT—See Wounds.
  CUT-THROAT.—In this horrible casual-
ty two dangers chiefly threaten life imme-
diately :  the  one,  death  from ^immediate
bleeding, if any of the large vessels of the
neck have been divided ; or, if this has not
been the case, death from blood finding its
way into the  windpipe.   In  the first,  few
unprofessional persons  could  possess on
the instant either  sufficient  knowledge or
presence of mind to  render much  efficient
assistance—certainly not in the case of the
large arteries ; but bleeding from  a small
brauch  might be  arrested by the means
suggested in  article Artery.  Should a su-
perficial vein be wounded, and  pouring out
dark blood, gentle pressure  in its course,
between  the wound and the head, might be
of service.   To prevent the danger of suffo-
cation, when  the windpipe is  opened,  and
when the  bleeding does  not  immediately
threaten life,  the position  of the person is
the principal  thing to be  attended to;  this
should be either on  the side or on the face, in
whichever situation fluids  may most easily
run  off without  entering  the  tube.   This
being done, and some  light gauze  material
thrown  loosely over  the  wound,  nothing
more should be attempted before the arrival
of that  medical assistance which must as
speedily as possible be procured.  Above all
tilings, no  attempt  should be made to close
the wound.
  Refer to  Artery—Hemorrhage—Wounds.
  CUTANEOUS.—Belonging to the skin.
  CUTICLE.—The  epidermis or scarf skin.
—See Skin.
  CYNANCHE.—A term  applied  to affec-
tions  abont the throat, which tend to pro-
duce suffocation.
  CYST.—A membraneous-like bag, within
the body, containing morbid matter.   The
matter  varies  much  in  consistence   and
appearance.   Cysts  frequently form just
beneath  the  skin,  and some  persons  are
peculiarly liable to them.  In  aged people
cysts often form,  and are conspicuous upon
the head.   Cysts  in  superficial situations
are generally quickly and easily removable
by the surgeon.   The  upper eyelid  is often
the site of a small cyst.
  DALBY'S CARMINATIVE—Is  a quack
compound of carbonate of magnesia with va-
rious essential oils.  It also contains opium,
and this fact alone ought  to be sufficient to
exclude it  from use.   Magnesia, carmina-
tive distilled waters,  and  opium likewise,
are all  unquestionably, when properly  em-
ployed, useful  even for infants; but in the
majority of cases, the latter  drug is quite
uncalled for, and when it  is  necessary, its
administration requires the utmost care and
circumspection of the medical man.  It can-
not, therefore, be  a matter of indifference
whether a medicine sold and kept for gene-
ral use contains  so powerful an ingredient
as opium, or whether,  when a  simple  mix-
ture of magnesia, or chalk and dill watei
will  answer  every purpose, a medicine—
that is, opium—is given, which cannot fail
to act injuriously, unless  positively  indi-
cated by the  peculiar circumstances of the
case.   A dose pf "Dalby" will undoubtedly
" still" a child, perhaps more quickly than
a simpler or more cautiously combined pre-
paration ; but its  very power of action  in
this respect indicates its power likewise  of
inflicting evil consequences.  If a carmina-
tive simply is required, a simple carminative
should be given in some such mode as that
recommended in  the   article  Children.  If
opium is called for, let it be given—under
medical sanction—as opium, in known and
graduated doses; but it is criminal folly to
use it in the indefinite hap-hazard way in
which such productions as the one in ques-
tion  are used.   " According to Dr. Paris,
there  are  five- drops  of  the  tincture  of
opium to two ounces of this mixture; but
in another formula it is  stated  that this
tincture  forms  one eighteenth  part  of the
liquid.  Like most of these quack prepara-
tions, it  probably varies in  strength.   An
infant is reported to  have  been destroyed
by forty drops of this preparation—a quan-
tity equivalent to little  more than two drops
of the tincture  of opium."—Taylor's Juris-
prudence.
  The possibility of any preparation intended
for children  containing a variable propor-
tion of opium, ought to be sufficient to deter
those  who have the care of the  young from
hazarding either the lives  of the latter,  or
their own peace of mind, by its administra-
tion.  Moreover, it is impossible, habitually,
to give opium, even in  small doses, to  chil-
dren without injury,  even  if fatal  conse-
quences do not result.
  Refer to  Opium—Quack Medicines, $c.
  DARNEL GRASS—Is a  species of  rye-
grass, the seed of which has a beard or awn,
like barley, and which, unlike the  grasses
generally, is poisonous.  It is more common
on the continent than in England, and the
seeds are occasionally so abundantly mingled
with those of barley, or other  grain, as  to
cause symptoms of poisoning in those con-
suming articles of  food made from the meal
—a point of some consequence, now that  so
much continental  grain  and meal is  con-
sumed in this country.  When chewed, mea!
containing  darnel  grass  caus«s a burning 
D  A 31
166
D A N
sensation in the throat, and giddiness, head-
ache, and lethargy follow.   An emetic would
probably be the  best remedy.
   DAMP.—Moisture  is  one of  the most
prolific and  most generally acknowledged
sources of disease ; in whatever way applied
to the body, whether in the atmosphere, or
clothing, or bed, it is alike apt to  be pro-
ductive of bad consequences, often  of  the
most serious  character.   When  combined
with  decaying vegetable matter,  and more
especially when favoured by heat, fever  and
ague are  the results of  undue  moisture;
when cold  and damp unite their depressing
influences, colds of  every kind,  inflamma-
tory  attacks, scrofula and consumption,
rheumatism and neuralgia ensue.
   Dampness, or injurious excess of mois-
ture, may depend  upon the natural forma-
tion of the  country, or character of the soil,
or upon a superabundant  growth of timber,
which obstructs the drying effect of the
sun's rays and of a free circulation of  air.
The effects of these conditions are evidenced
by the agues of the marsh districts, the cre-
tinism of the  low,  dark,  damp valleys of
the Alps, the fevers of the  tropical  forests
and African  rivers,  or  in a lesser  degree
by the relaxing  effect of a damp and some-
what mild  climate, like that of Devonshire.
The advance of  the  improvements of civil-
ization does much, if it  cannot  do all, to
rectify these  sources of disease.  The cut-
ting of watercourses, the clearing of timber,
are for the  most  part attended with increas-
ed salubrity of the district.   The latter, of
course, requires  circumspection;  for much
harm may  be and has been done by  the in-
judicious removal  of protecting belts  of
trees; neither must it be forgot, as mention-
ed in article Ague, that the intervention of
a  wood may prevent the extension  of  the
malaria of a marsh.  But the shelter of trees
is  a different thing from closely encircling a
house with them; they will retain moisture
around, more or less according to the  nature
of the soil and the denseness of their growth,
and in a way which is not compatible with
health.
  Dampness and moisture in excess  cannot
of course be prevented, when owing to  the
vicinity of large bodies of water; but in such
a case the chief evils to be dreaded are  the
cold winds which  " come  off the  water"
laden with vapour, and which, as happens
in many situations,  are  liable to produce
croup in  children and catarrhal  affections
in  the  predisposed.   If these influences
cannot be  guarded against,  of course  re-
moval is the only remedy.
  Damp  houses  must be  unwholesome; if
occupied too soon after building;  disease,
especially of a rheumatic character, is the
frequent consequence.   .Most  generally, in-
sufficient drainage, particularly in the coun-
try,  is  the  cause  of dampness,  and  it is,
moreover, after a house has been built, one
difficult to rectify, but it should be done as
far as possible; even  houses which appa-
rently stand high are damp from this cause,
especially if the ground slopes to, as well
as from them.  If no other remedy is avail-
able,  nothing is so effectual  as covering the
damp floor  with  sheet  lead, which  effec-
tually excludes the  moisture, if it does not
do away with  the cause.
  Damp clothes and beds are so generally
recognised as causes of disease,  that  the
fact  scarcely requires to be insisted on or
indeed  the  additional  one,  that  when  the
former are unavoidable, the danger is much
if not wholly done away with  by continued
active motion, which keeps  up the animal
temperature;  and it is probable that  this
preventive  not being available in the case
of the latter,  renders  a damp bed almost
synonymous with disease and death.
  Damp in  most instances  acts, undoubt-
edly,  by abstracting, either  by evaporation
or otherwise, the natural temperature of the
body; but  as  dry cold does this  likewise
without producing the same certain injuri-
ous consequences, it  is probable that mois-
ture  also calls into action changes connect-
ed with the  electrical  conditions  of   the
body, of the precise nature  of which  we
are not  at present cognizant.   One  thing is
certain, that moisture  is always  more  apt
to act injuriously upon the system when the
nervous power is  either depressed or  not
in its full state of activity,  as it is during
sleep, or for the first hour or more in  the
morning, after rising,  and before food of
some  kind has  been  taken;  hence  it is
always  found  that fogs  and  moisture  are
much more likely to  injure during the first
morning period, and that the best protec-
tion is some warm food or drink, [not alco-
holic,] which may  support or gently stimu-
late the system.
  Refer to Ague—Neuralgia—Rheumatism—
Scrofula.
  DAMSON—The  well-known  fruit,  is
wholesome   when  ripe;  but  for invalids
should be cooked.  It is slightly aperient.
  DANDELION,  or  Leontodon  Taraxa-
cum.—The plant,  native to this country, is
too universally known to require descrip-
tion.   Its leaves, when  blanched, are used
as a salad in  some  parts of the  continent,
and the root is sometimes roasted and mixed
with coffee.  As a medical agent, taraxacum 
DAN
167
DE A
 is  too  much  neglected.  It is found  by
 every hedge side, and is one of the most cer-
 tain and active diuretics we possess, whether
 native or foreign.   Perhaps no better proof
 of its utility can be cited than that the author
 always finds patients who have once taken
 the medicine, recurring to it again and again
 of their own accord.  No doubt something
 is due—and it is a consideration  of  some
 weight  to  the fact—that  it  is  procura-
 ble without expense.   It rarely fails to  in-
 crease  very considerably the flow of urine.
 Various preparations, extracts,  &c.  of dan-
 delion are recommended and are employed,
 and are undoubtedly efficient, but the  fresh
 infusion of the recent root is the best  mode
 of administration.   For this, roots of not
 less  than  the thickness of the little finger
 should, if possible, be used, and after being
 washed from the soil, sliced  transversely in
 pieces a quarter of an inch thick.   Of these,
 a good double  handful,  or from  two ounces
 and a half to three ounces, are to be put into
 a jug, a pint of boiling* water poured  upon
 them, and the  whole allowed to  "draw" for
 an hour or two beside the fire, but not boiled.
 The  infusion  will  have a greenish-brown
 colour, and two or three cupfuls should be
 taken  during  the day, until  the  desired
 effect is produced.  The taste is  not  very
 unpleasant, is  slightly bitter, and  to  some
 mawkish, but may be improved by  the ad-
 dition of a little orange-peel.  In addition to
 its action  in increasing the  flow of urine,
 dandelion  improves the tone of the diges-
 tive  organs, and  most  certainly  exerts  a
 stimulant action upon the liver.  Indeed, it
 is in disorder of the digestive organs  accom-
 panied  with deficient action of the kidneys,
 the urine being scanty,  high coloured, and
 depositing a pink  sediment, that dandelion
 exhibits its most beneficial influence.  It may
 be advantageously combined with  broom,
 as a diuretic, and of course with other medi-
 cines, such  as the tincture of columbo,  with
 potassa, &c.
   Refer to Broom—Liver—Kidneys.
   DANCING—Properly  so-called, is the ac-
 tive  exertion  of  the  body  in sprightly,
 graceful movement,  accompanied with ex-
 hilaration of mind, and, when thus  indulged
 in by the young,  is a most  beneficial and
 healthful  recreation.    It  is no argument
 against dancing in itself, that it is  too often
 connected with  many things that are injuri-
 ous, such as heated rooms, late  hours, and
 the like—these belong to other  considera-
 tions ; but as an exercise, congenial both  to
the minds and the physical requirements  of
the young, it is,  as every exercise of the body
in which the mind enters with pleasure and
 interest, a most efficient promoter of health,
 and it is much to be regretted that its abuse
 and associations, in some  instances, both
 with physical and moral evil, should cause
 its abandonment in any place where there
 are young people.
   DANDRIFF—Is  the formation and sepa-
 ration of numerous thin white  scales, or
 scurf, from the skin, and is most usual upon
 the scalp; but in persons of delicate skin,
 occurs also upon  the face.   In infancy it is
 very common upon the head, and among the
 poor there  is  a  prejudice  against  its re-
 moval,  "for fear of cold," so  that  it is
 allowed to accumulate  along with the dirt,
 and presents  a  most  filthy  appearance.
 Generally, the skin underneath,  the seat
 of dandriff, is not much changed, but some-
 times  it  becomes  reddened  and  slightly
 irritable.
   In adults,  the disease, if  it can be called
 so, is  troublesome,  from the  quantity of
 scales, or scurf, which mingle with the hair
 and shake from it upon the  clothes.
   In any case, care should be taken to avoid
 irritating the skin; the hair-brushes should
 be soft, and  the  small-tooth comb—at all
 times a  doubtful substitute for thorough
 washing—must never be used.
   In the case of infants, washing regularly
 with soap and water, and the  use of some
 simple pomatum, or of an  ointment com-
 posed of ten grains of  red oxyde of mer-
 cury to the ounce of lard, will remove the
 inconvenience ; and either in their case, or
 in that of adults, an alkaline wash will be
 found  useful.  Mr. Erasmus  Wilson  re-
 commends two drachms of solution of caus-
 tic potash to eight ounces of soft or rose-
 water.  [A drachm of borax in four  ounces
 of water,  with a few drops of oil of  berga-
 mot, is also a cleansing wash for the head
 afflicted with dandriff.]
   DANGER.—See Death.
   DATE.—The fruit of the  date-palm con-
 stitutes a considerable portion of the food
 of the people of Egypt and  Northern Afri-
 ca, Arabia, and Persia.  The nutritive ma-
 terial is  chiefly sugar.   As imported  into
 this country, dates are not a  digestible arti-
 cle of diet.
  DATURA   STRAMONIUM.—See Thorn
 Apple.
  DEADLY  NIGHTSHADE.—See  Bella-
 donna.
  DEAFNESS—Or  deficiency in the sense
of hearing, may be either partial  or com-
plete, and it may be  accompanied with
dumbness.  The  causes  of  deafness may
be temporary or permanent, and  the affec-
tion may  be  due  to disorder of the brain 
DE A
168
D i: A
 and  nervous system,  to  disease  and dis-
 organization  of the essential portions of
 the organ of the heoring itself, or to causes
 which  interfere with  the  transmission of
 sound.
   The temporary causes of deafness may be
 such as have their origin in temporary dis-
 order of the brain, resulting from  external
 violence,  or from disorder either  local or
 general, more particularly some  forms of
 fever, of  which deafness is a frequent con-
 comitant.   Some drugs,  quinine  particu-
 larly, given in too large doses, also give rise
 to the affection.
   Temporary deafness is  frequently occa-
 sioned  by common  cold,  which  seems to
 cause tumefaction of the membranes lining
 the passage  of  the  external ear; or when
 the  throat is  affected, obstruction of the
 Eustachian tube, which extends between the
 internal ear and the throat, either by swell-
 ing or  accumulated mucus.  These  causes
 often continue in action,  and keep up the
 deafness, long after the cold has disappeared.
 [Infants whose heads are left without caps
 in cold  weather are very liable  to  suffer
 in this  manner; and many cases of  "run-
 ning from the ears" are also due to the same
 cause.]
  Permanent deafness may result from dis-
 ease of  the brain, such as paralysis, or from
 violence, such as severe blows or falls upon
 the head.  The author has one patient,  a
 gentleman afflicted  with permanent partial
 deafness,  the result of a dangerous  fall
 when hunting,  the  effect  upon  the brain
 being evidenced by the fact that his  pulse,
 which formerly  ranged at 7'2, has  never
 since  exceeded, in health,  which is perfect,
 40 in  the minute.  Disease of the ear itself,
 or its  effects, can scarcely fail to cause deaf-
 ness.  The internal portions of the ear are
 liable to a variety of disorders or  diseases
 which it would  be useless  and out of place
 to notice in this  work.   Many of these take
 their  origin during attacks of  acute disease
—particularly measles or scarlet fever—in
 scrofulous  individuals.   Discharges  occur
from  the ears,  and  the minute  bones con-
tained in the cavity are sometimes discharged.
 To allow of this,  of course, the membrane of
the tympanum   or drum of the  ear must
be wholly  or partially destroyed.   This im-
portant  membrane  of the ear  being dis-
eased, is often the occasion of deafness.  As
mentioned  above, the  obstructions, either
in the outer ear passage, or in the Eus-
 tachian  tube, first  arising from  common
cold,  may become permanent; in  the case
of the latter,  when  the swelling subsides,
 thick  mucus may block it up;  in that of the
 former,  hardened wax, or cerumen.   This
 last mentioned cause of deafness is very fre-
 quent,  is  easily discoverable, and  no  less
 easily removed, affording most striking relief
 to an almost total defect of hearing.   It is
 perhaps  the only affection of  the  organ
 causing deafness  which is  likely to be well
 or safely treated domestically.—See article
 Cerumen.
   The subject of deafness, and of diseases of
 the ear generally, has been greatly neglected
 by medical men, and consequently has  fallen
 into the bunds of quack aurists.   Within the
 last few years, however, it has been  taken
 up  by more than  one distinguished member
 of the profession, and promises fair to take
 the  place its importance demands, and to
 have its causes and  treatment investigated
 and established  on  a  true, scientific, and
 rational basis.
  A person  affected  with  temporary  deaf-
 ness, if it is  traceable  to an  assignable
 cause, such  as cold, should wait  the  effect
 of time for  its  alleviation.   A blister  ap-
 plied behind the affected ear, or, better still,
 an eruption brought  out just below the ear,
 by  tartar emetic or croton-oil,  may  pro-
 bably give some relief.  If wax be suspected
 or ascertained to have accumulated, it should
 be removed,  as directed under article  Ceru-
 men, but never by  ear-picks or  such like
 dangerous weapons.   AVhen no  assignable
 cause for the deafness, whether permanent
 or temporary, can be discovered, a medical
 man should  be  consulted—if he has given
 special educated attention to aural surgery,
 so much the  better—but unqualified quacks
 with nostrums and never-failing cures  must
 be shunned.  No one, surely, can be so cre-
 dulous as to believe that any application, or
 variety  of applications, put into the outer
 ear—and strong  stimulants  are often  used
 in this way—can be remedial for a symptom
 owing to causes so varied.   Some varieties
 of deafness are alleviated  by appliances to
 the external  ear-passage, and some remark-
 able cases have been  published of great im-
 provement in hearing resulting  from small
 pellets of cotton  wool, or other substances,
 moistened and introduced so far into the ear
 as to be in contact with the tympanum mem-
 brane, which bad been perforated by disease.
 For moistening these, and indeed for moist-
 ening the passage  of the external ear, when
too dry,—an  occasional  cause of deafness,—
or for moistening hardened wax previous to
syringing, the fluid named glycerine is better
adapted  than the oil generally in use.   Ara-
rious other modes  of treating deafness, with
reference to  its  various causes, have  been
and  are employed.   Its dependence  upon 
                  DE A

 obstruction of the Eustachian tubes has ori-
 ginated the practice of passing an instru-
 ment, or Eustachian catheter,  up these pas-
 sages, for the  purpose of clearing them.
 The operation is  one which requires both
 practice and tact  for its  safe and efficient
 performance.   Some years ago the same
 thing was attempted by forcing air into these
 tubes by  an  instrument made for the pur-
 pose ;  but a fatal  accident seems to have
 interfered with the continuance of the prac-
 tice.  Lately, the pressure exerted upon the
 membranes of ears by the diving-bell  has
 been brought forward as a cure for deafness.
 These and other practices  and propositions
 may be good,  or the reverse; but one thing
 is certain, either  these or any other reme-
 dies,  except  the  one or two simple ones
 mentioned above,  should  never be  resorted
 to  without proper  medical sanction  and
 management.   When deafness is confirmed,
 and cure  cannot be obtained, relief must be
 sought  in the various artificial methods—
 ear-cornets, and the like—for collecting and
 conveying to  the  ear as large  a  body of
 sound as  possible.   The  remarkable power
 of gutta-percha in the conveyance  of sound
 has afforded many facilities for adding com-
 fort to the deaf, and improving their means
 of hearing; and many instruments for the
 purpose  are  manufactured by  the Gutta-
 percha Company.   It seems probable, how-
 ever,  from the  investigations of Dr. Allen
 Thomson, that while attention  is  given to
 concentrate and convey sound in  cases of
 deafness through the usual ear-passages, its
 communication  through  the bones or hard
 parts of the head is too much overlooked.  Dr.
 Thomson's investigations were founded upon
 the fact, "that sounds transmitted by contact
 of the sounding body directly to the head or
 other hard parts, appear louder when the
 external meatus—or ear-passage—is closed."
 The same authority further remarks, "I am
 inclined  to think  that much more  might
 be done than  has  yet been attempted, in a
 certain  proportion of such cases, by assist-
 ing the  hearing through the hard  parts of
 the head, or  by other means.  Indeed,  it
 seems surprising,  considering how long  it
 has been  known that in some deaf persons
 the hearing of sounds is  improved by pro-
moting their transmission through the bones
of the head,  that  an apparatus calculated
to facilitate this mode of communication of
the sonorous vibrations has not been  em-
ployed instead  of  the  ear-trumpet,  which
can be  of comparatively  little  service to
them."  Further,  "In  those  hearing best
through the hard parts of  the head, it  has
long been known that the air passages, or
      P
59               DE A

 accessary  parts  of  the  organ,  principally
 are  affected.  In  those  partially deaf per-
 sons, on the other hand, who hear best  by
 the  meatus,  it appears  very probable that
 in general  an affection of the internal ear,
 or loss of sensibility of the auditory nerve,
 is the cause  of  deafness.   In these last
 the  ear-trumpet  is of essential  service,  by
 concentrating all  the weaker vibrations in
 the  passage which is to carry them to the
 nerve, whose sensations are deadened.   In
 the  former the meatus should be closed, and
 every means ought to be used, as by sound-
 ing-boards, to collect, and solid elastic rods
 to conduct the vibrations to the hard parts
 of the head."
   With respect to the  deaf and dumb,  or
 "deaf-mutes,"  as  they are now  called,
 whatever  the  cause, whether  congenital
 deficiency, or complete deafness  brought on
 by disease or accident before the power of
 speech had been  thoroughly  acquired, the
 education  should be conducted  in  an es-
 tablishment  for  the  purpose.  It  cannot
 be  done at home, but  much  may be done
 by the philanthropic  and  earnest  endea-
 vours  which  have devised, and  are now
 daily devising,  new  methods for imparting
 to these  unfortunate  individuals'the  bless-
 ings of knowledge.  It  has  probably been
 an error in the education of the deaf-mutes
 hitherto, that they  have been brought  up
 in  establishments by  themselves—a plan,
 it would  s<!em,  less  likely to fit them for
 mingling usefully with the world in general
 in  after-life, than commingling them with
 children who have  the power  of speech.
 In  Donaldson's  hospital  for the education
 of  poor children, recently opened  in  the
 neighbourhood of Edinburgh, an endeavour
 is now being made to correct this error, and
 a considerable number  of deaf and  dumb
 children are  being brought  up with  the
 others, being of course taught in a different
 manner.  It seems unquestionable that this
 commingling must have a beneficial influ-
 ence, not only on the  unfortunates  them-
 selves, but also  upon the others, teaching
 them to  regard  their deaf-mute playmates
 with familiar kindness,  instead  of the dis-
 tant dislike or ridicule, which are too apt to
 be attached to, or openly displayed toward,
 the persons and manners of those who pre-
 sent any unusual defects, either of mind or
 body, by children more happily constituted.
   Dr.  Allen  Thomson  further  remarks—
 " Dumbness  is known  usually  to  proceed
 from deafness, either existing from  birth,
 or arising  early in life.   The exceptions to
 this  are very rare, and occur only from de-
 fective formations of the organs of voice and
II 
D  K A                170                D  K A
 speech, ->r from disease of the brain.  In
 the  case  of dumbness arising  from  total
 congenital deafness, sounds  can never  be
-associated  with  ideas,  and  consequently
 feelings, emotions, actions, and the names
 of objects or description of their qualities
 and  states, must find a language in natural
 gesture, or  in  conventional  written  and
 manual  signs.  In the  second  case,  that,
 viz., of total deafness coming  on  later in
 life, even if speech shall already have been
 acquired, it  may be gradually lost, in con-
 sequence of the want  of habit  to associate
 sounds with speech.  This  occurs, however,
 only in early life,  when the habit of speech
 has not been fully impressed on the memory.
 I am informed by Mr. Kinniburgh* that  it
 rarely happens  that  dumbness  is  entailed
 by deafness  so late as the  tenth or eleventh
 year, and that the extent to which this may
 occur  will depend very much  on  the cir-
 cumstances in which the individual is placed.
 In  those who become  only partially  deaf,
 but  to such an extent as  to incur the risk of
 becoming also mutes, it seems probable that
 much  of the power of retaining voice and
 speech, or of regaining it,  may depend on a
 very small difference in the amount of hear-
 ing ; and I am inclined to  think that much
 more might be done than has yet been at-
 tempted,  in a certain proportion  of  such
 cases, by assisting the hearing through the
 hard parts of the head, or by other means."
   Refer to Ear—Glycerine,  §c.
   DEATH.—The departure of the animat-
 ing  spirit  from  the material   body, the
 separation  of the  living  soul from  the
 frame so "fearfully and wonderfully made,"
 which is no  longer fitted  to be its habita-
 tion or medium of communication with earth
 and earthly things, is a subject which few
 can  approach without awe and fear—none
 without interest,  though  it  may  be  of a
 solemn kind, as the one event  from  which
 no child of Adam is exempt.  The possibi-
 lity  or the probability  of illness having a
 fatal termination,  devolves a great respon-
 sibility, and much anxiety  upon  the mind of
 a medical  man, as regards the patient more
 particularly.  There is  the preparation of
 the  mind  for the  great change to be con-
 sidered ;  the settlement of worldly affairs
 on which may depend the  future welfare of
 others  to  be thought of;  but there is also
 the  effect of the announcement, nay, of the
 slightest  hint of  danger,  upon some  indi-
 viduals, to be duly pondered, lest the mental
 shock may put the finishing stroke to what
 * The late superintendent of the Deaf and Dumb
A.evlum in Edinburgh.
disease  has begun, and extinguish the last
faint chance of recovery.   None  but those
who have had  to bear it know the weight of
anxious  thought  that  such  considerations
press  upon a  conscientious mind.  It is a
position  for which  no stated rule can be
framed,  and in which the judgment must
be guided  by  the many  contingencies and
considerations which surround every case of
the kind.   It  may be requisite on the first
symptoms of danger occurring in some dis-
eases, particularly in those likely to  affect
the powers of the mind,  to  make the an-
nouncement early; in others it may be de-
layed for some time  after the physician has
decided  in  his own mind  that the case cau
have none but a fatal issue, till, indeed, the
idea, without  being  actually imparted, has
gradually  dawned  upon,  or  been  gently
awakened  in the mind of the patient, and
has by degrees ripened into conviction.
  The question of encouraging hope of re-
covery depends upon considerations similar
to those which influence  the announcement
of necessary death.  Many of these rest upon
religious grounds, which it would be out of
place to touch upon  here;  but in a medical
point of  view, the tonic   influence of this
powerful emotion of  the  human heart must
never be forgotten.   With  some, the  hopes
of a blissful  future  may  be so strong that
they overpower all  wishes  connected with
this world : but these are, it must be said,
exceptional cases ; the love of life is strong,
the majority hope to get well.  This hope is
as it were an anchor and cable, linking them
with the life and activity of earth : destroy
it, and they sink at once ; the emotion is a
sustaining  tonic which no remedy can sup-
ply.  It  is for this reason that the office  of
announcing the possibility or probability  of
death should not be devolved upon the medi-
cal attendant,  except  in   certain  cases.
Coming  from  him,  it takes too  much the
form of a  final sentence.  There  are, it is
true, various ways of breaking the subject;
but softened down us it may be, it comes,
with a  depressing force  which  it has not
when friends or ministers breathe the pos-
sibility  of such  an occurrence.   To  the
poor,  and  even to  those who might know
better,  an important  caution is  required.
Too frequently it  happens  that while  a
medical  man  is examining his  patient,  or
still within hearing, questions  relative to
the patient's state are put,  whether  " there
is any  danger ?"  whether  the person  will
"get better?"  and other  interrogatories,
which he can  scarcely either answer or  re-
fuse to  reply to, without  conveying to the
patient   information  he   may not  wish to 
DE A
171
DE A
 communicate.   Every medical  man  must
 have felt  himself  at times  thus  unfairly
 embarrassed.
   The symptoms of approaching death must
 of  course  be liable to great variation, de-
 pending upon the cause of the  fatal event,
 and the peculiar constitution and tempera-
 ment of the patient.
   Sudden  death is usually considered to be
 that which  occurs without immediate  pre-
 vious warning;  for there are few cases in
 which  some indications  have not  been de-
 veloped of-the disorder of the organ, or
 structure,  which  at last gives way and snaps
 the thread,  unless, of course, life has been
 quickly destroyed by some external acci-
 dental  agency.
   Dr.  Alison says, " All causes of sudden
 or  violent  death  operate either  by directly
 depressing or suspending the vital actions
 of the organs of circulation, or by obstruct-
 ing the arterialization  of  the  blood, and
 thence  arresting  the circulation  at  the
 lungs." The action of the organs of circu-
 lation,  that is, of the heart  and blood-ves-
 sels, may be fatally depressed by a sudden
 shock   communicated to the  brain  and
 nervous system,  and death quickly pro-
 duced,  as  in  the case of severe blows,  ex-
 tensive burns, and  the like :  or  the depres-
 sion may  be caused by  abstraction  of  the
 blood itself by hemorrhage.   In  such cases,
 death is the result  of faintness.  The  arte-
 rialization of the blood  may be fatally in-
 terfered with, and speedy death ensue, from
 injuries to the nervous system, which inter-
 fere with the process of respiration,  or by
 causes  which impede directly the access of
 air to the  lungs,  causing  asphyxia  or suffo-
 cation, death being the  result of the influ-
 ence of the unchanged,  or it might  be
 called   poisonous, blood  upon  the brain.
 Nearly all  cases of death  are, indeed, refer-
 able to the above direct  causes ; but many
 cases of sudden death are  most obviously so.
 Neither is  death always  owing to one or
 other of these causes distinctly acting by
 itself, for they may be variously commingled.
 The premonitions  of approaching  dissolu-
 tion are often strongly marked.   Independ-
 ent of these authenticated cases, in  which
 the  mind  has  been  powerfully impressed
 with the conviction  of impending death, in-
 dependent  of, or not directly connected with
 physical causes, there are others which come
under the notice of the physician; such are
strange and  sudden impulses of the  mind,
longing  after  familiar  friends  or scenes
suddenly acquiring unusual force, to be  in-
dulged  in  before the  eyes are sealed to the
things  of this world.   As the closing scene
draws near, most appear  conscious of the
coming change;  but some hope on to the
last,  and cherish the idea of a return to
earthly joys and  sorrows  and business, till
the latest breath  is drawn.
  When death is slow in its approaches, the
physical  signs, though varying, preserve a
measure  of  uniformity, which in most cases
too plainly points out the coming event.
They are  thus well described in a  recently
published work.*   " AA'hen the evidences of
dissolution, however, begin to manifest them-
selves, a general  failure of the temperature,
with a cold dew on the skin, may generally
be considered as indicative that the scene is
about to  close.   In many cases it is easy to
recognise the fatal turn which diseases take
by the alteration which the symptoms  un-
dergo.  Where internal inflammations  are
about to  issue in death, there is mostly a
striking  change  in  the expression of  the
face,  and  sometimes a curious shrinking of
the body."
  " The  nose and lips are very character-
istic in the dying.   The lips  become pale,
the nostrils dilated and dark-looking, and
the hairs about  the  lips  seem  more  than
usually apparent; the teeth look like pieces
of ordinary bone,  and the  eyes  seem  to
shadow through the eyelids, or are partially
turned under the  lids; the nails look dark,
and the ends of the fingers sodden.  Finally,
convulsive twitchings often show themselves
in the face, with  singular elevations of the
eyebrows, and staring of the eyes.  A  gap-
ingattempt to breathe terminates the strug-
gle.  When coma is present, a mucous rattle
is of fatal import; and e contrario, when the
lungs are  affected, the supervention  of coma
is equally to be dreaded.
  "When fluids  taken by the patient flow
back from his mouth, or fall  heavily down
his  throat,  as if poured into an ordinary
tube,  death is soon to be expected.
  " In young children a curious playing with
the bed-clothes often attends fatal affections
of the brain.   I  remember a little child,
who  had  her handkerchief  in her hand,
which she spread out repeatedly with appa-
rent  care, and in a fantastic  manner  that
would have been  amusing, but for.  its fatal
import.    The picking of  bed-clothes, and
catching  of the  hands as if at imaginary
objects, are  well  known as terrible indica-
tions.
  " Chomel remarks, as of  serious presage,
the  automatic manner in which a  patient
will unceasingly draw his  hand  to his side,
  * "Medical Aspects of Dealb," by J. Bower Har-
rison. 
D E A
172
DE A
In spite of the efforts of the physician to
ascertain his pulse.
   " The signs of death are not.  however,
always very marked ; for when death arises
in advanced and feeble age, the vital powers
are so  easily depressed, and the  heart's
action brought to a stand in so  impercep-
tible a manner, that it  is common to speak
of it as a quiet sleep."
   These signs of approaching dissolution are
terrible and  distressing to witness in those
we have loved:  and  though, undoubtedly,
existence is sometimes  terminated in a pa-
roxysmal agony of pain, there is reason to
believe  that  in slowly  approaching death,
such as has been described,  the sensations
are much  blunted  in  consequence  of the
insufficient  change of the blood.
  The symptoms which  indicate  that death
has actually taken place are, in the majority
of instances, perhaps too unequivocal to be
mistaken;  but sometimes it  is not so, and
there is a difficulty  in determining whether
life actually has departed, even hours  after
any appreciable sign of conscious existence
has been given.  The signs of death may be
divided into those which precede putrefao-
tion, and the occurrence of that unequivocal
evidence itself.   Some, indeed, have  con-
tended that it alone should  be received as
evidence of death ;  but  there are obviously
many circumstances under which it is im-
possible  to await its  occurrence, nor  is it
necessary to do so.
  The  absence of apparent respiration is a
generally received  symptom  of death, and
a looking-glass, or  light feather or down,
placed before the  lips, are  used as  tests.
Mr. Harrison, whose work has been already
quoted, says both  are  fallacious,  and in-
stances the  circumstance  represented by
Shakspeare, of Prince  Henry having  been
deceived when he carried off the crown  from
his father's pillow.
              " By his gates of breath
   There lies a downy feather which stirs not:
   Did he suspire, that light and weightless down
   Perchance must move."
  The  light down  may be  stirred by any
passing current, or the mirror may be dim-
med by some exhalation from the body, and
either prove deceptive.
  Mr. Harrison  further observes,  " If the
observance of the respiration be taken as
the indication of life, and  its absence as a
proof of death, the exposure of the naked
chest and abdomen would enable the spec-
tator to form a much more accurate appre-
ciation of it, especially if it be made care-
fully and for a sufficient length of time."
  Stiffening or rigidity is another generally
received sign of death, but it mny not occur
at all, or very transiently.   A false rigidity
may be present immediately after dissolu-
tion,  in  consequence of death from  soma
nervous affection.   It was formerly thought
that  persons  killed by lightning did not
become rigid,  but the examination  of re-
cent cases  has proved  this to be erroneous.
"The rigidity of death appears to come on
with  various  degrees  of rapidity, and its
duration is also various.   It usually com-
mences in  about seven hours,  but it may
be deferred considerably longer," even  from
twenty to tnirty hours.  AVhen  the body is
greatly weakened by disease,  the rigidity
comes on much sooner,  but is  much ntoro
evanescent.  It has been known to arise in
fifteen or  twenty  minutes.   Its  duration
varies from twenty-four to thirty-six hours,
but may  continue many days.   In some
nervous diseases  affecting  the  living body,
rigidity occurs, but scarcely in a way to
deceive.   When  the limbs have become
rigid, and the rigidity has  been succeeded
by flexibility,  the  fact  of death having oc-
curred can never  be doubted."   Professor
Louis, from observations made  upon more
than  five  hundred  subjects  after  death,
found  that the  articulations began to be-
come  stiff  even before  the  loss  of  animal
heat.   Fodere\ another  authority, has veri-
fied the justness of this observation several
times in  hospitals, and concludes that the
flexibility of the limbs is one of  the prin-
cipal  signs by which we  may judge  that a
person is  not dead, although  there  is no
other sign of life.
   The cooling  of the  body  after  death
depends much  upon contingencies ; the co-
vering, the surrounding temperature, the
presence  of much  fat, &c. all exert a modi-
fying effect.   In cases where  much blood
has been  lost the body is observed to become
cold rapidly.
  The occurrence of discolorations  on va-
rious   parts of the body,  particularly the
most  dependent portions, are frequent se-^
quents to  death,  and  the darkening  of
that portion of the white of the eye which
is  exposed to light, has also been pointed
out as a symptom to be  depended  upon,
and along  with it, dilatation of the  pupil.
The above symptoms, singly, might not per-
haps  convince  of the occurrence of  death;
but more or  less combined, they cannot be
doubted.  Putrefaction commencing of course
does away with all doubt.
  It may seem to  some that it  is unneces-
sary to dwell  so minutely upon the  evi-
dences of the last great change; but it is
a subject  on  which many  entertain great 
                  DE A

anxiet j , and from the fact that a considerable
number of ascertained cases have occurred,
in which  mistakes have  been  made with
respect to death, it is desirable  that accu-
rate information upon the subject should
be generally diffused.  It ought to be re-
membered that the  corpse  of a person who
has died of a contagious  disorder,  particu-
larly the  eruptive fevers,  may  propagate
the  disease.   The influence of season  in
causing death is well  marked.  "According
to Quetelet's tables of mortality in Belgium,
the greatest  number  of deaths among indi-
viduals above twenty-five  takes place  in
February, and the smallest number in July.
Other researches, as regards Berlin, show
that the greatest number of children die in
summer and the fewest in winter, while with
adults the case is exactly  reversed.   It  has
also been observed that more deaths on the
average occur  between six  a. m. and noon,
than  at  any corresponding period in  the
twenty-four hours.
  Lastly,  one word as to the treatment of
the dying.  Let quiet, attention to every sign,
the moistening of the  lips, the gently shifted
position, be the attentions ; but who can tell
how painful the  disturbance of  the forced
Btimulant or medicine, the  noisy lamenta-
tion, or the pulling about or pulling away
of pillows which nurses are apt to practise,
may be to the last moments ?
  In  persons found dead,  or apparently so,
the first  thing is of course  to ascertain the
real  state of the case.  If death is doubtful,
judging hy the signs stated in  the early
part  of this  article,  the  first object must
be to ascertain, if possible, the cause of the
condition  which so nearly approaches to it:
this  must be the first step, but it  must be
taken with all possible speed, in order that
proper measures for resuscitation  may be
adopted.  The causes may either be natural
or violent.  Of the former, apoplexy, sudden
fainting, or suffocation from internal affec-
tions, may be in operation; of  the latter,
suffocation from  unnatural  causes, poison,
wounds, burns, cold,  starvation, lightning,
include the most probable influences.  Some
of these, such as burns, wounds, the action
of lightning, cold,  and many of the usual
modes of  suffocation,  such  as hanging,
drowning,  &c. are  too evident, either  in
themselves  or from  concomitant  circum-
stances, to be overlooked; but others, par-
ticularly those  cases of  apparent  death
resulting from natural causes,  from some
forms  of  suffocation, and   from  poisons,
are almost  beyond the  power  of  the  un-
professional to investigate.   For the mode
of distinguishing, and for the  subsequent
      p 2
'3               DE A

 treatment,  the  reader is referred to the
 articles  devoted to these subjects.   It  is
 repeated, when  a person is found apparently
 dead, do  not let  the fact be assumed without
 investigation, [do not wait for the coroner;]
 the spark of life may yet linger in its earthly
 tenement, may yet be not past recall, beyond
 which the loss of even  a  short time, or the
 total abandonment of care, may quickly place
 it.   If there is  the faintest hope that life is
 not quite gone,  while the  causes of the mis-
 hap are  investigated, means, such as are
 recommended under the peculiar circum-
 stances,   should be at once  adopted, and
 vigorously—no  half measures will turn the
 scale between life and death.  These things
 are  peculiarly important, for often it can
 only be  a fortunate  chance that places a
 medical  man on the spot where  cases such
 as  the above have occurred.   Of  course,
 where it  is  possible, medical  assistance
 ought to be as quickly procured as may be,
 but  time may or  must necessarily elapse,
 and while it slips by, life slips away, which
 might be preserved by the knowledge pos-
 sessed by some intelligent bystander, which
 might lead him to think that   there was
 still hope—often too readily given up  by
 the crowd—and lead him  to direct the adop-
 tion of rational and really efficient measures,
 instead of the useless, or worse than useless,
 treatment followed, where there is no infor-
 mation to guide or head to direct.
  When  persons are found who are undoubt-
 edly dead, there yet remains something  to
 be  done, for the cause may be  natural  or
 unnatural, and  in the latter case the ends
 of justice may  either  be forwarded  or re-
 tarded by those who first  discover the body.
 The exact  position  should be  noted.  The
 stiffening or not of the limbs.  The presence
 or absence of warmth about the chest  or
 abdomen particularly.   The state of the
 clothes.  Whether there are signs of vomited
 or other matters discharged from the body.
 Wounds  noticed, and the  state of the blood
 upon them, whether fresh, coagulated but
 yet  soft,  or hardened.  And, indeed, what-
 ever the  circumstances connected with the
 finding of the body can suggest to the intel-
 ligent mind, should be written down.  On the
 arrival of the judicial and medical authori-
 ties, there are other matters of course to be
 investigated, which only they can undertake;
 but  as most of  those above mentioned are
 evanescent, the persons first on the spot can
 best, or only, testify to them, and facts, which
 may appear trivial to note at the moment,
 may. in criminal cases, be the turning point
 on which conviction hinges.—^Refer to Apo-
 plexy—To causes of unexpected death generally.
r 
DEB
1
74                D E H
  DEBILITY, or Weakness—Is a falling off
from  the  usual power of the individual to
perform  those exertions, whether  of  duty
or pleasure, in which he  has habitually en-
gaged, and which, judging from the consti-
tution, mode of life, &c. he might naturally
be expected to perform.
  Illness  and  debility may also be said to
be synonymous, for it is difficult to  imagine
the former unaccompanied  or  not followed
by weakness, except in the few exception-
al instances in  which apparent  debility,
caused by the presence of morbid matter in
the blood, is relieved by the disorder which
carries  off  the cause of  the depression.
Such  is seen to be the case  in mild attacks
of bilious diarrhoea,  which do not go far
enough to affect the general strength, and
which are immediately followed by relief to
the feelings of languor and weakness which
preceded them: indeed, unwonted discharges
of any kind, whether in  the urine,  or from
the skin, or even of blood in small quantity,
if they do not  go too far, are often followed
by feelings of  strength rather  than  of  de-
bility. In these cases, however, the  debility
was apparent, not real; that of oppression,
rather than of  depression.   To these and
similar  sources,   then,  may   be  referred
all those  causes of apparent debility, or in
other words, of languor or torpor, which
arise  from impurity  of  the blood, conse-
quent upon the retention of noxious  matters
in that fluid, which are from some cause un-
removed, as they ought to be, by the agency
either of  lungs, liver, kidneys, bowels,  or
skin,  or which have been absorbed into the
vital fluid from without.
  It may  be said that these are not cases of
debility at all,  and perhaps by medical men,
understanding  and  strictly  investigating
their  causes, they would  not be considered
bo;  nevertheless they give rise to an  appear-
ance  of weakness, of which the  unprofes-
sional only can judge; and under these cir-
cumstances, it  is requisite  plainly to point
out the distinction, which is of no light im-
portance,  in  the modes  of  treatment and
management usually resorted  to.   A  per-
son from some cause or other gets his blood
loaded with  morbid matter; either he has
indulged  in too full living, animal diet, and
alcoholic  drinks especially, or he  has  ne-
glected to take exercise, or to keep the skin
in active  operation;  or the  lungs,  liver,
kidneys, or  bowels are oppressed or inac-
tive ;  he has, in fact more or less poisonous
matter circulating throughout his frame,—
he feels low, both in body and mind, languid
and listless, thinks himself weak, and takes,
perhaps,  a little extra animal food,  a little
more wine  or malt liquor,  to  correct the
(supposed) debility.   The consequence must
be a fit of illness of some  kind, "a bilious
attack ;" a fit of gout or gravel, of piles 01
of some cutaneous eruption, which the sys-
tem makes a safety valve;  or it  may he that
apoplexy or some other congestive disease
is induced.  It is  surely superfluous  to say
more  respecting  the serious tendency  of
such an error as that which mistakes false
debility for real, and induces the individual,
instead  of seeking strength by the reduc-
tion  and alteration of his  diet,  and by the
regulation of the excreting functions  of the
body, either by general  or medicinal means,
to rush to the other extreme,  and, in the
endeavour to get rid of  the disorder, to add
to the cause of it.   Of course real debility
may co-exist  with  apparent, the  result  of
impure  blood ; such happens  in  acute  or
exhausting affections of  the liver,  lungs,
&c. &c. and the case assumes a complicated
and highly dangerous character.
  As  apparent debility is referred  to im-
purity of blood, so the cause  of real debility
must  be  looked for, in many cases,  in its
deterioration or deficiency.   The vital fluid,
which is the  medium  for supporting our
animal temperature, and for supplying plas-
tic elements to the ever-wearing textures of
the  body, may be deficient in all or any of
the elements required for these purposes, or
it may itself  have been drained  away by
hemorrhage.   The first  office of the blood,
the maintenance of animal  heat, is so  essen-
tial, that it seems arranged  by the Author
and supporter of our life,  that  to  carry on
this,  the  soft constituents of the body may
be sacrificed almost to  the extreme  limit;
but this very circumstance must be a cause
of debility  during illness,  when, to  obtain
fuel as it were, muscular substance is con-
sumed away, while muscular motion  is un-
exercised. Again, whatever plastic elements;
the  blood may be  deficient  in, the organs
to which  those elements should be  supplied
become debilitated.  This  is  most  striking-
ly exemplified in the case of the  bones  in
childhood,  where  food  is  deficient,  which
become soft—rickety—for  want of the due
supply of earthy matter;  still  more  gene-
rally  is it exemplified, in those  cases  so
often  quoted, of  animals  fed, or  rather
starved, upon certain kinds of food, such as
arrow-root,  white  sugar,  bread  made  of
fine flour,  &c. &c , which, however  whole-
some  as  articles of  diet in  themselves, do
not contain plastic elements for the  build-
ing up or sustaining the  bodily tissues  in
strength  and healthy active operation:  to
deficiency, therefore, of the blood, as regards 
D E B                175                DEB
 those elements  required in the unceasing
 operations of the living frame, must we look
 for the  most generally operating and palpa-
 ble cause  of  debility.   But this cause  is
 itself only  an effect of other causes.   If the
 blood is to nourish well, it  must be well
 nourished  itself.  The supplies it is ever
 yielding to the system must be rendered  to
 it from  without; the food must not only be
 in quantity and quality sufficient to pre-
 serve the  balance of nutrient  materials  in
 the blood,  but it must be properly digested,
 properly fitted for its  commixture with the
 vital fluid ; if  either food or digestion be defi-
 cient, more or less debility must result.
   Many causes,  of course,  may operate  to
 diminish or  totally  prevent the supplies
 of food  taken.  Febrile disease of any kind,
 accident, disorders of the digestive organs,
 and numberless others do this; and so certain
 as  they do—except, to  be  sure, where  a
 little wholesome  starvation is required—so
 certain  does debility follow; for although
 food may neither be taken nor digested, the
 bodily requirements, heat,  movement, and
 even  the power  of thought, must be kept
 going, and if  the materials  are not furnish-
 ed from without, they  will be  taken from
 within—the body preys upon itself, or lives,
 as it were, upon its capital—and it is need-
 less to say that debility must result.  The
 body, in such a  case, might well be  com-
 pared to a steamship  at sea, run short  of
 coal,  the inner  wood-work of  which,  even
 at the risk of  weakening  the hull, is neces-
 sarily broken  up to  supply the  engine and
 enable  the vessel to reach  the harbour  of
 safety.   So the body, suffering under acute
 disease, and  unsupplied with  food,  must
 make use of that which  constitutes its in-
 ternal structure, although it may be  fear-
 fully  weakened,  or  perhaps destroyed, by
 the process.   The supply of proper  nutri-
 ment, and its  presence  in the blood, are so
 intimately connected, that they may be re-
 garded  as one and the great source of real
 strength.   Without  good  blood,  neither
 muscle, nerve, nor any other constituent of
 the body can be in its best state of healthy
 efficiency.   Of  course,  deficiency  of the
 circulating fluid caused  either by loss from
 hemorrhage, or  any other drain which ab-
 stracts  all  or part of its constituents,  must
 act as a cause of debility  equally with those
 previously  mentioned.
  Again, the blood may be  adequate to ful-
 fil all that is required of it, but some organ
 fails; it seems to lose  its power of appro-
priating to itself  elements fitted for its
Mutrition,  although  brought  to  it  in  the
circulation, even  in sufficient proportion  to
maintain moderate healthy action ;  ir tht
individual  organ  may  be overtasked and
debilitated, its tissues used up more rapidly
than  they can be repaired, or its nervous
power exhausted.  Here  we have another
source of strength  or weakness, real  or
apparent, the  nervous power, the  agent
through which movement  is communicated.
The action of the  nervous system, as regards
strength  or  debility, must be looked at in
connection with  its healthy  or its morbid
operation; in other words, its strength con-
sists in the amount of exertion  it is capable
of stimulating and maintaining, either gene-
rally  or  partially, without  subsequent ex-
haustion.  This  limitation is requisite, for
were  it not drawn, it would make the ex-
citement of the nervous system the measure
of strength—it would make the transitory
exertions of enormous  power  exhibited at
times by patients in the last stages of real
debility,  from fever, or the almost resistless
struggles  of the  delicate hysterical  girl,
tests of real strength, instead of paroxysms
of morbid excitement, which terminate in
the most exhausting, or it may be, fatal de-
bility and collapse.
  In the  healthy  constitution, and sufficient
nutriment of the organic constitution of the
body,  and of the nervous system, lies the
true  element of strength, or the real seat of
weakness.   To use a  simile, the machine
must be strong  in  all its parts, and its
moving  power adequate  to  its  require-
ments,  to   constitute   real,  well-balanced
strength.
  When  the  central organ of  the nervous
system, the brain itself,  becomes  debili-
tated,  the condition may be  manifested by
partial or general affections of  the body, or
by disorders of the mind.  The brain may
be debilitated or exhausted by the excessive
stimulation  of  alcohol, opium, and  other
agents which act  upon it peculiarly, also by
sensual excesses, over-nursing, and the like ;
but perhaps the  most  frequent source of a
weakened brain  in this country is undue
exertion  of  it as the  agent of the  mind ;
it is  tasked till   it gives  way—is used up
This is not a figurative expression—it is the
actual truth that  the  substance of  the
brain is  actually consumed by the process
of intense thought, the amount of consump-
tion, probably, being in proportion  to the
exertion the mind is put to.  In persons of
irritable  and nervous temperament it is not
uncommon  to  find deposites  of phosphatio
salts in the  urine after  the mind has been
strained; and we can only look to the nerv-
ous system and brain as the  most probable
source of the additional excretion of  phos- 
DEB
176
DEB
phorus.   The subject is undoubtedly an
obscure one at present, but it is deserving
of notice, from bringing directly and  sen-
Bibly to the mind, and in a physical point of
view, the  possible and probable manner in
which  this wonderful agent of man's intel-
lect may be and is exhausted.
  Having  then  seen that  debility   may
either be  apparent or real, and  that in the
latter  case  it may depend upon deficient
nutriment  or deficient  healthy  supply of
nervous power, it remains to consider the
causes which most generally tend to bring
about these conditions.
  Debility has been  divided into original
and acquired.  The  former is witnessed in
the children  of parents whose constitutions
have been weakened  by any cause, such as
dissipation, advanced life, &c. &c. and also
in the children of scrofulous families.   The
latter,  or acquired debility, may of course
be caused by whatever lowers the standard
of health.  As  already  mentioned, insuf-
ficient  nourishment is one great source of
debility;  likewise the absence of the usual
Btimuli of solar heat and light, deficiency of
fresh air and exercise, and of stimulation to
the mind by  a  proper  amount  of  healthy
active  exertion.   Again,  there  is  the de-
bility  produced  by  the  direct  action of
injurious  agents, a continued damp climate,
either  warm  or  cold, poisons  gradually
absorbed in necessary employment,  or  acci-
dentally but continually taken into the sys-
tem, and such like;  and  also by depressing
passions of the mind, such as anxiety,  fear,
&c. &c.
  Lastly, there  is  debility,  the result of
direct  abstracting  and  exhausting  influ-
ences.   Any  habitual loss of blood, or drain
or discharge of any kind, over-nursing, or
sexual excesses.  One especial cause of  debi-
lity requires notice: it is that occasioned in
young children  or people who   sleep  with
the aged; for the fact is an undoubted  one,
that the  practice has an extremely debili-
tating effect  upon  the former.  It is one
which should never be followed or permitted.
The withdrawal  of accustomed excitements
often  occasions  debility of  an alarming
and even fatal character.  The  debilitated
drunkard or the opium-eater cannot without
danger be deprived of his usual stimulant;
and even the man  who  has lived in the
most   perfect moderation cannot  always,
without  danger  of inducing great debility,
leave  off an accustomed stimulus.   It  is
not said  that in many instances this  may
not be done with impunity, or even benefit,
but there are cases  in which it  is hazard-
ous.  The effect is not manifested, perhaps,
for a considerable time—it may he weeks or
months—but it i* manifested some time ; and
the author  has met with  some  cases of
extreme  depression  and general  weakness,
traceable to no other cause than an unad-
vised  and rigid adherence to the  strict  rule
of teetotalism.  It  matters not what  the
long-accustomed stimulant may have been,
whether of alcohol, of fresh air, or of mental
exertion,  it  cannot be withdrawn without
danger of inducing weakness.
  In  the treatment of  debility,  whether
Bimple, or complicated with disease, it must
be obvious to all that  it must be  adopted
with  due reference  to  the cause.   This
must,  if in continuance,  be  removed or
rectified  as  quickly as it may be.    If the
mischief,  as  occurs  in  original debility, or
in that  produced  by  causes  which  have
ceased to operate, cannot be prevented, of
course nothing remains but to build  up or
restore strength by nourishment, tonic medi-
cines, change of air  and scene,  especially to
the seaside when that is practicable.   In
every case, however, of marked debility, the
medical  man  should be consulted; he only
is likely to detect with certainty the cause
or causes, and  to  direct the  adoption of
appropriate remedies.
  It may seem that too much space has been
devoted to this subject, but it is one which
is so erroneously regarded by the  public
in general, particularly by the lower classes,
that it is a matter of importance that more
correct views should be imparted,  and  that
there should  be a more enlightened under-
standing of the subject, of the principles by
which debility is to  be judged and treated.
The case of apparent debility was  disposed
of in the first portion of  this article.
   In  the weakness which  accompanies fever
and acute inflammatory attacks, nothing is at
times more difficult  than  to convince people
not only of the utter uselessness, but of the
injuriousness, of administering any food but
that of the mildest and most unstimulating
character, such as the appetite alone desires,
if it desires  it at all; and notwithstanding
nature  herself points  instinctively to the
proper course, they will persist in the idea
that if the person " would eat, he would be
better."    Undoubtedly  if he  would and
could eat  and digest  the food taken, he
would be better, for he must be better be-
forehand to do so.  But the popular idea is,
that  if food can be got  into the  stomach,
it must  give  strength ; and foolish friends
foster the same irapresbion in the mind of
the invalid,  till  he force*) himself to  take
food; and many a promising case is thrown
back in  this  way,  although  the  medicai 
DEC
17'
DE F
 attendant is never informed of it, and can only
 guess  at the  cause.   Fortunately, nature
 often resents the error, and vomiting relieves
 the  stomach of its  injurious load; if not,
 fever, headache, &u. and relapse are the too
 frequent consequences.
   It is repeated, in the treatment of debility,
 whatever may  be  the cause, if still in ope-
 ration,  that must be rectified;  but the weak-
 ness itself is only to be repaired by a suffi-
 ciently   ample  supply  and  circulation  of
 healthy blood.   The latter must  be pro-
 cured by every means  which  tend to enrich
 and  purify the  vital  fluid.   Good  food
 well  digested, air,  exercise, and  the use
 of all accessories to health,  assisted  when
 suitable by such regular and regulated ex-
 ercise of the  debilitated  parts themselves
 as will  increase  the  circulation  of  blood
 through them, without exhausting  either
 their constituent tissues or nervous power ;
 but  it is useless,  and worse than useless, to
 load a stomach which cannot digest it, with
 food  and drink, in the vain hope of giving
 strength, as people too  often do, or wish to
 do, in cases of febrile or other disease. To
 resume  the simile of the steamer, although
 the  seasoned  wood-work  within   may  be
 broken  up to feed the  engine and  to carry
 the vessel  safely  into port, it would be  no
 Blight hinderance, and no small aggravation
 of her danger,  were she to be loaded with
 water-logged or  green  wood, which  would
 not burn when  it was wanted.  So it is with
 the body in fever: the already prepared and
 digested components stored  up  in its tis-
 sues, though not perhaps  accumulated for
 the special  purpose, will yet answer well to
 keep its works  in  movement; but  crude
 food is like the green, wet  wood, useless for
 good, and fitted only to  overload and retard.
 When increase  of nourishment is called for
 in cases of debility, care  must always  be
 taken to adapt it to the  condition of the
 digestive organs;  these are generally weak-
 ened, and while the food given contains much
 nutriment, it should be as easily soluble in
 the stomach as possible.  For information
 on this head, however, the reader is referred
 to the articles on Digestion, Food,  &c.
   Refer  to Animal Heat—Bilious Cholera—
 Blood—Fever—Nerves, §c.
   DECAY—Or  the gradual giving way  of
 the physical powers in  old  age, may almost
 be considered  as a  part of the  preceding
 article.   After  the sixtieth  year in  men, and
 somewhat earlier in women,  as a  general
rule, the period of old age  or of decay com-
mences.   The descent has  begun impercep-
tibly perhaps at first, but it is progressive.
There may be no positive  disease,  but the
12
circulatory  powers  fail,  the  arteries  lost
their elasticity and tone; and in this, per-
haps, lies one great cause of the decay of the
body generally—the deficient circulation of
blood; the brain, the muscles, the whole body
becomes smaller, and shrinks, and  if there
is no disease, the powers of material life are
gradually extinguished, a few degrees' fall in
the thermometer may be all that is required
to put  out  the  flickering flame.   For  the
management of this stage of life the reader
ir referred to the article on Old Age.
  DECIDUA, or Deciduous Membranes—
Are those which line  the uterus  during
pregnancy, and  which are cast  off shortly
after the birth of the child.
  DECLINE.—See Consumption.
  DECOCTION—Literally, means a prepa-
ration which has been boiled ; but in medi-
cine, by the term  is understood  that which
has been boiled for a certain length of time
for  the purpose of extracting matters from-
crude materials, which cannot otherwise be
obtained.   Moreover, when improperly em-
ployed  as a  process, it drives off  volatile
matters which ought to be retained.  The
most useful  decoctions  used  in medicine,
are—
  Compound decoction of aloes.
  Decoction of cinchona-bark.
  Decoction of oak-bark.
  Decoction of sarsaparilla.
  Decoction of senega-root.
  Decoction of elm-bark.
  Decoction of poppy.
The preparations of gruel, barley, flaxseed,
&c. &c. are also classed with the decoctions,
  There are many other  medicinal decoc-
tions, but they either do  not require men-
tion in this work, or the preparation, as in
the case of dandelion, broom, &c. is better
made as an infusion.  For information re-
specting those mentioned, the reader is re-
ferred to the respective articles.
  DECOMPOSITION—Is  the separation of
the  component  principles or  elements of
compound bodies from each other, the pro-
cess being either  naturally or  artificially
excited.—See Antiseptics—Fermentation—Pu-
trefaction.
  DEFORMITY—Means  "any and every
deviation from the recognised symmetrical
proportions of the human frame;  but  the
word is more  definitively applied to those
irregularities of  form which consist in a
partial deviation from the natural position
of the body, unaccompanied by  malforma-
tion  of  the general original structure.  It
is probable that to a conviction on the part
of the profession that club-feet  are actual
malformations, we are to ascribe the unac- 
D E F
ITS
D E F
 :ountatle  fact of this species  of distortion
 having almost to the present day been left
 without rational or truly scientific attempts
 made to remedy it."  Deformities are either
 congenital—that  is, dating from birth—or
 acquired.  With  respect to the causes of
 congenital deformities, " some are at present
 inclined  to attribute them  to a mental im-
 pression,  generally a sudden  one, received
 by the mother during  pregnancy—but  it
 oftentimes happens that the mother can as-
 sign no cause; in other cases  the deformity
 appears  hereditary."  "In non-congenital
 cases,  teething, worms, and irritation of the
 spinal  chord  are frequent causes.   Certain
 occupations,  such as much standing, or car-
 rying  heavy loads;  position  also  may  be
 regarded  as  a cause,  especially in lateral
 curvature of the spine; but occasionally we
 are  at a loss  to  discover  any cause, the
 deformity coming on insensibly, while the
 patient is apparently in  perfect health."
 These  cases, if attended to at their  com-
 mencement, might certainly be relieved and
 prevented ; but it often unfortunately hap-
 pens that  there  is little  interference with
 the general health. The deformity, as in the
 foot for instance, coming  on insidiously, no
 attention  is paid  to the circumstance;  a
 weakness, as it is termed, of the ankle is felt,
 and the foot deviates occasionally from its
natural position;  and thus, if the case be
neglected, the foundation is laid for a per-
manent deformity, or at all events a perma-
nent weakness  of one or both  limbs, which
may involve their being disabled for life.
  The  most simple form of distortion is the
horse-foot,  which  consists of complete ele-
vation  of  the heel,  so that the patient  in
walking rests  entirely on the  toes,

                  Fig. Ii.
Mr. Tamplin,  the  experienced surgeon  to
the Royal Orthopaedic Hospital, from whose
work-the substance of this article  is taken,
gays that he has never met with this kind  of
 deformity as a congenital one, but it is a con-
 sequence of disorder of the system, and more
 especially of nervous irritation, such as that
 caused by  teething,  worms,  &c.   It may
 also be occasioned by wounds or local irri-
 tations, such as ulcers, affecting the calf of
 the leg, or " it may arise spontaneously, the
 patient experiencing  no pain or  inconve-
 nience beyond  the inability to bend the foot
 or  ankle-joint in the  act  of walking, and
 retaining at the same  time power  over all
 the muscles."  AVhen  weakness of  the liga-
 ments of  the  ankle-joint is  conjoined with
 the above deformity, in the course of- time
 the  foot  is liable  to  become  so much dis-
 torted that the person at  length comes  to
 rest on its outer edge  in walking.
  Another deformity  of  the foot,  that  in
 which it  is simply bent  inward, may date
 from birth, and frequently does ; but it may
 also be induced by various causes of irrita-
 tion  affecting  the nervous system.   The
 flat or splay foot, although it maybe a con-
 genital formation, is also liable to be caused,
 where previous debility exists, by the carry-
 ing of heavy loads, and other things which
 necessitate much pressure upon the arch of
 the foot.  " The  first  thing which  attracts
 the attention of the patient to this deformity
 in its incipient state, is a sense of weakness,
 more especially  on the  outer  side of the
 ankle-joint;"  they then  observe  the flat
 appearance of  the sole of the foot, and the
 tendency  of the inner ankle to approach the
 ground in walking.  As  the deformity in-
 creases, the pain  in the joint and the sense
 of weakness increase to such an extent that
 the patient becomes totally unable to follow
 his ordinary occupation.
  It would be  a  superfluous waste of time
 and space here to enter further into a con-
 sideration of   the various deviations from
 the  natural formation  to which the limbs
 are liable: suffice it that whether the infant
 is born with these deformities, or whether
 it becomes the subject of them as life ad-
 vances, they cannot loo soon  be submitted to
 medical management.   Modern surgery has
 demonstrated that they are remediable so far
 that all striking deformity can be removed,
 and that an otherwise almost useless member
 can be adapted to perform its natural offices,
 if not with grace, at least with  comfort.
 The great improvement in the treatment of
 these defects   consists in  division of the
 tendons which  occasion the distortion. This
practice Mr. Tamplin strongly recommends
as the preferable  one, whether " for in-
fants  at the  earliest age, or late  in  life,"
for  the following  reasons:--" First, from
the facility with which it ix  accomplished; 
DEL
179
DEL
 secondly, because  it  incurs  comparatively
 no risk, and  scarcely any  inconvenience;
 thirdly, because you  at once overcome the
 principal resistance, and render the after-
 treatment painless to  the patient,  and com-
 paratively easy to the  attendant. Independ-
 ently  of this  the  child  is  not  subjected
 to such constant confinement  of the limb as
 is absolutely necessary when you  do not
 have recourse  to  an  operation;  you can
 allow exercise to be taken for  a certain time
 during the  day—and  that, even in infants,
 must have a most beneficial effect."
   The  above remarks of perhaps the most
 experienced surgeon in this kingdom in the
 treatment of  distortions, have been brought
 forward  in  the  hope  that  parents  and
 others  having the care of children may not,
 knowing the general causes of non-congeni-
 tal  deformity,  neglect  the   first  warning
 symptoms of  its insidious approach; and in
 the case of children born with  distortions,
 may place them at the earliest possible pe-
 riod  under efficient surgical  management,
 and not be deterred by the fear of an ope-
 ration,  which, in proper hands,  is perfectly
 safe, comparatively painless, and unattended
 with loss of blood.
   Deformity occurs from the  softened con-
 dition of the bones, in  the disease of child-
 hood named rickets, and also from soften-
 ing of the bones in adults, but these cases
 are the  effect of distinct and well-marked
 diseases.—See Rickets—Softening of Bones, ^c.
   Deformities and contractions of the shoul-
 der  and elbow-joint are very generally the
 result of injury or disease.  The wrist-joint
 and the joints of the fingers are also liable
 to distortion from the same cause.   In some
 cases the contraction is seated in the skin;
 in others the joints are deformed  and per-
 haps displaced by rheumatic  disease.   De-
 formity of the fingers  may also  be congeni-
 tal.   Such  cases should  be  put  at  once
 under the management of the surgeon.
   Refer to Neck—Rickets—Spine, $c.
   DELIRIUM—Is a temporary disordered
 condition of the mental faculties, occurring
 during  illness, either of a febrile  or of an
 exhausting  character.   It is generally  a
 symptom of serious import, but not always.
 Manj- children,  and some adults, become
 partially delirious, or "wandering," from
 very slight causes—even a simple feverish
 cold  being sufficient to produce the effect.
 In such cases, of course, judgment must be
 formed  with  some reservation.   In lever,
 and febrile diseases generally,  delirium may
be no more than slight confusion of ideas
 on waking from sleep, or it may amount to
furious and dangerous excitement, or merge
 in low muttering, or terminate in confirmed
 coma or stupor.
   Delirium may be the effect of disordered
 or  inflammatory action affecting the brain
 itself,  or it may be sympathetic with  active
 disease in  other parts of the body, such as
 the  heart; it may be caused by  long-con-
 tinued and exhausting pain, and by a state
 of inanition of the nervous system.   In the
 treatment  and alleviation of the  symptom,
 it is of the highest importance that it should
 be  ascertained to which of the above con-
 ditions it  is owing;  and from  this circum-
 stance, any attempt to remedy it by the un-
 professional (who  must  be liable  to error
 on this head) cannot but be  attended with
 some risk.  It may, however,  at  times, be
 requisite  even  to  run this  risk  for  the
 chance of  doing good, and then the follow-
 ing directions may serve as some guide.
  When delirium occurs in a person of full
 habit of body, accompanied with inflamma-
 tory fever, with quick strong pulse, blood-
 shot eye, and flushed  countenance, abstrac-
 tion of blood  in the  first  instance,  either
 from the arm, by leeches, or  by  cupping,
 cannot  fail to be  of  service.   Along with
 bleeding, free purging  with calomel, com-
 bined  with compound colocynth  pill, with
jalap or scammony, or followed  by  senna
 and  Epsom salts, should be resorted to ; the
 head should be shaved and  kept  cool with
 the coldest applications to be procured, the
 feet  should be kept warm, the room dark-
 ened, and  every  source  of excitement re-
 moved. If  there is violent effort and unruly
 conduct, the limbs must be restrained firmly,
 but  gently, whenever attempts to  exercise
 them in an improper manner are made.   In
 this  case a broad belt passed  loosely over
 the bed, and fastened at each  side, so as to
 confine only when  any attempt at  rising is
 made,  is of  considerable  assistance.   In
 this  form of delirium, it is  of  the  most es-
 sential  import that watch should  be kept
 without  one  moment's  interval, night and
 day.  There must  be  no risk run of sleepy
 attendants, and there  must  be  sufficient
physical power to restrain the almost super-
human, though  transient, efforts  made by
delirious patients.   Some of the most pain-
fully distressing accidents of illness have
occurred in consequence of neglect of these
precautions.  One  unguarded  moment, one
five minutes' sleep, have neutralized days
and  nights of anxious care and watching.
In the brief interval of remitted surveillance,
the  patient has escaped  from bed,  from
room, even from house, by the usual modes
of egress, or has dashed madly through the
first window in  his way, or laid hold *f  tbo 
DEL
ISO
DEL
 first  means of self-destruction.  The  force
 of the excitement, it  is true, is  generally
 soon  over, but it  lasts long enough for se-
 rious or fatal  mischief.  No apparent  quiet
 for some  time is  to be trusted; unceasing
 care  must  be exercised  till intelligence
 returns.
  The low form  of delirium is differently
 characterized.  The mental disturbance is
 equally complete,  but wants the violence of
 the inflammatory form.  Generally the per-
 son  lies in a  dreamy state  of incoherent
 thought;  but even in  this  form, occasional
 fits of excitement, and  attempts to get out
 of bed, and the  like, occur, and must be
 guarded against.  It is this form of delirium
 which generally becomes  developed in the
 progress of typhus and typhoid fever.   The
 head  is hot, but it is not the fierce heat of
 the inflammatory attack, the vessels do not
 throb in the same  manner,  and the eyes are
 not bloodshot, the  pulse is feebler and  more
 easily extinguished,  the  tongue  and the
 hands are tremulous, the former when pro-
 truded, and the latter are perhaps affected
 with  convulsive   startings.   AVhen  these
 symptoms  are at  all marked, there can be
 hut  little   doubt  as to the  nature of the
 case.   To take away blood  now, is to kill.
 The head should be shaved and kept  cool,
 the bowels moderately but sufficiently open-
 ed,  and the warmth of the  feet attended to,
 perfect quiet  being observed around the
 patient.  In such  a condition, particularly
 if there is  tendency to  nervous or convulsive
 twitching of the fingers or of the tendons at the
 wrist, opium  may  certainly  be  given  with
 benefit—the best form  is Battley's sedative
 solution: the dose  for an adult, fifteen drops
 in the evening, "five drops additional being
 given every two hours till sleep is procured,
 or till thirty drops  have been administered
 in all; or  the  muriate of  morphia  may be
 given, in half  or quarter grain doses, in the
same  manner; or  in the absence  of these,
 any other  preparation of  opium in corre-
sponding quantity.  Sleep is the only remedy
 for  the irritation  and  irritable exhaustion
of the nervous system which is  attended
 with this form of delirium, and opium alone
is to be trusted to for procuring  the soft,
 restorer.  Strong meat-soups and wine may
also   be  requisite, but  the  consideration
 of these matters rather belongs to  the  sub-
 ject of fever.
  A  form  of  delirium, accompanied  with
 much  nervous irritation, is  apt to be de-
 veloped in  the course  of scarlet fever, to-
ward  the   third day of the eruption,  or
when  it is beginning to fade.   In  the  pro-
gress  of rheumatic fever, this same delirium
 of  exhaustion may  occur,  and,  like  the
 others already mentioned, requires the treat-
 ment by opium.
  Sympathetic delirium takes either of the
 above forms, according  to  circumstut'ces,
 but  it is more generally the low type, espe-
 cially when consecutive to severe accident
 or operation, or  during protracted child-
 birth.   Generally, therefore,  opiates  and
 supporting measures, meat-broth, wine, and
 bark, &c. are required rather  than the re-
 verse.
  It is of consequence that delirium should
 not be mistaken for insanity, as it might be,
 and  has  been, but scarcely ought to be by a
 medical  man.   The  concomitant  circum-
 stances of disease, &c. &c.  will  generally
 guide.  In true delirium, the  presence of
 fever more or less, the  acute disorder of
 the  functions generally, such as digestion,
 &c.  and  the  disorder  of the  whole mind,
 generally sufficiently  indicate  its  distinct-
 ness  from  insanity, in which the faculties
 of the mind are only perhaps partly affected
 or perverted, and disconnected.   The  in-
 sane, moreover, do not exhibit the appear-
 ance of illness which accompanies true de-
 lirium, and the functions are  not usually
 impaired in the  same  way.   Still the two
 affections may nearly approach one another;
 and  in the form of delirium which follows
 childbirth,  or the delirium tremens of the
 drunkard, it  may  often be difficult to make
 the definition as to which the case belongs.
 Still  more difficult  of discrimination  are
 some cases of hysterical delirium, which,
 when long  continued, might well  be mis-
 taken for insanity, unless submitted to medi-
 cal  judgment.    Indeed,  in  every case of
 delirium, medical  assistance should be pro-
 cured  as early as possible.   No  unpro-
 fessional person in his senses would thiuk
 of treating a  case of  delirium,  when pro-
 fessional  assistance  is  at hand.   In  its
 absence,  the  foregoing article  should  be
 useful.
  DELIRIUM  TREMENS—["The  Hor-
 rors," or Mania a Potu]—Consists of a pe-
 culiar exhausted   condition of  the nervous
system, which is accompanied with more or
less mental disorder of a peculiar kind. This
 disease is generally the result of excessive
continued intoxication with alcoholic liquors,
 or of their  withdrawal when they have been
 habitually consumed in considerable  quan-
 tity.   It  may also, however, be  produced
by the continued  use of  opium, and  has
been known to  arise from other  causes of
cerebral  exhaustion.  The first symptom of
delirium tremens is a state of restless nerv-
ous  irritation;  if the exciting  cause  b« 
DEL
181
DEL
 continued sleeplessness follows, there is no
 rest, and if there is any approach to sleep,
 it is haunted  by dreams and figures, which
 seem to excite the greatest terror. The mind
 is more collected than  in most other forms
 of delirium, but seems always to be more
 or less haunted with  suspicions  of  those
 around.  The entire frame  is in a state of
 tremor, the  closed eyelids  and  the  pro-
 truded tongue  are  tremulous;  the  hand
 which attempts  to  perforin  any action re-
 quiring exactness,  cannot  execute  it for
 shaking ; the patient is exhausted, and still
 sleep does not come.  Succeeding the above
 condition, the nervous excitement becomes
 so great that the person cannot  be kept in
 bed, the mind becomes more  disordered, a
 state  of  temporary insanity ensues,  and
 convulsions, epilepsy, or apoplectic stupor
 closes the scene—a scene of the most painful
 nature, perhaps, which  the  physician is
 called  to  witness—the death-bed  of  the
 drunkard—of the man  slain by his own sui-
 cidal act, by the poison of alcohol.
   It  can  rarely  happen that an  unprofes-
 sional person could  have to  undertake, un-
 assisted, the  management of a case of de-
 lirium  tremens,  and  never  should do so,
 except under extreme  necessity.   The na-
 ture of the disease  is, unhappily, in almost
 all cases  too palpable, from its  exciting
 cause.  It is an exhausted condition of the
 brain  and nervous  system;  and the great
 effort  must be to alleviate this exhaustion,
 which is too great even for sleep.  Opium is
 the remedy among others, and must be given
 in full doses.   A medical man will, of course,
 give it more  freely  at  once  than another
 person ; but in a confirmed case of delirium
 tremens, twenty-five drops of  Battley's so-
 lution,  or  thirty of laudanum, should be
 given  at  once,  and ten  drops every hour
 afterward, until  sleep  has been  procured,
 or until fifty drops  of  the former, or  sixty
 or  seventy of  the  latter have been admi-
 nistered.  A medical  man would venture con-
 siderably  further than this,  if necessary;
 but cases  might occur  in which it would be
 unsafe for the unprofessional to do so.  It
 often happens that the  stomach is in so irri-
 table a condition that it will  retain neither
 food nor medicine ;  in such a case the opium
 is better given solid, in the form of pill, one
 grain and a half at  first, and  half a grain
 repeated at hour intervals, if requisite.  If
 the stomach is still irritable, a drop of crea-
 sote, in a little  spirit  ind  water, may be
 given, and a mustard-plister applied to the
pit of the stomach.   In cases of delirium
tremens, the  liver is more or less affected;
»t is loaded with  dark,  unhealthy bile;  and
 so much is this  the case, that some  have
 been inclined to attribute many of the symp-
 toms of delirium tremens  to the liver  dis-
 order, and to recommend a purgative treat-
 ment in preference to that by opium.   The
 author has  generally  found  the  medium
 course the best, that is, the combination of
 opium with calomel, and the compound col-
 ocynth pill. Five  grains of powdered opium,
 ten  grains  of calomel and twenty of com-
 pound colocynth  pill, are to be compounded
 together and divided into twelve pills ; of
 these, two or three should  be given  for the
 first  dose, and one at intervals of an  hour
 between each, till six  have  been given.
 Under this" treatment, after  sleep has con-
 tinued for  some  time, the bowels are gene-
 rally acted upon, with  immense discharge
 of  dark, black-looking  bile, much  to  the
 relief of the patient.  After this, the re-
 maining pills, may be  given, two every night,
 and castor-oil in the morning,  if required ;
 five, ten, or fifteen-drop  doses of laudanum,
 or two teaspoonful doses of paregoric being
 given,if the nervous irritation is unsubdued,
 or threatens to return.   After  the  nervous
 irritation  has tolerably well subsided, the
 next object must be to restore the tone of the
 stomach.   Eight-grain doses of the carbon-
 ates of soda or potassa, combined with a bit-
 ter tonic, as columbo,  gentian, or chamomile,
 may be given for this purpose, every eight
 hours;  or  quinine  or bark,  in  some form,
 will be found useful.  The India bitter beer,
 with  ten drops of potassa solution, may be
 very serviceable.   During  the whole treat-
 ment, it will be necessary to allow the  un-
 fortunate  subject of the disease  a certain
 regulated portion of alcoholic stimulant, such
 as brandy and water, in some degree pro-
 portioned to the previous  habits;  and as
 soon as the stomach will bear it, the nourish-
 ment of strong  meat-broths,  yelk  of raw
 egg  beat  up with a little brandy, or gruel,
 or arrow root, with brandy, should be given.
 If the tongue is very red at the tip,  and if
 the pit of the stomach is very tender, milk,
 with  or  without the addition  of  a little
 brandy,  should  be  substituted for  the
 above; fifteen drops of the solution of potash,
 or one or two tablespoonfuls of fluid mag-
 nesia or of lime-water, may be added to the
 milk with advantage.  In cases  of persistent
 sickness, effervescing draughts, and ice given
 in small fragments, frequently repeated, are
 often useful. The reception of nourishment
by the system is  of the highest  importance
in this disease: so much, indeed, is this the
case, that as long  as a man continues to take
food freely, he  is not likely to become  the
subject of delirium tremens.  The necessity 
D  E L
182
DE L
 fir the  continuance, in  reduced quantity, I
 during the treatment, of the stimulant which |
 has  produced the disease, is  evidenced  by |
 the fact, that many  cases of  delirium tre-
 mens are precipitated at least by the sudden
 withdrawal of the accustomed excitement,
 and  relieved  by its  renewal;  and  for  the
 same  reason  the radical  removal  of this
 fearful disease, or indeed  of  intemperance
 generally,  though it  can only be effected  by
 the abandonment of the pernicious  habit,
 must, in many cases,  be conducted with ex-
 treme  caution; otherwise dangerous or fatal
 consequence may result.  Undoubtedly, men
 of naturally  good nervous  power, whose
 stomachs still retain some of their  pristine
 tone, and can  receive and  digest  food  in
 tolerable quantity, and where  the constitu-
 tion has not been thoroughly sapped by in-
 temperance, may, and do with impunity and
 benefit abandon  at  once  their habits  of
 drinking, and  when this  can be done, it  is
 the safest and most certain plan ;  but many
 cannot do  this without risk,  and  must  go
 more  cautiously  to  work.   Where spirits
 have been consumed, let them be exchanged
 for wine or malt liquor, in  reduced  and re-
 ducing quantities. At the  same time, with
 all who are  endeavouring to break through
 the evil habits of intemperance, some inno-
 cent and rational excitement  ought  to  be
 substituted for the pernicious one.   Excite-
 ment  of mind or body of some kind must
 take  the place  of  that  which has been
 abandoned, if  the full benefit of the change
is to be derived.
  Many methods have been devised  for gra-
dually  weaning the  intemperate  from the
craved excitement. Perhaps one of the most
feasible is  that of commencing with a cer-
tain quantity of the  accustomed stimulant,
taking from it a measured proportion only,
every day,  and for   every measure  with-
drawn  substituting  an  equal  quantity  of
water.   The  plan is a good  one;  but   no
plan will succeed  without the firmest deter-
mination of the drinker to conquer the vice
 which is dragging him to ruin in this  world
 and the next.   If he  will make this  resolve,
 and pray to Him  who alone  can strengthen
and uphold man's feeble will, then  may  he
 hope  to  overcome.   Again it  is repeated,
the intemperate man, whose  constitutional
powers will enable him at once and  without
compromise to cast aside the vice,  has the
easiest task: but no  man should do so ex-
cept  by medical sanction, and the  further
advanced  in life,  and the  more confirmed
the habits of the abstainer, the more neces-
sary does the precaution become.  But  in
any case  in which a  person who has been
in  the  habit of taking alcoholio  stimuli,
abandons the custom, he should be  under
medical surveillance for a considerable time
after ; otherwise formidable depression of
some or all of the vital functions may  be the
result.
  The question of restraint in cases of deli-
rium tremens is one of much  importance;
at  times  it  becomes  absolutely necessary
to exercise it, for the  preservation both of
the  patient  and of those around    When
the necessity does arise, it must be put in
force with as much gentleness as may be
compatible with firm command.  The indi-
vidual suffering should  be  kept in  a  bed
where  there  is  room for  persons  to  be  on
each side, and all efforts at violence should
be restrained by perfectly adequate physical
power in the  attendants. It is not necessary
to keep the hands constantly upon the pa-
tient;  if  he  knows—and  he  is generally
conscious  enough for this—and feels that
he is mastered, he will remain quiet;  but if
by the temporary absence of an attendant,
he thinks  he  can overpower the others, he
again becomes  unruly.    This conscious-
ness of  hopeless effort on  the  part of the
patient is  in many cases the  most  powerful
means of restraint.  A strong webbing band,
made to cross over the bed about the middle,
and to buckle at one side, is often extremely
useful in  checking sudden  violence,  while
it ought to be  sufficiently loose to  prevent
any feeling of restraint, such as the  straight
waistcoat gives rise to, thereby irritating the
patient to a great degree, and inciting him
to ceaseless and exhausting  efforts to  get
free;  the latter should never be used except
under great necessity.  The question of per-
manent  restraint, where  repeated  attacks
of delirium tremens occur,  and where the
patient is continually in a condition verging
upon  insanity, is a very puzzling one,  in
consequence  of  there being  no  asylum
adapted for such cases.  The person when
at liberty will  drink,  and when he drinks
he is mad;  but when sober, or nearly so,
his  mind is not sufficiently affected  to class
him with the  insane.
  The difficulty of dealing with such  cases
is often  extreme, both to the family of the
patient and to the medical attendant.  There
may, it is true, be procured  a keeper  or
guardian,  but comparatively few can  incur
this expense, and it is but  an insufficient
safeguard  after  all.   The consequence  is,
that numbers of such  patients  are kept at
home, they cannot be  prevented indulging
their irresistible propensity lo intoxication,
and  so,  for a longer  or shorter time, they
are a source of danger and of terr >r to their 
DEL
183
DEB
 family,  and to every one around, and run
 hourly risk of terminating their own mise-
 rable existence by a more speedy description
 of suicide than  the one they are  following.
 It is  much to be regretted  that no  proper
 provision  is  made in  this country for the
 reception  of such cases, which cannot pro-
 perly be handed  over to  a lunatic asylum;
 for no sooner is the stimulant withheld,  or
 regulated, than  they  become restored  to
 sufficient intelligence, at least, to make them
 unfit inmates of the place.
   Refer to Alcohol—Intemperance, Sec.
   DELIVERY.—See Childbed.
   DEMULCENTS.—This name, as used  in
 medicine,  is applied to remedies which ex-
 ercise a soothing influence, more especially
 upon  the mucous membranes and upon the
 skin,  when these are from any cause  in a
 state  of irritation.   The demulcent  may
 be  applied either directly to the irritated
 and irritable surface, as in  the case of the
 stomach and bowels,  or indirectly, as in the
 case of irritation of the urinary passages,
 and of the bronchi or air-tubes.
   The principal demulcents are—
   Almonds (sweet.)
   Arrow-root.
   Carrageen moss.
   Eggs, in the form of emulsion.
   Gelatine and isinglass.
   Gum Arabic.
   Grains,  and their preparations: barley-
 water, gruel, &c.
   Lard.
   Linseed.
   Liquorice.
   Marsh-mallow.
   Oils.
   Sago.
   Salep.
   Spermaceti.
   Tragacanth gum.
   AVax.
   It cannot be  said  that any of the above
 substances act as medicines  in the  proper
 sense  of the  word; nevertheless, they con-
 stitute a class of remedies peculiarly valu-
 able for domestic  use.  They are perfectly
 safe, and certainly most beneficial;  at the
 same time, it is a necessary caution that
 the prolonged use of demulcent remedies is
 liable in  some persons to occasion a relaxed
 and  debilitated  condition  of  the  system.
 For further information respecting the indi-
 viduals of the class, the reader is referred to
 ihe separate articles.
  DENTIFRICE.—See Teeth.
  DENTITION.—See Teeth.
  DEOBSTRUENTS—Are medicines which
lave, or are supposed to have, the power of
 removing  unnatural  thickenings or forma-
 tions from any portions of the body.   Such
 medicines were  formerly  much more used
 and depended upon, particularly as external
 applications, than  they are now.   That is,
 there were many substances employed for a
 sort of mysterious deobstruent action, which
 probably possessed no such  action at all.
 Mercury,  iodine, codliver-oil, and friction
 are, however,  deobstruents to be  trusted,
 and are much employed as such in  the pre-
 sent day.
   DEPILATORY—Is an  application which
 removes the hair from the skin.  Pitch ap-
 plied>to the surface to be denuded, and then
 forcibly pulled off,  so as to bring  the hairs
 with it, was formerly used for this purpose,
 but has, deservedly,  with  other barbarous
 customs of another age, fallen into disuse.
 Preparations of  quicklime and of arsenic
 have also been used for the same  purpose.
 In the few cases,  such as some kinds of skin
 disease,  in which it may be thought neces-
 sary to detach the  hairs by the roots, they
 often come out easily, and the process is
 better effected  by  means of tweezers than
 by the wholesale,  painful, and it  may  be
 dangerous, though perhaps quicker methods
 above mentioned.
   DERBYSHIRE  NECK.—See Broncho-
 cele.
   DERIVATIVE.—The term,  as   used  in
 medicine, signifies  whatever tends  to with-
 draw diseased action from any part of the
 body, by means of action—not necessarily
 diseased—set up in some other part.   Thus,
 bleeding from the lungs may be stopped  by
 the derivative action exerted  by the flow of
 blood  from a vein opened in the  arm,  or
 inflammation affecting the eyes may be re-
 lieved  by a blister, or seton, at the back of
 the neck.
   Derivatives may be either natural or arti-
 ficial.   The principal natural derivatives
 are either the  discharge  of  blood or the
 increase of natural  secretions;  thus, bleed-
 ing from the nose may act derivatively,  as
 regards the brain, or the bleeding from piles
 as regards the liver, or parts within the
 abdomen;  or an  attack  of diarrhoea  may
 also act in the same way.   Boils, cutaneous
 eruptions, ulcers, &c. also act as derivatives,
 but in many cases approach the class of coun-
 ter-irritants.  The great principle involved in
 the existence of natural derivatives is, that
 they must be the effect of some cause, and,
 in many cases, of  some internal disorder,
 which has  thus formed for itself a safety-
valve, through less important  channels, for
 the protection of more important  organs.
Much  caution  is  requisite  in  stopping,  or 
DE8
184
D I  A
j "rmitti ig to be stopped, incautiously and
blindly, what is to be regarded as a natural
derivative.  The  symptom  itself should be
regarded only as  the outward sign  of some-
thing which  requires  rectification within,
and  the  efforts  should be  directed  to the
discovery of this  inward acting  cause, and
to  its removal when discovered;  this being
done, the external symptom will possibly dis-
appear. But even should it not do so quickly,
in  consequence  of  having  established  an
habitual  local  tendency, it may  be much
more safely attended to as a local disease,
after the constitution has  been  relieved.
Not  only, however, must the constitution
be relieved at  the time, but if the natural
derivative is done away with,  it  must be
kept, if possible, f^ee from the primary dis-
order ; otherwise, should  this  recur,  and
should the constitution fail  to re-establish
the natural derivation in time,  serious or
fatal  consequences rday  be the  result.   It
not unfrequently happens that, some months
after an  old  ulcer  has  been   healed,  or
cutaneous eruption removed, that  the indi-
vidual is seized with some dangerous inter-
nal malady, perhaps apoplexy, which might
have  been prevented, if, after the natural
drain had been closed, strict attention had
been  paid to the regulation of the general
health.  This is a cogent reason why persons
in  whom  some  natural  derivative action,
Buch  as  any  of  those  named  above,  has
stopped,  or been stopped,  should pay the
greatest  attention to diet generally, to the
regulation of  the bowels, to the functions
of the skin by cleanliness,  of the  lungs by
fresh pure air, and of the system generally
by exercise, and why, on the slightest symp-
toms  of  indisposition,  they should subject
themselves to medical  treatment.  A  still
more cogent reason is it why such persons
should beware of tampering with  themselves
with quack ointments,lotions, and outward ap-
pliances, which, if they do cure sores, as they
profess,  without  constitutional  treatment,
must do  mischief, for they would merely
obliterate the outward symptom  of disease,
and  send the latter to attack perhaps some
vital organ.
  Artificial  derivatives, such as blood-let-
ting, blisters,  &c. may be referred to under
their proper heads.
  DESQUAMATION—Is the separation, in
scales or flakes,  of the  outward  or scarf-
skin.  Strictly  speaking, desquamation  is
constantly going on  on the surface of the
body, and scales or  scurf  are  constantly
being separated in small and almost insen-
sible quantity ; but after some inflammatory
diseases, particularly those  of an eruptive
| character, such as scarlet fever, measles, &o
 a much more copious desquamation takes
l place, and the scarf-skin sepnrates in large
 pieces.  The same  thing occurs after irri-
 tants, such as mustard-plasters, blisters, &c.
 have been applied to  the skin.  Desquama-
 tion, whether natural  or the consequence of
 disease, is always  facilitated by the use of
 the tepid or warm bath.
   Refer to Skin.
   DIABETES—Is . a  disease in which the
 urine is discharged  in unusually large, often
 in enormous quantity, and for the most part
 contains a large amount of saccharine  mat-
 ter.   The  serious  nature  of  the  affection
 renders it  one  of  those  which should  be
 trusted  for treatment only to medical hands.
 The same reason renders it important that
 its  first symptoms  should be  known, that
 they may not  be neglected.  It may creep
 on  a person  insidiously,  or  be  suddenly
 developed.   The first and  most prominent
 symptom which  usually awakens  attention,
 is the frequent call to pass urine abundantly,
 at the same  time the  thirst is extreme and
 the appetite voracious.   As Dr. Watson re-
 marks, some persons, especially among the
 lower orders, are apt to think  that as they
 eat and drink so well, there cannot be much
 the matter, and are thus lulled  into security
 while a fatal  disease is  undermining  their
 constitution.   In addition  to the  symptoms
 already mentioned, the mouth is  dry, and
 the tongue  clammy and sticky, often very
 red;  there  is flatulence  and  indigestion,
 and the bowels are  generally constipated.
 Emaciation and  general debility also occur;
 pain and weakness  in the loins, and feeble-
 ness of the  limbs.  The leading  symptom,
 however, is  the discharge of urine, which
 has  been  authentically  known to  exceed
 forty  pints in the  twenty-four hours.   At
 the commencement  of the disease  the urine
 may still retain the urinous properties  of
 the diluted secretion; but this passes into
 the saccharine condition, and sugar, which
 may be obtained in a crystalline state, is
 largely  discharged.   If yeast  be  added to
 the urine, it ferments, and alcohol is formed,
 the sugar partaking more  of the character
 of grape, or fermentable sugar, than of the
 cane.  Diabetes is often  accompanied  by
 other diseases, especially by pulmonary con-
 sumption.
   A disease of the  nature of diabetes can
 never with  propriety be treated domestic-
 ally, and an individual who  may  detect in
 himself the occurrence of the symptoms de-
 tailed above, should at once seek competent
 medical assistance.   The dietetic treatment
[ of diabetes is probably of more importance 
D I A                 185                D I A
 than  the  medicinal; the chief precaution
 being  the avoidance  of whatever—either
 sugar  of  any  kind, or vegetable starchy
 matter—is capable of being converted into
 grape or fermentable sugar.  This of course
 involves  the  prohibition  of bread  made
 from  ordinary flour, which  contains all the
 starchy matter  of the  grain.  This  priva-
 tion is always much felt and complained  of,
 and various substitutes have been proposed.
 The following,  by Dr. Percy,  is  probably
 the best:—" Take the woody matter of six-
 teen pounds of potatoes, washed free from
 starch ; three-quarters of a pound of mutton
 suet, half a pound of fresh butter, twelve
 eggs,  half an  ounce of carbonate of soda,
 and two ounces of dilute hydrochloric acid.
 This quantity to be divided into eight cakes,
 and baked  in a  quick oven until nicely
 browned.
    " It is,  as must be obvious, an expensive
 article,  but with many diabetic patients this
 will not be an object of consideration.   It
 is  somewhat improved  in  taste  by  being
 slightly toasted."
   Bullock's  semola, which  consists  nearly
 entirely of wheat gluten, would  form a nu-
 tritious  substitute  for the arrow-root and
 sago mucilages.   Animal diet is principally
 to  be  depended upon for nourishment, and
 some of the green  garden vegetables, such
 as  spinach, are permitted.  Distilled water,
 or  boiled water, but not toast-water, may  be
 used for drink.   Dr. Prout, in some cases,
 found  porter beneficial; and, in France,
 claret has  been given with advantage.
   The tepid bath, to induce perspiration, is
 often of service.  As regards medicine, its
 prescription must  be left  to the medical
 man.  Persons  who suffer  from  any sus-
 pected tendency to diabetes cannot attend
 too strictly to  the state of the  digestive
 organs.  Wet  feet  must be  particularly
 avoided, and flannel should be worn next the
 skin ;  while all sources of debility, sexual
 excesses in particular, must be most strictly
 eschewed.
  Refer  to Fermentation—Sugar—Urine, Sfc.
  DIACHYLON  PLASTER—Is  the  com-
 monly  used  adhesive  plaster  spread  on
 calico.   It was formerly prepared by hand,
 but, as now executed by machinery, is  a
 beautifully uniform  preparation ; and, not-
 withstanding many  substitutes,  is  still the
 most firmly adhering and  most to be de-
 pended  upon of the plasters for  retaining
 the edges of wounds in apposition.  People
 rn  general  have a  very  false idea of the
nature  and uses  of  this  and of other  plas-
ters.  They attribute to them some healing
power  over the wound, whereas their only |
       Q2
 use is, by keeping the edges of the wound in
 perfect apposition, to permit them to heal
 by the natural  power with which the living
 tissues are endowed.   This idea of the heal-
 ing properties of diachylon, however, often
 leads to mischief, from inducing persons to
 apply the plaster to  abrasions  and sores,
 which it  seriously  irritates, causing, with
 some, much increase of  inflammation and
 troublesome  ulceration.   The  practice  is
 most hurtful, and should never be followed.
 This idea of the healing  powers of diachy-
 lon has, also, been probably increased by
 its  known  use by surgeons  in  the treat-
 ment of the healing  of ulcers.   In this
 case,  when used as a strapping round the
 leg, and over the  sore,  the latter  quickly
 gets well,  and it would seem  under the
 influence of the diachylon plaster, which,
 however, in  this  case, is  used  only  as a
 convenient mechanical  agent, which will
 closely envelop  the  limb, and  give  support
 to the weakened vessels and infiltrated tis-
 sues  which  have  encouraged  and which
 surround  the sore.   The  diachylon,  it  is
 true,  passes over the ulcer, but  it is  pre-
 vented exerting any effect upon its  surface
 by the intervening discharge.   Sometimes,
 even when  applied to the sound  skin, dia-
 chylon is found  too irritating, in which case
 soap or lead  plaster  must be substituted.
 If diachylon plaster is kept folded up in too
 warm a situation, it adheres together and
 becomes useless.
   Refer to Plasters.
   DIAGNOSIS—Is a term frequently used in
 medicine, which may be applied either to the
 "art of discovering the nature of diseases,
 and of distinguishing them from each other,"
 or to the conclusion arrived at by the exercise
 of the art.  In other words, when  a medical
 man, after investigating a disease, expresses
 his opinion respecting its nature, it is called
 his "diagnosis" of the disease.  It must be
 evident to all  how much,  indeed how every
 thing  depends upon a correct diagnosis of
 the  existing disorder;  for, unless correct-
 ness  on this  point be  attained,  treatment
 can  scarcely  be of  much service,  and if
 active, may be worse  than no treatment at
 all.  It is true that there are certain gene-
 ral  symptoms  of disease which may bo
 treated, perhaps with benefit, in a general
 sort of way, without the medical attendant
 having any definite idea of the existing de-
 rangement.  Such is  the case with  most
 febrile diseases, and  many others;  and as
 the  natural powers do much  toward the
removal  of the malady, and promote resto-
ration  to health, a practitioner may practise
in this loose sort of way with apparent sue- 
D  I A
180
D 1  A
 cess: he treats p-ominent symptoms, attends
 to diet. &c. and  his patients get well.   But
 this is  not the true practice  of  medicine:
 it is  very different from the  active, well-
 directed,  and  energetic  measures  of  the
 man who, having both  the  knowledge  nnd
 the will to tru'iy investigate  his case,  and
 having  done so, strikes home at once.   The
 man who  does  not  or cannot make a cor-
 rect diagnosis is working in the dark ;  nnd
 if he uses edged tools,  so much  the worse
 for his patients, whose safety must in some
 measure depend upon the treatment of their
 cases being conducted upon the same inert
 plan  as their investigation.   At the same
 time, if there be any efficiency in  medical
 treatment at all—and no man who knows
 his profession  and  practises  it conscien-
 tiously can doubt it—how much passive evil
 must result from insufficient  and slovenly
 investigation of disease ;  how much must be
 and is  every day  overlooked, which  ought
 not to be so; how often are germs  of fatal
 disease  undetected, which ought  to  be de-
 tected, until  they have  ripened into active
 growth  that is not to be repressed!   One or
 two cases will more forcibly  illustrate  the
 difference between  a  loose  and  ill-defined
 treatment of disease,  and  that which is
 the result of accurate diagnosis.  A child
 is taken ill, becomes feverish,  the breathing
 quickened, and there is frequent  cough,
 along with other symptoms, indicating in a
 general way  inflammatory affection  of the
 lungs;  and so far, perhaps, the diagnosis is
 too plain  to  be  overlooked,  even by a very
 cursory examination;  and  tartar  emetic,
 mercurials, &c. are remedies  so  generally
 useful in such cases, that they will be pre-
 scribed  with  probable success, and it may
 be that  the little patient will get well under
 their use;—but  it may not so happen—the
 disease  evidently does not yield,  the fever-
ish condition, the quick breathing, and  the
 cough, all show that it is still active.   It is
 evident that  abstraction of  blood is called
for, but the child will not bear it from the
 arm, and it must be effected  by leeches—
 where ?—of course  on  the chest.  But on
what  part of the chest ?  Here comes  the
point of diagnosis.  The careless or slovenly
practitioner will be content with the general
indication of the forepart of the chest,  un-
less, indeed,  there  is complaint  of  pain—
which may mislead as well  as lead—to di-
rect his aim elsewhere; and  the chances are
that blood is taken  away,  comparatively
little good is  effected, and the  child, not the
disease, is weakened.  The error may be a
fatal one, which a correct diagnosis would
have prevented.  It may be that the ante-
! rior  portions of  the  lungs are  free  from
 disease, which is  confined  to the posterior
 and lower portion of one or both.  If a cor-
 rect  diagnosis has been made, this  should
 be known,  the practitioner, by the  pcrcus-
j sion of his fingers and the application of his
 ear to the chest, will  probably be able to
 lay his hand upon the skin over the seat of
 disease, and to mark out with confidence the
 limits within which blood maybe abstracted
 with the greatest  certainty of benefit.
   Again, a patient suffers from indigestion,
 from weakness, pain in  the back, and gene-
 ral symptoms of bad health ; the spirits are
 depressed ; a general diagnosis is perhaps
 made, and  the round gone of various tonic
 remedies, alterative remedies, &c.;  but the
 urine,  if thought of at all, is passed  over
 with a cursory glance: to the unassisted
 eye it looks all right, and perhaps is  pro-
 claimed so; but  place  a  drop  of it under
 the invaluable microscope, and  it is found
 laden  with crystals  of  oxalic, or phos-
 phatic, or  some other deposite.  The  cor-
 rect  method  of  diagnosis  affords at  once
 the key to the main points of the disorder,
 and  probably  to  its successful  treatment.
 which might have been groped after in vain,
 or if stumbled upon by  accident, and found
 successful,  the success  would give but little
 clue  in the next  case of the  kind which
 might occur;  or it may be that false ideas of
 the nature of the disease, a false diagnosis
 having been formed, the success itself will
 constitute an abundant source  of evil and
 error, not only to the individual practitioner,
 but to others.   The fact being  a false  one,
 leads to false conclusions.   The above cases
 —which might  be multiplied to any extent
 —have been brought forward to show  how
 much success in treatment must  depend
 upon the correctness of the diagnosis which
 the attendant practitioner forms of the dis-
 ease  of his patient.  They have also  been
 brought forward  to show that this correct
 diagnosis can only be  attained by time and
 patient  attention and  investigation,  even
 by the greatest in science.   In many cases,
 no extent of knowledge will enable a phy-
 sician  to  say what portion of a lung  is
 affected, unless his sense of hearing conveys
 the exact information to his mind in a  phy-
 sical examination.  A physician may suspect
 from symptoms that his patient  is suffering
 from disease which tends to the formation
 of oxalic gravel,  but  he cannot positively
 assure either himself or  others that  such
 is the case, unless he actually"see with his
 eye—through the microscope—the peculiar
 crystal  which marks  the disease.  From
 what has now been said, it must lie evident 
DI A
187
DI A
 that the  highest attainments  in  medical
 knowledge will not compensate for a hurried
 examination of cases :  there must be time.
 People forget this; attracted by some great
 name, and in  all probability a really  and
 truly great one, they crowd  the  reception-
 rooms, and are passed  in quick  succession
 through the consulting-room  of the fashion-
 able practitioner, who  cannot give  time to
 the  full  investigation of the cases which
 come before him.  Few, perhaps, attain the
 meed of  popularity  without having  well
 deserved it, or retain it without deserving
 to retain it by their progressive attainments;
 but, withal, they are not  gifted with intui-
 tion, and if  the public  will compel  them to
 see ten cases in the time they ought to take
 to two or three, the public must suffer;  and
 they do suffer, for many a case overlooked
 is unravelled  by the patient investigation
 of some less occupied practitioner.  It must
 not, however,  be supposed  that  it  is  here
 insinuated  that time and  patience alone
 are sufficient  for the proper investigation
 of disease in the living body:  the  man of
 experience, and who to his experience  has
 added accurate oservation, will undoubted-
 ly seize more quickly than one less  inform-
 ed the most  distinctive features of the case
 before him ; even at a single glance, in some
 cases, he may form  a  conclusion—and it
 may, probably, be a correct one—in his  own
 mind respecting the  nature of  a  case,  and
 this conclusion will lead him at once to  use
 the means of diagnosis  best adapted quick-
 ly and surely to satisfy his mind.  But even
 with all this, with abundant knowledge and
 ready tact, some  time  is  required  in all
 cases—often much more than is given by
 some in the full tide of  practice.  Nothing
 will compensate for a hasty  and  imperfect
 diagnosis, and evils innumerable spring from
 it.  On  this head, Dr. Watson, one   of  the
 ablest physicians  of the day,  remarks,  "It
 is mainly to the uncertainty in the diagnos-
 tic  part of medicine that we  must attri-
 bute the uncertainty  and variation both of
 doctrine and practice which  have brought
 so much suspicion and reproach  and ridi-
 cule upon  the  science we profess."   The
 case  of the fashionable London physician
 has been alluded to, overwhelmed with fees,
 and with  work, which he  cannot, in many
 cases, perfectly fulfil; but there  are  others
 in our profession  overwhelmed  with work,
 with the same effect, but unfortunately with-
out the fees, and without their patients hav-
ing a choice of avoiding the evil.   These
others are the union surgeons,  who are hired
at a miserable pittance in  many  instances
to attend an unlimited number of poor.  Un-
 able to  maintain an assistant  out of their
 wretched salaries, they cannot, within  the
 bounds  of physical possibility, if they  are
 to get through their day's work at all, give
 time to investigate their cases properly  : it
 needs not to point out how this must con-
 vert a miserable efionomy into extravagant
 and unnecessary expenditure.   There is yet,
 however, another essential—in  many cases
 at  least—either to facilitate or enable  the
 formation of an  accurate  opinion of  a case
 of  disease,—and this  is, perfect candour on
 the  part of  the patient  toivard  the medical
 man consulted;  and not unly candour, but
 thoughtful  consideration  and communica-
 tion of every circumstance which is, or may
 appear  to  be,  connected with  the illness.
 Whether it be  hereditary predisposition or
 personal transgression, nothing should  be
 concealed.  Females often permit prudery
 or  mistaken feeling to interfere with their
 communications  with a  medical  adviser.
 But one thing can be said upon this matter:
 if  they  cannot  confide  in  him on   these
 points, he is unworthy of their confidence
 at all; but the same  resolution which  in-
 duces  the  consultation, ought at the same
 time to  give this  resolve, to leave  nothing
 untold connected with the state of health.
  So much has been said  with regard  to the
 necessity for a well-defined diagnosis, that
 it may lead some to suppose  that this can
 be made out in all cases, which is not  possi-
 ble.   Many diseases  are, it is true, so dis-
 tinctively marked, that there is no difficulty
 in assigning them their true name and cha-
 racter; but there are many diseased condi-
 tions of  the  human frame, which will not
 fall  under any classification, and which baf-
 fle  the best-directed efforts of  our present
 knowledge for  their elucidation.   In this
 case, the diagnosis must  be what has been
 called  "empirical;" it is imperfect, because
 the science of medicine is yet an imperfect
 one, and if it do not inform us  of the real
 nature of the disease, it must, taken in con-
 nection with experience, be used as a  guide
 to treatment.  These observations are made,
 that too  much  may not be expected from
 medical  men by the public,  and to  show,
 that because a medical man will not or can-
 not give a defined diagnosis of a  disease,  he
 is not necessarily  ignorant  of  its  proper,
 or. at all events, best-ascertained mode  of
 treatment.    Further,  when it is reflected
 how strict  an investigation is  required  at
the  hands of those whose lives are and have
been devoted to the subject, it ought to  make
unprofessional  persons doubly cautious  in
dealing with disease.   To quote from the
 "prefatory address" to this work,—"AVhen 
D  1 A                188                D 1 A
 It is remembered how the nicest judgment
 that observation  and experience can form,
 the most patient  attention, aided by prac-
 tised ear and eye, by microscope nnd test-
 tube, are frequently necessary, to enable
 the conscientious  physician to judge of his
 case before he can apply the remedy, it is
 evident how  great  must  be the responsi-
 bility of those who, in rashness or ignorance,
 venture upon the treatment of serious  dis-
 ease, either in their own persons  or in those
 of others." This is not meant as a discour-
 agement, but as a caution; for the real  ob-
 ject of a work like the present can only
 be fulfilled, when  the good it offers is safely
 and judiciously employed.
   Lastly,  either  our physicians,  most of
 them men of Christian character and of high
 honour, make a  parade of their diagnosis
 of disease, and devote their lives of labour
 to deceive  the public,  or are  themselves
 deceived, or quackery and quack medicine
 must be impudent lies and wicked deceits.
 The individual who purchases a quack nos-
 trum can either  have no idea of the  dis-
 ease—if he has one—under which he is suf-
 fering, or only the crude idea—diagnosis—
 of his own judgment; and upon the faith of
 this, he prescribes for himself the unknown
 compound  of—to him  at least—an  un-
 known individual,  on  the  faith  of some
 lying advertisement.  Is  the diagnosis of
 the physician  a delusion  and a snare, or
 does the patronizer  of  the  quack remedy
 exercise the same judgment in  the treat-
 ment of his body  that he  would in  his
 worldly business ?  To our readers we leave
 the answer.
   Refer to Advice, Medical—Disease, §c.
   DIAPHORETICS—Are agents used in  the
 practice of medicine which  " determine to
 the skin" or produce perspiration or sweat-
 ing.   When it is  considered how extensive
 the surface of the skin is, how largely it is
 supplied  with  blood, and  how  abundantly
.with  means  for  exhaling  moisture,  (see
 Skin,) it must be  evident  how powerful an
 influence its excitation or depression must
 exert upon the condition  and functions of
 the body.   This influence is  so undoubted,
 and  so  marked, that in  all ages, and in
 almost all  nations, even the most uncivil-
 ized, the cure by  promoting  the flow of  the
 sweat  has  been a common  and favourite
 mode of  treatment.  Among the tribes of
 North American Indians it is employed, as
 described by Mr. Catlin, both as a curative
 and as a sanitary  agent.  The most general
 mode of exciting  perspiration, particularly
 among the  more uncivilized portions of
 mankind, is by means of hot vapour or  the
vapour-bath ;  but they also  employ abun-
dantly decoctions of  various  herbs as as
sistants to the process.
  The effect which  the constant  insensible
perspiration from the body exerts in dimi-
nishing its temperature must,  of course,  be
augmented as the excretion  nnd  evapora-
tion  of fluid from the surface is increased,
furnishing an active agent for lowering the
temperature of the body in states of fever.
Every one  knows how  much  and distress-
ingly the dry  heat of  the skin is felt, and
how grateful the sensation of moisture upon
the surface.   In  addition to  the  reduction
of temperature, however, the action of dia-
phoretics  must tend  powerfully  to relieve
congestion  or collection of blood, or  in-
flammatory action in internal  organs; and,
indeed, the  fact  is every day manifest  in
the  treatment of disease,  not as  regards
general perspiration  only, but also as a
consequence of the  effect of local agents—
such ay the bran-poultice so often mentioned
in this work—which  produce  sweating  of
the part to  which they are applied.  The
most  useful diaphoretics for  domestic pur-
poses are—
  Ammonia—In the form of carbonate, when
stimulation is  required at  the same> time,
and in the form  of  acetate  or "spirit  of
mindererus," which is one of our most cer-
tain diaphoretics.
  Antimony—In  the form of  the tartrate
of antimony, in small  doses, wh*n  fever is
excessive, and the true James's powder,
which is the safest form for children.
  Baths—Tepid,  warm, or vapour,  or used
as in  hydropathic establishments, by means
of the wet sheet and blankets.
  Ipecacuanha—In any of its combinations.
  Opium—Particularly  in its  combination
with ipecacuanha, named Dover's powder.
  To  the above may be added sweet  spirit
of nitre, gin, and diluent drinks of all kinds,
sometimes cold,  but  generally warm, and
exercise.   There  are  many   other  agents
employed in medicine as diaphoretics, but
they are not likely to be used  domestically,
unless, indeed, we except the dulcamara,  or
bitter-sweet, also  called woody night-shade,
which, being a common native plant, might
be used in the absence of other  remedies
of the class.—See Dulcamara.  For infor-
mation  respecting  the other diaphoretics
mentioned, the reader is referred  to their
respective articles.
  AVhen perspiration is thought to be desir-
able, it is immaterial what agent is selected
to produce it; thus,  if there  is very hot,
dry skin, and  quick, hard pulse, antimony
will  generally be most useful;  if  there is 
DI A
189
DI  A
depression, spirit of mindererus, sweet spirit
of nitre, or carbonate of ammonia will  be
most suitable ;  and with any of these ipeca-
cuanha or  opium  may  be  combined.   To
form one of the  most useful and certain  siveat-
ing draughts, take of spirit of mindererus
half an ounce, of antimonial or ipecacuanha-
wine fifteen to  thirty drops, and water four
tablespoonfuls,  adding  or  not,  as  circum-
stances dictate, ten drops  of laudanum  or
a teaspoonful of paregoric.
  As  there is  always a degree  of uncer-
tainty, especially  in  some  constitutions, as
to the  action of diaphoretic medicines, when
they are taken every means should be used
to assist  and  promote  the desired  effect.
Confinement to bed is absolutely necessary,
and before retiring there it is  always well
to  put the feet in hot "water for  twenty
minutes.   The diaphoretic medicine should
be  used on  getting into bed, and nothing
more  for three-quarters of an  hour, when
the warm diluent drinks  are to be com-
menced with, and  may after that be taken
very freely, and continued  as  long as the
sweating process  is kept up.   If the warm
diluent drinks  are taken too soon after the
medicine, sickness will probably ensue, and
so  the object in view be defeated.  Purga-
tive medicine, which  is likely to act during
the operation of  a diaphoretic,  should  be
avoided,  for  the   disturbance  occasioned
thereby will not only effectually counteract
the desired process, but may, by checking
it,  aggravate the disease it was intended to
benefit.   Some  persons  promote the  action
of sweating by  cold instead of warm drinks.
In cases of much febrile heat  and excite-
ment  they may be useful; but, as a general
rule, it is the safer plan to keep to the warm
fluid.   AVhen  sweating is  produced,  the
person should  always have flannel next  the
 skin,  never linen;  and of course there must
be sufficient covering to maintain the requi-
site temperature.  If the person is labouring
under infectious disease, additional care is,
 of course, requisite in the after disposal and
 purification of the woollen clothing.   AVhen
it is thought desirable to check  the  sweat-
 ing process, every source  of chill must be
 avoided,  the skin is  to be dried with warm
 towels, and fresh clothing, previously slight-
ly warmed, put on, the coverings lightened,
 and the hands and arms gradually exposed.
 There is sometimes  great  difficulty  in pro-
ducing perspiration in certain constitutions.
When such is the  case, the medicines should
be given, and  other  means resorted to, to-
 ward  four o'clock in the  morning, that is,
 just  previous  to the time in the four-and-
 twenty  hours,  when the  body,  eitlier in
health ©r disease, appears  most liable to
perspiration.
  Refer to Skin.
  DIAPHRAGM, or Midriff—Is thepartlj
muscular and partly  tendinous  and mem-
braneous partition, which extends between
the chest and the abdomen, (fig. Iii.,) sepa-
                  Fig. Iii.
rating the heart and lungs on one side from
the liver and stomach  on the  other.  The
diaphragm assists materially in the process of
respiration, descending and pressing down-
ward upon the contents  of the abdominal
cavity each time a breath  is drawn.  This is
more  particularly  seen in  some  cases  of
chest-disease, when the respiration becomes
almost entirely dependent upon this action
of  the  diaphragm.  From this  it must  be
evident to  all how important it is  that this
muscle should have free play, and how much
its essential  movements  must be impeded
by any thing, such  as tight  lacing, which
presses the  contents  of  the  abdomen up-
ward.
   Refer to Lungs—Respiration, Sfc.
   DIARRHOEA—Consists in  frequent  and
| urgent calls  to  relieve the  bowels,  the
evacuations  being  for  the most part more
liquid than usual.   The causes of diarrhoea
are very  nhmerous, but  may, perhaps, be
classed under three heads—nervous causes,
causes which act upon the surface of  the
body, and irritating causes which  act  di-
rectly upon   the bowels  themselves.  Per-
haps the  simplest form of diarihcea is that
 arising from nervous  causes, such  as some
I experience on the  approach of thunder, or
j from  electrical  disturbance  generally, or 
DI  A
190
DI  A
such as arises from  emotions of the mind,
as,  for  example,  fear.  In these cases the
bowels would appear to be simply "relax-
ed," the evacnations being healthy, with ex-
ception of being thinner,  from  their more
rapid  passage  through  the  bowels.   The
simple salutary diarrhoea in teething  chil-
dren is an example of the same kind.
  Influences  affecting the  surface of the
body, particularly cold, and especially cold
feet, often produce  diarrhoea.  Cold nights
succeeding hot days are often said to occa-
sion the disease ;  but it is  also remarkable,
that diarrhoea is apt to occur at the breaking
up of a long frost—indeed to be epidemic,
that is, of general prevalence.
  By far the most frequent  cause of diar-
rhoea, however, is irritation  in  the bowels
themselves, caused  either by undigested or
indigestible  food, by acid,  by acrid, morbid
bile, or by the deficiency of that fluid per-
mitting the digested food to become unduly
changed.  It may also be  caused by an ac-
cumulation of hardened feculent masses, or,
as  they are called  in medical  language,
"scybalas;"  or by  the  lodgment  of  such
matters as the skins of old peas or beans, or
of raisins, in the folds of  the large bowel:
the  above  are  frequent causes of teasing
diarrhoea in  children.   Lastly,  diarrhoea
may be dependent   upon disease of  the
bowels  themselves,  such  as affection  of
their minute  glands, when  it  constitutes
dysentery, or ulceration of the  glands  and
of the lining membrane, such as  occurs in
fever and consumption.
  It must be remembered, however, that to
some persons an habitually relaxed condition
of the bowels is natural, and at the same time
essential for health, and that to check it  is
dangerous.   It is evident,  that in  a disease
depending upon so many and various causes,
a due discrimination of these is requisite for
proper treatment.   It must not,  either, be
lost sight of, that diarrhoea is in many cases
salutary, an effort of nature to free the con-
stitution from  some  morbid matter which,
if retained, would produce disorder or dis-
ease.   On this account, the simpler forms
of  diarrhoea are better left  to right  them-
selves,  so long as they keep within moderate
bounds.  This caution is  particularly  to  be
observed with regard to that  which occurs in the
teething of children,  which, when moderate,
is a safeguard ;  but when  it becomes so fre-
quent that  the child is evidently  weakened
by  it,  and especially if the evacuatious ap-
pear to be losing  their feculent  character
and become like  shreds of skin, or streaked
with blood—in such cases, a warm bath for
six or eight minutes, of the temperature 02°,
should be used for two or three evenings in
succession;  isinglass or gelatine  given ^ in
the milk-food, and  the  castor-oil  emulsion
with  yelk  of  egg  (see  Castor-Oil) given
three or four times a day, each dose con-
taining from  a  quarter to half a drop of
laudanum.  Of  course  medical  assistance
being  procured if  the  complaint  is   not
quickly moderated,  for checked entirely it
should not be.
  In diarrhoea resulting from exposure  to
cold, the best plan of treatment is to mode-
rately  re-excite the skin according  to  the
system recommended in  the article "Dia-
phoretics," nnd also, if requisite, to adminis-
ter the remedies prescribed  for continued
diarrhoea generally.
  When  diarrhoea, is caused by  irritating
matters in the bowels, one thing is evident-
it cannot be  properly  relieved unless  the
bowels are freed  from the irritant matters.
It may, it is true, be stopped under these cir-
cumstances, but it will  recur, unless  indeed
the irritating substance has been removed by
the purging, previous to the use of the astrin-
gent medicine, and  the continuance  of  the
diarrhoea is merely the consequence of  the
previous irritation.   In  many cases in which
the diarrhoea is owing to irritant matters in
the bowels, particularly to acrid bile, all that
is requisite is to diminish  the acridity by
means of demulcent drinks  largely used, to
which, if there is acid  in  the  stomach,
a little carbonate of soda  is  to be  added.
In  other cases,  when  the  action  of  the
bowels is constant, painful, and exhausting,
it is absolutely  necessary to check these
symptoms in  the first place, and to soothe
the bowels, before means are resorted to for
freeing them from  the  irritant cause.   For
the former purpose, the common chalk-mix-
ture, in three tablespoonful doses, with  the
addition of five drops of laudanum to each,
may be given at short intervals till  the  dis-
ease is checked;  or the compound  chalk-
powder—dose  thirty to  sixty grains—and
the  same powder,  with  opium—dose  five
to  twenty  grains—are both useful.   Or
aromatic confection may be  given in half-
drachm  doses in  water,  with or  without
laudanum.  If the active diarrhoea does not,
from its comparative mildness, require these
remedies at first, or when  it is sufficiently
moderated, the bowels should be thoroughly
cleared  out with  a tablespoonful  dose of
castor-oil, to which ten drops of laudanum
have  been  added;  this will  probably clear
away  the irritating matters, if they consist
of indigestible  substances,  hard  feculenl
| matter, or the like.   AVhen cnstor-oil cannot
be,  or is not taken, the best substitute ia 
DI A
191
DIG
 twenty grains of rhubarb and fifteen of cal-
 cined magnesia, with some aromatic,  such
 as half a teaspoonful of  sal-volatile,  or  a
 teaspoonful of tincture  of  rhubarb, and, if
 there is much pain, five to  ten drops of lau-
 danum, the dose being repeated, if requisite.
 After the action  of  the opening medicine,
 one or two doses of astringent may again be
 required, as the bowels  are apt  to keep up
 acting simply  ftom  irritability.  Medical
 men sometimes give  more active purgatives
 to clear away irritant matter; but the prac-
 tice is not safe in the hands of the non-pro-
 fessional.
   When  diarrhoea has  been permitted to
 pass into the stage of irritation,  when there
 is tendency to fever, the belly tender, the
 tongue red, and the motions resemble shreds
 of skin, or pieces of jelly, and are mixed
 with blood, the case is of that serious nature
 that medical assistance should  at once be
 obtained, if it has not  been so before.  In
 the mean time, the  emulsion of castor-oil
 with yelk of egg will  be found the safest and
 most effectual medicine; two tablespoonfuls,
 with five drops of laudanum, being  given
 every four hours,  and starch and laudanum
 clysters, the  diet being as unirritating as
 possible, and containing abundance of gela-
 tine.  A most excellent drink in these cases is
 rice-water, in each pint of which from a quar-
 ter to a whole ounce of gelatine or isinglass is
 dissolved, with a piece of toasted bread in-
 troduced to flavour it, or a  little  cinnamon.
   In the more severe forms of diarrhoea,
 such  as  that connected with consumption
 or fever, or when  fever  is present, medical
 attendance should  alone be trusted to, but
 when unattainable, the disorder must be
 treated according  to  such  of the methods
 above detailed as may appear most suitable.
 In all probability the soothing and astringent
 plan, such as chalk with opium, will answer
 best.  The author has found  Bismuth of much
 service in some of these  cases.  Creasote
 has  been recommended  in cases  of intract-
 able diarrhoea.  In case  of much  tenderness
 of the bowels, a few leeches might be used,
 but  pain  generally should  be treated with
 the  hot bran-poultice.  The use of diluted
 sulphuric acid  in frequently repeated doses
 has lately been highly recommended in the
 treatment of diarrhoea.
   Diarrhoea may occur as a chronic, or long-
 continued affection, lasting for months or
years;  but  these  cases  depend  on  such a
variety of causes and influences, and require
so much care in treatment, that they can only
be advantageously managed by  a medical
adviser, and ought as soon as possible to be
put under the care of me.   In  these  and
 in all  cases of bowel complaint, diet exerts
 great  influence;  generally speaking, the
 preparations of milk and of the grains are
 most  suitable,  such as  arrow-root,  sago,
 tapioca, rice,  &c.   AVhen broth  is  given,
 it should be  in small  quantity and of to-
 lerable strength ; it is improved by the addi-
 tion of gelatine and of well-boiled rice.   Alum
 whey is sometimes found useful in these cases.
   Refer to Alimentary Canal—Bile, and Bilia-
 ry Disorder—Digestion,  Sfc. Sfc.
   DIASTASE—According to  Liebig, is  a
 portion of vegetable gluten in a state of de-
 composition, which  possesses the power of
 converting starch into grape-sugar,  in fact,
 of acting as a sort of yeast or ferment.
   DIATHESIS—Is a term used in medicine
 to indicate states of constitution peculiarly
 predisposed  to  certain diseases,  such as
 scrofula,  cancer, gout, &c.  Peculiar  dia-
 thesis is for the most part hereditary.
   DIASTOLE—Is the dilating  action of the
 heart,  or  that  by  which its  cavities are
 opened to attract and  receive a portion of
 the  current of blood, after a previous  por-
 tion has been expelled by the systole or con-
 tracting action of the organ.
   Refer to Circulation—Heart.
   DIET.—See Food.
   DIGESTER, or Papin's Digester—Is a
 strong iron pot, the lid  of which is fastened
 or screwed down, so* as to be steam-tight,
 and  is provided with a valve.   By these ar-
 rangements, when the digester is placed near
 to or over the fire in cooking,  the steam in
 confined, and by its  pressure  prevents the
 contents from boiling at  the ordinary boil-
 ing temperature of 212°;  consequently it is
 possible to raise the temperature above this
 point,  or that at which  the amount of heat
 carried off by the evaporated steam balances
 that received by the fluid.   This  power of
 elevating temperature  confers of  course
 upon the water which must be used in the
 vessel  increased power of acting upon bones,
 or any other substances immersed in it.  The
 use of the digester, either in an economical
 or dietetic point of view,  is to be strongly
 recommended.   The valve, of  course, pre-
 vents all danger from bursting.  The price is
 moderate. Bones which  have been well acted
 upon in a digester have their animal matter
 so thoroughly exhausted  that  when  taken
 out they fall in pieces, little being left except
 the  earthy  constituents.   The amount of
 animal nourishment  in the form of gelatine
 thus  extracted from  bones is very consider-
 able, quite sufficiently so to make it an object
to the  poor in their own homes, and, in the
houses of the  rich, as the foundation of soup
for distribution.  Refer to Heat— Gelatine, $c 
DIG
192
DIG
  DIGESTION*—Is the process  by which
food is fitted for the nourishment  of  the
animal body.   The whole process may be
divided into—
  The  mastication  or chewing of the food,
and its mingling with the saliva or spittle.
  The swallowing of the food.
  The digestion of the food in the stomach,
by means of the gastric juice.
  The mixture of the food with the bile and
juice from  the pancreas, and its conveyance
through the small intestines.
  The  passage of the remains of the food
into and through the large intestine or colon,
during which it  becomes acid and mixed
with the feculent excretions from glands of
that bowel.
  The discharge of the remnants of the food
from the body along with other excrementi-
tious matters.
  To the above may be added  the passage
of the  digested  and nutritious part of the
food into the blood.
  The  first process of digestion, the masti-
cation  or breaking down of the food  by the
teeth, and its mixture with the saliva, is one
of extreme importance [but often entirely
overlooked by many in the  United States]
The teeth of  man are evidently adapted for
the two processes of cutting and bruising;
the front, or " incisor teeth," being construc-
ted for the former purpose, the back, or molar,
for the latter.  These adaptations are well
seconded by the action of tie powerful mus-
cles of the lower jaw, which give it a direct
cutting, and a side to side or grinding motion.
The morsel of food submitted to this  mecha-
nical action being at the same time kept ad-
mirably under it by means of the extraordi-
nary mobility and sensibility of the tongue,
it is thoroughly moistened  by the saliva or
spittle, which is poured out abundantly from
the "salivary glands," which lie imbedded
around the mouth and jaws; the same me-
chanical action which grinds the  food serv-
ing also to press out the  secreted  saliva.
This fluid, however, does not act simply as
a mois-tener of the food; it exerts a distinct
chemical or digestive power upon its starchy
components,  acting in the same manner as
the  "  diastase" mentioned a  few articles
back, and  converting  them  into sugar, in
which state they become fitted for absorption
into the  blood—a capability which  starch
does not possess.   It has also been imagined
that air becomes mixed with the food during
mastication,  and that its  presence  in  the
stomach was in some degree connected with
the process of digestion; this, however, is
  * In connection with this article, the  reader U re-
quested to refer  to that under '• Alimentary Canal."
doubtful.   When the  food-morsel  has been
masticated, and  moistened  sufficiently—at
least such  ought to be the  case—it is col-
lected  by the action of the tongue into a
ball, and conveyed to the back of the throat
or fauces, where it  is consigned to the care
of involuntary muscles, and passes  for the
most part  from  under man's direct control.
Passing from the throat into the gullet, it is
carried by  the wave-like action of that tube
into the stomach.   This action  is  not, as
some  might  imagine,  a  simply mechanical
one, that is, the food does not drop into the
stomach as it would into a bag, by means of
its own weight,  but it is carried  thither by
the muscular movements of  the oesophagus,
or gullet, by the same power that water is
conveyed  upward through the gullet of the
horse or cow when drinking,  or indeed in our-
selves, as any one can testify who has drunk
from  a spring  by  stooping down  to the
water.f  The entire process of swallowing,
particularly that part of it by which the top
of the windpipe  is protected during the pas-
sage of the food over it, is a series of beau-
tifully connected actions.
   When the food has been passed  down the
gullet,  and  has reached the stomach, it
lodges in its  left or larger extremity.  As
soon as the lining  membrane of the organ
feels the  contact of nutriment, it becomes
reddened, there is  evidently increased flow
of blood to it, and  quickly  its peculiar se-
cretion,  the  "gastric juice,"  or  solvent
fluid of the  stomach, begins to  be poured
out.  This fluid is "clear, transparent, and
viscid, without  smell, slightly saltish, and
very  perceptibly acid,"  its  characteristic
power being  that  of dissolving the  chief
components of the  food, and reducing the
varied ingredients of a common meal to one
homogeneous,   gray  looking,  pulpy,  acid
mass, which is  called the "chyme."  This
uniform  mass,  when  formed, varies but
slightly  in  perceptible  character;   whnn
the food  has been  farinaceous,  it  is like
gruel,  but  when  much oily or fat nutriment
is mixed  with it, it has more of a creamy
appearance.
   The solution  of  the food, and its forma-
tion into chyme by the  powers of the gas-
tric juice,  is much assisted  by the muscular
movements (alternate contractions  and re-
laxations)  of the stomach,  which turn the
mass over  and over,  and thoroughly incor-
porate it with the solvent fluid.   When the
chyme is fully  formed, it  is probable that
the gelatine components of the  food have

  •f-One of the African barbarian de^po's hns h-i'ii »iU
to admini-ter drink to hi* subjects—as an hoiiuiir mhi
ferred—while they were plpw.-d heud downward. 
DIG                193               DIG
 been dissolved, and what are called its albu-
 minous components, such  as  the curd  of
 milk,  or  cheese, or  the muscular flesh  of
 .neat, or  the gluten of  grain, have for the
 most part been reduced to the condition of
 a soluble albumen, fitted for absorption into.
 the system.   The action of the acid gastric
 juice, however, puts a  stop to the conver-
 sion of the  starchy ingredients of the food
 into sugar  by the  saliva.   But this  is re-
 sumed in the small intestines, when the acid-
 ity  of the chyme  has been neutralized  by
 the alkalinity of the bile  and juice of the
 pancreas or sweetbread, with which  it be-
 comes mingled, immediately after it passes
 or  is passed through  the opening  at the
 right or  smaller extremity of the stomach
 into the  duodenum, or  first portion of the
 small intestines.  This passage of the chyme
 from the stomach into  the intestines  is ef-
 fected as each successive portion is perfectly
 formed, that is, has become of semi-fluid,
 perfectly  smooth  consistence;   for  in  a
 healthy condition  of the  digestive  organs,
 should a portion of solid  food  attempt to
 pass the  muscular valve at the "pylorus,"
 or place  of  exit,  it is  immediately closed
 against it, and the morsel  passed back into
 the stomach.  As  already mentioned, the
 chyme  has no sooner passed from the sto-
 mach into the small intestines than  it be-
 comes mingled with  the bile, which is con-
 tinually distilling into them from the liver,
 and with  the juice  from  the pancreas  or
 sweetbread.   The effect of this  admixture
 is to neutralize the  acidity of the  chyme.
 The  action  of  the  saliva in  converting
 the starchy  matters  into sugar is now re-
 sumed, and is  probably  assisted by the
 fluid from the pancreas, and the oily prin-
 ciples of the  food  are converted  into   a
 milky-looking emulsion,  in which  state they
 are fit for absorption into the system.   The
 digested and altered food mass is now passed
 slowly through the small intestines by their
 muscular, "  vermicular," or wave-like move-
 ments.   During this passage, the nutrient
 portions are absorbed, partly by the blood-
 vessels,  and partly (more particularly the
 oily emulsion portion) by the lacteal absorb-
 ent  vessels, until the now almost exhausted
 food, reaching the valve-like opening  into
 the  large bowel, or colon, is  discharged
 into it.   Here the food mass again becomes
 acid, and  this change is  supposed by some,
 and not improbably so,  to be of the nature
 of a second digestion, to insure the perfect
 solution  of  any  matters which  may  have
 escaped the  first acid digestion in the sto-
mach.   A more striking change,  however,
is  effected, for  here the  contents of the
       R                                 l
bowels assume their natural faecal or cxcre-
mentitious character, and acquire their cha-
racteristic odour  from being mingled with
used-up  matters  thrown out  or excreted
from  the system  at large,  from  the  small
glands with which the lining membrane of
the large bowel is studded.  The absorption
of the nutrient  matters  from the  chyme
requires  a  little explanation.   The process
is now considered to be largely  shared in by
the blood-vessels,  but much of it is doubtless
effected by the lacteal vessels, which, in-
deed, were at one time considered to be the
sole  agents  for the purpose.   These little
vessels (fig. liii. 1) are abundantly distri-
buted over the small intestines, (fig. liii. 3.)
Fig. liii.
 The lining membrane of this portion of the
 alimentary canal is thrown into folds for the
 purpose of increasing the surface for ab-
 sorption, and this  lining membrane has a
 velvety appearance, from innumerable small
 elevated points, or "villi," which cover it—
 each of these villi  contains a small  lacteal
 vessel.  These vessels were formerly thought
 to absorb the nutrient portion of the food or
 "chyle" by means of open mouths, but it
 is now ascertained that the  absorption is
 effected  in the first place by minute cells,
 which  burst when full, and deliver up  their
 contents to the lacteal twigs in contact with
 them.   By  the  lacteals,  the  "chyle,"  or
 milky-looking fluid  absorbed from the intes-
 tines,  is conveyed  through a set of small
 glands, (the  mesenteric, fig. liii. 2,) after
 passing through which,  the chyle, this ex-
 tract from  dead food, seems (if we may so
 speak) to become in some degree vitalized ;
 it acquires power  of coagulating, and as-
 sumes  a red tinge when exposed to the air.
 The  chyle from  the various smaller  lacteal
 vessels is now collected in the larger trunks,
 which coalesce at  one point,  and form one
main vessel, the "Thoracic duct," (fig.liv. 1,)
which runs up and lies close upon the spine, 
DIG
194
D  I G
Fig. Ut.
-*t
till, arriving at the neck (2), it turns down
ind opens to  discharge  its contents into the
general current of  the  circulation  at  the
junction of the large  veins of the head and
neck (3, 8) with that from the arm.
  Such is the marvellous process by which
man's material body is daily nourished, and
its strength preserved and renewed ; such,
at least, is the healthy process, as it ought
to be.  The most generally prevalent causes
of its  disorder, and they are very general
and very prevalent,  it remains now  to point
out.   Of course the nature of the food must
exert great influence, for good or evil, over
digestion; but as that will be  fully discuss-
ed under  the  article  Food, it need not  be
entered into here.
  One of  the  most  frequent  causes of dis-
order of the digestive function  is insufficient
mastication, either from want of teeth, from
a habit of hurried eating, or from careless-
ness :  many  persons but  half,  or indeed
scarcely at  all, chew their food, which is
swallowed  in  lumps, and,  of course,  not
being  broken  down,  is  unmixed with  the
due proportion of saliva.  Fortunately, the
solvent powers of the  gastric juice are suffi-
ciently active  to compensate, in the course
of time, for the imperfect performance of
the first of the digestive operations.  But it
must be evident to  all how  much longer
ind more  laborious the process must be of
dissolving a solid lump of meat or potato,
than of one well broken up nnd opened up
to the operations of the gastric juice. It
must also be  evident, that in the case of
farinaceous  and vegetable food, insufficient
admixture  of  saliva must occasion insuffi-
cient digestion, or conversion of the starchy
matter into sugar, and  that, therefore, a
portion of the food  consumed may become
useless.
  Another  evil resulting from imperfect
mastication is the rapidity with which food
is introduced into the stomach, so that, pro-
bably,  the organ is  overloaded before  the
natural sensation  of  appeased hunger  can
make itself felt.
  Many persons, again,   hurry over their
meals with minds intently engaged on some-
thing else;  the food is swallowed as quickly
as possible, and the  scarcely  interrupted
mental  effort  or  business anxiety is  re-
sumed, or, it  may be, active exertion at
once engaged  in.  Now, it  is a law of the
animal economy, that all the functions of
the living body, and  those  which are only
periodically called into exercise more than
others, require, for their perfect perform-
ance,  some  additional access  of nervous
power, and  some increase in their usual
supply of blood, while the peculiar function
is in active operation.  With  the  stomach
this  is peculiarly the case; the disinclina-
tion  for exertion  and the slight sensation
of cold which  generally follow a full meal,
are the results of the call  made upon  the
nervous energies, and upon the circulating
blood, by the stomach during the first stages
of digestion.   These  sensations are more
felt if the individual  remains quiet after a
meal; less so, or not at all,  if active exertion,
either of mind or body, is at once  engaged
in ;  and the reason for this is evident.   In
the first instance, the person who  remains
quiet permits  the nervous  power  and  the
blood to be, as they ought, directed to  the
performance of the digestive function, and,
consequently, their supply to the other por-
tions of  the body being  diminished, inca-
pacity  for exertion, both of mind and body,
is  experienced.   If,  however,  before  the
nervous and circulating  energies  have be-
come fully  directed  toward  the stomach,
(or, indeed,  if, after they have, exertion is
made by a strong effort of the will,) they are
attracted by a still stronger power,  either of
muscular movement or mental  exercise, the
inclination for rest is not  experienced ;  but
this disinclination is attained at the expense
of the  stomach and of its digestUc powers,
the food being more  slowly, and  perhaps
imperfectly, digested.  It is true that many 
DIG                 195                 DIG
 persons  go on for a great length of time,
 without  apparent bad results, violating the
 laws of  their  own  constitution,  snatching
 hurried  meals, and  running off to business,
 or study,  or exertion,  immediately after;
 but the  practice tells, in the course  of time,
 and  ,he extreme  prevalence  of disorder of
 the digestive organs, amid the commercial
 and professional classes in this country, is
 evidence sufficient of the  hurtful tendency
 of such practices.   There is, of course, much
 variation  in  the  injury which the diges-
 tive  powers sustain,  for  some have these
 naturally  much  more active than others,
 and  can with  much more impunity impose
 upon them ;  but, as  a general rule, moderate
 rest, both  of body and mind, is requisite for
 a short  period after  a  full meal has  been
 taken, to insure the perfection and  the con-
 tinued heat thy operation of the digestive powers.
 If exertion is  requisite,  the meal  should be
 made a light one, and the full supply of food
 delayed  till  rest can be taken.  Somewhat
 similar  consequences and enfeeblement of
 the function of digestion  are apt to occur
 if an individual makes a hearty meal when
 in  a state of  fatigue or  exhaustion from
 exertion previous to the taking food, even
 though quiet is observed after it;  the nerv-
 ous power being exhausted, cannot  be suf-
 ficiently  supplied to the  stomach to  support
 its efficient action.
   Another frequent  cause  of  disordered di-
 gestion is  excess  of food, either at once or
 by its too frequent repetition.   It would
 seem that the  healthy digestive power and
 secretion of  the gastric  juice is dependent
 in  some  degree upon the  requirements of
 the  system; and, as the gastric juice can
 only dissolve a certain proportionate quan-
 tity of aliment, if more  is taken than there
 is gastric juice to act upon  it, it must be
 imperfectly or  not all digested, and  if it is
 not, it becomes subject to the same chemical
 laws as if exposed to heat  and moisture out
 of  the living body.  Fermentation, and, it
 may  be,  putrefaction, take  place;  gas—
 "wind"—is  generated,  acids are formed,
 both in the aliment  itself,  and thrown  out,
 probably by the efforts of  the irritated sto-
 mach, and heartburn, pain, and the many
 other uneasy sensations connected with indi-
 gestion are developed.   Many of the causes
 of indigestion are  undoubtedly traceable to
other sources, but the consideration of those
will be taken up in  the  articles devoted to
 the  subject.   The  digestive  power of the
stomach  is remarkably  interfered with, or
even negatived, in many  diseases, especially
those of  an acute or febrile  character; it
seems to lose almost  entirely its  power of
| secreting the gastric juice, and with  it, of
 course, all  power of digesting.  If food is
 put into it, it is unacted upon, and is pro-
 bably vomited  after  many  hours almost
 unchanged.  There can be no question that
 this  instinctive sympathy, as we may call
 it, of the stomach with the constitution at
 large, is wisely intended  to prevent  nutri-
 ment being introduced into the system, and
 into  the blood,  when it would either only
 tend to  embarrass the curative  powers of
 nature or to aggravate the disease.
   From the review now taken of  the nature
 of the process of digestion, and of the more
 general causes  of its  disorder, the reader
 must have  been  made rationally aware of
 the necessity and reasons for attending to
 those requirements which have been pointed
 out as imperative for the  immediate proper
 performance or for the continued health of
 the function.  The  food  must be prepared
 for the  stomach  in the mouth,  and the
 stomach must not have the nervous energy
 and  blood  supply,  requisite  for  the im-
 portant office it performs for  the system at
 large, abstracted  from it by unseasonable
 exertion.   The  food must,  too, be propor-
 tioned to the wants of  the  system.  If a
 man  will be sedentary, if he will not use up
 his blood, his muscle, and nerve in  active
 exertion, he must not  expect  to  enjoy food
 like  one who does; he  may  eat  the  food,
 and,  if he possess  naturally strong digestive
 powers, his stomach may dispose of it  with-
 out giving  him much  inconvenience; but
 when the excess of nutriment reaches the
 blood, it must  either be deposited  as  fat—
 itself, when in excess, a disease—or it must
 be developed in the  poison of gout, gravel,
 or biliary or other disorders.
   Hitherto, the processes of the first or pri
 mnry digestion have been considered, being
 the changes of the food from its  introduc-
 tion into the mouth, to the discharge of its
 refuse on the one hand, and the passage of
 its nutrient materials  into the blood on the
 other.  Physiologists, however, recognise a
 secondary digestion, embracing the changes
 undergone by the  blood and  tissues in the
 performance of the various  functions  of
 the  living body,  and the final  discharge
 of their components after they have fulfilled
 their offices.   As the consideration of  these
 changes is entered into in various  articles,
 such as "Animal Heat," "Nutrition,"  "Re-
 spiration,"  " Motor Change," &c. it is un-
 necessary to pursue it further in this place.
   It may, perhaps, have puzzled the unpro-
 fessional reader thai at times the digestive
 operations have been  alluded to  as if they
 had  been  actually witnessed  by the . eye, 
                 DIG                 1!

*na such is the fact;  for it happened that,
between  twenty and  thirty years ago, an
American physician—Dr. Beaumont—enjoy-
ed the rare  opportunity of experimenting
and witnessing with his eyes the results of
his experiments, upon the  healthy stomach
3f a living, healthy man.
  The  subject of  Dr. Beaumont's experi-
ments was Alexis St. Martin, a young Cana-
dian of good constitution and robust health,
who was accidentally wounded by the dis-
charge of  a musket, which carried away  a
portion of  the skin and muscles covering
the stomach, and perforated the organ: by
good treatment, St. Martin recovered from
the injur}', but the opening into the stomaflh
never closed.  The case coming  under  the
notice of Dr. Beaumont, he, fortunately for
science, availed  himself most fully and in-
telligently of the unique opportunity it af-
forded :  and, by numerous well-conducted
and accurately recorded  experiments,  he
cast light upon many unascertained points
connected with the process of digestion, to
some of  which  allusion will  be  made in
future  articles, particularly  in  that  upon
food.  Those who wish further information
respecting  the case will find  all its details
in Dr. Beaumont's  work.
  Refer to Absorbents—Alimentary Canal—
Chyle—Food—Indigestion, §c.
  DIGITALIS,   or   Fox-Glove—Is  well
known, and one of the  handsomest of our
native plants.  It  is  biennial, that is,  the
first year a tuft of leaves only is formed, and
the flowers do not appear till the second
summer.   About  the  middle of  June,  the
wand-like  stem, rising  from  two  to four
'eet high from the  centre of the root-leaves,
begins  to  expand  its  purple blossoms,  re-
jembling in some degree, in shape, the finger
of a glove, from which resemblance the plant
is named.
  Digitalis is a very powerful  medicine,
and, except in skilled and careful hands,  a
dangerous  one, and can never be employed
with propriety as a domestic remedy,  al-
though in Ireland it is used by the peasantry
for the cure of epilepsy.
   Fox-glove  acts powerfully upon the kid-
neys in many cases, but its most marked,
nnd  at the  same time,   most  dangerous
property, is that which it possesses of  de-
pressing the action of the heart,  the hazard
being increased from the  tendency of  the
medicine to accumulate in the system, and
suddenly to develop its depressing or poi-
sonous effects.   There are but few cases of
direct poisoning by fox-glove recorded,  but
accidents  sometimes  happen  from the  in-
rautious administration  of it as a medicine:
6                DIL

in these cases, great languor and depression
of the action of the heart, yawning, giddi.
ness. nausea, and a sense of anxiety  are the
usual symptoms.   The best antidotes would
be  wine or brandy, small doses of  opium,
ammonia, and strong infusion of greca tea.
  DILL, or Dill-Seed—Is the fruit of an
umbelliferous plant, the Anethum Graveolens.
It is a native of South Europe, but is culti
vated in England.  The distilled water, 01
" dill-water," is one of our best carmina-
tives for infants, in one or two teaspoonful
doses,  either alone or  combined with mag-
nesia or chalk.
  DILUENTS—Are agents used medicinal-
ly for  diluting the fluids of the body, and
in  many  diseases  their employment is  a
subject of much practical importance.  In
most cases, either in health or disease, the
necessity  for the  use  of  diluents is made
known by the  occurrence of  thirst. This
sensation, which is perceived in the mouth
and throat principally, is evidently only felt
from  sympathy with  the  body generally,
for it is not relieved by the mere moistening
of these parts, but  only  by  a supply of
fluid afforded to the system at large, either,
as in most cases, by the stomach, or through
the medium  of the skin.   Diluents may,
however,  be very serviceable  in the treat-
ment  of some diseases when  thirst is not
felt,. as in  gravel; they are much more
largely used, and perhaps abused, as medi-
cinal  agents, in Europe, than they  are in
this country.   Many reputed mineral waters
act most  beneficially  by their diluting ef-
fects :  under the hydropathic system, the
treatment is carried to a most unlimited and
often injurious extent.
  There is no  question, however, that the
employment  of diluents  is  too  generally
neglected in the treatment of disease in this
country, although it is more resorted to now
than  formerly.   Dr.  Holland classes the
beneficial  action of diluents under three
heads :—First, the dilution  and  washing
away of excrementitious and morbid matter
from  the  alimentary  canal;  secondly, as
acting upon  the  blood  by  dilution; and
thirdly, by influencing the various  secre-
tions and excretions of the body.  Diluents,
therefore, are useful  in many affections of
the stomach  and bowels, in  which their
contents—as in  bilious cholera—are acrid ;
in  fever generally, and  in  those cases  in
which  natural secretions  and  excretions,
such as the urine, are diminished in quan-
tity and irritating in quality.  In  health,
a  certain amount of fluid, or of diluent,  is
required periodically by the body to supply
the waste continually going  on by the dis- 
D  I  L                197                 DIN
charge r-f vapour from the lungs and skin,
and by ihe excretions from the kidneys and
bowels.   The amount must, of course, vary
somewhat according  to  the  conditions of
the surrounding atmosphere as to tempera-
ture and dryness, and also according to the
amount of exercise taken ;  a  man  making
much active exertion, and perspiring  pro-
fusely, requiring a much larger supply of
diluent  than one who is not.   Stokers, iron-
founders, and others who work  hard under
great heat,  consume an almost incredible
amount of fluid.   The unnecessary use of
diluents by persons in health is undoubted-
ly hurtful, particularly when the amount is
taken along with food ; the gastric juice is
thereby diluted too greatly, and its digestive
powers  impaired.   Moreover, persons who
drink  largely  with  their  food  are apt to
wash it down in a half-masticated condition,
and to  take  more  than is  necessary.  A
certain amount of dilution is, nevertheless,
requisite for digestion, and error on this side
also is  undoubtedly committed; but these
are points connected with individual consti-
tution, which every man's sense  and experi-
ence ought,  as far as he himself is concern-
ed, to determine better than another can do
for him.
   All dilution must,  of  course, be due to
water,  and  the various  forms  of diluents
used in illness are but varied modes of- ad-
ministering the pure element disguised.   In
many cases this is  too  largely practised,
and patients very commonly, after having
gone  the round  of  the  various  artificial
drinks,  are  found to prefer  and to adhere
to the  simple  water as their most grateful
and only drink.  How often  does the child
with fever ask for "water from the pump,"
in preference to every thing else.
   Water may be  used  as a  diluent in its
purest condition, that of distilled water, or
rain-water, or as procured from the various
sources  of  spring, well, river,  or lake, in
which cases it is more or less impregnated
with foreign matters.   Its temperature may
be modified, for it may  be used either ice-
cold, or  tepid, or  warm; or it  maybe  ad-
ministered in the form of some of the arti-
ficial  drinks,  such as toast-water, barley-
water, thin  gruel, or, as on the Continent,
as ptisan of various  kinds.   AVeak  tea is a
common and favourite diluent with many.
But diluents are not necessarily unstimu-
lating, though most generally so: as a diete-
tic diluent,  beer, or wine,  or spirit and
water,  may  be more serviceable than  the
simpler forms, and  the  same may be the
case on  occasions, where  there is intense
thirst along with nervous exhaustion.   Per-
      r2
sons who have become exhausted by sever*
labour, having  at  the same time been  ex-
posed to heat, may often with greater bene-
fit  and  safety  take a  small  quantity of
slightly stimulating diluent, than a larger,
or even the  same amount, of plain  water.
This must  not  be understood as a recom-
mendation  of  stimulants  under  circum-
stances of ordinary labour, but as applying
to cases  of exhaustion; and even in these
the  stimulant must be in very moderate
proportion.
  The instinctive desire for fluid in cholera,
and in diseases generally which are attended
with fever,  ought not to be neglected.  There
appears to be almost a superstitious fear with
many, particularly of the poorer classes,
of allowing the sick to "drink cold water,"
and many  a sufferer regards most  grate-
fully the unlimited permission of the medi-
cal attendant to take it freely, after it had
perhaps been begged  for,  but withheld by
mistaken friends.  There are few safer pre-
scriptions, none perhaps which may be more
freely carried  out by unprofessional  per-
sons, than the  unrestricted  allowance of
simple, unstimulating drink,  in all  acute
diseases in which thirst exists, and especial-
ly if fever be present.
  As mentioned in the first part of this ar-
ticle, diluents may be administered through
the medium of the skin, and thirst and dis-
tress allayed in this  way,  when the power
of swallowing is impaired, or lost either tem-
porarily or permanently, or when the only
diluent  at command, such as  sea-water,
is unfit for drinking.   Diluents may also be
administered by injection into the bowels.
  Refer  to  Cold—Cookery—Heat—Thirst—
 Water, <$fc.                          »
  DINNER—Is the meal of the twenty-four
hours, the  principal occasion on which the
daily waste of the body is restored by food.
At  dinner, for the most part, the  articles
either of food or drink taken, are stronger
and more  stimulating  than  at any other
meal; consequently its disposal makes  the
greatest demand upon the digestive powers.
it matters  not that what some persons  call
dinner others would call supper, for  by the
designation  is  here  meant  the principal
meal of  the day.  The regulation  of the
meal as  to time and  circumstances, often
requires  more attention and care, in rela-
tion to  health, than  is bestowed upon it,
either by  medical men or  the  public.  In
more primitive times, and  where primitive
habits prevail at the  present  day, the tim-
ing of this principal  meal must obviously
be  very  different from what  it should be
when taken  in connection with the habits 
                 D I X                1!

and modes of life of many in this country,
particularly in our large cities.  AVhen per-
sons, such as those engaged in country and
agricultural  work,  rise  very early, break-
fast early, and are  engaged  in astive mus-
cular exertion in the open air, there onn be
no question  that, by  the time of noon, the
system is ready for, and  requires a full sup-
ply of good  nourishment; and the powers
of  digestion  are fully equal to the task,
even  though the interval of rest be  not
very great;  and that, further, half a dozen
hours' work  afterward,  pave the way for
another substantial meal. Such being the
case with our agriculturists,  the healthiest
and strongest, probably,  of our population,
and people seeing this, have  jumped some-
what hastily to the conclusion that the early
dinner is the secret of health, forgetting the
other accessories of fresh air and  exercise,
and, in case  of the labourer, not  over-active
minds.  The  case of  mechanics and arti-
sans generally, who begin the day early, is
nearly, but not quite  similar to  that of the
labourer.  They require a good meal tolera-
bly early in the day, but  not having the ad-
vantage in many cases of the fresh air of
the agriculturist, many of them  might with
advantage divide the meals  a little  more
equally, diminish the dinner, and add  to
the  meal  made after work  is  concluded,
more particularly when  the dinner-hour is
short, or shortened by the necessity of walk-
ing home  from the  place of employment to
the meal.
  When the  cases of  the higher classes is
considered, it must be   evident  how com-
pletely the time  for  their principal meal
must be altered by circumstances.  Begin-
ning the day, for the most part, some hours
later than the operatives, making,  general-
ly, much less physical exertion,  and work-
ing the head more, there  is not the necessity
for the  principal meal  being early in  the
day ;  moreover, the employments generally
of the class  in question  being more of the
mind than of the body,  and often of an
anxious  and  thought-engrossing   nature,
they cannot in the midst  of them cast loose
the mind,  or place it  in  the  same careless
ease as the physical labourer can  do—conse-
quently the digestive powers  are interfered
with.  If  these observations  are taken  in
connection with those  upon "Digestion," in
the article devoted to that  subject, their
force will  be  seen.  From them  the follow-
ing deductions may be drawn; that although
those engaged in physical exertion, either
of  business  or pleasure, particularly  if
early hours are observed generally, require
and ought to  have the principal meal of the
                  D  I  X

day early, those engaged in occupations of
mental   rather  than of  bodily  exertion,
ought to delay it  till the  necessity for  the
mental  stretch is passed  over.  This sub-
ject has been more dwelt  upon, from its so
frequently being the case,  that early dining
is prescribed in cases of stomach  disorder
as  a sort of a panacea, which  it does  not
prove.   It is not counselled that the dinner-
hour should be thrown too late in the even-
ing—probably six o'clock should be the limit;
but it  is far better that it should be late,
than interpolated  in  the midst of  the tur-
moil and anxieties of  business or  mental
strain of study.  It is  objected that a late
dinner involves either too  long an interval
between breakfast and dinner, or a luncheon,
This is matter of constitution simply. Some
persons of good constitutional powers, who
can make a substantial breakfast  between
eight and nine in the morning, do  not  re-
quire, and indeed are  better without food
between that meal and a five or six o'clock
dinner;  those who cannot  take so much at
a time,  are  much  more likely  to  do *ell
with a light luncheon, not a meat one, in the
midst of their work, than  with  a  heavy
meal, as even the  lightest  dinner  must be.
It is no  real objection against a late  dinner,
that, its  being made  after  work,  induces
people  to indulge in the  pleasures  of the
table more than if they dined early: abuse
will neutralize the good of any thing, how-
ever beneficial, but it is not an argument
against  its use.   Further,  there  are  un-
doubtedly  invalids,  and certain  impaired
states of health, in which an early hour for
dinner  is found beneficial; but these must
be cases in which either the state of health
or circumstances require or permit all ar-
rangements to be  made conformable to the
one object—health.   An  early dinner  al-
most certainly involves supper of some kind,
and this may or  may not be an objection,
according to circumstances.
  Undoubtedly, modern habits and  luxury
tend frequently to  make even this principal
meal a  much too  abundant  one, chiefly  by
tempting the appetite  with a variety of food;
and it is impossible  to lay  down  any set
rules on this head  beyond that which every
rational  man  must be well aware  of, that
none  can   perseveringly  transgress  the
bounds  of  temperance,  either in eating or
drinking,  without  sooner  or later  disease
being the result.
  Sleeping after, dinner may suit a few per-
sons, but it is not advisable for those of full
habit  of body.    For the  reasons already
mentioned,  the time  immediately succeed-
ing dinner should be one of easy relaxation,
IS 
d I  r
199
DIS
to the man of mental toil in particular. The
use of wine, beer, or any stimulant falls
of course to be considered under the other
articles more directly bearing on these sub-
jects.  A cup of coffee is  sometimes taken
shortly after dinner:  opinions differ as to
the propriety or not of the practice.  It will
probably be found to  be best regulated  by
individual  experience.  The  practice, how-
ever,  of  taking tea  or coffee two or three
hours  after the  meal is  unquestionably a
serviceable one amid the usages of civilized
life, and  assists the perfection of the latter
Btages of digestion.   These  diluents, how-
ever, ought not to be taken  too strong, or
too late in the evening; otherwise their effect
upon the nervous system will interfere with
sleep.
  Some individuals of weak digestive powers
are in  the habit of taking a  "dinner-pill,"
for the purpose either of exciting the appe-
tite, of stimulating the digestion, or of both.
As  a habit, the practice is bad, because it
must  be  a substitute  for more efficient and
permanent means of improving appetite and
digestion;  occasionally,  however, in some
cases the dinner-pill is useful as a temporary
remedy.   Eighteen grains of compound rhu-
barb pill, six grains of cayenne pepper, and
twelve grains of extract of gentian, made up
into twelve pills, of which one or two may
be taken a quarter of an hour before dinner,
will be found useful.   The practice of taking
spirits, or stimulant cordials or bitters,before
dinner, is highly injurious to the  stomach,
exhausting and irritating in a way that must
interfere with digestion.   A draught of cold
water  is a much better preparative;  with
persons of very weak powers,  however, cold
water, either before or during the meal, de-
presses too much.
  Refer to Digestion—Food—Stimulants, §c.
  DIPLOE—Is the  name  given by anato-
mists to the more cellular or  porous  portion
of bone (fig. Iv. 2,2) which intervenes between

                  Fig. Iv.
the more condensed nnd solid, but  thinner,
Duter and inner  "tables," or plates (fig. Iv.
1,  1) of the skull.
  Refer to Skull
   DIPSO-MANIA—Is a  state when habits
 of intemperance have reached such a heigh!
 that the unfortunate  victim becomes partly
 insane, or at least so much so as to lose all
 self-control on the one point, and to become
 affected with the species of monomania to
 which the term  " dipso-mania" has been ap-
 plied.  Sir Alexander Morrison describes it
 as a "morbid craving for drink which gene-
 rally occurs at intervals, in which  persons
 are  seized with an irresistible propensity to
 drink to  excess, although conscious at the
 time of their misconduct, but are unable to
 control themselves."
   Refer to  Delirium  Tremens—Intoxication—
 Stimulants,  SfC
   DISCHARGE—Used  as a medical  term
 generally, means any thing cast out from the
 body ;  it is often applied, however, in a more
 restricted sense, to the excretion of purulent
 matter solely.
   DISEASE—Is any departure from  the
 naturally healthy actions of the system at
 large, or of any structure or organ in par-
 ticular.  The divisions and  subdivisions of
 diseases,  generally according to their nature,
 causes, &c.  are very numerous.  A distinc-
 tion is made  into organic  and functional
 diseases—the former being such as are ac-
 companied with perceptible and appreciable
 change from the natural structure or  com-
 position of any component of the body—the
 latter those in which  the actions  are not
 healthy,  but in which,  as  far as  present
 means  of investigation  go,  no appreciable
 departure  from the  ordinary structure can
 be detected. As, however, it may be doubted
 whether  disordered  action can take place
 without change of structure, temporary or
 permanent, its non-detection  is probably
 owing  to  the  deficiency  of  our  present
 means of investigation;  and, indeed, chemi-
 cal  analysis and the use of the microscope
 have demonstrated,  and  are daily demon-
 strating,  the nature and tendencies of many
i alterations in the composition and structure
 of the bodily  constituents which had pre-
 viously escaped notice.
   Perfect  health  consists in  the uninter-
 rupted action and perfect balance of all the
 functions of the body—this  involving  of
 course perfection of structure ;  the slightest
 pain or ache must be indicative of a hitch
 somewhere in the machinery.   In this view,
 perhaps  none  are  free  from disease for  a
 day, for  few can boast of such perfect un-
 deviating health as to pass four-and-twenty
 hours without some  slight twinge  of pain,
 without some  ache or weariness to remind
 them  that their  bodies  are  mortal;  and
I from this  slightest  passing  uneasiness t* 
DIS                200                 DIS
the  confirmed  and  fatal  malady, disease
passes through every gradation.  Many of
the most painful and deadly disorders are
not more felt at  their commencement than ,
as a slight sense of discomfort; and perhaps
numberless of the lesser  pains  felt during
what is considered  health, might pass on
to real disease, were it  not for the natural
tendency to cure  with which our bodies are
endowed—that which is called  the "vis
medicatrix   naturai,"—the  same   tendency
which restores the fractured bone to sound-
ness and heals the  wound.  There can be
no  question, that,  but  for this  tendency
toward health, this  power of resisting and
casting off disease, our bodies would quickly
succumb to the innumerable causes of dis-
order to which they are hourly  exposed.
This power  of resisting disease is without
doubt much  greater in  some  persons than
others, and  even  in the same person at dif-
ferent times, often without  any  perceptible
reason why it should be so.  The  power of
the  system  in casting  off disease,  when
forming or formed, is for the most part more
plainly exercised, but of  this  more will be
said hereafter.
  Again, it it must be remembered that con-
stitution and other causes occasion so much
variation in  the  actions of the  body, that
what would be disease in one man  is health
in another.    For instance, one man's pulse
may average sixty in a  minute,  another's
eighty;  and  it is certain that  the former
could not  rise to the level of  the  latter, or
the latter sink to that of  the former, with-
out disease or disorder being present. Such
considerations are important in judging of
the real state of  a person labouring  under
disease.   To  judge accurately of  disorder,
we  must know the whereabouts of the level
of health;  and in this consists the great
advantage of the  regular  medical attendant
over one who is casually consulted, and who
first sees the  patient when suffering under
illness.  In  popular  language, the regular
attendant  " knows the  constitution"  of his
patient; the other has it in many respects to
learn.  But if there is  a tendency toward
health, there is also a tendency, more or less,
toward certain forms of  disease,   existing
with every one—this tendency being either
hereditary or acquired.  The power of here-
ditary tendency toward certain forms of dis- j
ease, such as scrofula  and  consumption,
gout, gravel,  and rheumatism, paralysis, &c. !
is so generally recognised as to be a matter ]
of popular information ;  that is to say, when
these diseases have affected parents, or rela-
tives of parents, they are  regarded as here-
iitary in descendants.  There is,  however,
an hereditary predisposition not so apparent,
which requires more notice than it receives:
it  is that which devolves upon  children in
consequence of the habits, &c. of the parents.
The  latter may  be of healthy families, but
if  there has existed much inequality of age
—especially if the father has  been advanced
in  years, or if marriage has been  contracted
too early in  life, or if either parents  have
lowered the standard of health  by dissipa-
tion  or by any other means, their sins, in
obedience to those laws which the Almighty
has  connected  with our being,  are visited
upon the  children,  in tendencies  to certain
diseases.  The  offspring of  drunkards are
very frequently the subjects  of affection of
the brain  and nervous  system ; the child of
the woman who gives  way to indolence, or
indulges in  undue  excitements,  will in all
probability fall below the standard of health.
Tendency to disease may also be given in
persons previously  healthy,  by whatever
lowers their own standard of health.  Dis-
sipation of any kind, deficient food or  sup-
ply of pure air, exhaustion from whatever
cause, depressing passions of the mind, &c.
all  give that tendency to  disease which
renders the constitution  more susceptible
of  its attacks.  Even the time of day exerts
some influence ; for it  is well known  that
a person  is much  more liable  to become
affected with any malady,  either of a  con-
tagious or malarious  character, such  as
ague, if exposed  to  its influences in  the
early morning, before  the  powers  of  the
constitution  have  been  invigorated  with
food, especially with that, such as warm tea
or  coffee, which  affords the gentle stimula-
tion of heat.  Further, individuals are never
so  liable to  succumb to disease as they are
during the stage of depression succeeding n
debauch.  Every day adds to  our experience
of  the way in which the ill-ventilated and
badly-drained dwelling gives the tendency to
fever and  to cholera, while at the same time
it  fosters  their deadly germs into activity.
Lastly, nothing predisposes more  to disease,
or  increases the tendency to it, than the de-
pressing passions, such as fear, despondency,
&c.  Those who give way to the fear of taking any
malady, open the readiest door for its incursion;
and  even without the  fear  of the disease
itself being the cause of the depression, the
fact of the mind  being depressed increases
greatly the  susceptibility to  any causes  of
disorder in  active operation at the time.
This is often strikingly exemplified in the
case of troops;  it  is always observed that
sickness is more prevalent among  the men
of  a retreating and desponding  army than
under the reverse circumstances.   Perhaps, 
DIS                201                DIS
 under no circumstances  is the worldly  ad-
 vantage of  a firm reliance upon Providence
 more palpable than when that reliance sus-
 tains the mind in cheerfulness, hope, and
 resignation—resistants  to diseases which
 come to the  aid  of those  who hold them,
 when other help seems to have" vanished.
   There is a  kind of mixed tendency  to
 disease, partly hereditary, and partly  ex-
 cited by external  circumstances.  It is this
 form which the children born  in India and
 other hot climates, of English parents, suf-
 fer, particularly  if the parents have been
 long resident.   They cannot be  retained
 in  the clime of  their birth,  without the
 greatest risk to life, before the age of puberty
 is attained.
   Most  of  those  causes which give a ten-
 dency to disease,  also, in themselves, when
 acting with increased intensity, tend to pro-
 duce it, or to aggravate it when  existing.
 The influences  of climate,  of  air,  whether
 pure or impure; of food, whether  deficient
 in  quantity or quality ;  of occupation,  of
 habits, or mental  influences, are all power-
 ful  excitants of  disease.   The remittent
 fevers of the  tropics  and  the typhus  of
 England, the scrofula, the rickets, and cuta-
 neous eruptions,  the consumption of the'
 metal-grinders, the  delirium of the drunk-
 ard, are all instances which might be multi-
 plied, of diseases  produced by external in-
 fluences.   The diarrhoea of fear, the nostal-
 gia or home-sickness (which is actually ac-
 companied with disease in the lungs) of the
 Highlander or  of the Swiss,  the  diseases
 of the heart which result from the agitation
 of political  or commercial  excitement, are
 all examples of the production of disease
 by the internal agency of the mind.
   AVhen disease has  established   itself  in
 the constitution, were it  not  for the "ten-
 dency to health," it must run on to a fatal
 termination.  The wound would remain un-
 healed, the inflammation would extend,  or
 its effect remain unrepaired, were it not for
 these curative powers  existing  in the consti-
 tution itself.  If,  then, whatever  tends  to
 lower  the  standard of health favours the
 inroads of disease, so  the preservation  of
 that standard, as  far  as  may be consistent
 with the safety of the  patient and the re-
 duction  of  his malady, insures  a  more
 certain  and speedy  throwing off   of  the
 effects of the disorder, or in one word—con-
 valescence.   Patients  who  have been pro-
 fusely bled are often very long in  recover-
ing, and during the  period  of  recovery are
liable to relapse, and to be attacked  by other
forms of disease.
  Moreover, during the progress of  disease,
 nothing assists more the powers of the con-
 stitution which  tend  toward  health, and
 to throw off the enemy, than a cheerful and
 hopeful mind ;  as the people call it, a "good
 spirit."  It may  make all the difference be-
 tween recovery  or  the reverse.   Indeed,
 every medical man must have met  with
 cases of illness, in which the patient seemed,
 as it  were, resolved not to give in—seemed,
 even  under  unfavourable   circumstances,
 determined not to  die, if they could  help
 it—and did not  die.  Even  when  physical
 powers tended  to death, the mind tended to
 life, and the mind succeeded.  Were it not
 for the tendency to health,  or to cure, ex-
 isting in the body, our medicines would be
 in vain; and  he  is  the best  physician who
 can detect those tendencies to recovery,
 permit  them to act when  they seem strong
 enough, and assist them when  they do not.
 The patient  in the lowest stage of  fever
 still has the tendency to health existing,
 and acting within,  and battling  with the
 disease; the  powers of a good constitution
 may of themselves be  sufficient to conduct
 him over the  crisis ;  but they may  not, and
 unassisted, the patient must sink  ere the
 tendency  to  throw off the disease  gets the
 mastery.   But  the physician steps in ;  he
 gives his help to the constitution ; his wine,
 and bark, and  nourishment,  and regulation
 of the functions,  support  the frame till the
 struggle is over, and the disease is  van-
 quished.  This power  of throwing off dis-
 ease,  this  tendency  to health  with which
 the living  body is endowed,  requires  to be
 impressed  upon  the mind of people  gene-
 rally ; for they are too apt to attribute that
 to the action of  medicine, which  medicine
 only gives  its  assistance to,  and to despise
 the simpler modes of treatment, which place
 the natural powers in the most favourable
 position  for curing.   The vulgar  attribute
 the healing of the  wound  to the plaster
 which merely holds it together, and  cold
 water is too simple to do good.
  The aggravation of existing disease, both
 by physical influences and mental emotions,
 is one of the most serious enemies the  phy-
 sician has to contend with.  The subject is
 sufficiently entered  into  in the  various
 articles  of  this  work.
  Lastly, disease  is  often established  as  a
secondary affection: it occurs inconsequence
of some previously  existing morbid  con-
dition of,  or  in,  some part of the body.
Dropsy is a disease peculiarly of this class.
Affection of the  heart, liver,  kidneys,  or
other  disorders, all tending to  produce  it
Apoplexy  may  result  from  disease of the
heart.  In these cases the secondary disease 
DIS                '20-2                 DIS
 appears simply a  result, without  beneficial
 influence—but in many cases  it exerts a
 tendency to remove the primary one ;  and
 this fact  is one of great importance  in the
 treatment of  all  disorders of the body, for
 rash interference with the natural effort
 may throw the diseased action back  upon
 the  previously affected, or upon some more
 vital part. The healed-up ulcer, or cured (?)
 eruption, may occasion head disease, or the
 stopped diarrhoea may throw back upon the
 constitution, with serious or fatal effect, the
 blood poison  of  which the vital  fluid was
 endeavouring to  relieve itself.   Even  that
 alarming incident, spitting of blood, though
 in itself a grave  symptom, may tend to re-
 lieve from worse  evil.  These efforts of the
 constitution, therefore, to  cast  off or  cure
 disease,  are  to   be  cautiously interfered
 with.
   In  the treatment of disease,  two  very
 different methods  have to  be pursued :  the
 one  is  that which exerts  itself directly to
 cure by the direct action of certain medi-
 cines.  Of this,  the  cure  of ague, of  neu-
 ralgia,  and other periodical diseases, by
 quinine or iron, is an example.  Experience
 has  unfolded to us that in these  and similar
 eases, the medicine has the power of curing
 by some relation established between it and
 the disease by the Author of all things—and
 in nothing is his mercy more strikingly ex-
 emplified.   But  why  quinine should cure
 neuralgia, why opium should allay pain, we
 cannot  tell, at least in the present state of
 our  knowledge; the  only approach  to any
 explanation  being one  given  by Liebig.
 The other method in  the treatment of dis-
 ease  is not so much of the active  as of the
 expectant or passive character.   There are
 many (perhaps the majority belong to this
 class) forms of disease  for which  we know
 of no cure, such as quinine is to  ague.   The
 throwing  off the malady must be by the na-
 tural powers, and  our only resource consists
 in putting and keeping those natural powers
 in as favourable a state for this purpose as
 possible.  Of this, many forms of fever are ex-
 amples. We cannot hope to cure,  we can  only
 hope to pilot the body through the rocks and
 untoward currents which arise in the course
 of the disorder, to allay secondary diseases
 which show themselves, to  alleviate painful
symptoms, and to  support  the constitution.
 These facts should  be made plain to the
minds of  unprofessional  persons generally,
for the most erroneous notions prevail upon
the points just alluded to, and often lead to
dissatisfaction with medical men.  One who
is  content with guiding  the course  of a
fever, either with the gentlest treatment, or
 with  what  people  may consider no treat-
 ment at all, is looked upon as inefficient,
 while  the  busy  meddler,  who  interferes
 without aim or object, and probably thwarts
 with uncalled-for medicine the natural tend-
 ency to cure, is regarded as  the "active"(?)
 practitioner.  •
   The reference from this article must be
 to the work at  large, for it bears upon the
 whole.
   DISINFECTANTS—Are any agents which
 detroy the  power or means  of propagation
 of such  diseases as  spread  by infection or
 contagion.  Purification of every kind, there-
 fore,  either by fresh air  or by water, is a
 disinfectant, these agents acting by dispers-
 ing or diluting the morbific germs, whatever
 these may be.   A high temperature doubt-
 less acts as a disinfectant,  by destroying
 their  chemical composition, and  chlorine
 and muriatic acids probably  exert a similar
 influence.   Quicklime and charcoal, on the
 other hand, most likely owe  their disinfect-
 ing properties to their power of absorbing
 various gases.   These chemical agents are
 all useful, but cleanliness and ventilation are
 disinfectants in the  power of all, and their
 operation is both continued  and conducive
 to comfort.
   Refer to Air—Contagion—Chlorine.
   DISLOCATION—In  medical, or rather
 surgical  language, means the displacement
 from  their  natural   positions  of bones or
 portions  of bones, at  the points where they
 are connected  together by means of joints
 or "articulations."   There is not, perhaps,
 a bone in  the  body which may not be dis-
 placed by  violence,  but  some are much
 more liable  to the accident than others.  It
 would answer  no good purpose, in a work
 of this kind, to enter into details respecting
 the varied  dislocations which  may  and do
 occur: a few, therefore, only of the  com-
 monest, most easily recognisable, and most
 readily remediable will be noticed.   There
 is some difficulty in  treating the subject of
 dislocation in a popular work  ; for, although,
 from the nature of the accident, and of the
 circumstances  in which it is apt to occur,
 it is highly desirable that some knowledge
 should be possessed by the unprofessional,
 both as regards the signs and symptoms of
 dislocation,  and its  more immediate treat-
 ment,  the  difficulty  that occasionally  pre-
 sents  itself, even to the skilful surgeon, in
 determining whether dislocation  actually
 exists  or not,  or whether it  is  complicated
 with some  other injury, such as a fracture,
renders the matter a delicate one  for lay
interference.  With this  caution, therefore,
that unless  tolerably clea- upon the point, 
DIS
203
DIS
 it will be better to wait  even days for the
 arrival  of  skilled  advice,  than  to  make
 attempts to remedy an  uncertainly ascer-
 tained  injury,  the  following hints may be
 useful, particularly in  those cases in which
 the accident does  not  happen for the first
 time, and  this will often be the case; for,
 having once occurred, it is very apt to do so
 again,  even from  slight causes.  In  such
 cases, the doubt as to the nature of the mis-
 hap will be most  materially  diminished;
 indeed,  the  patient  himself is  generally
 perfectly well  aware of what has occurred,
 and can often  give directions accordingly.
 The symptoms of  a  dislocation having oc-
 curred after violence or accident  are  pain
 with loss of power  over the limb or member,
 and its becoming fixed in one position, so that
 it cannot be moved, either by the patient or
 by others, at least not without occasioning
 severe  suffering;  numbness  is felt in the
 limb,  the  person becomes  faint  and  sick,
 and if the  shape of the joint be examined, it
 will be found deformed.
   AVhenever doubt  exists as to whether dis-
 location has or has not happened, the case
 should be examined by a competent surgeon
 as  early as possible, and  no time wasted in
 fomentations and rubbings, which are per-
 fectly useless.   If a bone is "out of place,"
 it cannot be too soon restored to its proper
 position, and  nothing  will  give  relief,  at
 least for a long period, if this is not effected
 A bone  certainly may remain  permanently
 dislocated,  and the member  attain, in  the
 cdurse of time,  a very considerable amount
 of  motion, by the formation of a new joint;
 but it is long before it does  so, the power
 of  movement is never equal to what it was
 was before, or would have been had the in-
 jury to  the joint  been properly rectified,
 and much  unnecessary pain is  suffered.
 The necessity for the speedy reduction  of a
 dislocation is great, from the fact that every
 day increases the difficulty of its perform-
 ance;  and when a certain time has elapsed,
 no  force which can be exerted—consistent
 with safety to  life and limb—will be  ade-
 quate to return the  displaced bone, partly
 owing to the resistance of the muscles, but
 also to obliteration or doing away with the
 cavity  which formed  the one portion of the
 joint.   AVhen dislocation occurs, two differ-
 ent actions  take place;  one, that by which
 the bone is driven from its  usual  position;
 the other, the action of the muscles, which
 tend still further to draw  it from its proper
 site as  soon as the balance of resistance of
bone against bone  is removed.   It is, too,
in most  cases,  the action of the  muscles
 which  tends to keep  the bone  displaced,
 and to resist the efforts made to replace it.
 This is evident from the fact, that if a per-
 son be seen immediately after a dislocation,
 and while suffering from the faintness which
 almost invariably accompanies the accident,
 and while  the muscles  are necessarily in a
 state of weakness and relaxation;  the dis-
 location may often be reduced  with the
 greatest possible ease,  even  by the unskill-
 ed ; and further, when the surgeon  has to
 deal with a case  of dislocation in a  strong
 and muscular subject, he  endeavours to
 produce this faintness—if that  following
 the accident has  passed away—by bleeding,
 nauseating medicines, warm baths, &c, [or
 by causing the patient to inhale aether or
 chloroform.   These articles are, however,
 too dangerous for an  unprofessional person
 to  use; and the  necessary relaxation had
 better therefore  be accomplished, when  it
 is essential,  by making  the patient "dead
 drunk."]    When, therefore, a dislocation
 occurs, the bone  is not simply pushed out
 of  its place,  but  is drawn for the most part
 upward, or toward the body ; the dislocated
 bone of the finger is drawn upward over its
 fellow; the arm-bone, in dislocation  of the
 shoulder,  may be  drawn  upward, or into
 the armpit—in this case  downward, it is
 true, as regards  the joint, but still  toward
 the body;  and the same will  be found to be
 the case in most  forms  of dislocation.  The
 first object, therefore, in treating a disloca-
 tion, must be to  draw it down from  or out
 of  the situation to and in which it has been
 drawn and is retained by the  muscles of
 the  limb,  and to  get  it as near the  corre-
 sponding part of the joint, or, in other words,
 as near the part from which it has been dis-
 located, as possible.   If the dislocated bone
 is thus drawn down to,  or near to the level
 of the  other portion of the joint from which,
 it has been  removed,  the  muscles will of
 themselves tend to draw it into its old posi-
 tion.  A good deal  is often said about the
 adjustment, &c, &c. of the bone in reducing
 dislocations;  and though, perhaps,  useful
 in some cases, in  many  nothing of the kind
 is required, at least unprofessional persons
 should not attempt it; all that is to be done
 is, give the muscles the chance of drawing
 the bone into its old place,  by bringing it
 to a position in which this can be effected.
 This is often exemplified in cases in  which
 much force is used in  the reduction of a
 dislocation ; if the force  be kept up strongly,
 the bone cannot  be drawn into its socket,
 because the force is stronger than the mus-
cles of the patient; but relax  the external
force for a  moment, and without any fitting
or adjustment, the bone is instantly drawn 
DIS
'   204
D  I S
into its proper position by the power of its
own muscles.  The above principles will be
better understood by a reference to the an-
nexed cut—for which the author is indebted
to Professor Fergusson's Manual of Surgery.
In this,  (fig. lvi.,) 1 is the  shallow cup
Fig. lvi.
   2
[glenoid  cavity] attached to the shoulder-
blade, (3,) in which the round extremity or
head (2)  of the arm-bone (4) ought to rest,
but from which it is represented as dis-
placed or dislocated.  The muscles are  not
here represented.  It is evident, that before
the round head (2) is replaced in the cavity
(1) it  must be  forcibly drawn  down  to  its
level;  this   drawing   down  the muscles
strongly  resist, but  also tend by the same
power to draw the head of the bone into its
place, as soon as it is drawn down sufficiently
for them to do so.
  These  principles  respecting  the  nature
and management of dislocations have been
dwelt upon, from the author thinking that a
Knowledge of them would be more likely to
lead an intelligent non-professional person to
judge correctly and act efficiently on such
emergencies,  than  the bare enumeration of
certain sets  of  symptoms, often sufficiently
obscure,  which  characterize  the different
forms of dislocations, and which he could
not carry in  his mind.   There is, however,
yet another important principle involved in
the reduction of dislocations.  It has been
pointed out  how the bone farthest from the
body—which is usually drawn up—is to be
drawn down; but, that this may be done
properly, the bone  above it  must be fixed,
otherwise it will be drawn down  too.   This
is easily effected in such cases  as the ankle
or the wrist,  by any one grasping and hold-
ing firmly either the leg or the forearm;
but in the case of the  hip or the shoulder,
more  management is requisite.   In the lat-
ter, which is the most likely to  fall  under
non-professional treatment,  the  shoulder-
 blade must  be fixed  or prevented   from
 giving way with the "extending" force ap-
 plied to the arm-bone;  how this  is  to be
 done will be pointed out when  the particu-
 lar  dislocation is  treated  of.   Again, in
 "making the extension," that is, using the
 forcible effort to return the  dislocated bone
 to its place, the extending force will best he
I made in the direction in which  the limb is
 fixed, and  in  the  manner  most  likely to
 bring the  joint portion, or " articulation"
 of  the displaced bone,  as near to the old
 position as possible, and it must be applied
 directly to  the bone  which is displaced.
 Thus, in  dislocation  of the shoulder, the
 reducing force is applied to the arm-bone;
 in dislocation of the hip to that of the thigh.
 This extending power may simply be by the
 hand, but  a  cloth,  or  band of some  kind,
 put  round the member to  be  replaced, is
 often more advantageous.  In  order to put
 this band on most efficiently, it is applied in
 the form of what is called  the clove-hitch,
 [or knot often tied by sailors,] (fig.  lvii.,)
Fi«. lvii.
which  will be better understood  from an
examination  of  the  cut  thnn  from  any
description.   This double noose, which may
be formed of any suitable material, such as
a large soft  handkerchief,  being  fitted  to
the part to which force is  to be used, with
a piece of cloth  interposed  between it and
the skin, is  not  liable to tighten  when its
loose ends are used to pull by. The particu-
lar dislocations most likely to be recognised
and to be remedied by unprofessional per-
sons, are those of the small joints, such as
fingers  and  toes;  of the wrist and  ankle;
of the  elbow, shoulder, and lower  jaw.
  Dislocations of  the  fingers or toes may
generally be  made out by  any person, and
should, if possible, be reduced at once; the
dislocated bone beinggrasped as represented,
(fig. lviii., also taken from  Ferguson's Sur-
                  Fig. lviii.
 
DIS
205
DIS
gery,)  and forcibly  pulled  into place; or
the clove-hitch noose, made with a piece of
tape,  may be  used.   Dislocation of the
thumb, it should be  known, is extremely
difficult of reduction, and should this not be
effected at once, the attempt ought to be given
up until  the surgeon's arrival;  it is, more-
over, one of the dislocations which  may be
left unreduced with less  subsequent incon-
venience than many others.   Dislocation of
the  ankle is very  generally accompanied
with fracture, but the distortion is often so
great  and evident, and the suffering so se-
vere, that when the accident does occur far
from proper aid, some attempt ought to be
made  to  put the  displaced parts  in better
position.   For this purpose, while one indi-
vidual grasps the leg firmly,  another,  put-
ting one hand on  the heel and the other on
the instep, should endeavour,  while steadily
pulling downward, to bring the joint into its
natural position.
   Dislocation of the wrist  is reduced by the
forearm  being tightly grasped by one indi-
vidual, the surgeon laying hold of the pa-
tient's hand in his,  and endeavouring by
steady traction downward, and slight up and
down  movement, to  bring the joint  into its
proper condition.
   Dislocation of  the elbow,  if attended to
quickly after the accident,  may  often be
easily  reduced by seating the person in  a
chair,  carrying the  arm well  behind the
back,  and pulling, not very forcibly,  upon
the forearm.
   Both these dislocations—of  the wrist and
elbow—may be  suspected, when, after  vio-
lence—particularly such  as is calculated to
push either the hand or lower arm upward
—inability to use the limb below the seat of
the injury, and distortion and impaired mo-
tion of the joint, are unaccompanied with
any grating sensation, such as occurs when
a  bone is fractured.
   Dislocation of the shoulder is most  generally
occasioned by violence applied to the elbow,
or by falls, while the arm is not close down
to the side of  the  body.  Sometimes the
exact  discrimination  of  an  injury to the
shoulder joint is a matter of much difficulty,
for fracture alone or fractures with disloca-
tion  may  occur.   At other times,  particu-
larly in thin persons,  it is tolerably easily
made out—more so if the examination is
made before swelling comes on.  In addition
to the  general  symptoms of dislocation al-
ready enumerated, the injured shoulder will
be perceptibly altered  in  shape; it will ap-
pear more depressed  and flatter  than the
sound  one, and if the  hand is placed upon
the spot which ought to be occupied by the
       S
round head of the arm-bone—and this may
be discovered  by examination of the unin-
jured  shoulder—it will  be found  hollow;
and further, if the arm be now gently moved
about, and its bone traced up toward the
shoulder, it will  be found  moving in some
unusual position, most probably in the arm-
pit.  Supposing,  therefore, that the case is
sufficiently clear, and that the sufferer from
the accident,  in the absence of proper surgical
assistance, is content to risk the  matter upon
non-professional  judgment, or  that,  from
having  been  the  subject of the accident
on some previous occasion, he  is tolerably
certain of its present nature, the means for
the reduction ought to be  set about  as
speedily as possible—if it can be, while'faint-
ness from  the injuries  continues.   These
means vary  considerably.  Hanging  over
doors or gates, the arm-pit being placed  on
the edge,  have been employed  and recom-
mended; and, in  persons who have been the
subjects of frequent dislocations in the same
shoulder, may be  efficient; but in  a first dis-
location should never be resorted to.  One
method of reducing dislocation of the arm-
bone into the arm-pit frequently employed is
for both patient and surgeon to lie down upon
the ground  side  by  side, but  with their
heads different ways,  and so that the sur-
geon having previously taken off his boot,
can place his heel in the arm-pit of the pa-
tient, while he grasps the  hand,  or a towel
fixed  to the  arm of the affected side;  in
this way,  while  the heel is  used to push
against the displaced bone in the arm-pit, it,
combined with the traction exerted by the
surgeon upon the limb of the patient, fends
to give a leverage by which the bone is so
placed that it can be drawn into the socket
by the muscles.  This method may be a con-
venient one, when only one person is in com-
pany with the individual to whom the acci-
dent has happened. The following is the most
useful and most generally resorted to method
of reducing  a dislocation of the shoulder.
The patient being seated on a chair, a large
towel or a table  cloth, folded  broad, is to
be passed round  the chest, close  under the
arm-pit of the affected  side,  crossed over
the opposite shoulder, and held either by a
strong assistant  or fastened  to some fixed
point.   By this  application, the shoulder
blade is fixed*; the arm itself is then to be
pulled, chiefly in  the  direction  in which it
has been fixed, firmly, steadily, and slowly ;
this being done, either directly by the hands
of assistants, or  by a towel fastened  round
the arm by  the  hitchnoose, (fig. lvii.)  If
when this steady  pull has been persevered
in for  some  time, the displaced  bone does 
DI S
206
DO V
not get into place, the effect of suddenly
taking off the attention of the patient may-
be tried, either by some sudden exclamation,
or by dashing a little cold water in the face.
By such a  proceeding, the muscles which
resist  the reducing or pulling force  applied
to the  arm, are for a moment, so to speak,
thrown off their guard, and  that moment
may suffice to permit  the bone to pass into
its socket.
  Dislocation of the lower jaw is  not  a very
unfrequent  occurrence,  and  happens from
persons  opening the mouth  very  wide,
either in laughing or gaping; the jaw slips,
and its articulations  or  joint  portions on i
both sides  are drawn forward ;  the  person
cannot close the jaws, but remains with
the mouth  wide open, a  most inconvenient
position  should  skilled  assistance  be  far
distant. The accident, however, can scarcely
be mistaken, and may be rectified  without
much  difficulty by  a  bystander.  For this
purpose,  the thumb or thumbs, according
to whether  the joint  is entirely dislocated
or only on  one  side, are to be placed by
the acting party upon the upper  portions of
the back teeth,  and strong pressure exerted
downward, while the chin is drawn  upward
by the fingers at the same time.  As the jaw
returns to its place,  its  powerful muscles
draw it upward with a sudden snap, and if
the fingers of the operator are not  covered
with a handkerchief or some other material,
[or quickly slipped to the sides of the teeth,]
they may get smartly bitten.
   After the dislocation of any part  has  oc-
curred and been reduced,  a bandage, or
some  application which will confine  the in-
jured  members, should be worn for some
days,  not simply from fear of the accident
recurring at the time, but to keep the parts,
which  must  have been more  or less lace-
rated, quiet, and to permit the internal traces
of the injury to  be  as much as possible ob-
literated,   in conclusion, although the sub-
ject of dislocations has been dwelt upon at
some length, it is chiefly for the  reason that
these  accidents, painful at the time,  and, if
unremedied, productive  of deformity and
impaired usefulness for the future, are often
overlooked, or are apt to occur at great dis-
tances from skilled  assistance.  In such
cases,  the information  given in the fore-
going  article may prove  a useful guide,
either  by diiecting atteniion to the import-
ance of the injury and of its speedy rectifi-
cation, or,  if acted upon with care and pru-
dence, by pointing out  the most  effective
treatment —Refer to Join's—Muscles.
   DISORDERED FUNCTION—A term very
frequently used in medical language, means
departure from the usual  healthy action of
any  portion of the body, either  unaccom-
panied with perceptible change of structure,
or as a consequent of altered structure  of
the part.
  Refer to Disease.
  DISTILLED  WATER.—See AVater.
  DIURETICS — Are  medicines which in-
crease the flow of urine.  The class cm-
braces very many substances, but it will  be
sufficient to notice only those which may be
most safely and generally used : they are—
     Broom,
     Dandelion,
     Fir Top,  J
     Gin,     j- which contain turpentine,
     Juniper,  j
     Parsley,
     Potash—Solution or Liquor Potassse,
       "     Acetate,
       "     Bitartrate, or Cream of Tartar,
             Carbonate,
       "     Nitrate of Saltpetre,
     Soda—Carbonate,
     Spirituous Liquors,
     Spirit of Sweet  Nitre,
     Squill,
     Turpentine.
  There is always  some  degree  of uncer-
tainty in the action of diuretic medicines,
but with some  more than others.   The au-
thor  has  found the  two first on  the list
(broom and  dandelion) as certain,  or more
so,  than any others,  and,  as domestic  reme-
dies,  they have the advantage of  being
easily procurable in this country, and  of
being  perfectly safe.    Fluids  should  be
given freely  during the  action of  diuretic
remedies.   It sometimes happens, that diu-
retics which would not act before, act after
the  administration of an  active purgative.
Similar effects are  found in the hands of
medical  men,  before  and  after bleeding.
As  mentioned  under the article  Coffee, the
infusion of the raw berry is diuretic.  Men-
tal  emotion such as fear, and nervous dis-
orders such  as hysteria, it is well known,
give  rise  to  great increase in the flow of
urine.
  Refer to the  various separate articles, for
the uses, &c. of the diuretics mentioned.
  DOA'ER'S  POWDER—Is a compound  of
one grain of opium,  one of ipecacuanha,
and  eight grains  of sulphate of potass,
well powdered together; ten grains  conse-
quently contain one of opium.  It  is much
used as a remedy to produce perspiration,
(in  which, however, it often fails,) and in
cases generally where opium  is requisite.
The ipicacuauha may occasion sickness.
   Refer to Opium. 
D 0 U                207                D II A
   DOUCHE—Is a stream of water directed
 upon any part of the body, and " is most fre-
 quently  performed while the  patient is  in
 the bath.  Douches are of various kinds, as
 the descending, the lateral, and the ascend-
 ing.   The  water  in  the first kind falling
 from a  reservoir,  at a  greater  or lesser
 height, upon  the patient in a single or di-
 vided stream, the size of which may be va-
 ried according to circumstances. The lateral
 douche is produced by a man's pressing the
 water through a tube, as with a fire-engine,
 the stream being directed against any  part
 of the body that is indicated.  The strength
 of this can be regulated by the  attendants
 pumping with a greater  or less  degree  of
 force, and also by  a finger  placed over the
 aperture, by  which the  stream is divided.
 In the  ascending  douche, the column of
 water is  directed  upward,  and  is  usually
 taken in a  sitting posture;  this  douche
 being almost  exclusively employed in com-
 plaints of the organs  contained within the
 pelvis.
   " Douches are directly exciting  remedies,
 and are mostly used to produce a greater de-
 gree of vitality and activity in  the parts, as
 in cases of local debility, scrofulous swell-
 ing, muscular rigidity, paralysis, contracted
joints, neuralgic pains, &c. They are mostly
 administered  while the  patient  is  in  the
 bath, and are often advantageously com-
 bined with  friction.   The  employment of
 the douche requires to be carefully super-
 intended."—Extracted  from Lee's " Baths  of
 England."
   Refer to Bath.
   DRASTIC—A medical  term  applied to
 purgative medicines, which act strongly and
 produce watery evacuations.
   Refer  to Purgatives.
   DRAINAGE—Is  the important process by
which superfluous moisture is removed from
the soil,  through the soil itself, or  by means
of channels made in or through  the earth.
 It may  be  eitlier  natural  or  artificial,  to
carry off the simple excess of fluid resulting
from  atmospheric  moisture, such as rain,
or to remove  the impure and  deteriorated
fluids, which more or less result where man
and the domestic animals are congregated.
   The  salubrity of  a district is  always
ck sely connected with its natural  drainage.
AVhenever moisture  accumulates, either from
position,  that is,  want of  inclination or
slope to run it off, or from the nature of the
soil, disease is apt to prevail.    Professor
Ansted* remarks, "there  can  be  no doubt
* Professor of Geologyr King's College, London.
 that  the district where  sand  and gravel
 allow the water to drain off at once beneath
 the  surface, and that where  hard  and im-
 permeable rock permits the  rain to_ escape
 readily  into the nearest  running stream,
 will be  on the whole  the most  healthy;
 while, on the other hand,  that in which the
 tough  clays retain the water in ponds on
 the surface will be exposed to marsh fevers
 and various  disorders affecting the throat
 and lungs.  These remarks apply chiefly to
 temperate climates, but when the conditions
 of vegetation are taken into account, they
 are  no  less true than important for warm
 countries, where the  rankness of the vege-
 tation must, no  doubt, be connected  with
 the  nature of  the sub-soil  over  which it  "
 grows."
  These considerations are  important for
 all,  and  especially for  the  emigrant  and
 settler in new districts, who ought always
 to fix, if possible, upon a  site for his dwell-
 ing, where the water has or may be made
 to have  an efficient drainage  in  every di-
 rection  and way; and to exercise  caution,
 also, that the dwelling of himself and family
 is not so placed that any  generally prevail-
 ing wind can blow upon  it from a marshy
 or  badly drained tract  of  country.   The
 effect of draining the soil, in  rendering a
 country more salubrious, and in removing
 disease,  is well exemplified  in  the disap-
 pearance of ague  from  many  parts of
 England in which it formerly prevailed, a
 circumstance which can only be accounted
 for  by the increased attention to the drain-
 age  of  those districts.   As  might be  ex-
 pected, low situations  are not likely to be
 so well drained as those situated on  elevated
 ground.   The  latter  does not alone, how-
 ever, suffice in  all cases, if the drainage is
 improperly managed, and some of the worst
 local forms of typhus have been known to
 prevail in such places.
  .The drainage of houses  or collections of
 houses,  where  day  by  day there   must be
 removed  the excretions,  both  solid   and
 fluid, of  man  and animals, is  one of the
 most important points  connected  with the
 preservation of health ;  it might almost be  t
 added, and one of the most neglected ones.
 Both in town and country, the necessity for
 sufficient drainage,  whether of the natural
 moisture of the soil, of the results of animal
 life, or of domestic habits, has  been, if not
 entirely overlooked, most  insufficiently pro-
vided for.   It  might  shame  the  boasted
civilization ot our era,  to  learn that in  Mr.
 Layard's  researches in Nineveh, he found
the  buildings (of an age  estimated at 120C 
D  R A
■JOS
D R A
years befoit. Christ)  provided with a com-
plete system of sewerage.   Each room had
a drain connected with a main sewer.
  It is generally thought that in the coun-
try less necessity exists for perfect drainage
than there does in large towns, and to some
extent the idea may be correct, in so far as
the smaller number of individuals collected
in a given spot and the freer circulation of
air must  tend to preserve  greater purity
of atmosphere.  But  this  idea,  by lulling
suspicion, has proved a dangerous one, and
the  single  homestead or  small  isolated
hamlet has  been desolated by the scourge
of  fever,  which a little precaution  might
have prevented.  One most striking instance
has been recorded by Dr. Christison, which
occurred  in  and close round a farm-house
occupied  by an extensive  farmer, in "a
thinly-peopled  rural  district, in  Peeble-
shire."    With  respect  to  situation, Dr.
Christison, after describing  it,  concludes
with,  "a  healthier locality could not well
be chosen ;"  and yet, in, and close to this
healthily-situated house, and in no other in
the district,  fifteen  cases  of a  severe and
peculiar form of fever occurred within the
space of  a  few weeks,  and  three  proved
fatal.  Such  a well-marked visitation  could
not  well  escape  searching  investigation,
which brought to light  the fact  that the
house was completely surrounded by drains,
which had, in the  course  of time, become
filled  up  with  the drainage  of  the farm-
yard, of  the necessaries, &c. &c.    Such
cases are by no  means  uncommon, even
in  country  situations which would  be at
a  first glance  esteemed  most  salubrious,
and indeed would  be, but for the  shame-
ful neglect of the inhabitants.  The author
cannot recollect  during  ten years'  prac-
tice in a  rural  district,  any invasion of
fever going through  a house, or collection
of  houses, which has not  been  traceable
to deficient drainage  and negle'ct  of sani-
tary measures  generally.   It is  not fever,
however,  as  generally  so   called,  which
alone occurs  in consequence of  deficient
drainage, but bad  health  generally.   And
whatever  case  of disease or  accident may
remain  within  the  tainted locality, ac-
quires a certain  unfavourable  tendency
and type;  even recovery from childbed  is
affected  by  it,  and perhaps  more  cases of
childbed  fever  and   death  than  would be
imagined,  might  be traced  to the  unhealthy
influences  originated  by  habitations  situated
in  a  badly-drained  locali'y.   Surely  this
last consideration, if no other, might rouse
men to act.   The point touches the wealthy
cit'zen as well as the poor one.
  Inflammation of the eye. or rather of i^«
covering membrane, the  "conjunctiva," h\.u
been found  occurring commonly in  parti-
cular localities,  no cawse being  assignable
beyond  that of  stagnant and   putrefying
ditches  or unwholesome  drains.   The con-
tamination  of  wells which  supply  water
used for drinking and cooking,  by  badly
arranged or imperfect drainage, is a very
fertile source of disease ; many of the worst
invasions  of fever,  and  cholera  also, have
been traced to this disgusting source.
  Whatever has been said respecting drain-
age in country places, applies with increased
force to the  provision in towns, with their
dense  populations.   On this  head, Mr.
Grainger, in his  pamphlet published by the
" Health of Towns  Association," remarks,
" The  most  prolific  source  of   disease  in
towns is, certainly,  defective  drainage and
sewerage.   Where large  numbers of human
beings are collected  together,  it is apparent
that there  must  result  a  vast  amount  of
refuse matter of every description, to  which
must be added the  solid and fluid excre-
tions of the body, the former of which  alone
amount in a town  like Liverpool  to nearly
six  thousand tons annually."
  The  first  essentials for proper drainage
are  well-constructed sewers,  that is,  such
as will not promote  the  deposition of solid
matter in their interior.   That the majority
of the  old  sewers and drains do this has
been proved before the  Health of Towns
Commission.  It was shown that " by their
unnecessary size  and defective form, most
of the old sewers being flat at the bottom,
they cause a retardation in the flow of theii
muddy  contents,  and thus,  of  necessity,
produce a  lodgment of  putrefying animal
and vegetable matter.   Another source  of
deposit is the improper direction of  these
conducts,  the sharp angles and curves  of «
which, especially where the smaller sewers
enter the main trunks, lead to obstruction,
and to  these must  be  added the various
irregularities of surface  connected with the
masonry."   Again,  drains  are  frequently
placed  too near the surface,  and leave the
under-ground premises either undrained, or,
what is worse, receptacles for their leakages,
should they get out  of order; then the gut-
ters, the most superficial drains of all, are
full of holes and  crevices;  the entire sys-
tem, including the gratings over the under-
ground drains,  being calculated rather to
foster disease than to  remove the causes of
it.   In  addition, however, to construction,
a full supply of  water is requisite, one that
can thoroughly and  periodically, at not  too
distant intervals, be sent  in  full volume- 
D R A               209               D R  A
 ' flushed"—through the passages so  as  to
sweep every thing before it.
  One  gentleman,  Mr.  Guthrie,  examined
before  the Health o/ Towns Commission!
gives the following important points of evi-
dence.  He says, " My  attention has been
more especially directed to private drainage,
or the  sewerage of individual tenements;
for I am satisfied the public health is more
deleteriously influenced  by the exhalations
which  arise from  pent-up  matter in them,
than by those  which issue from  the  great
main or  common  sewer.   I  hold every
system of flushing to be imperfect which
merely hurries  along the  contents of the
principal or main sewers, while the putrefy-
ing debris of  inhabited tenements is left
undisturbed in house-drains.   The reason
why house-drains act so imperfectly, that
they frequently get entirely choked up, is
simply because their too limited supply  of
water is spread over so great a surface that
its power  to carry along matter in suspen-
sion is  lost.
   Choking from accumulation  seldom takes
place in  the  small iron or lead  soil  pipe,
neither would such a circumstance ever take
place if the calibre of  the tube  or drains
intended to carry off the  soil were not made
so great that the usual  allowance of water
is unequal to the task  of  washing out  its
interior.    " The  tubes  made for house-
drains  should be circular, and not more, for
any  ordinary tenement,  than from three to
six inches in diameter.   The form of main
sewer  most recommended  by  those  who
have paid much attention to the subject, is
the oval, (fig. lix. 1,) or with a lesser curve at
                  Fiir. lix.
sition of solid matter, and also being more
easily cleansed.  Sufficient fall for the fluid
is of course requisite for a complete drain
  Effluvia are very apt to escape from drains
" by the improper position of  the  gully
gratings, and from these not being trapped.
By  improper position is meant the  top of
an  eminence,  where no surface-water can
properly accumulate."  Gratings and gullies
are therefore injurious in such situations;
and, indeed, should only  be  placed  where
absolutely  necessary to carry off surface-
water, which will clear them out; and they
should be trapped.  The inmates of houses
close to  gully-holes have been known to be
attacked with fever which could in no way
be accounted for, except by the emanations,
proceeding   from the  sewers, through the
gratings.
  Lastly, all those parts of a house which
are connected with sewers and drains, such
as water-closets, sinks,  &c, ought to be so
constructed that they do  not  allow effluvia
to escape.  This may be simply and cheaply
done by means of earthenware soil-pans,
with siphon-pipes, as represented, (fig. Ix.,]
                 Fis. ix.
bottom than at top, (fig. lix. 2.)  It is calcu-
lated that this latter form " gives full action
to the water at the time it is most needed,
namely,  when  the quantity is smallest.'
Drain-tiles or  bricks may  be  used  to form
these oval  sewers; but tubes in moderate
lengths are most strongly recommended.  In
nddition, it is advised  that whatever mate-
rials are used  for drains should be glazed in
the inside, as tending less to promote  depo-
      s 2
in which the stratum of water, (fig. Ix. 1,)
which always must remain in the lowest part
of the pan, acts as a valve against all efflu-
vium from the  pipe, (2.)  Where a sink is
not  attainable,  a simple funnel-like  pipe,
with a cover, (fig. lxi.,) may be fitted into
                Fig. lxi.
the floor, and made to lead into the drain.
The subject of drainage generally is so im- 
DR E
210
D  RK
i  irtaut, and its connection with health is
so intimate, that  it might be extended  to
a much greater length than the limits  of
this  work  will admit of.  Enough,  it  is
trusted, has been said to direct attention to
it; and those in whom a spirit of inquiry
has been excited, and who desire more ex-
tended information, cannot do better than
seek it in the valuable and cheap publica-
tions of the  Health of Towns Association.
  DREAMING—Is the wakeful and sentient
condition  of some of  the faculties of the
mind,  while  the  others  are  asleep.  The
whole subject of dreaming is highly interest-
ing in  a psychological point of view;  but it
is only in its connection with the body that
we have here to do with  it.  Some persons
naturally  dream  more than  others;  but
there is no  question  that  the  occurrence
and,  more   particularly,  the  nature  of
dreams are both much influenced by the con-
dition if the body.  Few are so fortunate as
to have escaped  an  attack of incubus,  or
nightmare, arising from disordered diges-
tion ; and  all who  have  been much  with
children, know well how liable they are to
suffer from disturbing dreams,  whenever the
Btomach and bowels are disordered.   It may
be safely asserted that a large proportion
of uncomfortable dreams are connected with
disorder of  the digestive functions—gene-
rally  overloading, but sometimes  the re-
verse.   Some people always dream if they
do not take  some slight  refreshment just
before retiring to rest.  Mental excitement
during the previous  day is of  course  a fre-
quent cause of dreaming.  Organic diseases,
which  give  rise to  oppression  within the
chest,  such  as diseases of the heart,  are
peculiarly liable to occasion uncomfortable
dreams and nightmare.  Uneasy and pow-
erful  sensations excited upou  any portion
of the body occasion  what are called sug-
gestive dreams ; that is, the sensation seems
to start some thought in relation to itself
from  which  a train  of incongruities,  such
as occurs  in  dreams,  appears  to  arise;
a blister is the foundation for some dream
of torture;  or a loud  sound for one  of
tumult.
  Although  made the subject  of  much cre-
dulity, dreaming, not  only in its  general
character, but as regards the nature of the
dreams, is not to  be altogether disregarded
with respect to the indications it affords of
the bodily condition.   AVhen natural  sleep
is thus disturbed, particularly  by dreams
which cause alarm and uncomfortable sen-
sations, or which  occasion  children to start
and  scream, the  cause should be  investi-
gated ; some error, simply as  regards diet,
either as to time, quantity, or quality, may
be the  reason ;  or disease may be forming.
One  or two smart purges will frequently
remove the symptom.   Whether in child or
adult, should much mental exertion be going
on, nnd sleep become unusually disturbed by
dreaming, mental  relaxation  nnd a greater
amount of  physical exercise should be com-
bined with attention to all  the  functions.
The  shower-bath, eitlier generally or as a
local application to the head  alone, will be
useful  in such cases.
   Refer to  Sleep.
   DRESS.—See Clothing.
   DRESSING.—This word is employed  by
the surgeon to  express the  application  of
various substances or agents to diseased ot
wounded parts, to protect them  from the
action  of the air and from external injury,
and, either by mechanical  action or other-
wise, to promote their healing or cure.  It
is, of course, also requisite both  for clean-
liness  and  for  the comfort of the patient
and of those around.
   In former times, the process  of a surgical
dressing was a  much more formidable and
complicated affair than it is now  under the
modern, simpler, and more efficient practice
of surgery, which is sometimes too simple
to please patients.  As the treatment and
mode of dressing burns  and  wounds  is re-
ferred to in the  articles on these and similar
subjects, it is unnecessary to reiterate them
here, and for what is requisite respecting
the application  of bandages, the reader is
referred to the  article itself.   At  present it
is proposed to give  rather  the  principles
on which dressings generally should be con-
ducted, than their details.
   The  first essential in dressing is gentle-
ness and lightness of hand.    Parts which
require the process are generally in a state
of greater or less inflammation, and conse-
quently of  increased sensitiveness;  and the
patient, owing  to the weakness  which ac-
companies or follows disease  or accident, is
most probably in an irritable  and  nervous
condition;  for  these  considerations,  if for
no other, the  dressing, which is bo  often
dreaded, should be  conducted  with  the
utmost  gentle  care.   The next essential is
to have at  hand whatever is  likely to  be
wanted; warm, soft water, with a sponge—
or in its place some soft material—scissors,
and lint, or linen.  A piece  of waterproof
material to place  under the part  is often
useful.  If plasters, bandages, &c. are re-
quired,  they should not have to  be sought
for or cut when  the  wound is  exposed and
the patient waiting.   If  the  old dressings
have become in the least hard or adherent, 
DRE                211                DRE
jr, if plasters form part of the applications,
they should all be well softened by the warm
water before  the attempt is made to remove
them, and  they should not be pulled  away.
When strips  of plaster  are to be taken  off
a wound, the  lips of which they  hold  to-
gether, they  should be lifted at both ends,
so that the detaching process meets just at
the wound ; the object of this proceeding is
to prevent the newly-healed and adhering
surfaces  from  being torn  asunder,  which
they are  likely to be if the plaster is pulled
off from  end to end.  For taking dressings
off wounds, a pair of "forceps," as repre-
sented,   (fig. lxii,) will be  found  useful.
                  Fig. lxii.



                  1
 When the old dressings have been removed,
 the  parts   around  the  wound  Bhould be
 gently but  thoroughly cleansed.  If there
 are  any loose, mortified, or  "sloughing"
 substances  upon  the wound, they may be
 lifted off;  but its  surface must not—as is
 too frequently done, even by medical men—
 be washed  and deluged with water.  The
 matter which covers the surface of a wound
 is the protective covering provided for it by
 nature, and if this be removed, it is much
 more likely to become irritable and painful,
 and  to be  longer in healing.   When the
 proper cleansing has been effected, the re-
 quisite dressings should be put  on without
 delay, leaving room, if there is likely to be
 much formation of matter, for its  due dis-
 charge—the part being so  placed, when the
 dressing is  finished,  that  the discharge can
 easily escape.
  The various dressings requisite  for inju-
ries will be mentioned in their proper places
and articles, but one often recommended in
this work requires notice here: it is the
simple water-dressing.  This is at  once the
most convenient, agreeable, and universally
applicable dressing to wounds of every kind
The popular fallacy, that the applications
have in  all cases something to do with the
healing  of  wounds, is very apt  to make
people, especially the poor, look suspiciously
on  so simple an agent as pure water.  It is
true, the interference of art is frequently
requisite, either to stimulate or to  repress
action while wounds or diseases are in pro-
cess of cure;  but in  the  majority of in-
stances the cure is the work of the  natural
powers alone.   All that has to be  done  is
to place these in as favourable a  position
for exerting their agency as possible,  and
nothing  answers  this  purpose  so well as
pure, soft water.  The application  is made
either by linen or lint soaked in the water
—warm, tepid, or cold, as  most agreeable
to the sensations  of the patient—and is in
most cases covered over with some material
which will prevent evaporation.  Oiled-silk
has  generally been  used for the  purpose,
and oiled-calico where economy is an object,
but latterly thin sheet gutta-percha has been
employed, and  answers extremely well.  If
linen or common lint is used, it will  require
folding at least double to enable it to retain
moisture sufficient.  As a dressing,  Taylor's
new patent  lint is  a much thicker and more
spongy, and, for this purpose, better adapted
material than  the others.  Water-dressing
is not necessarily covered with waterproof
material; if the part requires keeping very
cool it is better not so, but then it will re-
quire much more frequent  wetting, either
by a nurse  or  by the  system of irrigation
recommended  under  article  Cold.  When
waterproof  material  is put over  the  wet
linen or lint, it of course prevents evapora-
tion,  and keeps in heat; it should always
be larger than the lint.  A mistake  is very
commonly  made in  this  matter.   A great
piece of linen or lint is put on with its edges
sticking  out beyond the oiled-silk, or what-
ever is used;  and these  edges, or even a
very  slight  protrusion,  are  sufficient  to
drain off the entire  moisture, leaving what
ought to be a most soothing dressing, a dry
and irritating  one.  Among the poor the
most complete ignorance respecting the use
of water-dressing prevails—it is too simple
to get much of their  confidence,  and very
often, unless the most particular  and re-
peated directions are given, the waterproof
material—mistaken  for a plaster—is  put
next the sore, and the wet  lint on  the top
of it!  Of course, when requisite, any de-
scription of lotion can be used as a dressing
in this way in place of the simple water.  So
universally applicable is the  water-dressing,
and  lotion applied in  the same way, that 
D RI
212
D  RU
they  may almost  entirely supersede  oint-
ment, to which  there  are  many objections.
A greasy application  is seldom as pleasant,
and never  so  cleanly, as the fluid  one;
moreover, ointments  are very often indeed
used  rancid, and thus become sources of
irritation rather than of benefit.   When a
simple greasy dressing is  required, a little
perfectly fresh  lard, or olive-oil, is as good
as any.
   Refer  to  Adhesion—Bandages—Blisters—
Burns—  Wounds, $c.
   DRINKS.—Fluids  taken by the mouth
may be simple,  medicated, nutrient, or sti-
mulant.  The only simple drink is water.
AVhen agents which act medicinally  upon
the body are dissolved in  that fluid, as in
the case of mineral waters,  either natural
or artificial, when it is rendered nlkaline or
is acidulated, or is impregnated  with car-
bonic acid gas, as in the case of soda-water,
it becomes  a medicated   drink.   Barley-
water, toast-water, milk, &c. are examples
of nutrient,  and alcoholic  liquors,  tea, cof-
fee, &c. of stimulant drinks.   It is difficult,
however, to  draw the  line between  these
classes.   Many drinks which might be called
medicated ore in daily use; those which are
Btimulant are in many cases  nutrient, and
vice versd.   As drinks come under the head
of " Diluents," the reader is referred to the
article under that head.
   DRIPPING—As  this article is often used
for household purposes, or given away, it
should be known  that symptoms  of lead-
poisoning, or colic, have  been induced  by
the drippings from meat  which  had  been
baked in a  newly-glazed  earthen vessel;
the lead-glaze being  soluble  in the  fatty-
matter.   Neither should what was said  of
the power of fatty matters to act upon cop-
per, when kept in vessels composed of that
material, and especially if  mixed with salt,
be forgotten in connection with this subject.
  DROPSY—Is the effusion or accumulation
of the serous or watery portion of the blood
(such as  we see  thrown out in a blister) in
any of the  tissues or cavities of  the  body.
Thus  the watery effusion  may take place
in the cellular  tissue, (see Cellular Tissue,)
which connects  the various portions of the
body, and fills up their interstices, in which
case it will  show itself in  the eyelids and
other portions of the face,  or swell  the feet
and legs, hands and arms, or the body gene-
rally.  This  form of  dropsy is  called  by
medical men " Anasarca."  The effusion, on
the other hand, may  be into some of*the
larger cavities, as into the abdomen, when it
is named "Ascites;" or into the cavity of the
chest, between the  lungs and ribs, when it
is known as " Hydrothorax," or water in
the chest.   Again, effusion may take place
into souk' of the smaller cavities, or rather
"sacs," as into the bag which surrounds the
heart.   AVhenever it occurs, dropsy is always
to be regarded seriously.   It is,not, as the
unprofessional generally think, a disease in
itself, but it is almost invariably a symptom
of disease, either constitutional or local, ex-
isting in the system.  It is not here  meant
that dropsy is not  a disease, but that it is
generally a secondary one, not the original
affection, which  may, however,  be  so ob-
scure,  that nothing is left  for the  practi-
tioner to treat but  the dropsy, and that he
must get rid of, if possible ;  for though in
itself an effect only, it tends to produce other
diseased actions, by impeding or stopping
the functions of important or vital organs.
  Anasarca,  or  effusion into the cellular
tissue,  may be simply  the result  of general
constitutional debility, of which  the  blood-
vessels, both  large and small, and the heart
partake;  this  form of dropsical swelling
usually shows itself in the  feet  or  ankles
toward night, especially after long standing;
many delicate persons are subject to it as a
temporary  ailment, when  from  any cause
the general  health  has  become  impaired.
When it  shows itself and continues  in the
weakly, as in delicate girls, along with weak-
ness generally, pallor, &c. it is only to be got
rid of by measures which restore the tone
and vigour of the system, such as good diet,
with port wine and porter,  tonic  medicines,
exercise, and change  of air.  Should the
error be  made of confounding it with an in-
flammatory condition of body—and the quick
irritable pulse might mislead—and  lower-
ing measures be resorted to, the disease will
be greatly aggravated.  Local anasarca, or
dropsical swelling,  may  arise   from  any
cause  which impedes  the  return  of  the
blood  through the  veins,   and  is  a very
common  accompaniment of  disease of the
liver or  heart, or  of tumours which pres9
upon the great veins: of this, pregnancy,
which  often occasions  swelling of the legs
during its continuance,  is an example, the
effect passing oil  as ioon  as the cause is
removed.  The lower  limbs  are  the most
frequent seat of anasarcous, or, as it is often
called,   " cedematous"  swelling;  but  the
hands,  face,  &c. are also  occupied by it;
indeed, swelling of the eyelids in the morn-
ing, with stiffness  on  first  trying  to open
them, is  often one of the first symptoms of
the tendency to dropsical effusion, whatever
the cause.   Again,  anasarcous  dropsical
swelling may be occasioned  by an affection
of the  kidneys, which  cannot carry off th« 
                 DRO

fluid from the body with sufficient rapidity.
The above are all instances of what are called
" passive"  dropsies;  the  cause generally
acting slowly,  and unaccompanied  with  a
marked feverish state of the system ; there
are,  however,  forms  of dropsy which  are
attended with  this feverish state,  and in
which the watery effusion takes place rapid-
ly—sometimes  surprisingly  so.  The  best
instance of this is the acute form of dropsy,
which  is apt  to happen  to convalescents
from  scarlet fever, and which  is traceable
to cold.   Whatever  occasions "anasarca,"
or effusion of watery fluid  into the cellular
substance  of the body generally,  may also
cause its occurrence in the cavities, as of the
abdomen  or  chest;  but it may also  take
place both in the large and small cavities,
as a  consequence  of  local inflammation.
Their lining "serous"  membrane becomes
inflamed, and pours out a watery secretion
in greater or less abundance.  It is  matter
of popular information, that dropsy in the
belly is  apt to follow inflammation, and that
water in the chest results from pleurisy.
  From what has now been said in expla-
nation of the nature and causes of dropsy,
it  must  be evident that its serious treat-
ment  is not for the  unprofessional;   the
causes are often too obscure, and the proper
and efficient remedies too  active, to be in-
trusted  to non-medical  hands,  particularly
as it can rarely be  an emergency.   A case
of inflammatory dropsy, such as occurs after
scarlet  fever, might of course happen  at  a
distance from  medical aid;  and  for  the
measures to be adopted the reader is referred
to the article Scarlet Fever.
  No matter what form dropsy assumes, the
case should at  once be put under medical
superintendence.  As temporary palliative
measures, the bowels should be kept either
simply  open  or actively purged, according
as the patient is of weak or strong habit of
body ;  and the  effusion of water may  be kept
in check  by the use of diuretic remedies.
(See Diuretics.)  Of these, infusion of broom
or dandelion, cream of tartar, sweet spirit
of nitre, or saltpetre, will be found the most
suitable.
  Refer to Blood—Diuretics—Urine, $c.
  DROWNING—Is death by suffocation from
immersion in fluid.  Few subjects treated of
in this work are more important.  Accidental
drowning is so  frequent an occurrence,  and
it so often happens  that no medical assist-
ance is at hand during those first few precious
moments after the body of a drowned person
is recovered from the water, that  some by-
stander, who is possessed of the knowledge,
not only of what ought to be done, but of
3                DRO

what ought to be  avoided  may haTe  *tie
satisfaction of saving  a  life \vhich must
otherwise have been  lost.   When an indi-
vidual falls into  the water,  especially from
a height, there may or may not be consi-
derable shock, from the body striking  the
surface;  or the  head or  other  parts may
have struck against a stone or  some hard
body; or  there  may  have  been fainting
caused by the fright: all these circumstances
must,  of course, modify the  effects.  The
last has been said to account for  those cases
which have been reported as recovered, after
very long immersion, that is, half an hour
or longer.
  The longest well-authenticated  time of
complete  immersion,  after which  recovery
has been effected, is fourteen minutes,  and
this case stands  by  itself.   Other cases of
ten, six, and five minutes are recorded,  but
there is always  doubt whether immersion
has been complete  during the whole time;
this doubt, however, which must  occur in
most cases, is the yery reason why hope
should not be abandoned, even after persons
may be thought to have been  in  the water
a considerably longer period ;. and  though
it might be established that none could be
entirely under water for five  minutes, and
recover,  this is not to be acted upon;  half
an   hour's  supposed  immersion, or even
longer,  should be no  barrier to efforts at
restoration.   AVhen an individual  falls into
water, the body  generally rises again to the
surface,  when an effort to breathe is made ;
air may be drawn in to  some extent,  and
with it water, more  or less, which passes
into the stomach ; this may be repeated  two
or three times, or efforts to breathe may be
made beneath  the  surface.  However  this
may be,  the contact  of the  water in  the
breathing effort causes closure of the " glot-
tis" or chink at the upper part of the wind-
pipe; a small portion of fluid may pass in;
but the principal effect is the exclusion of
the  air, and  thus  the drowned person  is
effectually suffocated, and  the  lungs  in a
considerable degree emptied  of their  air,
which is pressed out in the vain respiratory
efforts,  and rises in bubbles to the surface.
The amount of water which may have been swal-
lowed is comparatively of little moment,  andean
have but little, if any thing, to do with the fatal
consequence. A  person,  therefore,  who  is
rescued  from  the water after immersion,  if
not  dead beyond recall,—and here is the
doubt of which they should be given  the ad-
vantage,—is partially suffocated:  the  vital
powers are also depressed by the action of
cold, and probably also by the struggles and
shock, both mental and bodily: but still th*
21 
DRO
214
DRO
murhinery is perfect,—the pendulum may be
sturped, I'Ut the spring  may yet be capable
of action.   In other words,  vitality, though
apparently suspended, may  yet linger in a
frame of which the structures are as capable
as ever they were of  acting as its agents;
the mysterious link which binds them  in ac-
tion  may be almost severed, but our efforts
may restore it.
  The first thing to be  done when a person
apparently drowned  is  rescued  from  the
water,  is to wipe  and  cleanse thoroughly
the mouth and nostrils—the next to  apply
warmth to the body.  This  last cannot pos-
sibly be done as long as it  is covered with
wet  clothing;  and if this  is the  case,  it
Bhould be removed—cut off,  if necessary for
haste—as quickly as  possible.  If  there  is
a house or shelter of any kind very near the
spot where  the body  is got out, it may be
taken to  it  at once and before the clothes
are  removed;  but  if  such  is not  the case,
provided  dry coverings are at hand, the wet
clothes should be stripped off  on the spot.   In
removing the body,  it  is best done by laying
it on the back  or  side, on some flat board,
Buch as  a door or shutter, the  head and
shoulders being well raised; butif there isno-
thing at hand on which the body can be laid,
care should be  taken  in carrying it that
the head is well supported,  neither allowed
to fall   back, nor forward upon the  chest.
As soon as  may  be,  warmth is to be  ap-
plied to the entire external surface; if a
warm bath—temperature 98°—is available,
it should be used;  if not, the body is to be
covered  up with warm  things; bags of hot
bran, hot salt, or sand, or  any other con-
venient vehicles  for heat are  to  be placed
wherever they can be,  without interfering
with the  necessary manipulations; to the
pit  of  the stomach, and  to the feet espe-
cially,   their application  is to  be  used.
Frictions  with stimulants  of  some  kind,
such as camphorated oil,  brandy, or any
other spirit mixed  with oil, or turpentine,
should  any of them  be  used warm, and
rubbed in with a flannel;  a  warm stimulant
clyster,  consisting  of  gruel—temperature
]O0°—containing a tablespoonful  of tur-
pentine, or double  the  quantity of brandy,
may be given,  and  strong-smelling  salts
held to the  nostrils at  intervals.   Artificial
respiration,  recommended by some, is con-
demned  by  others.   Certainly the old me-
thod of using  bellows and  other means  to
inflate  the lungs was much more  likely to
do  harm than  good,  particularly in the
hands  of the unprofessional, who would be
much more likely to inflate the  stomach,
and  thus  impede respiration.  Attempts  m
imitate  the  natural  process of respiration
may, however, be made by pressing inward
the ribs and pit of the stomach, and allow-
ing them  to  rise again  by their own  elas-
ticity, repeating-this process twenty or five-
and-twenty times in  the  minute.   Galvanic
and electric shocks passed through the chest
nnd upper portions of the spine would pro-
bably be useful,  if the apparatus chanced
to be at hand—but this will seldom be the
case.   The new electric belts will probably,
however, afford greater facility in this re-
spect.   These are, however, but accessary
means, which  may be  employed or not,  as
available and convenient, nnd as far as they
do not interfere with those essential remedies
which are most to  be relied upon: these are,
external warmth and continued friction, with
care taken that the shoulders and  head are
raised, the mouth and nostrils free.  For
the more  easy application of remedies, the
body should be laid on a table of convenient
height.
  Having  now mentioned what ought to be
done in cases of  drowning,  it is necessary
to notice what ought not to be done;  for many
old and most  injurious  modes  of  treat-
ment  are  still apt to be resorted to by the
ignorant and prejudiced.  Most of these have
originated in the idea that water swallowed
was, or had something to do with the cause
of death;   hence patients have been hung
up by  the heels,  rolled on  barrels, choked
with emetics, under the idea of making them
disgorge the water.
  Undoubtedly, if there is much water swal-
lowed—as sometimes  happens—it would be
better to remove  it;  but any means which
unprofessional persons can use for its re-
moval  would only be  a worse evil.   If a
medical man is present, and thinks well to
use the stomach-pump quickly, remove the
water and replace it with a small quantity of
hot brandy and water, it may be of service;
but no attempts should be made to administer
any thing by the  mouth  as  long as uncon-
sciousness continues.
  In cases of drowning, the  motto  should
be,—never despair:  when  all hope seems
to have vanished, and no sign of life  been
given for  one,  two,  four, six, or even eight
hours,  the  perseverance of  those around
has  been  at last rewarded, nnd  existence
preserved.
   After a person has been  restored to con-
sciousness, there may.be  considerable con-
gestion of blood about the head, which may
require leeches.  In  all cases of recovery.
the greatc-t care must be taken to preserve
the  re-excited actions; if stimulants nr*
thought requisite, they must be given  most 
DRU
215
DYS
 cautiously,  and all sources of  excitement,
 such as  visits  from  friends or  relatives,
 guarded against;  hot fluids, tea, coffee, and
 the  like,  should be given moderately,  and
 the strength supported by nourishing meat
 soups.—Refer to Lungs—Suffocation, Src.
   DRUG—Is the  general  term applied to
 medicinal agents  used in  the treatment of
 disease ;  it is, however, more generally em-
 ployed with  reference to  the crude or com-
 mercial substances; after these have under-
 gone preparation,  they  are usually  called
 medicines.   Although, undoubtedly,  many
 medicines are  largely adulterated in  this
 country,  many  are  impure in  consequence
 of the adulteration of the drug in its collec-
 tion or preparation by the  natives of the
 country of which  it is  a product.   Thus,
 senna is  largely mixed with the leaves of
 other plants, opium with seeds  and leaves,
 and sometimes with small stones, &c. &c, to
 increase  its  weight;  scammony is mixed
 with chalk.   As, however, the adulterations
 to be guarded against are  mentioned  under
 the respective articles, the reader is referred
 to them.  [The  recent appointment by Con-
 gress of an inspector of drugs will do much,
 it is hoped, to prevent or detect adulteration
 in drugs imported into the  United States.]
   Refer to Medicines.
   DRUM  of the EAR, or Tympanum—Is an
 anterior portion of the  organ  of hearing,
 which contains the  small  bones  and  air.
 See  Ear.
   DRUNKENNESS.—See Intoxication.
   DRY CUPPING.—See Cupping.
   DUCT—Is  a  medical term applied to a
 tube or "canal,"  adapted to convey fluid
 from one part of the body to another.  Thus,
 the  "hepatic duct" conveys the bile from
 the  liver  into the intestines, the " salivary
 ducts" carry the saliva into the mouth from
 the glands, by which it is secreted from the
 blood;  the  " thoracic  duct" (see Digestion)
 conveys the chyle into the blood, &c. &c.
   DULCAMARA, or Solanum Dulcamara,
 or Bitter-Sweet, or  AVoody Night-Shade
 —Are all  names for the same native plant,
 which  is,  however, widely distributed over
 the temperate portions of the globe.  It is a
 shrubby climbing plant, bearing clusters of
 flowers, closely resembling, but smaller than
 those of the potato, which belongs  to the
 same family.  Under its name  of " bitter-
 sweet" it is well known in  the country.  It
 flowers in June, and in the  autumn  bears
 clusters of red, somewhat transparent, ber-
ries.   The twigs are used  in  medicine,  and
arc directed  to  be  gathered when of  the
thickness  of  a goose-quill.  The medicinal
use of dulcamara is as a  soothinc diaDho-
j retic, producing perspiration, nnd it mighl
 be used in the absence of other remedies for
 this purpose.  To make the decoction, one
 ounce of the twigs, chopped, is to be  boiled
 in twenty-four ounces, or a pint and a half,
 of  water, till it is reduced  one-third.  Of
 this,  the dose is two to six  tablespoonfuls
 twice or thrice a-day.   [Dulcamara tea re-
 duces the venereal desires, or is an " aphro-
 disiac."   In this way it is highly useful. It
 is also employed in the treatment of  " Tet-
 ter."]
   Refer to Diaphoretics.
   DUMBNESS—Or  inability to utter arti-
 culate sounds,  may  arise from  absence of
 the tongue, or from defect in the formation
 of the organs of voice; probably, also, from
 causes affecting the nerves which supply the
 organs of speech; but most generally from
 complete deafness, either congenital, that is,
 dating from birth, or as the result of disease
 before the power of speech had been acquired
 and fixed in the memory.
   Refer to  Deafness.
   DUODENUM.—The  first portion of the
 small intestines, and that immediately con-
 nected with  the  stomach.   It derives its
 name from the idea  that it did not exceed
 twelve finger-breadths in length.
   Refer to  Alimentary Canal.
  DURA MATER—Is the term applied to a
 firm white  fibrous membrane which  lines
 the skull on  the one hand,  and invests the
 brain. Between it, however, and that organ,
 two other membranes lie: the  "arachnoid
 membrane,"  so named  from its  extremely
 fine texture, which  lines the dura mater,
 and also covers the brain, forming a double
 layer,  or "shut sac,"  in  the  interior of
 which a  watery fluid is exhaled; and the
 "pia mater," or vascular membrane  of the
 brain, which lies directly upon and  covers
 the organ itself.
  The "dura mater" is prolonged into va-
 rious  "processes,"  or  projections,  which
 pass between and give support to the differ-
 ent portions of the cerebrum, or brain, and
 cerebellum, or little brain, which are in fact
 partially separated from each  other by a
 fold of  the  dura mater.  This membrane,
 and the  others above  mentioned, are con-
 tinued from the interior of the skull down
 the spinal column.
  Refer to Brain—Spine, fyc.
  DWELLINGS.—See Houses.
  DYSENTERY—Or, as it has  been popu-
 larly  called,  '«bloody  flux," is  a  disease
 characterized by severe diarrhoea,   fever,
 &c. the  accompaniment of  a peculiar in-
flammation of the mucous membrane lining
the large intestines.  It is much  more fre- 
D Y S
216
D Y S
 quent  in  tropical climates and marshy dis-
 tricts  than  it is  in this country at the pre-
 sent day,  although formerly  it  was very
 prevalent, forming a large item in the bills
 of  mortality of  a  hundred  or a hundred
 and fifty years back ; and at times showing
 itself in a fatal epidemic  form.  It  is pro-
 bable  that  the  diminished  occurrence of
 dysentery in England at the present day is
 owing  to the increased comfort of the popu-
 lation, the drainage of the land, and  some
 attention  to  sanitary influences;  for, defi-
 cient  as the regulations  attached to  these
 stiU are, they are certainly better than they
 were a century ago.   A kind of dysenteric
 affection—that is,  severe diarrhoea,  with
 fever,  tenderness of the  bowels, indicative
of inflammation,  and bloody stools—is fre-
 quently met with  in  autumn  during the
 prevalence of the common cholera morbus.
 Dysentery appears  to  be engendered  by
 exposure  to cold,  wet, and  to  privations
 connected with food; hence it has been one
 of the greatest scourges of armies.  " In two
 years and a half  the British  army in Spain
 lost no less  than 4,717  men by this  com-
 plaint."  The same causes and its connection
 with variations in climate, particularly with
 a hot one, must render dysentery a  disease
 respecting which the emigrant ought  to
 possess information; for  it  may happen,
 and it often does, that the disorder  attacks
 those far removed from medical aid. and it
 is not  one  which  brooks much  delay in
 treatment.  Medical  men in this country
 have comparatively so little experience of
 the disease,  that the author gladly avails
 himself of the recent valuable work of Dr.
 Parkes in the compilation of this  article.
 By this author the  symptoms of dysentery
 are thus succinctly described:—"Dysentery
 commences  either gradually  or  suddenly;
 the general  commencement is, however, by
 diarrhoea.
   " First, as to the kind of stools.
   " These are, first, simply numerous, per-'
haps feculent, in a few very rare  instances
scybalous—(that  is, containing hard black-
looking lumps, about the  size of beans or
nuts, called  by medical men scybalae.)
   " After^this the stools  become numerous,
 slimy,  gelatinous, bloody; blood in streaks,
 or mixed  with a dark watery fluid ;  in an
 other  form  pure, perhaps clotted.  After-
wards, stools watery, muddy, like the wash-
ings of meat, or gelatinous-looking, shreddy,
 offensive in  odour.  Sometimes  after  this
the stools  present  an  appearance  some-
thing  like pus, (matter,)  or  this  is mixed
 with mucous slime and blood,  in such a way
 as to form a variously coloured stool, which
causes  great  griping and  tenesmus  when
passed."
   With respect to the causes of dysentery
Dr. Parke says—" V\ e may admit as both
predisposing and exciting causes, nccording
to circumstances, the following agents: —
   " 1st.  All  acrid  agents, whether  pro-
duced  by irritating ingesta, or secretions;
as bad or  too rich food, bad water, fruits,
or retained excretions, or  derangement of
the biliary  secretions, &c.
   " 2d.  Suppression  of  secretions rapidly
accomplished, as that of the  skin  by cold,
wet, sudden changes of temperature  from
hot to  cold, &c.
   " 3d. Epidemic states of the atmosphere
and probable alteration of the blood, either
from food or its digestion."
   The  power   of these causes to  produce
dysentery should be well fixed in the minds
of all  those whose lot it may be to be ex-
posed to their  influences; for by their avoid-
ance the disease may probably be escaped;
and  there  can be few misfortunes greater
than for a  new settler, whose welfare, and
that, perhaps, of  a family, depends  upoi.
his health and strength, to be attacked with
dysentery.
   The  treatment of dysentery which  may
most safely be practised by  an unprofes-
sional  person, in the absence of a medical
man, would be, in the first instance, if they
were procurable, the  application of leeches
to the  belly, [near the groins or around the
fundament,] a dozen  or  more at once, nnd
repeated according to the  strength of the
patient, if the  symptoms remain unrelieved.
Should leeches not be obtainable,  and even
if they are, a  warm  bath once or twice (if
it did not exhaust too much) in the twenty-
four hours, would be found useful, \or hot brun
poul ices to the bowels.']  To allay pain and re-
lieve the disease  generally, opium is the
most valuable remedy ;  but as  there  may
be irritating  matters in  the  bowels,  they
must  not  be  confined,  which  the opium
alone might do, and thus, though  relieving
apparently for a time, aggravate the disease
ultimately.  To avoid this, the opium should
be combined  with castor-oil,  or  olive-oil,
either  simply  or in  emulsion with yelk of
egg.   If castor-oil  is procurable,  it should
be trusted  to;  if not. Epsoin salts, in tea-
spoonful doses, each dissolved in from half
a pint  to a pint of gruel or barley-water, or
some  other demulcent,  with  four or five
drops  of  laudanum  added, may  be  given
every  four or five hours.  Ten grains  of
Dover's powder, given once or twice  in the
twenty-four hours,  may probably be of ser-
vice, or a pill  composed of half a graiu of 
D Y S
217
EAR
 opium, a  grain  and  a half of blue pill,
 and half a grain of  ipecacuanha,  may  be
 given  every six or eight hours.   The safest
 course, however, will be the treatment by
 the  oily aperients and laudanum.   In ad-
 dition [an enema of half a wineglassful of
 thin starch, with the addition of fifty drops
 of laudanum  for an  adult] will  give much
 relief.  Sometimes the lower bowel is too ir-
 ritable to bear the clyster,or even the clyster-
 pipe, in which case, a suppository, a pill,
 made with a  grain of opium, mixed with a
 little flour and water, may be passed into the
 bowel.   The  food requires much attention,
 and should be of the mildest character: milk,
 and preparations of the grains, and sago,
 arrow-root, &c, combined with gelatine or
 isinglass,  will be most  suitable.   [Fresh
 buttermilk, when agreeable to the patient,
 is an excellent article of  diet, and  has  by
 some been regarded as a specific in the treat-
 ment of the complaint.]  If the  strength is
 much  reduced, strong concentrated animal
 soup will perhaps be required.
   Of course so serious, and it may be fatal,
 a disease as dysentery should be put under
 medical care as shortly as  possible.  In the
 meantime  the above directions  may be of
 much service.
   "The first appearance of recovery is evi-
 denced by the stools  becoming less slimy,
 perhaps copious and feculent, or  bran-like,
 or dark and  slightly  beaten up; or while
 one  part of the stool is slimy, the remainder
 consists of natural feculence."  A person
 convalescent from dysentery will, of course,
 require the greatest possible care  in diet;
 and also with respect to all exposure to the
 causes which  originated it.
   Refer to  Castor-oil—Clyster—Diarrhoea—
 Suppository— Tenesmus, Sfc.
   DVSMENORRHCEA.—Difficult or painful
 menstruation.—See Menstruation.
   DYSPEPSIA — Indigestion.— See  Indi-
gestion.
  DYSPHAGIA.—Difficulty in swallowing.
—:See Swalloicing.
  DVSPNCEA—Difficulty  in breathing.—
See  Respiration.
  DYSURIA.—Difficulty in  passing water.
—See  Urine,.Bladder, §c.
  THE EAR—Is the organ of hearing,  by
means of which man and animals are made
sensible of what we call sound, that is, of
certain vibrations  communicated to the at-
mosphere,  or  surrounding  medium, which
give  rise to the sensation of sound, by acting
upon the organ fitted by structure to receive
them, which  organ  is  connected with the
brain,  or  agent of the  sentient mind,  by
nerves special to the  purpose.   The entire
       T
organ of hearing is called the ear. Its ana-
tomy and functions constitute  a wide and
interesting branch of study; but  here  it
will be sufficient to explain just so much  as
is requisite to give the unprofessional read-
ers some idea of the nature of  the organ—
some rational view of the disorders to which
it is  subject; sufficient, it is   trusted,  to
guard  them  against submitting  so valuable
an  agent,  of which the varied structures
must give rise to varied forms of disease, to
be  tampered with by  ignorant quackery.
Any one who will for a moment consider in
how  many ways deafness may be produced,
must see there can be no  specific to  effect
it% cure, but  that the means of cure must
vary with the cause of the  disease.
  The human ear consists of an external,
middle, and  internal.   The external  being
composed of the  flat folded organ attached
to the  head, usually  called the  ear, (fig.
Ixiii. 1,) and of the ear-passage, or  "me-
atus," (2.)   The  external flap of the ear is
divided by anatomists  into various parts,
which it would answer no  good  purpose  to
go over here  ; its evident function is to col-
lect as much as possible the body of sound.
Its  adaptation for this purpose  is  more
plainly evidenced in the movable ears  of
the lower animals than  it is in man.  The
air-passage,  or meatus, is oval in  form,
curved upon  itself, and rather narrowest in
the middle;  it contains a  few small  hairs,
and glands which secrete the peculiar bitter
wax,  or "cerumen,"  which  is  probably  a
provision to  prevent  insects entering the
air-passage.
  The  inner  extremity  of  the  ear-passage
is closed by a membrane, (fig. Ixiii. 8,) that
of the  tympanum, or drum of the ear: it is
placed obliquely.  The cavity  of which  it
forms the external boundary, is  the portion
of the  middle ear named the drum, or tym-
panum, (4;)  it contains air, and communi-
cates with  the atmosphere  by means of the
Eustachian tube  (5) which opens  into the
throat.   The tympanum contains three very
minute bones, articulated or jointed together
so as  to  admit of slight  motion ;   these,
which are represented magnified, (fig. lxiv.,)
extend across the cavity;  the   small  bone
(fig. lxiv. 4)—which resembles a stirrup  in
shape,  and, indeed, derives its name,  " sta-
pes," from  that  resemblance,) being  at-
tached at a small opening to a portion of the
membrane  which  lines the  inner  ear  or
" labyrinth," as it is called from its com-
plex  construction.   The  "labyrinth,"  or
inner ear, is  composed of  three parts, the
vestibule, (fig. Ixiii. 7,)  the "cochlea," or
shell-like portion, (10,) and  the semicircular 
EAR
218
K  A R
Fig. Ixiii.
FIr. lrt».
canals, (8.) Both the middle and inner ears,
and indeed part of the external ear-passage,
are accommodated in a portion of the tem-
poral or  temple bone, excavated  for  the
purpose.  To the  small bones of the tym-
panum  are  attached  four  minute muscles,
which by their agency act upon  the  mem-
brane of  the drum.    The office of  these
bones being  evidently at the same time to
conduct the  vibrations of  sound from  the
membrane of the  tympanum, which is  ex-
posed to the  external  air, to the  membrane
of the vestibule, which, with the other parts
of  the  labyrinth,  constitute the  essential
organ of hearing.   Within the labyrinth, a
watery-like fluid is the medium for conduct-
ing the vibrations of sound to the nervous
expansions which are also contained within
the cavity.
  The disorders to which the organ of hear-
ing is most  liable are  loss of function, or
deafness,  noises in the ear,  neuralgia or
affection of its nerves, abscess  within  the
meatus  or in the cavity of the tympanum,
chronic discharges, polypus ;  and further,
the meatus  in children is very  apt  to  be
chosen  as the receptacle  for peas,  small
buttons, or indeed  any thing  they can poke
in easily, but which  are  often   extremely
difficult to get out again.
  The subject of deafness has been already
treated of, but the attention  of the reader
is again called to  the many causes which
may produce  the one effect.  The malforma-
tion at  birth of the inner  ear, as  a cause
of complete deafness, is also connected with
dumbness; or accident  may at any time of
life injure the delicate  structures contained
within their cover of bone.  The passage of
the air  through the  external ear-passage
 may be obstructed or prevented by an ac-
 cumulation of wax or other  matters;  the
 membrane of  the drum may be perforated;
 the bones may have been discharged hy
 disease ;  or the Eustachian-tube be blocked
 up by swelling temporarily, or permanently,
 by thickened mucus.  There are no diseases,
 perhaps, which require—as  must be evi-
 dent to all—more  tact  in their discovery
 and in their treatment  than  those of  the
 ear; and   yet, till lately, they have been
 almost entirely left in the hands of ignorant
 assumers, and the name of  "aurist" has
 almost been synonymous  with quack.  The
 anomaly  is now  passing  away,  and   the
 labours of talented and  scientific  men are
 placing the knowledge  and   treatment of
 these  disorders upon a  more rational  and
 scientific basis.
  Noises in the ears, such as singings, ring-
 ing of  bells, roaring as of the sea, &c. &c.
 are often  extremely troublesome, and may
 arise from many and different causes. Mere
 temporary derangement   of  the digestive
 organs will in  some persons produce them.
 They are often indicative of  determination
 of blood  to the head, and, when accompa-
 nied with  symptoms of this tendency, ought
 not to be neglected.  Partial obstruction
 of the Eustachian-tube by cold; or accumu-
lation of wax  in  the  external ear-passage,
are apt to occasion these noises, and they
are accompanied with some degree  of deaf-
ness   Of course the remedy must vary with
the cause.  If  the  digestive organs are de-
 ranged, they must be regulated; if cold be
 the cause, the symptoms may be left to
 pass away with the temporary ailment.  In
 some  cases of chronic or continued noise
 in the  ears,  regularly  bathing the head 
«;AR
219
EAR
 with cold water every morning will, after a
 time, remove it.
   Ear-ache,  or  neuralgia of  the  ear,  is
 treated of under the head of Neuralgia ge-
 nerally.
   Abscess in the meatus is often also called
 ear-ache.   It is one of the most painful dis-
 orders, and is generally the  result of  cold.
 It is characterized by intense throbbing pain
 in  the ear,  with,  frequently, perceptible
 swelling externally, and more or less fever.
 There is  no relief to pain till the  abscess
 bursts, and this result is to be encouraged
 by the assiduous use of fomentations, poul-
 tices, <S;c.   After the matter has discharged,
 the ear ought to be gently syringed out three
 or four times a day with warm water, till
 the discharge ceases.  It will be advisable
 to  give a  few doses  of aperient medicine
 during the progress of the case.
   The abscess may form within the tympa-
 num,  and the membrane be perforated  in
 giving exit to the matter.   Inflammation  of
 the ear ending in abscess  differs from  true
 ear-ache, or  neuralgia, in the pain being
 comparatively slight at first,  and gradually
 increasing  in intensity as  the disease  pro-
 gresses : whereas in neuralgia it commences
 with full severity.
   AVhen the discharge after an abscess  does
 not disappear, or  when running  from the
 ears shows itself after acute diseases, such
 as  measles, scarlet fever,  &c. the symptom
 must not be  neglected, and should be ex-
 amined into by a medical  man.  It is most
 general in children of weak or scrofulous
 constitution,  and  may be with or without
 disease of the bone;  in the latter case the
 discharge is extremely fetid, and often stains
 the linen black.  These discharges must not
 be  too quickly stopped, neither can they be
 allowed to go on without risk; in the former
 case, the  sudden stoppage may throw back
 the disease upon the  brain;  in the latter,
 this organ or its membranes may become
 affected by its gradual  extension  to  them
 through the bones.  Counter-irritation, by
 blisters or  tartar emetic,  behind the ears;
 strict attention  to  the bowels; the general
 tonic  treatment  recommended under the
 article Scrofula; and syringing with slightly
 astringent washes,  such   as  one  grain of
 lunar  caustic, or  two of white-vitriol,  to
 the ounce of water, will constitute the most
 appropriate  treatment.   The  safest plan,
 however, is to submit the case to medical
 inspection.   Bodies of various kinds are apt
 to be thrust into the  external ear-passage
 by children, or to find their way there by
 accident;  and farm-labourers sometimes get
grain, peas, &c. projected  into the ear  dur-
ing threshing.   If  the introduced body is
much smaller than the passage, its removal
may be attempted by syringing  freely, and
with a strong syringe ; but  if the body fills
up the meatus,  or nearly so, this will not
succeed;  and, in the  event of its being a
pea, or any  thing which will absorb  fluid
and  swell, will  do  mischief.  Neither, in
case of a large body, which the syringe
will  not  disengage, is it well  for friends
to attempt the  removal  in  any other way;
they never do any good,  and only push the
obstruction farther in, rendering its extrac-
tion by the surgeon  more difficult, particu-
larly if it is  passed beyond the middle and
narrowest portion of the canal.   [When an
insect  gets into  the ear, it  may be quickly
killed or made to come out, by turning the
head to one side and pouring sweet-oil into
the ear until  the canal is full—a change of
position will  soon empty it, and then the
canal  should be syringed  out with  weak
soap and water.]
  Refer to Cerumen—Head—Indigestion, $c.
  [EAR-ACHE.—See NeuralcIia.]
  EARLY RISING.—There  can be no ques-
tion, as a general rule, that the  habit of
early  rising  is  conducive  to health;  but,
like many other similar matters, the general
application would, by many, be  converted
into a universal  law, and much fallacy and
no little mischief has been done by the pro-
pagation  of  the  dogma.  The poets  have
given  their strains,  the  philosophers their
aphorisms, and  the  hearty  centenarian his
experience, to eulogize early rising as a sort
of elixir of life, and  preventive  of illness
and disease.   It is a great good, but not a
universal  one.
  It is generally said that  all  those who
have attained great and green old age have
been  early risers;  therefore, say others,
early rising is a  promoter of health ; there-
fore, it might be whispered, those whose
constitutions  have carried them  through a
long life have been  able to  be early risers.
As in many other things, the truth probably
lies between the  two; there  have been  good
vital powers  on the one hand,  and  good
habits, of which early rising is  often  an
indication, on the  other.   The  wrong de-
duction, however, that early rising is  an
unmixed good, has occasioned much erro-
neous practice, and many a delicate person,
either in  consequence  of the false idea, or
badly advised by others, has injured their
health  materially by perseverance in  the
practice;  this, however, is more  common
among the young,  than among  the  aged,
who require less sleep.
  There is no question but  that  the bodily 
E A R
220
E D U
 powerr. and  constitution undergo marked
 and regular changes during  the twenty-
 four  hours—changes  which  are  probably-
 influenced by electrical and  other causes
 not at present understood.   At all events,
 in disease, evening brings fever if it is pre-
 sent at all, and toward morning excitement
 abates if it does so at all: further,  in health,
 the body, it is well known, is more obnoxious
 to the causes of disease in early morning
 than  it is  at other times; and lastly, per-
 sons of weak nervous power generally feel
 better toward evening than they do in the
 morning,  even  when the refreshment of a
 night's rest might be expected to have given
 strength.   The reason of these differences
 it is, perhaps, not possible fully to explain,
 but we may  reasonably conclude that the
 same influence which causes or aggravates
 the evening fever, and abstracts excitement
 toward morning,  may also act as the eleva-
 tor or depressor  of the constitution gene-
 rally,  although only felt when it  is not in
 full vigour: it may, or it may not, be owing
 to the presence or absence of solar influ-
 ence, but still it is so, and the  fact is one of
 general experience.   The fact, too, explains
 why early rising is not only not good for all
 persons,  but  why to some  it is  positively
 hurtful, and why those who are  able  to
 practice it are generally of strong  and good
 constitution.   Moreover, the fact tells that
 the person who cannot  rise early  with  im-
 punity is  not in full vigour, but requires
 means for attaining a better state of health.
 When the  powers of life are  raised to the
 proper level, then, by all means,  let them
 be kept to it, and early rising used as one
 of the preservative means.
  What is meant by early rising is getting
 up from rest before the sun has exerted some
 power upon the earth ; the exact period to
 suit the invalid it is impossible to specify—
 it ought to be matter of experience:  that
 is to say, retiring to rest at a reasonable,
 early hour, such as tep o'clock, the person
 should rise as early as can be done without
 creating feelings of sleepiness, languor, &c.
 during the day.   There  are certainly evils
consequent upon  continuance  in bed in the
 morning,  such  as  perspiration,  &c.  but
 they may be greatly obviated  by the non-
 use of feather beds or too  much clothing;
they are less, however,  than those which
result from a nervous system exhausted at
a period of the  day before it had come into
full activity.   The  same arguments which
apply to early rising,  also do  so  to exer-
tions or continuance without food by weak
 individuals in the first part of the morning;
I they can practice neither with  impunity.
 There is no time of the day so pleasant, nnd
 the hale and  strong  can enjoy it to perfec-
 tion nnd gather health in its  fresh breezes;
 and their description will often tempt the
 unwary invalid to leave his couch and fol-
 low the example; and he really does enjoy,
 for  a  short time, the novelty;  but shortly
 languor creeps  over him;   the  breakfast
 which disappears before the appetite of the
 strong morning-walker  has  no charms for
 his exhausted weaker companion, who  pays
 with a day of lfstless languor for this ill-
 advised attempt.  These hints  will, it  is
 trusted, not be taken as  an encouragement
 to laziness, but as pointing out a very com-
 mon error in  popular belief and popular
 practice.   The person of weak vital power,
 who cannot be an early riser, must  guard
 well that he does not mistake sloth for ina-
 bility,  nor encourage the  inability  by in-
 dulging in late  hours, which are often  to
 him the most vigorous.  Persons who suffer
 much  from debility  in the  morning,  and
 who are constrained to be up early, ought,
 as soon as possible, to have some warm re-
 freshment—a  cup of warm milk if it agrees,
 or tea, coffee,  or cocoa.   In some cases, the
 popular addition of a teaspoonful of rum or
 brandy to milk is undoubtedly useful, parti-
 cularly where there is tendency to faintness;
 but  the cordial must be taken  as a medicine,
 and abandoned as soon as possible.
  Refer to Bed.
  EATING.—See Food,  Digestion,  Indi-
 gestion.
  ECCHYMOSIS—Is  a  medical  term  ap-
 plied  to discoloured  swelling, caused by
 effusion of blood beneath the skin or in the
 tissues of the  body.   A common  bruise  is
 the most familiar example.
  ECTHYMA.—A disease of  the  skin in
 which pimple-like pustules containing mat-
 ter are developed.—See Skin.
  ECZEMA.—A disease of  the  skin in
 which minute  vesicles are developed.  [This
 disease is sometimes called  " chronic  ery-,
 sipelas" by the public]—See Skin.
  EDUCATION—As applied to man, means
 literally the bringing forward or encourag-
 ing and regulating the qualities or proper-
 ties  of which  his  whole being is capable.
 The natural  division of the  process is  into
 mental and physical—the education of the
 mind and of the body.  Strictly, in a work
 like the present, it is  with the  latter only we
 have to do, but the two are so intimately  con-
 nected that it is impossible to separate them.
  So much that is applicable  to the subject
 of physical  education is said  in  the article 
E  D U
221
EDU
  Children;" and  also in the various arti-
 cles on  "Air,"  "Clothing," "Food," &c.
 &c.  that it leaves but  little to be  added
 here ;  and to the above-mentioned articles,
 and to those bearing upon sanitary mea-
 sures  generally, the  reader is referred for
 information.
   The great difference between the physical
 education of the male and female sex com-
 mences  when  children  leave the nursery.
 The boy, much less hampered by the mode
 of clothing, and permitted much more free-
 dom in  physical  exertion  than the girl,
 has, as far as these are  concerned, a better
 chance  of  attaining his  full measure of
 health,  provided  the mind  be not  over-
 worked, and constitution  and surrounding
 circumstances  are not  absolutely  deficient
 or adverse.  The girl, on the other hand,
 is submitted  to many  artificial restraints
 and  modes  of  education  which  militate
 strongly against the  chance of her making
 a perfectly healthy woman.  The diffusion
 of a knowledge of those  principles on which
 health depends has,  of  late years, tended
 to ameliorate many  of  the most injurious
 practices connected  with the bringing up
 of girls, but  many yet  require  to be  cor-
 rected.
   The bad results which are  often brought
 about  by the use  of stays have  been so
 often  exposed   and  condemned,  that the
 subject has become almost hackneyed, and
 yet  by a majority of the  female  sex the
 practice  is still followed to an  injurious
 extent.   It seems  as if people imagined
 that the Creator had  made the body of the
 adult female so weak that it cannot support
 its own  weight; for either on this account,
 or without reason, they case it up in artificial
 supports.  This abuse extends even among
 the  poorest;  and  girls   of ten  or twelve
 are  kept from bending  naturally by a stiff
 piece of wood stuck down the front of what,
 at  least, stands instead of  stays.   True,
 these articles of dress do at last become in-
 dispensable, but it is only after the muscles
 of the frame have  been  weakened, in con-
 sequence of not being permitted to exert
 their appointed and  regular  action.  Any
 muscle or set of muscles of the body, if not re-
 gularly exercised, becomes diminished both
 in substance and power.  The human frame-
 work or skeleton is so constructed that the
 muscles  with which  it  is  furnished,  and
 particularly those connected with the spine,
 preserve its equilibrium ;  supersede these
muscles by artificial support,  and they be-
come weakened.  But as  their  artificial sub-
stitutes cannot act with the  perfection of
the natural supporters,  the defect  sooner
       t 2
or  later  shows  itself;  the  unsupported
spine gives way somewhere, and curvature
more or less, ensues.  It would astonish most
persons, if they were  made  aware of how
many curved spines there are—in how many
the deviation exists—who even do not them-
selves  suspect  it;  and  how often  it is  the
occasion of impaired health, palpitation of
the heart, hysterical and other affections.
To the above assertion  it is only necessary
to add the high  testimony  of Dr.  John
Forbes, who says, in a  note to the article on
"Physical Education," in the  Cyclopaedia of
Practical Medicine—"We lately visited, in a
large  town,  a boarding-school  containing
forty girls; and we learnt, on close and
accurate inquiry, that there was not one of
the girls who had  been at  the  school two
years—and the majority had been as long—
that was not more or less crooked!"   True,
the whole of this enormous evil is not  en-
tirely due to the use of stays, but much of
it is so coupled with long standing lessons,
seats without backs, and too many hours
devoted to the  education of the mind,  by
which  the constitutional  powers generally
are enfeebled.   Moreover, the above spinal
weakness  is not the  only evil  consequence,
for  it is too often  mixed up with disorders
of the  digestive  and   circulatory  organs,
originated by their  compression  by  the
clothing.  The too prolonged hours of study
inflicted upon girls  have been alluded to,
and  are  unquestionably a great -evil, but
they would  be  less  so were the hours  of
relaxation and  exercise more rationally
conducted.  No exercise  can  be beneficial
unless  the mind be  actively interested,  or
at least  pleasantly occupied  during  the
time of exertion ; but little good can result
from demure walks,  taken without interest,
and almost without enjoyment.
  Nothing perhaps  is  more  certain  than
that, for the full development and  healthy
exercise of all the powers of the  mind,  a
healthy body  is required.  The Almighty
has connected our mental manifestations in
this world with a material organ, the brain,
and this organ, like every other in the body,
is dependent for its healthy action  upon
that  of the other organs: how evident,  then,
that  to preserve this wonderful instrument
in harmonious  and vigorous exercise of its
powers, the whole body must be in health !
But modern  fashion  and fallacy, and many
modern educationists, say, No; let the body
and instrument take  care of themselves, our
part  is  to elicit as  many tones from  the
latter as possible.  And  elicit them they  do,
but they often sadly jar; moral perceptions
and  acts, influenced by  bodily disorder, 
                 EEL               2'

often  war  with  moral  and religious  pre-
cepts.  The precept " slow to anger" cannot
always control the  irritabilities of a mor-
bid nervous system ;  and the not "slothful
in business" cannot  at  all times rouse the
body, oppressed by morbid and narcotizing
blood, to the active and vigorous discharge
of its duties.  As- long as our abode is in
this world, our bodies  and  minds must be
in intimate relation, in  action and reaction
with one  another ;  God has joined them,
and man cannot dissolve the union without
paying the penalty of his transgression.  A
perfectly healthy mind is  only  compatible
with a  perfectly  healthy body;  and, in
civilized  life, with its  many causes of  dis-
order,  the latter can  only be insured  by
attention to the laws of physical health  and
education.   The mind,  on  the other hand,
has its influences upon the physical health ;
but these  will be considered  in the article
devoted to the subject.
  EEL—Is one  of  the oily fishes, and is
peculiarly indigestible.
  EFFERVESCENCE—Is the rapid extrica-
tion.of gas or vapour from a liquid; hence,
boiling is effervescence:  medically, however,
the term is generally applied to the extrica-
tion of carbonic acid  gas solely.  Many
mineral waters, such as Seltzer water, are
effervescing,  from containing the  gas  na-
turally ; soda water  and other effervescing
drinks are impregnated with  it by mecha-
nical means, while in fermented liquorB it is
generated  in the process  of fermentation.
In  the  practice of  medicine, effervescing
draughts   are  most frequently,  perhaps,
formed by  the direct separation of the  gas
from one of the alkaline  carbonates, such
as  the  carbonate  or bicarbonate — which
latter contains the  gas in  greatest abun-
dance—of  potass,  soda, or ammonia;  the
solution  of bicarbonate  of magnesia,  or
•'fluid magnesia," is also  used for the  pur-
pose.   In  many forms  of  illness, particu-
larly those attended with thirst, no kind of
medicine is so grateful  to  the patient, or so
readily taken, as that  which is  given  in a
state  of  effervescence.  If  the stomach is
irritable, and a tendency to sickness present,
medicines given in this  way are more likely
to be retained, the carbonic acid  apparent-
ly exerting a quieting  and soothing  effect
upon the organ; at the same time, the taste
of medicine is Considerably obscured by its
administration by  this  method.   When the
tongue is  much furred,  and particularly in
eases of sore throat, when medicine in  any
effervescing form can  be swallowed, none
appears to exert a more cleansing effect, in
removing  thick  mucus and incrustations;
                  E F V

and if it does this for the mucous membrane
of the  mouth, it must probably  have the
same effect on that of the stomach.
  Some persons  who  are liable  to  suffer
from difficulty of breathing, whether  from
asthmatic or other causes,  and those who
do not easily get rid of flatulence, cannot
take  effervescing drinks  without  incou-
venience; this,  too, occurs  if  patients to
whom  they  are administered are confined
to bed, and lie down too soon after taking
the dose.   A minute or  two ought  always
to be allowed for the eructation of the gas,
before a patient who has taken  an effer-
vescing draught resumes a recumbent posi-
tion.
  One of the alkaline carbonates above men-
tioned being made the effervescing agent,
many medicines may  of  course  be given in
combination.  The acids most generally and
beneficially used to combine with the alkali
and set free the gas are lemon-juice, citric
acid,  and tartaric acid;  they ought to  be
used  in  the  following  proportions:—To
thirty  grains  of bicarbonate  of potassa,  a
small tablespoonful of lemon-juice, or twenty
grains of either tartaric  or citric acid.  To
thirty grains of  bicarbonate  of  soda, about
one-fifth  more of the  above acids.   To six
grains of carbonate  of ammonia,  two tea-
spoonfuls  of lemon-juice, or  about  eight
grains of either citric or tartaric acid.
  So common has the use of  effervescing
draughts become,  that the materials,  soda
and  tartaric acid, and  a measure for the
purpose, are  kept in many  houses.  The
practice  is not free from danger or injury;
the continued  use of soda being apt to im-
poverish the blood.  To  the weakly it is of
course more likely to prove hurtful than to
the strong.
  The  mode of mixing  effervescing draughts
which  is commonly recommended is a bad
one.  The two powders are generally ordered
to be quite dissolved in separate portions of
water  before mixing;  the consequenee  is,
the gas is extricated  all at  once;  the vio-
lence of the effervescence—unless  the glass
is a very large one—is very liable  to carry
up and spill over a portion of the liquid, and
the action  subsides  before  the  person can
drink.   All this may be avoided if the acid
and alkali, in  fine powder, are put dry into
the glass, and the water poured  slowly upon
them from  some little height.   In this way
the gas is more slowly extricated;  there  is
no spilling,  and, if properly done,  full solu-
tion of the powders ought to be effected.  If
lemon-juice is used, it  should be mixed with
the water, and poured  upon the  alkali in the
same way.  Of course, when the draught is 
E  F F                223               E M A
  a very small medicinal one, thtf same pre-
  cautions are not required.
    Refer to Ammonia—Carbonic Acid—Potas-
  sa—Soda.
    EFFLUA'lUM—Is a gaseous emanation or
  exhalation from  any body, generally of an
  offensive or noxious character.   Effluvia is
  the plural.
    Refer to Contagion—Disinfectant,  §c.
    EFFUSION—Is a medical term applied to
  the  throwing  out of  an unnatural amount
  of fluid  into  cavities,  or tissues, which
  ordinarily  contain  a small quantity only.
  Thus, the watery fluid which  is thrown out
  into the chest in consequence of inflamma-
  tion of  the pleura or covering membrane of
  the lungs, is named an effusion.  There are
  also effusions  into the abdomen and in the
  head, also into joints  and cellular tissue.
    EGG—Of the domestic fowl, or  of birds
  generally, as articles of diet,  is one of the
  most nutritious.   This  is  evident,  indeed,
  from the fact, that  from the contents of the
  egg the entire young bird is formed.  ,As a
  means of nourishment for the sick, espe-
  cially when it is beaten up,  and given mixed
  either with hot or cold fluid, the yelk of egg
  is often  most valuable.   The  white of the
  egg  is composed of  albumen  and earthy
  salts; its yelk, similarly constituted, con-
  tains in  addition oily matter and sulphur.
   In the  preparation of medicines of an
 oily character, the yelk of  egg is often ad-
 vantageously employed, formiug with them
 an emulsion which is miscible with distilled
 or rain-water.  Castor-oil and turpentine are
 both advantageously given by this method.
   ELASTICITY—Is the power possessed by
 various  bodies of returning quickly to the
 form from  which they have been forcibly
 altered.  India-rubber, both in its natural and
 in its vulcanized condition, presents one of
 the most familiar and  best  examples.  The
 elastic properties of this most useful pro-
 duct  of nature have been abundantly taken
 advantage of in the  formation of appliances
 of various kinds for the treatment of disease,
 and for the  relief of suffering.—See Caout-
 chouc.  The gum-elastic cushions have al-
 ready been adverted to under the  above ar-
 ticle.   The elastic bandages, stockings, and
 supporters of various kinds are among  the
 most valuable additions to the modern prac-
 tice of medicine;  and with them may be
 classed the  elastic pads of  M.  Bourjeaurd,
 which, while they exert a sufficient amount
 of  pressure, yield,  when,  from  counter-
 pressure  such as that caused by swelling of
the part to which they are applied, inelastic
hardness  would prove injurious.   The author
makes no excuse for  bringing forward these
 I improvements: many persons go on suffer-
 I ing in consequence of not being aware that
  there are means of relief existing.
    ELATERIUM—Is a medicine possessing
  most powerful drastic cathartic properties.
  It is obtained from the juice of the Momor-
  dica elaterium,  or  "squirting  cucumber."
  The plant is native to the South of Europe.
  It is  a  most valuable remedy in proper
  hands, but one much too powerful to be used
  with safety by unprofessional persons.
    ELBOW-JOINT. — See  Dislocations —
  Joints, &c.
    ELECTRICITY, or the Electric or Gal-
  vanic  Fluid—Is  a material  agent diffused
  throughout nature,  either latent or unmani-
  fested, or active and manifested, according
  to circumstances.   Much yet remains  to be
  learned respecting the electricity of our own
  bodies, and that of the  objects and agents
  with which they  are surrounded, and  its
  relation with the phenomena of disease.  As
  an agent in the treatment of disease, electric
  or galvanic action is now much employed.
  It is a powerful excitant.  The shocks from
  an electric  machine, or other electrical ap-
 paratus, are not often useful, except in such
 cases as suspended  animation from  drown-
 ing, &c. when their passage in not too great
 intensity, through  the spine, to the pit of the
 stomach, may be  of service.   A continued
 current of the galvanic fluid is a much bet-
 ter application of the excitant powers of the
 agent;  and various contrivances for its con-
 venient medical employment are sold.
   The latest noticeable  application  of the
 curative powers of electricity is the electric
 chain or belt of  M. Pulvermacher, which
 is made of various sizes  and powers.  The
 author has not yet tried the large and more
 powerful forms of the apparatus, but he has
 found the application of the smaller chains
 of much service in the cure and alleviation
 of neuralgic disease.
   ELECTUARY.—A medicinal preparation
 made of sugar.—See Confection.
   ELEPHANTIASIS—Is a name applied to
 two very distinct forms of disease.   One is
 a cutaneous eruption, the other a thicken-
 ing of  the  tissues ben'eath  the skin  and
 around  the muscles.   Both are peculiar  to
 hot climates. Their discussion could scarcely
 be of service in the present work.
   ELM-BARK, [Slippery Elm]—From the
 well-known  tree, has been used as a remedy
 in skin diseases.
   EMACIATION—Is wasting of the tissues
 so that the body becomes  thin.  The process
 of emaciation,  however, is very different
from simple diminution of bulk: the latter
may take place while the appearance of 
E M  B
224
E M  E
 nealth is still retained;  but with  true ema-
 ciation,  the skin, and aspect generally, pre-
 sent an unhealthy appearance.  There  are
 few diseases which  are not  accompanied
 with loss of flesh or emaciation, and it is
 not unfrequently the first observable symp-
 tom.  Dr. "AVatson remarks—"It occurs in
 complaints  that  are  not commonly danger-
 ous—as in  dyspepsia, and  in hypochondri-
 asis, which is often connected with dyspepsia
 —and when  it  does  occur,  it  marks  the
 reality of the disease.   This wasting hap-
 pens in many fatal maladies—in pulmonary
 consumption, for example—and  in dropsy,
 although the dropsical  enlargement some-
 times masks  it.   It  accompanies many
 acute diseases, and  is  reckoned  an unfa-
 vourable symptom;  for it shows  that  the
 body is not properly nourished.   Sometimes
 the emaciation is so extreme that the inte-
 guments give way—the bones of the patient
 are sjiid to  come through his skin.
   Refer to Atrophy.
   EMBROCATION.—A  fluid applied, with
 friction  to  any portion of the body.—See
 Liniment.
   EMETICS—Are  substances which excite
 vomiting; that is, which cause the stomach
 to  be  forcibly emptied of  its  contents  by
 the mouth,  and which do this by a peculiar
 action, exerted  either  directly  upon  the
 organ itself,  or in consequence  of  their
 having been taken into the circulation; thus,
 vomiting may be excited by the injection of
 some emetic substances into the veins.
   Many  agents  are  capable of  exciting
 vomiting, which are mot classed as emetics,
 such as nauseous tastes or smells, swinging
 motions,  such as that which  causes sea-
 sickness, mechanical irritation of the throat,
 &c.; but these  causes are very different
 from the specific action of a  true emetic,
 which acts  independently of taste or smell.
 Emetics constitute a class of our most valu-
 able remedies, although not so indiscrimi-
 nately and  extensively used  as  they were
 formerly.   In ancient  times,  particularly
 among the luxurious  Romans, emetics were
 conjmonly employed for the disgusting pur-
 pose of enabling them to disgorge one luxu-
 rious meal  as soon as swallowed,  that they
 might  immediately  begin with  another.
-" Cicero, in describing a visit paid to Caesar
 at a villa near Rome, states that Caesar paid
 him the high compliment of taking an emetic
 before  dinner,  when  he understood that
 Cicero intended to spend the day with him."
   The emetics  most generally  used,  and
 most useful, are-
   Antimony.
   Ipecacuanha.
  SulphatVof zinc, or white vitriol.
  Chamomile.
  [Alum.]
  Mustard.
  Salt is sometimes used as an emetic  »nd
the mechanical  irritation  of the throat is
often  resorted to with benefit for  the pur-
pose  of exciting vomiting.   The  reader
will  find  further  information  respecting
the above emetics under  their  individual
articles.
  When an emetic is  given, it  should be
mixed in the first place with a small quantity
of water.  Except in  the cases of sulphate
of  zinc (and  some other  mineral  emetics
not adapted for domestic  usel some little
time  will elapse before the effects of the
emetic  are experienced—longer  if the sto-
mach be full  of food, and vice versa.  The
first sensation is  one of nausea, aocompanied
with a flow of the saliva, slight faintness, anil
cold  perspiration.   At last the effort of
vomiting  supervenes,  and the contents of
the stomach are ejected.  As sdon as actual
vomiting commences,  as a general rule, but
not before, some tepid fluid (water, gruel,
chamomile-tea,  or such  like)  should  be
given in moderate quantity, not  exceeding
a pint at a time.   A slight caution is requi-
site upon  this head, for occasionally indi-
viduals  under the action  of an emetic are
encouraged to drink very freely of fluid and
to distend the stomach.  This is not well,
for it  not only embarrasses the action of the
organ, but might  cause its being lacerated
or  burst.   It is also  requisite to  caution
against giving the diluent fluid too soon,
that  is,  before  the  specific  power  of the
emetic substance has come into action.  If
this is done, the  dilution will cither delay,
or  altogether prevent the desired effect.
When there is much  debility of stomach, it
is better  to  choose for the  diluting fluid,
a bitter, such as chamomile-tea,  which has
the additional  advantage  of  being itself
emetic.   As a general rule, the mineral act
more  quickly and violently than the vege-
table  emetics.  For this reason the former
are generally selected in cases of poisoning,
such  as  that  by opium, in  which there  is
some  difficulty in rousing the stomach to
action at  all,  and in  which it is important
that it should be relieved of its contents aa
speedily as possible.   In such cases medical
men may give the sulphate of copper; but
for the unprofessional, the sulphate of zinc,
or white vitriol,' is the  safest, and is a nearly
equally efficacious remedy.
  When there is much fever, and  in some
forms of inflammation, the salts of anti-
mony, particularly tartar emetic, are most 
E  M  E
225
E  M I
 generally used if emetic action is desirable.
 As a simple  emetic  to relieve the stomach,
 and also in cases of chest affections, ipeca-
 cuanha will be found the best.  In diseases
 of depression, mustard is most useful, and
 carbonate of ammonia may also be employed
 alone or combined with  ipecacuanha.  In
 cases where  the  power  of swallowing is
 lost,  medical men can excite vomiting  by
 the injection of emetic substances into the
 veins.  This  practice, of course, cannot be
 followed  by  the  unprofessional, yet they
 may  safely, and with much certainty of suc-
 cess, have recourse  to mechanical irritation
 of the back of the throat, either by the fin-
 ger  or by a feather.   A few  individuals
 possess the power of spontaneous vomiting,
 or at least of exciting  regurgitation of the
 food  from the  stomach  into the mouth, a
 process somewhat analogous to the rumina-
 tion of animals.   Such persons usually suf-
 fer from  dyspepsia, and  have recourse to
 the operation to free the stomach from food
 it cannot digest.
   The evening is generally the most suitable
 time  for administering  an ordinary emetic,
 as the stomach has time  to recover itself
 during the night,  and the uncomfortable
 nausea which often follows is less felt.
   Emetics are used to fulfil various indi-
 cations, the most direct and obvious being
 the emptying of the stomach  of any nox-
 ious  substances,  either formed within  the.
 body, such  as  bile, or  taken  in  by  the
 mouth, as indigestible food or poison.  For-
 tunately, these matters  often of themselves
 excite vomiting, but  in many instances, they
 do not sufficiently  empty the stomach, in
 which case the action must be  kept up, or
 re-excited, either by a diluent or by some
 emetic medicine.  It must  be remembered,
 however, that in the case of some poisons
 it  is not desirable  to  dilute largely.   In
 addition to their  power  of emptying  the
 stomach,  emetics  are  valuable from  the
 mechanical effects, both general and local,
 which they exert upon the body.  Formerly,
 the general mechanical effect, or " shock,"
 of an emetic, was believed to have the power
 of checking fever and other diseases at their
 outset. It is not now, however, much trusted
 to by medical men, and,  if it does  not  do
 good, is apt  to prove injurious, by causing
 an  irritable  condition of  the organ,  which
 may  continue throughout the disease.   In
 many cases of incipient disease, however,
 characterized  by depression, coldness of the
 skin,  &c. the  mechanical  action of  a smart
 emetic of ipecacuanha, either alone, or with
five to eight  grains of  carbonate  of am-
monia, is most  beneficial, by rousing the
 system, and removing  the  tendency to in-
 ternal congestion, or accumulation of blood.
 Another  and  most beneficial  mechanical
 emetic effect is  in  the  case of  children
 suffering from affections of the chest, with
 accumulation of mucus,  or  phlegm.  Chil-
 dren cannot expectorate, and are liable  to
 be suffocated, if the phlegm is in large quan-
 tity and  cannot  be removed.  Nothing in-
 sures its removal so effectually as an emetic,
 or rather emetics repeated from time to time
 (every few  hours) according  to  circum-
 stances.  In cases of jaundice  and over-
 loaded liver, the mechanical action of eme-
 tics  is often beneficially had recourse to.
 In consumption,  the periodical  exhibition
 of emetics  has  been  recommended.   In
 spasmodic diseases, either general,  as hys-
 teria, or local, as in spasm  of the stomach,
 emetics are beneficial—in  the latter  case,
 often, of course, by freeing the stomach
 from the offending  cause of the disorder.
 In asthma  they often relieve when nothing
 else will.
   Emetics are not always safe remedies. In
 pregnancy,  in  persons  of very full  habit,
 particularly if there is determination to the
 head, in rupture, in falling  down either of
 the bowel or of the womb, vomiting should,
 if possible,  be avoided.   The ancients held
 the opinion  that  emetics strengthened the
 stomach,  and they were  even used in the
 training of the athletae.   Modern  experi-
 ence  certainly does not uphold the fact, for
 the habitual use of these agents assuredly
 injures the tone of the organ and weakens
 its power.
   An error is frequently committed in using
 antimonial, or, as it is  called,  " antimony
 wine," as an emetic ; it is far too depress-
 ing for general purposes.  For these, ipe-
 cacuanha is quite the  safest agent of the
 class; it should be given  in  powder mixed
 with  water, and not in the form of wine, if
 the former is procurable.
   EMIGRATION. —For  those  who leave
 their native country and go to seek a home
 and fortune in other lands,  one thing is es-
 sential to success.  Invaluable to all, health
 is necessary to the emigrant.  It is to him
•a capital  of more value than money;  and
 yet this foundation of future fortune, nay,
 even  of existence, is often  carelessly  and
 ignorantly undermined  at the very outset
 of the enterprise.  Many are undoubtedly
 too poor and too ignorant to profit by coun-
 sel even  when it is given,  but  thousands
 annually leave the shores of Britain as emi-
 grants, who are  capable of acquiring  and
 acting upon useful information concerning
 matters of health; and how few, compara 
E  M  1
2-.0
i<: m i
tively, have even a slight acquaintance with I
the  laws  which  regulate  their being, on
the observance of which their health and
usefulness depend !   How few are capable
of acting intelligently  and promptly under
the occurrence of those accidents and con-
tingencies which it must often fall  to the
lot of the emigrant to encounter!   Into the
hands  of  some who  meditate emigration
these pages  may fall;  to them the author
more particularly addresses himself.
  The first thing to be considered must be,
not whether gold is  to be extracted from
the river-sands in  one place, or corn is to
be grown without exertion in another, but
the question should be, AVhat  is my consti-
tution ? AVhat are its tendencies, hereditary
or  acquired ?  To  what climate is  it most
adapted ? AVill it endure the  hot summers
and severe winters of America, or  will these
probably develop the consumptive tendency
I inherit ? Is it not more suited for Austra-
lia  or  New Zealand;  are not my children
more likely to be  reared in the one climate
than  the  other ?   These  and numerous
other  considerations   connected  with  the
adaptation of constitution to climate and proba-
ble occupation ought to hold the chief place
in the  decision as to emigration.   That
being decided, the next is the preservation
of  health during  the voyage.  As far as
circumstances will permit, a vessel  should
be selected which guaranties sufficient room,
ventilation, supply of water, and fresh food.
Of course circumstances must, to a certain
extent, modify these requirements ; but let
circumstances be  what they may,  a man
had  better remain at  home,  and  lay  his
bones with  those  of his fathers, than take
ship in some of the floating pest-houses that
have been  permitted  to carry across the
Atlantic their freight of wretched humanity,
marking their track  on the deep with  the
bodies of  those poisoned  in  their  iniqui-
tous holds,  and landing the survivors with
disease  or  death upon them, or with  the
strong arms that were to win  the  bread of
themselves  and  children   weakened and
unnerved. Space will not permit, in a work
like  the present,  the  detail  of  all  those
means and  measures  which  the  intending
emigrant should adopt as  regards health.
Much information on  these points  he may
gather from the various Emigrant's Guides,
particularly those of the Messrs. Chambers;
and  further,  he is  referred to the various
articles in  this Dictionary  which  treat of
matters connected  with the  preservation
nnd regulation of health, more particularly
Ague, Bed,  Climate,  Clothing,  Consumption,
Food, Medicines,  Ventilation,  Water,  $c. $c.
I These and others  contain many hints which
 will be found valuable, both in the selection
 of the  future home  and of the mode \\n<l
 means  of transit.  One thing is generally
 agreed upon, that however good an emigrant
 ship's dietary may be, it is always advisable
 for the passengers to add a private one, of
 such preserves and  pickles as  means will
 ftU0W—common cabbage will  do, preserved
 in vinegar—which may afford a supply of
 the vegetable acids, the best counter-agents
 to the effects of the salted provisions which
 necessarily form  a  large  proportion of the
 food  on board ship ;  a few bottles of lemon-
 juice are always  a valuable  addition to the
 sea-store.
   As regards clothing, it is  unnecessary to
 repeat here what is said  in the  article on
 that  subject; but it may be mentioned that
 emigrants who probably have to encounter
 exposure on first landing in  their  adopted
 country,  would  do well to  provide  some
 cheap waterproof material to place beneath
 them at night.  An attack  of rheumatism
 is an  unfortunate, and often,  when once
 acquired,  too constant companion of the
 emigrant, and may cripple him permanently.
 Those  who  have to  undergo  the  confine-
 ment which a long voyage must entail, most
 especially require to attend to all  the laws
 of health, and particularly exercise, which,
 from the small walking-space on board ship,
 is often neglected;  it should  be a carefully
 observed rule to walk  for  a certain time
 daily.
   The  amusement of  the mind is a matter
 of much importance, even in a health point
 of view, for those exposed to the monotony
 of a  long sea-voyage.   Happy are those to
 whom  books afford their  never-ending re-
 source ! and the time might  be worse em-
 ployed than in the perusal, or  rather study,
 of works like the present.  AVhen the new
 scene of labour is reached, the opportunity
 will  be past, but the man who has acquired
 for himself information which may enable
 him  either  personally to  avoid, or, in the
 case  of others, to counsel  the  avoidance of
 sources of disease, or  to act  intelligently
 and  promptly in  cases of sudden illness or
 accident, may have reason to bless the  per-
 haps otherwise wasted time  spent in the
 acquisition  of the  principles of  Domestic
 Medicine,  or of Household Surgery.
   After landing  in  his new country, the
 emigrant ought to inform himself as far as
 possible  respecting  the occurrence  and
 causes of illness, either in the one district
 of his residence, or in those he may have to
 pass  through.
   As said  at the  commencement of this 
EMI
227
EM  P
 article, health is, next to trust in God, the
 essential;  and it cannot be too jealously
 guarded by the emigrant, to whom its loss
 is ruin  and misery.   For information re-
 specting medicines, the emigrant reader is
 referred to the article.
   The following  extract  from an American
 publication will, perhaps, add force to what
 has been said  respecting care in selecting a
 vessel, and attention to the means of health
 during the voyage: —
   " The condition of the German and Irish
 emigrants, prior  to their embarkation and
 during their transit of the ocean, was, in most
 instances,  conspicuously  different.   AVhile
 the former were generally robust, and  well
 provided on the passage with the means of
 subsistence, and observant  of  cleanliness
 and  ventilation,  the  latter  were,  in most
 cases, enfeebled for the want of sustenance,
 and  on  shipboard destitute  of  supplies  of
 wholesome food,  depressed in mind, clothed
 in filthy  garments, and  crowded and con-
 fined in air rendered pestiferous  by the  ex-
 crementitious matters eliminated from their
 own  bodies.   In  contrasting the hygienic
 circumstances  in  which the  two  classes of
 emigrants were placed, it is easy  to account
 for  the  greater  amount  of  sickness  and
 mortality which occurred in one  class than
 in the other.  It is said  that of  the admis-
 sions of emigrants  into  the  hospitals  and
 almshouses of New York,  the Irish exceeded
 the German in proportion of ten to one.
   "The Montreal Immigrant Committee, in
 their report for 1847, state that that year
 has been unparalleled for the amount of im-
 migration  into Canada; near 100,000 souls
 have left  the  British  Isles  for these pro-
 vinces during  that period;  over 5000  of
 these died  on  their  passage out,  3389 at
 Grosse Isle, 3802 at  Montreal,  and other
 places  in  the same  fearful  proportions.
 Never had  Canada presented such  fearful
 scenes of destitution and  suffering.  ' From
 Grosse Isle, the great charnel-house for vic-
 timised humanity, up  to Port Sarnia, along
 the borders of our magnificent river, upon
 the shores of Lakes Ontario  and Erie, and
 wherever  the tide of  immigration  has  ex-
 tended, are  to be found  the  final  resting-
 places of the sons and daughters of Erin—
 one unbroken chain of graves, where repose
 fathers and mothers, sisters and brothers,
 in one commingled heap.'
   "The disease of which  the emigrant pas-
 sengers, and in many  instances the officers
 and crews of ships, perished  at sea,  and of
 which a great number were ill on their arrival
in the United States and Canada, was typhus
[or ship] fever in its genuine form.   In some
 ships,  dysentery,  small-pox,  i^nd measles
 swelled the amount of mortality, and added
 to the number of sick that reached the ports
 of destination."
   E.MMENAGOGUES—Are medicines which
 exert, or  are supposed to exert, their action
 upon the womb, and to  promote the  men-
 strual  discharge.   The only  well-known
 medicinal agent which  exerts an undoubted
 specific action  of  the  kine.',  is the  Secale
 cornutum, or ergot of rye.—S^e Ergot.   Re-
 cently, a Chinese emmenagogae, the  Key-
 tse-sing,  has been highly spoken of;  but
 at present  the  experience of its powers is
 limited.  Some medicines seem to exert their
 influence  upon  the womb  by  stimulating
 neighbouring organs:  to this  class  aloes
 belongs;  others, such  as valerian and asa-
 fcetida, by their action  on the nervous sys-
 tem, and  another set, such as iron, by their
 tonic influence upon the system  at large.
   Refer to Menstruation.
   EMOLLIENTS—Are  remedies which pos-
 sess the power of relaxing and softening parts
 to which they are applied.  Heat and moist-
 ure, and  oil or fatty matters,  are the chief
 and best emollient remedies-
   EMPHYSEMA—Is a medical  term  ap-
 plied to  two very  different  disorders.   In
 one case  it denotes a  state of coalescence,
 and  unnatural distension of the air-cells of
 the lungs.—See Lungs.   In  the other, it is
 applied to the distension or blowing up  of
 the cellular or areolar  tissue of  the body
 by air.   This latter form  of emphysema
 sometimes follows upon  the accident of frac-
 tured rib, when a point of the  bone  pene-
 trates  the lung.  In this case,  with  every
 breath drawn in, air passes  from the  lung
 into the cavity of the chest,  from whence it
 finds its way through the wound made in the
 walls of the cavity, and by this means be-
 comes diffused through  the  cellular tissue;
 the features and  the whole  body become
 greatly swollen,  and when  the  surface is
 indented by the finger, a crackling sensation
 is experienced.  The mere distension of the
 cellular tissue is not a  circumstance of so
 much  importance  as  the accident which
 gives  rise to it, but in those perfectly una-
 ware of the possibility  of such %n occur-
 rence, the appearance presented  by the af-
 fection would cause much alarm : of course
 the broken rib itself should be attended to;
 the emphysema  may be relieved by punc-
 tures made in the skin  by a lancet, and by
 the application of bandages.
  Refer to Fractures—Rib, §c.
  EMPYEMA—Is a collection of matter in
the cavity  of the chest, between the lung and
the ribs.   Refer to Inflammation of Lungs. 
E  M  P
228
K  I' I
  EMPYREUMA —Is  the  peculiar,  and
often offensive smell which many substances
acquire after exposure to considerable heat
in close ovens or vessels.  The fact of  an
article  of  diet  becoming empyreumatized
renders it unwholesome and  irritating to
the stomach; on this  account baked meats,
pastry,  &c. are more  apt to  disagree  than
the same articles roasted or boiled.
  Refer to Baking.
  EMULSION—Is  a  mixture  of oil  with
water by  the intervention  of a third  sub-
stance.  This may  be effected  by means of
gum mucilage, syrup, &c.;  but perhaps the
best agent for forming emulsions is the yelk
of egg.  The oil must  first  be rubbed  up
with  the yelk,  and then distilled, rain,  or
perfectly soft water added gradually.   Milk,
which is itself a natural emulsion, is also a
very good agent for uniting some oily or such
like matters resembling the oils in composi-
tion, with water, particularly camphor.—See
Camphor— Castor-oil— Turpentine.
  ENAMEL.—The outer hard casing of the
teeth.—See Teeth.
  ENCEPHALON.—A  medical term  em-
ployed to designate  the parts generally con-
tained within the skull.
  Refer to Brain.
  ENDEMIC—Is a  term applied to diseases
which are peculiar to, and  persistent in,
certain districts  or  countries.  Thus, ague
is endemic in marshy  districts; bronchocele
or goitre  where the water is impregnated
with  magnesian limestone;  and cretinism
in the  low dark valleys of  Switzerland.
These, and other  endemic  affections,  are
undoubtedly due to  natural peculiarities of
soil and climate; but their  power  is un-
questionably much  augmented by the pri-
vations  attendant on  poverty,  and by the
depressing influence of dirt  and vice;  or,
as in  the  case of bronchocele,  by laborious
lives.
  Besides  naturally  caused  endemic  dis-
eases, there are others  which  may equally
be called endemic, though arising from the
artificial circumstances which have hitherto
been attendant on man when  living in com-
munity ; such  are the fevers of our large
towns, which are so constant in their  ope-
ration in  particular localities, as  truly  to
merit the name of endemic.
  In  many situations, the  constitutions  of
the natives of districts in which  endemic
influences prevail, appear to become habi-
tuated to, or  proof  against, the morbific
causes,  which are  quickly  productive  of
disease  in strangers.   Such is strikingly
the  case in the rivers  of the African coast;
and the Niger expedition afforded  melan-
choly  proof of  how fatal to Europeans a
climate may  be, in which the natives live
with comparative impunity.  In many cases
something is due to the adaptation of habits
and modes of life by the inhabitants, which
are  eitlier  unknown  to  or  neglected  by
strangers.
   Refer to Climate—Epidemic, frc.
   ENDERMIC—Is the transmission of medi-
cinal actions to  the constitution through the
skin.—See Skin.
   ENEMA.—A  clyster.—See Clyster.
   ENTERITIS.— Inflammationofthebowels.
—See Alimentary Canal.
   Refer to Inflammation.
   ENTOZOA—Are  parasitic animals which
are found in a living state within the body.
The most common  entozoa in man are the
various forms of worms.—See  Worms.
   ENURESIS.—Incontinence of urine —
See Urine.
   EPHEMERA.—A fever  which  does not
last more than twenty-four hours.
   EPIGASTRIUM.—The pit of the stomach.
   EPIDEMIC—Is a term applied to a disease
which attacks a large number of individuals
simultaneously,  or at least in quick succes-
sion.   Perhaps  the  best  instance  of an
epidemic  is the well-known influenza,  which
seems more independent  of endemic,  or
local,  influences, than  most others  of the
class.  Cholera  is an epidemic disease, but
the liability to  its  visitation is evidently
connected with  local circumstances,  which
either assist in  developing the  activity of
its mysterious germs, or at all events exert
an attracting  influence over them.  Scarlet
fever,  measles,  small-pox, and other dis-
eases of   the class,  most  certainly prevail
epidemically at  times;  for though they un-
doubtedly disseminate  themselves by con-
tagion, observation  would show  that the
contagious influences are much more potent
in different places at different times.  The
reason why this.should be so is not always
traceable; but as regards the greater and
more   pestilential  epidemics,  it has  been
observed that they  have been  preceded or
accompanied by striking vicissitudes  in the
weather.   It  is  well known that the first
extensive  diffusion  of  the Asiatic cholera
dated from a swampy district at the mouth
of the Ganges, after  a very wet season; and
it  is matter of history that the epidemics of
plague were associated with unusual  modi-
fications of weather; the  extremes of heat
or cold, of drought or moisture.   Neither
are the epidemic influences always confined
to  man:  the  lower  animals are  also fre-
quently and fatally subject to them.   It in
remarkable, as indicative of this innuendo, 
E  PI
229
E  PI
that birds have been  observed to  forsake |
districts  ;n which  an  epidemic pestilence
prevailed.
  Epidemics were much  more common and
fatal  in  former times  than they have been
within the last hundred years.   Such were
the plague at Athens,  430  years  before
Christ, the black  death  or plague of the
fourteenth century, the  sweating  sickness
toward the end of the fifteenth, and the great
plague of  London  of the seventeenth.   At
the present day, the plague of Eastern coun-
tries,  of Egypt in particular, and the cholera,
are the modern pestilences.  All these, and
many  others,  are  undoubted  epidemics;
but equally certain is it that they owed
and still owe  much of  their potency  for
evil,  to local  and  endemic causes, and  to
the entire want  of attention  to  sanitary
arrangements.   However deficient these
may be in this country, even at the present
day,  were it  not for  such regulations  as
there are, we know of no reason  why the
plague which still lingers  around and some-
times decimates the neglected oriental city,
should not again visit our shores.
   Refer to Contagion—Fomites, See.
   EPIDERMIS.—The  outer or scarf skin,
or cuticle.—See Skin.
   EPIGLOTTIS—Is a cartilage of an oval or
heart-shaped figure, situated  at the root  of
the tongue, which falls upon and covers the
glottis or opening into the larynx,  so as to
protect it, particularly during the passage
»f food,  in the act of swallowing.
   Refer to Larynx—Swallowing, $c.
   EPILEPSY,  or  Falling Sickness —Is
one of the very afflicting maladies to which
man  is subject, belonging to  the class  of
convulsive diseases.  It  is also one of the
most  eminently characteristic,  and  at the
same time terrible to witness, when it occurs
in its severer forms.
   The fits, or convulsive seizures of  epi-
lepsy, are most varied  as to  occurrence.
Occasionally an individual has suffered from
one paroxysm, and one  only,  the disease
never again returning ; in other cases, years
have intervened ;  frequently the interval is
one of months, but again, daily fits, or even
two or three times a  day, are the rule  in
the worst cases.  The  attack of epilepsy is
for the most part sudden : the individual, in
the midst of some accustomed  occupation,
or  while  holding active  communion with
persons around, suddenly utters a  loud—a
fearful—cry, and,  if unsupported,  falls  to
the ground; the eyes are staring or rolling;
*he head, or rather chin, is drawn toward
one shoulder, the countenance becomes dark
or livid,  the veins of the  face and  temples
turgid with  blood, and  the features  are
thrown into convulsive movement; there is
frothing at the mouth, while a kind of choking
noise is often made in the throat; the limbs
are also  more  or  less convulsed,  and the
excretions are often expelled involuntarily.
The  tongue  very often suffers  from being
bitten, and the teeth  have even been frac-
tured during  the  fit.   Gradually, these
convulsive movements diminish,  and  the
person awakes  to consciousness,  with  a
heavy  stupid look,  or falls into  a  deep
lethargic  sleep, which continues for some
hours; but  even when roused  from this,
there often remains  slight temporary sus-
pension  of the  activity of the mental func-
tions.  Such  are the phenomena of a severe
epileptic paroxysm ; the disease, however,
occurs in.much milder forms, even in those
who at other times suffer from it in greater
intensity. A slight temporary unconscious-
ness may be the  only symptom, with  or
without the slightest approach to convulsive
movement, as evidenced by the twitching  of
a finger,  the  roll of an eye, or  slight spas-
modic action of the muscles of the face;
the patient may fall gently as in a faint,  or
remain standing as it were asleep for a few
moments. As there  is every variety in the
nature of the attacks, so  is there likewise
in their  duration: from a few  moments  to
the average  period of  from five  to eight
minutes,  but sometimes much longer.
  The attack in many cases appears to by-
standers  to come on suddenly and  without
warning  ; but most  epileptic patients are
sensible  for  some time previously of the
approach of the paroxysm, and  even  for
twenty-four  hours are always aware that a
fit is at least probable, although its direct
accession may not be  certainly known until
just previous to its  occurrence.  It may,
however, happen that these symptoms will
pass oft'  without a fit, either independently
of  any  effort of the patient to ward  off
the  attack,  or in  consequence  of  some
of those  measures found to be efficacious,
and  adopted by epileptic patients for the
purpose.
  The premonitory symptoms vary greatly;
low spirits,  or  unusual irritability, some-
times an  increased energy, dizziness, noises
in the ears, floating specks before the eyes,
and many other signs connected with  dis-
order of the  nervous system, are  the pre-
cursors of the epileptic paroxysm.   But the,
most  generally  marked  and  remarked
precedent is  the  epileptic "aura," a sort
of creeping  sensation, which is  described
by  the  patient as arising at  some par-
ticular part  of the body, such as  the ex- 
EPI
230
E P I
tremity of a limb, and gradually ascending
upward to the trunk or head, till the indi-
vidual loses his consciousness in the con-
vulsion.
  Epileptic  seizures are  very frequent in
the night-time, just as the person is falling
asleep ; but they may occur  at  any period
of the twenty-four hours, and may be in-
duced by causes affecting the nervous sys-
tem;  the excitement  of joy  or  passion, or
the depression of grief, intoxication,  and
sexual excesses, are most frequently not only
actual exciters, but also predisposers, to the
attack of epilepsy.
  Epilepsy  may  be a  congenital  disease,
that is, the child  is born with the tendency,
and becomes subject to the fits, either with
or without  apparent cause,  early  in life.
Indeed, many of the convulsions of children
occasioned by teething, &c. are in fact epi-
lepsy, but as they arise  from causes irri-
tating the brain,  and not  from affections of
the organ itself, they are  possibly not re-
peated when the cause of the irritation has
subsided.   If, however, the tendency exists
strongly in  the constitution, and  has  not
developed itself before puberty, it is very
apt to do so at that period, and more espe-
cially if favoured by circumstances which
lower the tone of the body generally or of
the nervous  system in particular;  but no
period of life is exempt from becoming the
period  of  epileptic, development,  even to
old age.   The  following observations  of
Dr. Bright  upon  this point are  generally
instructive,  he says—" There are  leading
periods in the evolution of the frame, and
peculiar circumstances connected with cer-
tain periods, which may well  be considered
as influential in  the  production of the dis-
ease.   In infancy, the nervous system  is
delicate, and easily acted upon  by various
causes of irritation.  Then follows the try-
ing period of teething.  In a few years the
second  dentition  occurs.   In a  few years
later, all the great changes connected with
the age of  puberty.   To this  follow the
excesses and  exposures of manhood;  and
after  the lapse of years  the vigour of the
system fails, and many causes  act  to
derange the nice  balance of the constitu-
tion :  the bowels often become sluggish, &c.
&c."
  A person may die in an epileptic fit, even
in the  first, but  this is  seldom  the case.
More generally- the disorder does not imme-
diately threaten life, but the  individual goes
on from year to year, suffering more or less,
and  still lives;   even  when  the fits occur
daily, or two or  three  times a day, this is
the case.  When  death does occur early in
 the disease it is more probably due to suf-
 focation  arising  from the  spasm of  the
 muscles of the throat and neck, than to the
j braiu affection.  But if life  is continued to
I the confirmed epileptic, the intellect too often
 becomes affected.  This may not be palpable
 after a first  seizure, not even after many
 seizures for  many years, not throughout a
 tolerably long life, but these are exceptions.
 The  generality of epileptics  become feebler
 in intellect, the memory fails,  the power of
 continuous exertion of the mind is lost, and,
 perhaps, at last the condition ends in mental
 fatuity.
    That epilepsy is  due to  disease or  dis-
 order  of the  brain  and nervous  system is
 unquestionable; the affection either directly
 originating from them, or through them, in
 consequence  of irritation in  some  portion
 of the body.  It  is well ascertained  that
 hereditary predisposition gives greater effect
 to causes which have  plainly exerted influ-
 ence in the  production of this distressing
 malady.    Dating, either directly or  indi-
 rectly, from  the nervous system, whatever
 weakens that  system tends  to cause epi-
 lepsy.  From this it  is  evident  how  well
 founded the  observation  is, that there is no
 more  fertile  source  of epilepsy  than  the
 abuse of the sexual organs,  particularly in
 the  young.  The  subject is  a painful  one,
 but  the  direful consequences  of  vice, with
 which the merest children become  imbued at
 school, is frequently coming before medical
 men.  Unaware of the sin  and evil conse-
 quences  of their  acts, they ruin  constitu-
 tions at the most critical period of life, and
 lay  the foundations of epilepsy and other
 nervous diseases,  which  are  either quickly
 developed, or do  not  show  themselves  till
 late  in life.   The subject is one  to which
 parents and  tutors  cannot be too strongly
 alive.  Intoxication is a  cause of epilepsy,
 and  delirium tremens may be  complicated
 with  it.   Strong  and  prolonged  mental
 exertion may induce  epilepsy.   Fright is
 another and very frequent exciting cause.
 Worms and  irritations  in  the bowels, in-
 deed  whatever can  irritate  the nervous
 system, may induce the disease in question.
 Imitation,  or at least the witnessing an indi-
 vidual in the epileptic paroxysm, has been
 known to give rise to the fits in others;  but
 they were  most likely predisposed, or at all
 events of nervous and susceptible tempera-
 ment ; for this reason, such  persons, young
 females  and  children  especially, should
 never, if possible, be  permitted to witness
 an epileptic  fit.  The  premonitory cry  is so
 terrifying  that it  has been  known to affect
 even the lower animals. 
EPI
231
EPI
    Of the  predisposing  causes  there  is no
  question that hereditary tendency is a pow-
  erful one, and, especially,  if the constitu-
  tion of the family be  scrofulous.  Epilepsy
  in the  offspring has  been  traceable to no
  other cause than dissipated and, especially,
  drunken  habits  in  the  father.  It is fre-
  quently observed to  be concomitant with
  malformation, or at least mis-shape, of the
  head of the sufferer.  From what has now
  been said, it must be  evident that epilepsy
  is no disease  for  domestic management, in
  a curative point of view, but that it affords
  much room for preventive and other means.
   In families  in which  a tendency  to epi-
  lepsy is known  to exist, the greatest care
  should be taken to guard the nervous sys-
  tem  from all  causes either of irritation or
  exhaustion. In infancy, the period of teeth-
  ing  and the condition of the  bowels will
  require special  attention, and the  tone of
  the system to be maintained as  directed in
  article "Children."  The physical strength
  and  health are to be cultivated in early
  life,  even  at some sacrifice  of  educational
  advancement.   At puberty the strictest eye
  must be kept upon the habits and tenden-
  cies, and,  while  the constitution  is develop-
  ing,  and growth going  on,  all  exhausting
  exercises  prevented.   Indeed, during  life,
  the suspicion  of a tendency to  so  terrible
  an affliction as epilepsy  should be a never-
  forgotten  check  upon  excess in every way
 —a  check upon  the  man  who consumes
  his  energies  in the exertions of business
  or of study, as  well  as upon  those  who
  waste them in the pursuits  of vice or sen-
  sualism.  In addition to  passive preventive
 means,  all those  measures which are fully
 laid  down throughout this  work for  the
  preservation of  health, should be well at-
 tended to, particularly  the use of cold water
 to the  head, spine, and  surface generally,
 if there is sufficient reaction to bear the
 application.
   Care must be  taken  in the  curing or sup-
 pression of accustomed  or  long-continued
 discharges,  such  as  habitual  diarrhoea,
 bleeding from piles, &c.  At  the same time
 it must be borne in  mind  that the  dis-
 charge, by  weakening  the system, may be
 itself the cause of the  disease;  but  this is
 a point which the  medical attendant must
 determine.
   Certain precautions  are always requisite
 with  those  who  suffer  from  epilepsy, and,
 as a general rule, it may be laid down that
 they should never, if possible, place  them-
 selves or be placed in situations  in which a
sudden seizure will expose them  to danger.
Tiius, employmehts which  necessitate riding
 I on horseback, ascending heights, &c. ought
  never to  be engaged in,  neither  such as
  those  in  which even  momentary uncon-
  sciousness may involve  the  lives of others
  in danger.  Even  the suspicion of epilepsy
  in a railway official ought to be a disquali-
  fying circumstance.   Many, it is true, have
  sufficient  warning to enable them  to pre-
  pare  for the attack and to withdraw from
  danger, but  this  is  not  always  possible;
  the worst case of burning, or rather-roast-
  ing,  the  author  ever  witnessed,   was in
  consequence  of a  fall into the  fire in  an
  epileptic paroxysm.  AVhen means will allow
  of it, the epileptic ought to have an attend-
  ant constantly with  them.   When  an  indi-
  vidual is  seized with a fit of epilepsy, but
  little can be done  for its immediate relief;
  the chief  thing is to prevent  the  patient
  inflicting injury upon himself,  by  striking
  against surrounding objects, and  also to
  protect the tongue.   Those who  are much
 in attendance  upon  the  epileptic  ought
  always  to have at hand a piece of India-
 rubber, or a thick  India-rubber ring—such
 as is  used  for  children  teething—to insert
 between the teeth.   All fastening about the
 body, such as the neckcloth, &c. ought to be
 loosened, and air freely admitted;  the head
 should be raised, and cold wet cloths may be
 applied to it  if there is much heat.  It has
 been advised to cram the mouth full of salt
 as soon as the fit comes on.  Dr. Watson,
 who had the plan tried in hospital,  thought
 it  seemed to curtail the  duration  of  the
 convulsion.
   The  treatment of an epileptic patient in
 the intervals of the fits must be left to a
 medical man;  it involves  too  many  con-
 siderations to  be advantageously managed
 by others.   When well treated, there  is a
 hope of cure,  and  this chance .should  be
 afforded to the patient, which can  only  be
 certainly done under efficient  and educated
 management,  for even with all that skill
 and attention  can  do,  the  disease  often
 proves  intractable.   The  various  remedies
 which have been used in epilepsy—and they
 have  been very numerous—it would serve
 no good purpose to  enumerate here,  further
 than  to state that  much  benefit has  fre-
 quently  resulted  from  counter-irritation,
 such  as the introduction of a seton in the
 neck, or, better still,  a full  and free erup-
 tion produced over the  shaved  scalp,  by
 tartar emetic  and  croton-oil  ointment, or
 down  the spine, should  any tenderness be
 detected there.  It sometimes  happens that
 accidental counter-irritating effects  relieve
epilepsy, at all events for  as  long as they
are in action.  In-one case attended by the 
E  P
232
K P S
author,  .. man who was suffering from daily
attacks  of epileptic convulsion fractured his
leg, and from  that time  had  no  attack for
five or six weeks, during  the period the ac-
cident was  being recovered from.
  Further,  it is well to draw the  nttention
of the reader  to the  article "Cotyledon."
Where the  plant is within reach, eitlier of
the patient or of friends,  there could be no
possible objection to its powers being tested,
and of them the author can speak favourably.
  Epilepsy is often  a feigned disease, par-
ticularly among soldiers and sailors, and
also  by  mendicant  impostors. The  latter
usually  choose  public places for the exhibi-
tion, throw their legs and arms about, foam
at the mouth with a little soap mixed with
the saliva,  and  continue  their exertions for
a much  longer  time, and with more expen-
diture of heat, but with  less active power
than the real epileptic.   A real epileptic is
not susceptible to pain or sensation; where
suspicion exists, therefore, some test of this
kind which will not injure may well be tried.
Snuff may  be put up  the  nostrils, and if it
produces  sneezing  there  is  no  epilepsy;
sometimes  the  proposal,  within hearing  of
the person, to try some mode of  treatment
which involves  considerable suffering is suf-
ficient to dispel the fit.
  Refer to Ablution—Convulsion—Cotyledon
—Children. Src.
  EPIPHYSIS—Is the extremity of a long
bone, such  as of the arm  or thigh, which is,
in the young, connected  with the shaft or
main portion of the bone by means of gristle.
When such bones are boiled for some time
the epiphysis  separates,  as may  be seen in
the case of veal or chickens.  In children
the epiphysis is sometimes separated by ac-
cident attended with violence.
  Refer to  Bone.
  EPISPASTICS—Are substances used me-
dicinally for producing inflammation of the
Bkin, which may be followed either by blis-
tering or by the formation of matter.  Their
action is in fact that treated of under the
article •'Counter-irritation," which may be
referred to.—See also Blister, Sec.  Jfc.
  EFISTAXIS.—Bleeding from the nose.—
See Hemorrhage, Nose, Jfc.
  EPITHELIUM—Is  the  external layer of
a  mucous  membrane.—See  Mucous Mem-
brane.
  EPSOAI  SALTS —Are a  compound  of
magnesia and  sulphuric acid, (sulphate of
magnesia,) and derive their name from hav-
ing been first obtained by the evaporation of
the water of a  spring, situated near Epsom,
in Surrey, which contains the salt in large
quantity.   They are now prepared  largely
by  manufacturing  chemists  from mngne-
sian limestone,  nnd  also  from  sea-water.
Thev are solid in the form of small pure
white,  needle-like crystals, and from theii
cheapness are extensively, indeed too much
so, used among the poor as a general  aperi
ent,  and not  unfrequently by  all classes.
Epsom salts  are  tolerably certain in their
action, do not gripe much, and produce free
watery evacuations of the bowels ; on these
accounts the  medicine is  a most valuable
one  in many  diseases, particularly in per-
sons of a full habit,  but, as generally em-
ployed, it is not  suitable for  a  common  or
frequently repeated  aperient.    From  its
being in  many instances  taken in a state of
too concentrated  solution, it induces a dis-
charge of the watery part of  the blood into
the bowels, and  thus seriously  debilitates.
Moreover, after the action of  a dose of Ep-
som salts, the bowels, in those liable  to ha-
bitual constipation, are very apt to be left
with a greater tendency to inaction than be-
fore ; nevertheless, in persons of full,  strong
habit,  an occasional  dose of the medicine
is, without question, beneficial, but it should
be taken in smaller quantity and much more
largely diluted than  is usually  done. The
question  of  dilution is  a  very important
one in  the administration of this  salt, nnd,
if attended to, renders it safe and efficient
even for  the comparatively delicate.   From
half a drachm, or even  less, to n drachm,
should be dissolved in at least six  ounces or
half a pint of cold or  tepid water, and taken
on first  rising in the  morning,  when the
dose should be followed by the fluid break-
fast.   Many  persons liable to constipation
find  this  method a  simple and  effectual
remedy,  which may be used  for weeks to-
gether.  From five to ten drops of  dilute
[or  aromatic] sulphuric  acid are often a
good addition to  the dose, and one which at
the same time corrects in  some degree the
bitterness of the  salt.  If  there is debility,
either  of the stomach or  generally, from a
quarter to half a grain either of quinine or
of some  salt  of  iron may be added. The
quinine  appears  to  increase the aperient
power.   The most  convenient  method  of
taking Epsom salts in this form  is to dis-
solve one ounce in a pint (sixteen ounces) of
water, adding the acid or other ingredients
in proper  proportion.    Of  the  solution,
from half to a whole wineglassful may  be
taken the first thing in the morning, diluted
with- the  proper quantity of water  before
taking, or, if  preferred, by the latter being
drank  immediately after the medicine.
   The following method for the  administra-
tion of Epsom salts has been recommended 
ERG
233
ER Y
 in  France :—Take of water about  sixteen
 ounces, powdeied or roasted coffee two and
 a half drachms, Epsom salts one ounce, boil
 well for two minutes, (not in a tinned vessel;)
 remove from  the fire,  and let the mixture
 infuse for some minutes, so as to allow time
 for  the  development of the aroma, then
 filter,  or   merely strain off.   It must  be
 Bweetened  to  taste.    This  fluid does not
 impart the slightest  taste of the bitterness
 of the salt.  It should  be observed that the
 simple infusion  of coffee is not  capable of
 removing the bitter taste.
  The combination of Epsom salts with in-
 fusion of senna, constituting the common
 black  draught, is one of the best forms of
 active occasional purgative in common use.
 It is well to bear in mind that there is con-
 siderable resemblance between oxalic acid,
 in its crystalline commercial form, and Ep-
 som salts, and that, in consequence,fatal mis-
 takeshave occurred.  The intensely acid taste
 of a single crystal of the former would at
 once clear up any doubt.  Perhaps it might
 be well always to use so simple  a test.
  Refer to  Oxalic Acid—Purgatives—Senna.
  ERGOT  OF  RYE—Is a peculiar diseased
 or fungoid  growth which is developed upon
 the seed of the common rye.  The affected
 grain  is sometimes  called " spurred rye,"
 from the peculiar curvature of  the  growth,
 which varies from half an inch to an inch
 and a half in -length, is about a quarter of
 an  inch thick, slightly angular in shape,
 and black  in  colour.   As a remedial  ad-
 junct in the hands of the accoucheur, ergot
 of rye is most valuable, but is scarce likely
 to form part of the domestic medicine-chest.
 It is more commonly met with on the conti-
 nent, where much rye is grown, than in this
 country ; and  when the grain is largely in-
 fected with it, pestilential  diseases have
 been ascribed  to the use  of  the flour  in
 which it has been mixed.  It is certain that
 a peculiar kind of dry mortification  of the
 extremities has followed the prolonged use
 of grain containing ergot.
  Ergot of rye has been used  in medicine
 in  hemorrhagic  and other diseases,  but
 chiefly on  account of its undoubted  action
 upon the womb.  It can only be safely used
 by medical men.
  EKRHINES—Are   medicinal  substances
 used as snuff to excite  discharge from  the
 lining  mucous  membrane of  the nostrils.
 They are, in fact, means of counter-irrita-
 tion, but are not much employed by medical
men.   In some cases  of headache they are
useful, and common snuff may be used with
 vs much effect as any of the class.
  ERUCTATION—Is the rising, either of
      u2
 gas or fluid, into the mouth from  the  sto-
 mach. It is a constant symptom in dyspepsia.
   Refer  to Flatulence.
   ERUPTION.—A  diseased appearance on
 the skin.—See Skin.
   ERYSIPELAS, or St. Anthony's Fire,
 or The Rose—Is an inflammatory affection
 of the skin, with or  without vesication or
 blistering,  sometimes extending to the cel-
 lular tissue beneath.  It appears on various
 parts of  the body, but most generally on the
 head and neck.  Unless the attack is very
 slight indeed, the  occurrence of erysipelas
 is generally ushered in  by symptoms of fe-
 ver, shivering, and  headache, furred tongue,
 perhaps  sickness,   followed  by  thirst,  hot
 skin, quick pulse,  &c.;  at  the  same time
 the part first  affected, such as  the nose,
 cheek, or ear, becomes stiff, painful, red and
 swollen,  the  paiti being of a burning cha-
 racter.   If unchecked, this inflammation of
 the skin  extends with more or less rapidity,
 and so rapid indeed is its progress  at times,
 that in  a very few hours the whole head
 and face become enormously swollen.  As
 the disease progresses, blisters resembling
 those raised by a scald  form over  the sur-
 face,  which  is intensely hot and red,  or
 purplish  ; the  pain is  severe, fever  runs
 high ; sore throat is a very frequent accom-
 paniment, and delirium is common.
   So  serious a disease as erysipelas ought
 only to be  treated  by a medical man ; but
 as it is important, if possible, to check it at
 its first onset, the following measures should
 be adopted  if proper  assistance  cannot
 quickly  be procured.  A disease  present-
 ing  the  symptoms above  detailed  must
 generally be recognisable even  by unpro-
 fessional persons.   There is great  diversity
 of opinion respecting bleeding from the arm
 in the first onset of erysipelas, but here, as
 in  many other cases,  the treatment must
 hinge  upon the constitution of the patient,
 and not on the name of the disease.  Under
 any circumstances,  however, it  would not
 be well for  an unprofessional person to use
 so  active a remedy  ; but if the affected in-
 dividual  be of very full habit, there is no
 objection  to  the   application  of  leeches
 around the inflamed patch ; that is, if there
 is no peculiar tendency to irritation of the
 skin  after  the  use of  leeches.   If the
 tongue is very foul,  an emetic may be given,
 and the bowels freely purged with the calo-
 mel and  colocynth  pill,  while eighth  of a
 grain doses of  tartar emetic may be admi-
 nistered every three or four hours, the diet
 being kept  as low as  possible.   In weakly
persons,  a  more negative plan  should be
pursued; the bowels must be more  gently 
E  R Y
234
E  11 Y
 aited  ipon, as by five grains of gray pow-
 der,  followed in a few hours by some gentle
 aperient such  as castor-oil ;  effervescing
 saline  draughts should be  given  (and. in-
 deed, are  useful in the former case alsoi
 every few hours,  while  all  stimulants and
 animal  food are cut off.  With respect to
 local applications, the most certain and effi-
 cacious is  certainly the nitrate  of silver, or
 luuar caustic,which, if carefully used, maybe
 employed beneficially even by the unprofes-
 sional.  Indeed it is quite possible to imagine
 a clergyman, for  instance, in the  country,
 checking effectually  a  fast-spreading  at-
 tack  of erysipelas, which would, unattended
 to, gain a dangerous ascendency before  the
 services of a medical man could  be obtained.
 The lunar caustic is  used for  two objects,
 one to  check the spread  of the inflamma-
 tion  over the skin, and  the  other  to  quell
 the disease;  for the first it is best used  in
 the solid stick, for the latter  purpose  in
 strong solution.
   Erysipelatous  inflammation  tending   to
 spread  may be stopped by surrounding the
 affected part entirely with a cauterized ring.
 The parts  to be touched  must in the first
 place be shaved, if covered  with hair, and
 the skin must always be thoroughly cleansed
 from  its natural oily secretion,  by washing
 with soap and water. It must then be moist-
 ened  all round, and the  stick of  caustic
 drawn slowly and gently  over it,  so as to
 make a line of  demarcation at least a quar-
 ter of an inch broad ; but  this line must be
 entire throughout—deficiency in  one spot
 may permit the inflammation to extend  by
 the outlet.   It  is not asserted that  in every
 case this caustic line will inevitably stop the
 disease,  but it will do so in the majority, if
 care be  taken that it is efficiently done, and
 that it  includes, without doubt, every por-
 tion of the affected skin.  AVhen the solu-
 tion of  caustic is  to be used to quell the
 disease, it  should  be  used of the strength
 of forty grains to two  drachms  of  distilled
 or rain water.  The inflamed surface must
 be gently cleansed by soap  and warm water,
 and  the solution  applied  all over it  by
 means of a camel-hair brush or a feather.
 The practice now recommended  is perfectly
 safe, is very efficacious, both as a preventive
 against  the extension, and  as a cure of this
 formidable disease, and might be quite jus-
 tifiably  employed by  an intelligent person
in the absence  of medical assistance.   It
has, however, the inconvenience of turning
the skin to which it is applied perfectly
black  for  some time  afterwards,  that  is,
until  the out-r skin has  peeled off, and
 been  replaced  by  a fresh layer.  For this
 renson it is  better in mild  cases  to have
 recourse  to some of the local remedies yet
 to be  mentioned.  It  is  desirable that per-
 sons  should  be duly impressed with the
 necessity of cutting or shaving off  the hair
 whenever erysipelas  in  a  severe form ex-
 tends  to parts naturally  provided with the
 covering.
   In  addition  to  the local  treatment by
 lunar  caustic, which the  author has always
 found the most to be  depended upon, other
 applications are used, and  may be  used,
 when  the  other is  not procurable, or when
 the cases are so very mild  that it is  unne-
 cessary to  incur the  temporary  discolora-
 tion of the skin produced by the caustic ap-
 plication.
   Flour  [especially that  of rye]  is a  very
 common  and  often a good and comfortable
 local remedy in erysipelas;  hot fomenta-
 tions,  either of  simple water  or a decoction
 of poppy-heads, applied continuously for many
 hours,  by  means of flannel, give much relief
 in some  cases; or a lotion  composed of
 twenty grains of sugar of lead, a drachm of
 laudanum, and sixteen ounces of distilled or
 rain water,  may be used slightly warm, and
 applied by means of linen cloths, with much
 advantage.
   The  remedial  measures,  both local  and
 general, which have now been recommended,
 ought  nnd may, under intelligent  unprofes-
 sional  management, do much to  keep  this
 formidable disease in check  until  the medi-
 cal man, whose presence must be necessary,
 can  be got.   Moreover, there ought not to
 be much doubt as to the  nature of the dis-
 ease, if the distinctions pointed out in the
 first part  of this article  are  attended to;
 and further, many attacks of  erysipelas are
 secondary ones, as  persons who  have  once
 suffered are liable to do so again.
   Much confusion  of  ideas exists  on  the
 part of the public with regard to erysipelas,
 and many affections of the skin are imagined
 to be this disease, which do not in the least
 resemble it.  It should be remembered that
 it is an affection which  appears suddenly,
 tends to  spread, and  is  accompanied  with
fever;  that the affected skin is red, hot, ten-
der,  and often blistered.
  The  causes of erysipelas  are numerous:
cold  and atmospheric vicissitudes, and pecu-
liar conditions of the atmosphere, are all apt
to excite  an attack, and every thing which
tends to produce debility  predisposes to it.
 Wounds and sores  often  nppear to  be  the
first  originators  of the  malady, and, in  such
 cases,  contagion has  much  to do with its
diffusion through a hospital or a town ;  even
the most trifling scratch being sufficient to 
E RY
235
EXC
become the  attraction. '  For  this  reason,
erysipelas  is the most  formidable enemy
which can  gain a footing in a surgical hos-
pital ; and for the same  reason,  when the
disease occurs in  private houses,  caution
should be  observed that persons suffering
from  wounds do not come into  close contact
with the affected; and, indeed, in any case,
the same precautions should be adapted in
erysipelas  as in  contagious  diseases gene-
rally.  This  is doubly requisite in a house
in which a confinement is expected, or has
recently  taken place, for there is an un-
doubted close connection between erysipelas
and fatal childbed inflammation.   The head
and neck are the most frequent sites attacked
by this disease, but any other portion of the
body  may be  liable to it;  the throat not un-
commonly suffers, and is  a dangerous  com-
plication, best treated by the  free applica-
tion of the caustic solution  to the  tonsils,
&c.   It ought to be quickly attended to by
a medical man, for death sometimes occurs
most  unexpectedly from suffocation, in con-
sequence of  swelling.  Hot  bran-poultices
and mustard-plasters .externally would per-
haps  relieve the throat in some degree.
   When erysipelatous inflammation extends
to the tissue  beneath the skin, it constitutes
what medical men call "phlegmon;" puru-
lent matter forms,  and the parts  slough or
mortify.   In such cases  it is usual for the
surgeon to cut through the skin to give free
exit to the matter, &c.; and by the proceed-
ing much relief is afforded. This, of course,
unprofessional persons cannot do, and poul-
tices  and  fomentations  must  be  their re-
source, should it happen  (which is not per-
haps  likely)  that a case which  has reached
this stage has been unvisited  by  a medical
attendant.
   Refer to Silver, Nitrate of—Skin, Sec.
   ERYTHEMA—Is  a more superficial and
evanescent inflammation  of  the  skin  than
erysipelas.   The most familiar instance of
it  is  the  inflammation   produced  by the
chafing which occurs in  stout children, or
adults, between  the folds of the  skin,  and
which has a tendency  to spread  from its
point of origin.   The application of cloths
dipped in tepid water,  or in the  sugar of
lead and laudanum lotion recommended in
erysipelas,  will allay the burning sensation.
A few grains of gray powder should be given
at bedtime, followed by castor-oil or senna in
the morning,  and then quinine administered
in  doses  suited to the age of  the patient.
Rapidly spreading erythema,  even in an in-
fant, quickly yields to small doses of quinine.
  ESCHAR—Is the portion of " killed" ani-
mal tissue which separates from  the living
body after the application  of a  caustic 01
cauterant.
   ESCHAROTICS—Are substances  which
possess the power of destroying chemically
the living  animal tissues to which they are
applied.—Refer to Caustic, $c.
   ETHER.—See  ^Ethers.
   EUSTACHIAN  TUBE.—The canal which
connects the throat with the ear.—See Ear.
   EXANTHEMATA.—The eruptive  febrile
diseases, such as scarlet fever, measles, &c.
   EXCITEMENT—Excitants,   or  Stimu-
lants.—To excite, to stimulate,  is either to
originate  action where no action previously
existed, or to  give  increased   energy to
powers already  in active operation.   Ex-
citants  or stimulants, therefore, are  agents
which are capable of producing such  effects,
and excitement is the effect produced.   Ex-
citants  may be artificially divided into—
   I.  Ordinary  excitants, the  regular  un-
ceasing action of which is necessary  for the
preservation of sound  health both of mind
and body.
   II.  Extraordinary  or occasional excitants,
which produce a certain amount of temporary
exalted action of mind or of body, or of both.
   III. Superfluous excitants, which are gene-
rally  those comprised in the second division
abused.
   Under the head of ordinary excitants we
have  the following:—
        A.—Physical  Excitants.
  I. Heat.             IV. Atmospheric air.
 II. Light.             V. Aliment.
III. Electricity, Mag-  VI.  Muscular action
       netism.              —Exercise.
          B.—Mental Excitants.
I. Occupation of the  mind with some defi-
    nite object.
   Under the head of extraordinary excitants
we have—
         A.—Physical Excitants.
  I. Alcoholic  excitants.
 II. Excitant ingesta generally:  tea, coffee,
       spices, drugs, &c.
III. Atmospheric changes.
          B.—Mixed Excitants.
  I. Sexual stimuli.
 II. Extra exercises:  dancing and athletic
      sports.
III. Travelling, and exciting or novel  scenes.
           Mental Excitants.
   I. Hope, Joy, &c.
  II. Love, Anger, &c.
 III. Social intercourse.
 IV. Argument, Politics, &c.
  V. Music.
 VI. Eloquence, written or spoken, Exciting
       literature.
VII. Religion. 
                  £ X C

   For the more particular consideration of
 the above-cited  agencies, both as excitants
 and otherwise, the reader is  referred to the
 various articles in which  they are  treated
 of in this work.   From these it will  be seen
 tiiat certain ordinary  physical  stimuli, or
 excitants, are necessary for  the sustenance
 of human health and life,  and that  equally
 important for  the preservation  of  vigour,
 not only of mind, but of body, is the stimu-
 lus resulting from the ordinary but  regular
 action and  reaction of  the  mind of  man,
 originating  either in daily intercourse with
 his  fellows, or  in pursuits  which  con-
 tinuously engnge the mental  powers.  And
 further,  that the  mental and bodily  func-
 tions are at intervals  acted  upon by occa-
 sional  or extraordinary stimuli, which tem-
 porarily occasion their exalted and increased
 action, not  only without actual injury, but
 with  positive benefit.   And, lastly, that
 these  extraordinary stimuli  are not liable
 to lose their power of beneficial stimulation,
 unless exerted  in a  disorderly  and unre-
 strained manner.
  EXCORIATION.—See Abrasion.
  EXCRETION.—Any thing, either super-
 fluous  or noxious, separated and  thrown
 out from the living body.  Excretions may
 consist of noxious and superfluous  matters
 which  have been introduced into the cir-
 culation by the stomach—in the food—or
 through the lungs, or skin ; but the  bulk of
 the excretions  consist of "effete" matters,
 that is, of substances which,  having fulfilled
 their part in the animal economy, could not
 be retained  in  it without danger  to health
 or life, and  are  therefore cast out by some
 of the outlets specially  provided for the
 purpose.  The urine  is perhaps the best
 specimen  of an  excretion, and consists of
 water  holding in  solution  mineral salts,
 and  the  used-up elementary substances in
 various combinations.   One  of these  com-
 pounds—the urea—is a narcotic poison, and
 if, from  disease of  the kidneys, or other
 cause,  it is retained in the blood, it acts as
 such, and kills.   The  chief constituents of
 excrement from the bowels are matters ex-
 creted  by the large bowel, which  cannot be
 retained in  the body without danger.  The
 kidneys, the bowels, including the liver, the
 skin, the lungs, are the excretory outlets of
 the body;  and what has been said of the
nature of excretions generally must  render
 evident the paramount importance of keep-
ing these outlets in free operation.
  Refer to Alimentary Canal—Bile—Blood—
Lungs—Skin—Urine, Sfc.
   EXERCISE — Spontaneous  Muscular
 Movement.—The stimulus imparted to the
!ti                E X E

 system generally, and to every one of the
 vital processes  particularly,  by the exci-
 tant power  of muscular movement which
 every healthy man is compelled or ought
 to undergo, is a fact  generally recognised;
 it is one  of those ordinary excitements the
 agency of which is linked with  our happi-
 ness and  health, and, it may almost be saH,
 with our existence.  A man engaged  in
 active bodily exercise is undergoing a re-
 gular course  of excitement; his will  is
 stimulating  the nervous system to rouse
 the  muscles to action, and in this  process
 both the rouser and  the roused  are using
 up their own  substance;  the acting  muscles
 are  sending the blood more quickly  through
 the  capillaries and large vessels, and the
 heart must   move more actively to keep
 pace with them,  and transmit the  quickly
 returned  blood, loaded with effete matter, to
 be purified in the lungs.  To preserve the
 balance the  respirations  are increased, and
 the   stomach  is  stimulated   to  crave for
 nourishing food and  unstimulating drink,
 fitted to  keep  in  repair the  ever-wearing
 structures of man's body, and  to supply
 the  fluid  waste.   Baron Liebig  has  done
 much to  give us clear views respecting the
 changes which take place within the body
 under the influence of muscular movements;
 and  from him we learn that, in  the ex-
 penditure of this  force, the  substance of
 the  muscles is used—burnt up by the oxy-
 gen  of the arterial  blood,  and  that  this
 burning up is requisite that the force may
 be produced.
   Exercise, therefore, is  in the  first place
 requisite  as  an  ordinary  excitant, to  be
 brought  into  daily  operation,  that  the
 vigour  of all the functions  of  the body,
 whether of digestion or of secretion or ex-
 cretion, may be preserved.   It is the mer-
 ciful provision by which the  decree, that
 man should  earn his  bread  by the  "sweat
 of his  brow," has  been converted into  a
 blessing.   It is the great compensating ba-
 lance which  gives  the labourer sound sleep
 and  healthy appetite and vigour, instead of
 the wealth which  too often seduces to indo-
 lence and palls every enjoyment of life.
   Exercise, again, is requisite as an agent
 with reference to the food consumed. Food
 is taken  to supply the waste  of the body,
 which must go on more  or less as  long as
 man lives—more if actual exercise is taken,
 and  vice versa.   Man ought  not, therefore,
 to expect, if neglecting muscular exercise,
 that is to use up the substance of his body
 in exertion, to have the  same appetite for
 and  enjoyment of food  as if he did; but
 man does  expect this in many  instance*.
!•. 
                 EXH

he indulges in indolence, and  then  excites
the appetite and stomach, by artificial means
and  tempting  food,  to  take  nourishment
which is not required, and which must, con-
sequently, produce disorder somewhere.  If
an individual's employments are of a kind
which do not require muscular  exertion, his
food should be diminished, either as regards
quality or quantity, in due proportion.  But
even under this regulation none can be well
or vigorous who do  not  take some amount
of exercise in the open air daily.
  AVith  regard to extra  exercises, such  as
dancing, and athletic sports generally, which
are only engaged in  at intervals, it  is cer-
tain  that their  beneficial  effect upon  the
functions and health depends quite as much
upon the excitement of  the  mind as upon
that of  the body ; and every one's experi-
ence must tell him  how  much his favourite
exercise  owes its renovating influence to the
mental stimulation which accompanies it.
  Refer to Blood—Excitement—Food,  Sfc.
  EXHALATION—Applied  to  the   body,
means  an excretion  in  a state of vapour,
such as  that from the lungs.
  EXHAUSTION—Is the diminished or al-
most extinguished power, either of the body
generally or of one or more  of its organs,
to continue its natural  active operations
until it has been recruited by a period  of
repose.   Exhaustion  may  arise  from two
principal causes—failure of  the nervous
power,'  and  deficiency of organized mate-
rials fitted to support the  requirements of
the living body.
  If every thought, every exertion  of  the
will  upon the  body, occasions  the  con-
sumption of nervous matter, exhaustion of
nervous  power must in all  probability be
due  to   using  up  of nervous substance.
Sooner or later, according to circumstances,
every exertion  must  come to  an  end, and
repose  must be taken, that  the exhausted
brain and nerves may be recruited;  and, if
man acts  wisely, he will if possible stop
exertion either of  mind or body  at  the
first point of  exhaustion.  It  is true that
powerful exercise of the will can  and does
compel exertion beyond  the point at which
nature says "stop;" but the  effort is not
made with impunity, and the after exhaus-
tion  is  proportionally increased.  No per-
manent  injury probably arises from those
occasional exhaustions,  either  mental  or
physical, which all  have at times  to un-
dergo; but  no man  can habitually go  on
exhausting his nervous  power, whether in
the direct service of the mind, in the la-
bours of the body, or in  the less excusable
requirements of vicious excess,  without suf-
J7                EXP

 fering eventually.  The early paralysis and
 softened brain of the mental, the  prema-
 ture old age of  the physical labourer, the
 wretched decrepitude of  the  debauchee,
 are  all  the  results of continued  nervous
 exhaustion.  It is not, however, simply the
 brain and nervous system which suffer, but
 the other organs of the body, particularly
 those of nutrition, suffer also, if the supply
 of nervous power which  ought to  sustain
 their healthy action is withdrawn to sup-
 port the exhausting efforts either  of mind
 or muscle.  Those, therefore, who can, will
 do wisely to avoid the cause of these evils;
 but all cannot do this: in many situations
 of life, continued exertions, which carry the
 individual to the  extreme of exhaustion, be-
 come  absolutely necessary.   It becomes  a
 question, therefore, how the evil effects of
 the necessity may be most efficiently coun-
 teracted.   This must be done by the proper
 management of the nourishment.   The sto-
 mach in such cases is  not receiving its full
 supply of nervous stimulation, and,  there-
 fore,  its work  must be  made as  light as
 possible,  consistent with  conveying  good
 nourishment  into the system.   Small quan-
 tities of food should be taken at once, and
 more frequently  repeated, rather than any
 thing like a  meal made.   In the  majority
 of instances, the most efficient nourishment
 will  be strong, concentrated  animal soup,
 either alone or  mixed with some farinaceous
 material; and n*ext in utility will be coffee or
 cocoa, along with bread  or  biscuit, or with
 the yelk of egg  beaten with them. Of course,
 if these are unattainable,  the next best
 substitute must be used;  but the  principle
 must be to keep the system, supported  by
 means of repeated small quantities of food,
 of as nourishing a quality and in as digestible
 a form  as may  be;  the use of  alcoholic
 stimulants being  avoided as long  as pos-
 sible.  At length, if the exhausting agencies
 are still in operation, a time comes when
 the stimulation of alcohol is eminently ser-
 viceable,  by  virtue of its peculiar  action
 upon the  nervous system,  when  it does
 that  to  support the bodily powers which
 nothing else can; and  then  the draught of
 porter, or the  dose  of wine,  or of  diluted
 spirit, does come like an elixir of life to
 "him who is ready to perish."
   Refer to Alcohol—Blood—Brain—Food, §c.
   EXFOLIATION—Is  the separation of a
 scale of dead  bone  from the living.   The
 term  is applied either to the  process itself
 or to the separated portion of the bone.
  EXPECTORANTS—Are  a  class  of , me-
 dicines whic'h  assist  the  separation  and
 expulsion of mucus from the air-tubes or
2: 
EXP
238
E Y E
bronchi  of the lungs.  Very many
stances are employed with  this view;
most useful are—
  Acids, which astringe and stimulate.
  Ammonia, which stimulates.
  Ammoniac [Gum], which stimulates.
  Antimonials, which relax.
  Ipecacuanha, which relaxes.
  Squill, which stimulates.
  Stramonium, or Thorn Apple.
  Tolu, which stimulates.
  Tobacco.
  Vapour,  either simple or medicated.
  In  whatever way  these medicinal  sub-
stances exert  their action upon  the  body,
the most important  practical point is the
division into relaxing and stimulant.   In
the first stages of affection of the bronchi
with cough, when  there  is fever (and pro-
bably  inflammation) present,  the relaxing
expectorants only should  be  used, either
antimony or ipecacuanha; the former may
be given with  solution  of  acetate of am-
monia, the  latter with carbonate of potassa.
AVhen there is  much debility, ammonia com-
bined with  camphor  is generally  employed,
and  probably  squill  added.   In  chronic
cough, with difficult expectoration, the same
combination may be used; and when there
is  a relaxed state of the system, with co-
pious  expectoration  and tendency to per-
spiration,  the  acids,  either  vegetable  or
mineral, alone or combined with  squill, are
most serviceable.
  The combination of opium or some other
anodyne with  expectorants is both a com-
mon and a useful practice;  it  allays the
irritability of  the bronchial membrane and
the frequency of the cough, and probably
also relaxes spasm.  Opium, however, tends
to stop expectoration, and on this account
ought  in almost every case—in which it is
given to allay cough—to be combined with
some counteracting expectorant.  More mis-
chief is, perhaps,  done  with squill  than
with any other of this class  of  remedies:
its  syrup  is much given domestically, and
generally too early, whereby both irritation
and cough are increased.  Tolu  syrup is a
good  and  pleasant addition to cough  mix-
tures.   Many  expectorants act also as eme-
tics, and in so doing, especially in children,
frequently  assist most  efficaciously their
expectorant action.  Tobacco or thorn-apple
smoked, or watery vapour inhaled, act di-
rectly upon the air-tu'oes.
  Refer to articles on various expectorant
medicines,  to Catarrh—Cough, §c.
  EXPECTORATION—Is the  term applied
either to  the  act  of coughing'up matters
from the lungs, or to the matters so coughed
I up, [but the latter are more correctly desig-
 nated as the "sputa."]  These vary grcntly
 in  consistence nnd appearance, and, conse-
 quently, are valuable guides in the investi-
 gation of disease affecting the chest; indeed,
 until the physical  examination of the chest
 by the ear was introduced  into practice, the
 expectorated matters were the most distinc-
 tive  evidences  attainable.   Expectoration
 may  be  thin  and frothy, as it is when the
 lining membrane of the air tubes is suffer-
 ing front irritation or inflammation, or thick
 and almost solid, as it becomes in the Inst
 stages of a cold.  It may be ropy, as it often
 is  in  old people, or viscid, in inflammation
 of the substances of  the lungs,  when it
 generally becomes of a dull  reddish-brown
 or rust colour; it may consist more or less
 of purulent matter, or be tuberculous and
 semi-solid,  as in  pulmonary consumption;
 it  may be  mixed more  or less with blood,
 or pure blood  may  be  expectorated, or it
 may  be what is called the prune-juice ex-
 pectoration from its colour,  as happens in
 mortification of the  lungs.   Generally, ex-
 pectoration is inodorous, but sometimes it is
 abominably fetid,  the odour being mostly,
 but not  invariably, indicative of mortifica-
 tion  of the lung itself: other matters,  such
 as bile, &c. are occasionally coughed up [or
 follow coughing].
    EXPIRATION—Is the act of expelling air
 from the chest after  it has been inspired.
    EXTRACTS—Are medicinal preparations
 made by separating the active portions of
 various drugs from the inert ones, this being
 effected by dissolving out  the former, either
 by water, alcohol, or aether, and evaporating
 the superfluous fluid, until a tolerably firm
 consistent mass of extract is left.  Formerly,
 heat was  used in the  evaporation ;  but as
 this  destroys in some  measure the activity
 of the preparation,  the best extracts  are
 now  all prepared without any heat what-
 ever, and these-should always be purchased
 in preference.   The extracts of  aloes, of
 colocynth,  of hemlock, of henbane, of gen-
 tian  maybe used by unprofessional persons.
 There are many others, but they are either
 dangerous, or the medicine is better used in
 other forms.
    EYE. — The organ of vision, not only in
 man, but in the lower animals, is an instru-
 ment so wonderful, so replete with beautiful
 structures  and  admirable  contrivances, that
 it  is always  alluded to as one of the most,
 if  not the most  splendid instance of the
 power and beneficence of  Ood, as displayed
 in his physical creation.   Its importance to
 man as an organ  of sense ought to render
I the study  of its' construction and aduptu- 
EYE                239                EYE
tions one of intense interest, and must ever
render its  perfection  and preservation an
object of the greatest solicitude.  The space
which can be spared in a work like the pre-
sent is too limited to do justice to the subject.
  The whole apparatus of vision  naturally
divides itself into two sections—the globe of
the eye and the appendages of the  globe.
The conical-shaped sockets, or orbits, in
which the  eye-globes  are  suspended, have
projecting edges, especially superiorly, which
protect the organ from injury.  The pent-
house of the eye-brow slightly shades from
the light and intercepts perspiration, which
might trickle down and irritate.  The fringed
curtains of the  lids are ever ready to close
over and instinctively protect their charge,
and on their internal surface  secrete a lu-
bricating mucus.   On their edges a series
of  minute   glands (fig. lxv. 2) open, which
secrete an unctuous  matter.   In the upper
and outer angle of the socket lies the lachry-
mal  gland, which furnishes  the tears, and
is always pouring out a watery fluid, which
is  continually passing  over  and cleansing
the exposed surface of the eye, being taken
up  at its inner angle at the points  (3) and
conveyed through the  lachrymal duct (1)
into the nose, which it also  supplies with
moisture. Through this duct, also, the mem-
brane (the conjunctiva) which lines the nose
is continuous with that which covers the fore-
part of the eye-globe and lines the lids.
  In the socket, the eye-globe lies embedded
in fat, but is also, as it were, slung in a kind
of membrane.   It is, further, both fixed and
moved by means of its six muscles, (fig. lxvi.
1, 1,) four of which pass forward from the
                 Fig. lxvi.
back or apex of the  conical cavity to be at-
tached to the globe. The optic nerve, fig. lxvi.
(2,) and other nerves and blood-vessels, are
also contained within the socket, the whole
being arranged so as to afford the most facile
but at the same time steady movement.
  The globe  of the  eye itself'is barely an
inch in diameter, and measures longest from
before backward.  Its outer coat, called the
sclerotic, (fig. lxvii.  1,)  is very firm, and is
composed of  interlaced  fibres.  Anteriorly,
                 Fi>'. lxvii.
a portion of it is, as it were, cut out to per-
mit the  insertion  of the cornea, (figs. lxvi.
3, and lxvii. 3,) or glass of the eye;  poste-
riorly it  gives  passage to  the optic  nerve,
(figs. lxvi. 2, and lxvii. 6.)  Within the outer
coat is the choroid coat, (4,) of a dark cho-
colate colour, and within that  the retina, or
nervous  coat, (5,)  which forms the sensitive
field of vision.  The mass of the  globe is
filled with  a remarkably transparent semi-
fluid substance, the vitreous humour, in the
forepart  of which the crystal  lens (7) is
imbedded.  In  front of this, and partly sur-
rounding it, is the iris,  (figs, lxvii. 8, and lxv.
8,) the circular aperture in  which (fig. lxv. 9)
constitutes the pupil.   In front of the lens,
between  it and the cornea, is the chamber
of the aqueous  humour, (10,) so called from
the watery fluid with which it is filled.  It
will be  remembered  that  the entire fore-
part of the globe, or white of the eye, and
the clear cornea are covered  with the con-
junctiva, as already mentioned.
  To give  the  sense of vision, the rays of
light from surrounding objects penetrate the
eye, first by the cornea, (3,)  pass through
the aqueous humour,  the  lens, and the vi-
treous humour, £10, 7,  11,) and, in doing so, 
EYE               240               EYE
undergo a series of refractions, which bring
them  at  last into focus  in the retina, (5,)
where the picture of external  objects is
formed, and  where the  impression is con-
veyed to  the  brain by the optic nerve, (6.)
The object of the black or chloroid coat (4)
being to absofb the superfluous rays of light,
which  would otherwise be reflected within
the eye and confuse vision.
  This  rapid  and  necessarily  imperfect
sketch of the construction and functions of
the organ of vision will, it is  trusted,  assist
the unprofessional reader in gaining some
rational idea of the dangers and diseases to
which so important a portion of his  frame
is  liable.  The membrane, or  conjunctiva,
which  covers the inside of the  lids and
white of  the  eye  is, from its  exposed  situa-
tion, liable to become inflamed from various
causes.  Minute  particles of dust or other
substances getting into the eye, and becom-
ing fixed in the lining  of the upper eyelid,
between  it and the globe, cause an amount
of pain and  irritation  which  could scarcely
be credited from their size, but which is well
accounted for by  the accurate apposition of
the two surfaces between which they lie.  A
particle so situated may be discovered without
much difficulty by a second  party examin-
ing the sufferer with the  head thrown back,
while he  slightly everts  the  upper lid with
the thumb and finger.    The  slightest speck
of foreign matter must be removed, and no
better instrument can  be employed for the
purposethan [acamel'shairpencil] orapiece
of not over-stiff writing-paper twisted like a
match.   Those who work in metals are apt to
get minute scales  imbedded in the forepart of
the ball; they cause much irritation, and are
often so extremely difficult to remove  that a
surgeon's assistance is required.  The effect
of these mechanical irritations is to cause in-
flammation of the conjunctiva. (See descrip-
tion.)  This, however, may often arise, and
frequently does from cold, from disorder of
the digestive organs, &c.  The first  symp-
tom  of inflammation is  a sensation as  if a
particle of some kind had lodged  in the eye,
and  if an examination  be made there will be
seen, not only  an enlargement of any small
blood-vessels that may be generally visible
on the white of the eye,  but  a new develop-
ment  of others,  the  appearance varying
from  the  slightest  apparent increase of
vascularity,  to the most intensely red  in-
flammation.   At the the same time there is
considerable increase  in the  mucous  secre-
tion—not in the  tears, as is  often supposed
 —and in bad cases this becomes purulent or
mixed with  matter.   There  is,  sometimes,
considerable swelling of  the surface, usually
distinguished as the white of the eye.   The
above  is the most superficial form  of in-
flammation to which the eye is  subject; if
neglected,  it may  extend  itself  over the
cornea  and produce  permanent blindness.
It is distinguishable from the  next form, or
inflammation of the  sclerotic coat, by the
size  and winding character  of the  small
blood-vessels,  and by their being slightly
movable along with the conjunctiva itself
when the lids are drawn down.  It  is im-
portant  that  these  distinctive  characters
should be attended to  in  the  first  place,
that no  error may be  committed between
this  form  nnd a  more  serious and  deep-
seated  inflammation  of the eye,  but  also
that proper  treatment  may  be  used.  A
great error is  committed  in  treating  this
form of inflammation  by means of warm fo-
mentations, &c. applications tending rather
to keep up than to cure the disease,  which
is generally quickly removed by astringents.
A drop of laudanum or of Battley's solution
in the  eye. repeated two or three times, will
often cure  the disorder; or a lotion of sul-
phate of zinc, from one to  three  grains to
the ounce of water, will be found efficient;
but the best of all is  the solution of nitrate
of silver, or  lunar caustic, of the strength
of four  grains  to the  ounce  of distilled
water, as recommended by Dr.  Mackenzie.
Of  this, a  single  drop  may be introduced
into the inflamed eye  twice or three times in
the twenty-four hours.   The eye,  of course,
should be exercised ns little as possible, nnd
if the  bowels are confined  or the stomach
disordered, a few doses of the blue pill and
colocynth will be found useful.   If the dis-
ease is obstinate, a blister to the back of the
neck may be applied with advantage.
  The disease which  has just been treated
of,  is  a comparatively  mild  disorder, but
tinder  certain  circumstances  it  becomes
much  more virulent.   The  secretion of
matter is very great, and acquires the power
of  propagating the  disease  by  contagion
from one  person to another.   The well-
known Egyptian ophthalmia is of this nature,
and is carried from individual to individual
by  the flies, which, according to travellers,
seem  to have  acquired an instinctive ten-
dency to fly toward the eyes in that country-
Newly-born  and  young infants frequently
suffer from a severe  form of  this ophthal-
mia, which often shows itself within three
days after birth.  The inflammation  is in-
tense,  and the  matter often  accumulates
largely between  the  lids, gushing out when
they are separated.  In scrofulous children
especially the  affection is  often  obstinate.
 The nitrate of silver in solution  is the best
L 
EYE               241                F A 1
 application, and small  doses of quinine the
 best internal  remedy.   Syringing between
 the lids with a solution of alum, four grains
 to the ounce of water, six or eight times a
 day, is also recommended.   A little lard
 should  be  used on  the  edges to  prevent
 them sticking  together.
   In inflammation of the sclerotic or outer
 coat of  the ball itself, there is  more actual
 pain, it is more deeply seated,  the  redness
 seen on the white of the eye is more of a
 pink  hue  than  in  the  conjunctival  affec-
 tion, the. vessels appear  much  smaller and
 straighter, radiate as it were from the cor-
 nea, and are not movable;  the affection is,
 moreover,  generally a more  serious one
 than the other.   The more interior struc-
 tures of the eye may also become inflamed,
 and especially the iris.   In  all these cases
 of deep inflammation of  the eye the consti-
 tution  is much affected,  there is shivering,
 followed by thirst, fever, &c. ;  the  pain  in
 the organ  itself is  often most severe, and
 extends  to  the forehead;  light cannot  be
 borne.   If the iris  is  the part affected,  its
 colour  is changed and often becomes of a
 dirty brick red ; the pupil at the same time
 is irregular.
   In these,  and  indeed in all affections  of
 so precious  an organ as  the eye, whenever
 proper medical treatment is attainable, it
 should be taken advantage of;  if not, sup-
 posing symptoms such as those enumerated
 show themselves, some active treatment is
 requisite; leeches should be  freely applied
. to the temples, or behind the ears, or cup-
 ping on the back of the  neck resorted  to;
 the bowels  must be freely purged with  ca-
 lomel  and  colocynth, &c. in the  first  in-
 stance, and then calomel in two-grain doses,
 or some other  mercurial,  given  at intervals
 of six or eight  hours.   The diet  must  be
 reduced as low as possible, all stimulants
 avoided, every attempt at exertion even  of
 the unaffected  eye forbidden, and the person
 confined to  a darkened  room, the only local
 application being continued hot  fomentation
 to the eye and a blister between the shoul-
 ders.  By a continuation of the above treat-
 ment, even  till the gums  get  sore with the
 mercury, much  may be  done, supposing
 circumstances are such  that a medical man
 cannot be procured.   If the iris is thought
 to be affected, some preparation of bella-
donna (or, in its absence, of henbane) should
be employed to  keep up dilatation of the
pupil.   For this purpose  ten  grains of the
extract should be rubbed up with half an
ounce of water, and a few drops introduced
into the eye.   For information respecting
Uie more chronic affections of the eye, the
      V                                  l,
 reader is referred to the articles Amaurosis,
 Cataract, &c.  In some eye affections the lids
 are apt to become glued together during sleep
 by the secretion.  This is best prevented by
 smearing the edges with some simple oil or
 ointment.  The  edges of the lids,  likewise,
 are apt to become affected with a succession
 of small  pustules, or abscesses, which often
 continue to form in spite of treatment, de-
 pending  probably on  some disorder of the
 digestive organs, which should be  attended
 to.   Local  treatment seems to do but little
 for their amendment.
   The lachrymal sac, or some of its ducts
 (fig.  lxv. 2) are apt to become the seat of in-
 flammation and to be blocked  up in conse-
 quence ,  the  tears, not escaping  by their
 natural outlet, run over the cheek, causing
 painful  excoriation, and the corresponding
 nostril is dry.   The  disorder is  not only
 troublesome to bear,  but often  to  manage,
 and should be  seen by a surgeon.
   A stye in the eye,  or rather  eyelid, is a
 small abscess, and often gives great pain.
 It is  best treated by fomentations.
   Blows  on the eye frequently give rise to
 effusion  of blood beneath  the  conjunctiva,
 which occasions the  white of the eye to
 become of a deep, almost black, red colour,
 and to present a very alarming appearance.
 The state of matters  may be distinguished
 from inflammation by the uniformity of the
 redness, and by the absence of those charac-
 teristic symptoms enumerated  above.  The
 eyes  frequently assume an " injected" or
 bloodshot appearance in affections of  the
 brain.
   Disordered  vision may be the result of
 causes, such as  cataract, &c. which inter-
 fere  with the  transmission of the rays of
 light; it may also arise from disorder of the
 digestive organs, and not unfrequently from
 incipient disease of  the brain.   Persons
 who  become  suddenly and unaccountably
 affected with disordered vision, should ma-
 nage themselves as directed in article Amau-
 rosis, and get medical  advice as speedily as
 possible.
   Refer to Amaurosis—Cataract, $c.
   FACE.—See Countenance, Complexion,
 &c.
   FACE-ACHE.—See Neuralgia.
   FiECES.—The excrement from the bowels.
   Refer to Alimentary Canal—Digestion, $c.
   FAHRENHEIT.—The German inventor of
 the thermometer which bears his name.—
 See Thermometer.
   FAINTING,   or Syncope—Is  a state of
partial, or of total unconsciousness, in con-
sequence of diminished  circulation  of blood
through the brain, the result of depression 
F A I
24
F  A II
of the heart's  action.  Some persons  are
much  more  liable to  become faint than
others, and there is often a good deal of pe-
culiarity with respect to the  acting cause.
Certain objects of sight will cause some
persons to become faint immediately.  The
most  general, probably, being accidents, or
their consequences, which injure the human
body, and cause  effusion of blood; certain
smells affect others,  and cause  immediate
faintness;  even  the  smell  of a  rose  has
been known  to have this effect.   Affections
of the mind,  and sudden emotions, debility,
habitual or  temporary, weakness  of  the
heart itself,  loss of blood, or, in fact, what-
ever  depresses  the acting  power of  the
central  organ of  circulation  is apt to pro-
duce faintness.
  A person  about to faint becomes affected
with ringing  in the ears, the  sight fails, the
ideas  are confused, and the mind incapa-
ble of exertion,  the  countenance becomes
deadly pale,  cold sweat breaks out over the
forehead, the power over the limbs either
becomes very unsteady or fails altogether,
and if  actual fainting happens,  the indi-
vidual sinks down, and is really in  a condi-
tion whicli much resembles death, and might
pass into death.
  As said above, the direct cause of fainting
is  diminished circulation of blood  through
the brain.  It must be obvious, that in  the
endeavours  to restore a person who  has
fainted, this  condition must  be altered as
quickly as possible ; and for  this purpose,
the  individual  should  be  laid   quite   flat
down, the head on  a  level  with  the body,
so that the  feebly-acting  heart may  not
have to propel  the blood upward, but hori-
zontally.  The neck  and chest should  be
exposed, fresh  air admitted freely, a little
water sprinkled on  the face,  and stimulant
vapours, such  as  ammonia,  held  to  the
nostrils at intervals.  Sal-volatile, or a little
spirit, or wine  and water, may be given at
the same time.
  It  must be remembered that the  first pe-
riod  of some  apoplectic or paralytic seiz-
ures is one  of faintness ;  and  also,  that
where  the  affection is the consequence of
loss of blood, its continuance to some ex-
tent  may be the safety of the patient.   In
either case the use of stimulants  must be a
very cautious one.
  Refer to Apoplexy—Hemorrhage, See.
  FAITH — In medicine  is  one of  those
strong emotions  of the mind, which, like
hope and despondency, exerts much influ-
ence upon the progress of a case of illness,
whether it attaches itself to the  medical
attendant, or to  the  system  of  treatment
pursued  by him.   The history of popular
delusions connected with the treatment of
diseases  is rich in illustration of how far
simple faith  in  some method of treatment
which has acquired reputation will  add to
the  apparent  curative  powers  of  that
method,  in  consequence  of results which
are due to that tendency to cure—vis medi-
catrix naturae.—which has no more  powerful
assistant than the hopeful and trusting, even
if  mistaken,  mind.   It  sometimes becomes
a nice question in  medical ethics how far
medical  men  are justified  in  using this
agent in the  treatment of their  patients.
With the intelligent and  unprejudiced, a
true faith in  curative means, grounded in
clear understanding of the nature of their
case, and the requisite treatment, is always
to be preferred to a blind and  unreasoning
trust, however implicitly  given; but amid
the ignorant,  if they will employ a foment-
ation . more  assiduously because  it has a
few  chamomile  flowers in  it, or such-like;
and  if it will insure their greater faith in
the treatment generally, it is a concession
to prejudice at least,  which ought to be
made.   Many persons  err  in  placing  too
great reliance—faith—in  mere medicines
and  drugging alone, to the neglect of the
equally important general aids in the treat-
ment of disease, so  often alluded to  in this
work.  Such persons are not content, and do
not think themselves properly ("actively")
treated, if they are not  constantly swallow-
ing physic.
  Refer to Advice, Medical,  §c.
  FALLING   SICKNESS,  or  Epilepsy.-
See Epilepsy.
  FAMINE.—See Starvation.
  FARCY.—See Glanders.
   FARINA—Derived  from  " Far,"  corn—
means literally  the meal  or  flour formed
from  grain,  when  ground, and  consists,
therefore, of starch, gluten, &c.   [Farina
forms an excellent article for the diet of
invalids.—See Diet.]   The  word, however,
is  sometimes  applied  to  the farinaceous^
matter contained in  other vegetable  pro-
ducts, such as the potato,  when it  consists
almost entirely of starch or fecula;  also in
beans, peas, &c.  The farinaceous matters,
or particles, are contained in a network of
cells.—See Fecula.
   FARINACEA.—Articles of food generally
which contain farina.
   FARINACEOUS  FOOD—Is an  article
of diet prepared from  one or other of the
grains, professedly, in such a manner  as to
make it easy of digestion.   The varieties of
the preparation are very  numerous;  most
of them  consist of wheat flour baked, with 
FAS
243
FAS
 or without the addition of sugar;  others
 contain rice-flour, potato flour, &c.   Semo-
 lina and semola belong to the  class of fari-
 naceous foods, and contain  more  of the
 gluten of the grain.  In consequence of the
 greater or less removal'of the  starchy com-
 ponents, they are more powerfully nutritious
 than those articles which have the full pro-
 portion of starch.   Unquestionably, baking
 the flour must make  it a more wholesome
 article of diet for the infant;  but there  is
 no reason why persons should not do this
 for themselves, and thus avoid  the chance  of
 getting an article mixed with other things.
 Moreover, the sugar  is not in all cases a
 desirable addition.
   Refer to Food—Gluten—Grains, §c.
   FASTING.—The  remaining without food
 for a longer  period than  usual, may some-
 times be a useful  proceeding,  as a kind  of
 negative remedy,  for those who have been
 living too  freely;  but even then abstemi-
 ousness, that is, the partaking of a reduced
 quantity of very plain food, is better than
 complete denial of aliment.   Fasting, as a
 term, is more properly applicable to  a con-
 dition in which the desire for food exists.
 When the  appetite fails, as it does  in dis-
 ease—and its failure is a natural indication
 that  the system is not in  a fit condition  to
 receive nourishment—it can scarce be said
 that a person  fasts.  The power of fasting
 depends greatly upon  habit,  constitution,
 climate, and other contingent circumstances.
 It has been, and still is, the custom of many
 nations to  take but one meal in the twenty-
 four  hours, but if into  that meal must be
 crowded the entire  nutriment required for
 the body during that space of time, it is need-
 less to remark that for some time after, the
 individual  can be fit for little beyond digest-
 ing his food,  and that  such  a division of
 duties would  but  ill suit the arrangements
 of civilized life, even if it could be followed
 without  serious detriment to health.   As a
 general rule, it may be said that it requires
 more than an average of constitutional
 vigour  to  enable  an  individual  in  this
 country  and  climate to do with but  two
 meals a day, that is, to fast twelve hours at
 a time.
  The consequence  of too long fasting  is
 physical exhaustion of  the  body generally,
 in which the  stomach is involved;  conse-
 quently,  when a  person has  gone  longer
 than usual without food, especially if under-
 going fatigue  at the same time,  although
 at the conclusion  the  system  at large re-
quires nourishment, the stomach is so  weak-
ened that it cannot digest a full meal.  The
inability to fast with impunity is increased
the more rapid the changes going on in the
system;  thus,  children  and young people
tolerate  fasting worse than others ; and for
the  same reason  physical exercise or fa-
tigue,  which quickens all the usual func-
tions within the body, also renders undue
fasting less easily borne, and  more  inju-
rious.   External circumstances, again^ such
as shelter, clothing, climate, all  exert much
influence as regards  the toleration of fast-
ing.  It  has been shown in more  than one
article in this work, that a certain propor-
tion of the  nutriment taken is required as
fuel, that is, as a physical agent, to assist in
sustaining the  bodily  temperature;  and it
is evident that  the less abstraction there is
in animal  heat—in other words, the better
either man or  animals are protected  from
the  cold—the  less occasion have they for
food within a certain limit; and as a neces-
sary  inference, fasting  may  be  practised
with less  injury in a  warm than  in a cold
climate,  and such is  found to be the case
among  civilized people.   Barbarians,  or
uncivilized tribes,  such as the Esquimaux,
who feed to a  repletion which would  kill
other persons—and thus lay in a store of
nutriment—are of course exceptional.  Per-
haps the  best  instances of the power—not
exactly of fasting, but of extreme abstinence,
is in the runners  of  Northern Africa, who
are said  to travel immense distances and at
a very rapid rate,  with only the  sustenance
of a limited portion  of gum  during  the
journey.  The  Arab horses, too, have often
excited the wonder of travellers from their
powers of endurance on  extremely small
supplies  of nourishment,  when compared,
at least,  with what is required by  the same
animal in  this  country.   Hereditary con-
stitution and habit, however, undoubtedly
assist the influence of climate.
  As a general  rule,  it may be  taken that
entire  abstinence from food by persons in
health in this country for more than six or
eight hours, must,  if habitual, be injurious,.
and  the more  so  the younger and more
delicate the constitution.  Very many cases
of stomach disease date from the practice.
  The marvellous  cases  of  long fasting
which have from time to time been brought
before the public have turned  out  on strict
investigation, to be impositions,  although
they have  served  to  exemplify  the power
of sustaining life on extremely small quan-
tities of nutriment.  The power of fasting,
without  injury, seems to be considerably
increased in cases of insanity ;  and if it is so
in one  form of  nervous excitement, it may
be so in other excited conditions of mind.
  The  subject of fasting has  been trerted 
F A T
24 t
F  A T
in this article in an every-day life point of
view, as  it  applies  to  society  generally,
more especially at  the  present day in  this
country,  and  without  any  reference to
Bcriptural  history,  or to those miraculous
powers  which are  recorded,  either in the
case of our Lord himself, or of  holy  men
of old,  when for his good  purposes they
were imparted.  The remarks  are  made to
impress  the  fact that  absolute  fasting is
injurious to the  majority—the more so if
habitual—and may  lay  the  foundation of
disease.  [Delicate  persons should therefore
never fast,  even  as  a religious observance,
without consulting a medical man.]
  Refer to Animal Heat—Blood—Digestion—
Food, §c.
  FAT—Is a compound of three principles,
stearine, margarine,  and oleine,  which at
the temperature of  the  living animal  body
are fluid;  but when, as after death,  the
temperature  falls, the two  former become
solid.  The fluid  fat is contained in simple
cells of  a spherical  form, which prevent its
being diffused,  or falling to the  most de-
pendent  portions of  the body.  The uses
of fat are, evidently, partly  to form  a  soft
pad or cushion for various parts ;  but there
can  be  no  question that it also constitutes
a store of fuel, or combustible material, for
aiding the  purposes of animal heat.  This
is palpable in the case of hybernating  ani-
mals, which   are usually very fat before
taking to their winter sleep, but the reverse
on waking from  it.   A  certain amount of
fat,  as a constituent element of the body,
is  requisite for health,  and desirable for
appearance;  but its accumulation may be-
come so great as to amount to disease,  and
may become  an impediment  to  the  per-
formance of the duties of life, as well as
a cause  of its  shortened duration.    The
following remarks from  the  high  authority
of Dr. Chambers ought to  be universally
diffused.  After adverting to a species of
"monstrous"  obesity,  or  fatness,  which
dates from birth,  and  is generally asso-
ciated  with   intellectual  deficiency,   and
fortunately proves fatal  before the age of
puberty, he   remarks—" AVhen   the  dis-
ease"—that is obesity—"begins  in  child-
hood, or  about the  time of puberty, we
must not be  deterred by the circumstance
of its being hereditary from attempting to
remedy the inconvenience arising  from it.
We cannot truly reduce our patients en-
tirely to the average  size and  weight;  but
we may enable them to pass  life with com-
fort  and usefulness.  The later the disease
commences, the  more controllable it is by
management, until the middle period of life
| is passed, and then old age impedes in some
I degree the benefit which we may confer;
] not by rendering  our measures inert, but
 by preventing our  employing them quite so
 actively ns we should have done earlier.
   "The  first  thing indicated, in all  cases,
 is to cut  off as far as possible the supply of
 material.   Fat, oil, butter should  be  rigor-
 ously interdicted in the diet-table.  But all
 eatables contain some portion of oleaginous
 matter,  and  especially those most conve-
 nient to  advise  the use of for a lengthened
 period;   and almost  all are capable  of  a
 transformation into fat, when a small  quan-
 tity of this substance is previously present.
 It  is desirable, therefore, that  the mass of
 food should lie in the stomach as short  a
 time as possible, in order that at least a fatty
 fermentation may not be sit up in  it.  Very
 light meals should be taken at  times most
 favourable to rapid digestion,  and should
 consist of substances easy  of solution and
 assimilation.   To this end, the  time of the
 meals should be fixed for an early hour in
 the day,  before  exertion  has rendered the
 power of the organs of nutrition languid and
 weak.  Breakfast should consist of dry toast,
 or" what  is still  better, sea-biscuit, and, if
 much active exercise is intended,  a  small
 piece of lean meat.   Dinner at one o'clock,
 on meat with the fat  cut off, stale bread or
 biscuit, and some plain-boiled maccaroni, or
 biscuit pudding, by way of  second course.
 Liquids  should be taken, not at the  meal,
 but half an hour after, so as not to impede
 the action of the gastric juice  upon  the
 mass, and here should end the solid feeding
 for  the day.   No second  dinner or supper
 should follow, nor, indeed, any more  meals
 be taken sitting down.   A  piece of biscuit
 and a glass of water can be taken  standing
 up, if faintness  is  experienced;  or a cup
 of  gruel, or a roast apple, before going to
 bed.
   " The smallest amount of  nutriment con-
 sistent with  the  health of the individual
 can be found  by experiment only; but we^
 need not fear that ten ounces of solid food
 a day is too little.   It may be remarked, by
 the way,  that it is  often advisable  to  add a
 small allowance of malt  liquor at dinner,
 as  otherwise  the  craving of the appetite
 is  less easily appeased.   The beers  to be
 avoided are of course the thick, sweet kinds:
 but that which is thoroughly fermented, a
 a low temperature, in  the  Bavarian  way,
 seems to contain very little injurious matter.
 I do not know that any advice concerning
 sleep is peculiarly applicable to obese per-
 sons,  beyond  what we  should  recommend
 to  all classes of men.   They  are usually 
FAT
245
FEC
 uneasy sleepers,  and, though lethargic, by
 no means averse to early rising.
   " In cases where the fat is largely accu-
 mulated m the  abdomen, it is  very conve-
 nient for the patient to wear a band round
 the cavity, which may be tightened gradu-
 ally.  The support thus given to the abdo-
 minal muscles  relieves the dragging sen-
 sations  in the  loins,  which many persons,
 whose viscera  are heavy in  proportion  to
 their strength,  experience.  It  enables ex-
 ercise to be taken with more facility; and
 appears also, by pressure, to afford some
 assistance to the absorption of  fat.  The
 above remarks  will  apply equally  to all
 forms of  obesity;  the abstinence recom-
 mended can be  borne even by the aged, and
 only comfort be experienced.
   "As  respects  exercise,  however, a dis-
 tinction requires to  be made.  The young
 and vigorous, whose obesity  does not pre-
 vent the use of  their  legs, cannot employ
 them more usefully than in walking as long
 as they are able. The greater number of
 hours per day  that can be devoted to this
 exercise, the quicker will  be the diminu-
 tion of bulk.    But as riding, by the gentle
 shaking of the abdomen, excites  the secre-
 tions of the digestive organs more, it should,
 where practicable, be employed in addition.
 AVhere freedom  of motion  has once  been
 gained,  rowing,  shooting—any,  or all, of
 the forms  of British gymnastics, should be
 adopted as regular habits.    *    *   *
   " Purgatives  I  have generally found not
 needed in the  plethoric form;  the bowels
 usually act once or twice in the day.   But
 in  the asthenic  obesity of old people, where
 the abdominal walls  are weakened by long
 pressure of an unnatural weight, it is neces-
 sary to employ them.
   " But there is  one class of medicines so
 universally applicable to all cases of obesity
 that I think a trial should never be omitted.
 The chemical affinity of alkalies for fat point
 them out as appropriate alteratives in this
 complaint, and experience proves  that they
 are  suitable  to  the state of  the digestive
 organs.  The most eligible one is liquor po-
 tassae, and it may be administered in much
 larger quantities than  any other.   If given
 in milk and water, we may safely commence
 with half a drachm, and raise the dose to a
 drachm and a drachm and a half, three times
 a day.   The milk covers the taste of the
 potash better than any other vehicle.   It
 has, truly,  the  advantage of saponifying  a
 portion of the remedy,  but there is no evi-
 dence to prove  that its  efficacy is thereby
 endangered;  indeed,  soap itself has  been
strongly recommended."
      v2
   Vinegar,  which  is  sometimer  foolishly
 taken largely, with  a view to reduce fat, can
 only do so by disordering the digestive organs.
   Food of a  fatty nature is generally diffi-
 cult of digestion.   As a remedy in the cure
 of disease, the fats  of various animals, deer,
 vipers, &c. were formerly used in medicine.
 In some cases of irritability or low inflamma-
 tion of the lining membrane of the stomach,
 fatty food seems to  be serviceable.
   Refer to  Axunge — Bacon — Digestion—
 Food, $c.
   FATUITY.—Mental imbecility.
   FAVUS.—A peculiar skin disease, gene-
 rally developed on  the head, but occasion-
 ally elsewhere, and remarkable from  the
 yellow cupped scabs being  the site of de-
 velopment of a minute fungus.
   FAUCES.—The  Gorge [or orifice of the
 oesophagus].—The  space  and its sides be-
 tween  the back part of the tongue and upper
 part of the gullet.
   FEAR—The exact opposite to faith, is one
 of  those depressing agents  which  always
 acts unfavourably in cases of confirmed dis-
 ease, and lays the person open to the attacks
 especially of contagious or epidemic mala-
 dies.  Sudden fear has sometimes acted bene-
 ficially, and paralytics have been known to
 recover the use of their limbs in their efforts
 under  a paroxysm  of  terror;  more gene-
 rally, however, its operation is the reverse,
 and many cases of  epilepsy,  mania, hearts
 disease, &c. date  from  fright.   In children,
 particularly of a  nervous temperament, the
 influence of fear, either in jest or earnest,
 is most sedulously  to  be avoided.   Above
 all  things,  care should be taken that  cir-
 cumstances in which children may be placed
 accidentally,  or individuals with whom  they
 may necessarily  have  to  come in contact,
 are not made sources of terror,   This is too
 often practised,  and  threats of what  the
 "doctor will  do" so  terrify a  child that,
 when visited  in illness, fright quickens  the
 pulse,  the tongue will not  be  shown,  and
 the sounds of the chest are so obscured by
 sobs, that it is next to impossible to arrive
 at an accurate judgment of the case.  Fur-
 ther,  if a  child  has  been systematically
 frightened about  the dark,  &c. it may, if
 accidentally placed  in it, suffer serious in-
 jury from fright.
  FEI3RICULA.—A slight fever.
  FEBRIFUGE. —  Any   medicinal  agent
 which  has  the power of subduing fever.
 The term was much more used in former
 times than it  is now.
  FECULA,  or Starch—Is a principle uni-
versally diffused  throughout the vegetable
kingdom, nearly approaching gum ui compo- 
FEC
24(i
F E R
sitioii; i\. is found in various parts of plants,
where it is evidently destined to be a store
of nutriment for their young or newly-de-
veloped parts; thus, in  seeds it nourishes
the young plant;  in tubers, such as  the
potato, the bud  shoots;  in the  sago palm,
the young  leaves.  Before, however, it can
afford suitable nourishment, it must be con-
verted into sugar, and this is done by the
influence of " diastase," a substance already
treated of.   It need scarcely be said that
while starch fulfils  its peculiar office as re-
gards the vegetable, it is  a no less important
provision for animal wants;  it is,  in short,
one of the chief elements of nourishment
derived from the vegetable kingdom for the
support of  animal life.   Amid other exam-
ples,  arrow-root is  nearly  pure  starch.
Starch occurs  in  the  form  of granules,
which vary considerably  in size  and shape,
according to the tribe of plants  from which
they are obtained.   These granules are com-
posed  of concentric  layers,  the  outer of
which, when exposed to a temperature of
160° in water, burst, and allow the inner
layers to be dissolved ; consequently starch
of any kind, after exposure  to the above
heat, can never be  restored to  its  original
condition.   It is  scarcely  requisite to re-
mark, that starch is insoluble in cold water,
differing in this respect from gum.
  The composition of starch is simple, that
is to say, it is made up of carbon and water,
or carbon  and  the components of water,
oxygen and  hydrogen,  but it contains no
nitrogen, no earthy matters.   From  this  it
is  evident  that  the  nourishing power of
starch, and of starchy articles of food gene-
rally, is limited, that is to say, they cannot
yield  what they do not possess, nitrogen
and  earthy salts; but as these are requi-
site for the full nourishment of every por-
tion of the  frame, starchy food, either alone
or in too great preponderance, cannot  suffi-
ciently nourish the body, particularly during
the period of growth.  This will  bear out
remarks made under articles " Arfow-root,"
" Bread," &c, which show that animals may
be starved  to death if fed  on starch alone,
or articles  principally composed of starch,
and that through ignorance of  these  facts
infants  and  children have been  seriously
injured by  the improper regulation of  their
food.   But though starch,  and  such-like
compounds, such as sugar, gum,  &c, cannot
build up bone and muscle, they  can protect
them, they can furnish respiratory aliment,
or fuel, and also, when  not  thus required,
assist largely in the formation of fat.
   Refer  to Animal  Food—Blood—Digestion,
  FEMOHAL  ARTERY.— The great nrtery
of the thigh.—See Artery.
  FEMUR.—The  thigh-bone.—See Thigh-
bone.
  FERMENTATION—Is  a process of de-
composition, or of change, in the* relations
of  the  various  elements of  fermentable
bodies.   For the action of this process of
decomposition or of fermentation,  it is in-
dispensable  that certain  "azotized"  sub-
stances, named ferments, should be  present.
These substances all  belong  to  the albumi-
nous  principles—bodies which  in  a  moist
condition putrefy and  decompose  sponta-
neously.   Thus, a  solution of  pure sugar
will not  ferment,  however long it  may  be
kept; but if a decomposing—putrefying—
azotized  ferment,  either  animal matter or
vegetable albumen, or  gluten,  or yeast  be
added  to the  solution,  the change quickly
commences,  and goes on until fermentation
is complete.   Vegetable juices, such as that
of the grape and others, and even a solution
of  brown sugar,  take  on the  process  of
fermentation  spontaneously, because  they
contain  sufficient azotized  principles—ap-
proaching the putrescible albuminous ani-
mal matter  in composition—to  act as fer-
ments.   Milk  also takes  on  a  spontaneous
process of fermentation  for the same reason,
but it is not the alcoholic; no gas is evoked,
and instead of spirit, a peculiar acid, the
" lactic," is generated.  Temperature, roore-
ever, exerts much influence  upon  the pro-
cess of fermentation,  and some juices  yield
either  alcohol or lactic acid, according as
the process  is carried  on under  a low or
high temperature.  The  acetous fermenta-
tion, or that which results in  the production
of acetic acid, or vinegar, is carried on in a
temperature of from 70° to  85° Fahr., and
of course likewise requires the presence of a
ferment.  A certain amount of moisture and
elevation of temperature are essential to the
process of fermentation;  dryness and cold
alike stop the action.
  " The  identity of composition  of the  chief
constituents of blood,  and of the nitrogenized
constituents of vegetable food, has certainly
furnished, in an unexpected manner, an ex-
planation of the fact,  that putrefying blood,
white of egg, flesh, and cheese, produce the
same effect in  a solution of sugar as yeast or
ferment."
  The explanation  is simply this, that fer-
ment or yeast is nothing but  a vegetable
principle, resembling  these animal  ones,
in a state of decomposition.   As it is only
that modification  of  sugar,  named grape-
sugar, which  is capable of being converted
into alcohol,  all fermentable  substances, 
F ER
24;
FET
 whether  containing  cane-sugar,  or  starch,
 must be, and  are,  converted into  grape-
 sugar, as the first step of the process.  Anti-
 septics stop the process of fermentation.
   " The maturation, as it is called, or sweet-
 ening of winter fruits, when  stored up for
 their preservation in straw, is the result of
 a  true fermentation.   Unripe apples  and
 pears  contain a  considerable amount  of
 starch, which becomes converted into sugar
 by the nitrogenous constituent of the juice
 passing  into a state of decomposition, and
 transmitting its own mutations to the parti-
 cles of starch in contact with it."*
   Refer  to  Alcohol—Antiseptic— Vinegar—
 Yeast, §c.
   FERMENTED  LIQUORS—That is, beve-
 rages  which have undergone the  process
 of alcoholic fermentation,  may  almost be
 considered  a natural  product of warm cli-
 mates, from the readiness with which vege-
 table juices take  on  the process in these
 situations.  The  pure juice of the grape,
 if left to  itself  in  a suitable  tempera-
 ture, will ferment in a few hours ;  and the
 palm-juice  of  Africa  and other  tropical
 countries, and the "pulque" of Mexico, are
 instances of the same thing.  Ancient re-
 cords, including those of Scripture, all tend
 to show  that fermented liquors  have  been
 known and used from the earliest periods.
 In  the  present  day,  the principal  fer-
 mented liquors in use are—1.  Grape wines ;
 2.  Domestic or home-made  wines, which
 are for the most part rendered fermentable
 by the addition of sugar;   3. Liquors made
 from  the fermented juice of the apple or
 pear;  4. Malt liquors, from various  grains,
 principally barley.  For further information
 the reader is referred to  the individual ar-
 ticles on the above subjects; also to  Drinks,
 Food, $c.
   FERN, or Male Fern—Or, as it is called
 in botanical language, the " Aspidium filix
 mas,"  is  a common  native  plant, noted
 principally as a remedy in tape-worm,  but
 until  lately too much neglected.  It is pro-
 bable, that if given with the same care  and
 precaution,  it might  not  be found inferior
 to the now celebrated Kousso.   The male fern
 (fig. Ixviii.)  grows  chiefly on strong ground,
 in  slightly-shaded  situations; no descrip-
 tion could guide an unprofessional and  un-
 botanical person to gather it with certainty
 if it  cannot be recognised from the figure,
'(Ixviii;) but perhaps the safest plan  for any
 one wishing  to use  it,  would be to have the
 plant  either collected  for him, or both it
 and its distinctive characters pointed  out

         * Licbig's Letters on Chemistry.
Fig. lxvili.
by some competent person.  Dr. Christisor
gives the following directions:—"The root,
which is the part of the plant used, should
be collected between the end of  May and
the  middle of September.  It  should be
cleared of  foreign matters, root-fibres, and
old  or  decayed  tufts,  but  without being
washed.  It should then be dried quickly
and  thoroughly  in  the open  air without
heat, and  in the shade;  these tufts, as well
as the parts  of the  root-stock which are
greenish internally,  should alone  be de-
tached, and  immediately  reduced to  pow-
der ;  and the powder must be kept in well-
closed bottles."  It  should  not be  relied
on when above one year  old.   The  usual
dose  of  the powdered  root  is from one
to three drachms;  but the oil extracted by
means of ether is  the best preparation, the
dose being eighteen drops  given  at night,
either in pill, emulsion, or mixed with castor-
oil,  and repeated  again in the  morning.
It is better to avoid much food  just before
taking.the dose of either powder or oil, or
during  their operation; and it is  always
requisite to follow the last dose taken with
some aperient—castor-oil  is perhaps the
best—two  or three hours  afterward.   The
worms are  discharged dead.f
  Refer to  Kousso—Worms, <"*c.
  FERRUGINOUS.—Connected  with iron.
  FETOR—Is a bad odour of any kind.  In
many cases it is the result  of the process of
putrefactive decomposition or fermentation,
and may be developed either on the external
or in the internal parts of the body.  The use
of chlorine or  of  chloric ether in various
ways [or of the  essential  oil of camphor]*
 f A case of tape-worm successfully treated bv malt
fern is recorded in the Lancet, for March 6th. 1852. 
F  K V
:'4^
I' E V
is the best corrective.  The mercurial fetor
is a peculiar odour always acquired by the
breath  when  the constitution is  sensibly
affected with mercury.
  Refer to Chlorine, Mercury, Src.
  FEA'ER—Is that condition of the body in
♦rhich the pulse is quickened, the skin hotter
than natural,  thirst present, and  the func-
tions  generally  disordered.  This  feverish
state of the system may arise from  and be
the concomitant of various local  and other
affections, but it may also constitute a  dis-
ease in itself, and it is  to  it in this light
that the present article applies.
  Fever,  properly so  called,  naturally di-
vides itself  into intermittent fever or ague,
eruptive fever, such as small-pox or measles,
hectic  fever,  remittent  and common con-
tinued fever.  It is with  the  two last that
we have to do at present; the others will be
considered under their own heads.
  Remittent fever may be regarded as  an
aggravated  form  of intermittent fever or
ngue,  (see Ague); it has the regular succes-
sion of hot, cold, and sweating stage,  but
the interval between the paroxysms is  not
characterized by the return to comparative
health, as it is in the latter.  Through most
tropical  countries,  the  principal type  of
fever  is  the remittent;  but the complica-
tions  of  the  fever, and consequently its
management,  vary  according  to  locality.
Under these circumstances, it would answer
no good end to devote more space to  the
subject at present, than to advise all who
are about to reside in hot climates, to in-
form themselves thoroughly on this  as well
as other  matters  connected with the pre-
servation  of health,  and  also on the nature
and management of the diseases in and con-
nected with  their future home.
  Common continued fever is an affection
of the whole  system; as described by  a
medical  author  of  eminence,  "it  affects
the head, the  trunk of the body, and  the
extremities;  it  affects the circulation,  the
absorption,  and  the nervous  system;  it
affects the  skin, the muscular  fibres,  and
the membranes; it  affects the  body,  and
likewise  the mind."  By medical  men  this
serious disease is subdivided into different
varieties and types; but it would serve no
good purpose to  enter into these here.  The
management of  a disease  so  gravely  im-
portant as fever can never be legitimately
undertaken  by  unprofessional persons, if
medical assistance is procurable;  but as a
provision  for  circumstances when  this is
absent,  the  less complicated the  account
both of the disease  and  its  treatment,  the
more  likely  is it  to be  managed with  ad-
 vantage domestically.  The first symptom!
 of  incipient  fever  are  usually displayed
 through  the  nervous  system.   The  indi-
| vidual feels an unaccountable languor, and
 complains of headache and shivering, can-
 not exert his powers either in the duties or
 pleasures of life, is easily tired, sleep is dis-
 turbed, the appetite is  impaired, the skin
 looks dusky and  the eyes  heavy, the pulse
 quickens, and at length the feeling of gene-
 ral illness drives the patient to bed.   The
 attack, however, may commence much more
 suddenly—a shivering, or, as  the people in
 many places call it, an " ague fit," may be the
 first symptom; or severe headache, or vomit-
 ing, or fainting, or even  convulsion may be
 the first symptom of the impending malady.
 When  fever is fairly established, the pulse
 ranges above  100,  the  tongue is furred,
 probably  brownish  and  dry,  sleep  is  dis-
 turbed or supplanted by  delirium, the mus-
 cular power is diminished  nnd diminishing,
 and the mind  indifferent to passing circum-
 stances ; dark incrustations  collect  about
 the teeth, the patient sinks down in bed, and
 perhaps passes the natural evacuations un-
 consciously, thus displaying the most evident
 signs  of debility.   This  condition may in-
 crease till  it terminates  in death, or tends
 toward recovery,  either  by  some  marked
 crisis,  such as profuse perspiration, or by an
 almost imperceptible amendment.  Tranquil
 sleep,  improved aspect of  the countenance,
 the skin cooler and with more tendency to
 moisture, the tongue cleaning  at the edges,
 and a natural desire for  food, all give sign
 that the disease  is  passing away;  on  the
 other hand, if a fatal issue is approaching,
 the general weakness increases, the patient
 slips down in  the bed in consequence,  and
 lies in a state of dreamy muttering; there is
 convulsive  starting of the fingers or other
 parts  of  the  body,  picking  at the  bed-
 clothes, the insensibility  to external impres-
 sions  increases, and probably stupor closes
 life.
   Such are the general  features  of fever,
 whether  simply continued, or when it runs
 on to  the more serious forms of  typhoid, or
 low, or nervous, or malignant  fever.   There
 are many other indications which occur, but
 which  it would serve  no  good  purpose to
 detail here; all that is required is that the
 disease should be recognisable, so  that its
 general management may be  properly and
 intelligently conducted when it  falls to the
 lot  of an unprofessional  person to have the
 direction.
   In the first  place it must be remembered,
 that for continued  fever we haw- no cure,
 that is, we have no medicine  which we can 
FE V
249
FE V
give with the tolerable certainty of remov-
ing the disease, as quinine removes ague:
it must  be vanquished by  the  powers of
the constitution, by the tendency to health,
and our endeavour must  be to place these
powers in  the  most favourable  condition
possible  for the  struggle, and, where they
appear to be insufficient, assist.   Sometimes
the  constitutional  power  will  throw off
fever  at  the very  onset.   Probably  few
medical men have not experienced in their
own persons, when attending fever patients,
that they had contracted  the  disease, and
that after all its symptoms had  been in
course of development for four-and-twenty,
or  eveu  eight-and forty hours, it has been
cast off, probably, by perspiration  or  diar-
rhoea,  and   health  restored.   From  this
almost ephemeral attack, to the week after
week of continued fever, the disease may be
thrown off at any period of its  course.  A
person attacked with  fever  ought  to  be
placed in as roomy  and well-aired a situa-
tion as possible—better even in a barn than
in  a close or crowded  room; the  greatest
cleanliness  as regards  every thing  around
must be  observed,  and perfect  quietude;
if thirst is  present, it  should be liberally
indulged with simple diluents ; if nourish-
ment is  taken, it should be given in mode-
rate quantities, and consist principally of
milk and farinaceous preparations ; grapes,
oranges,  and ripe fruits, if they  do  not
create flatulence or diarrhoea, are allowable.
If  the skin  is hot  and dry, it  should be
sponged  daily, or oftener,  with water, and,
indeed, this  practice is beneficial, more or
less, in most cases.  By these simple means
of  management,  almost without medicine,
beyond some gentle aperient  at intervals
to  keep  the bowels  perfectly free  of their
necessarily  depraved contents, many a case
of fever may be well conducted to a favour-
able issue,  with much more certainty than
under  a  more meddlesome treatment—care
being taken when  signs of amendment show
themselves,  that there is not too great hurry
in giving or permitting strong nourishment.
  In more serious forms of fever, the same
principle of treatment must be kept in view,
but more urgent  symptoms  may  call for
more active interference; violent delirium
may require  the  treatment  pointed  out
under  the article  devoted to the subject;
difficulty of breathing and cough  may ren-
der a  blister on  the chest desirable,  or
tenderness of the bowels  on  pressure, par-
ticularly  in  the right iliac region, (see -46-
domen,) may call for the application of half
a dozen leeches.   Diarrhoea may require to
be  checked,  (see  Diarrhoea,) or constipa-
tion removed by gentle aperients; castor-oi!
or rhubarb or senna will generally be found
safest and best, or by clysters.   Sleepless-
ness at night, with convulsive starting of the
fingers,  may require opium, (see Delirium;)
or the general sinking of the powers, the
pulse becoming  feeble and  easily extin-
guished,  may  call  for the  careful and
measured administration of wine or brandy,
or of camphor in milk, (see Camphor,) with
strong meat-broth, or gravy,  in frequently
repeated  small  quantities.    At  this  time
care must be taken to observe whether urine
is passed;  if there seems  to be difficulty, a
bag of  hot bran on the lower part of the
body  will  possibly make  it  easier;  if it;
dribbles  away, means  should be  taken  to
protect  the back  and  hips of the patient
from  being wetted with it.   This  may  be
done in  various ways, either by waterproof
material,  or by  constant  renewal of dry
cloths;  it is much better effected,  however,
by bags of bran, so placed as to absorb the
urine as  it comes away.  If with  every
quart of  bran, four ounces of the diluted
sulphuric acid  be mixed, it will neutralize
the ammoniacal emanations which so quickly
arise  wherever  urine  collects.   Very re-
cently, bags filled with  the powder of peat
charcoal have  been recommended for the
same  purpose; and where this article can
be procured, it will probably be superior to
any other.
  All patients who lie long in fever become
liable to bed-sores, or  ulcerations on  the
prominent parts  of  the  body  which  are
subject to pressure as  they lie; these are,
especially, the back and hips, points of the
shoulder-blades, back  of the  head, tips of
the ears, &c.  AVhen these ulcerations form,
they not only add materially  to the suffer-
ing of  the patient, but  may become  the
cause of a fatal termination to a case that
might  otherwise  have recovered.   They
should, if possible, be prevented.  The parts
named above should be frequently examined,
and on the slightest appearance of redness,
the skin at the spot should be rubbed with
spirit—brandy—or a solution of camphor in
spirit.   When the skin has actually broken,
it may be  dressed with simple  spermaceti
ointment  spread  on  linen;  lead plaster
spread on soft leather is often useful, or the
white of egg beat up with alum.—See Alum.
Both as a preventive and as a remedy after
the sores have formed, the parts should  be
relieved from  pressure  as much as possible
by various arrangements  of cushions,  &c.
the elastic  ones made for the purpose being
the most suitable.—See  Caoutchouc, Elat
tic, Sec. 
F I B
')()
F I L
  Such  are the general  principles on which a
case oj /eve- is to be managed;  by attention to
them an unprofessional person will be much more
likely  to do good than by meddlesome interfe-
rence.    Attention to the ventilation of the
room, to the perfect cleanliness of the pa-
tient  and of every  thing around—a free
supply of diluent drinks, and  care that the
bowels  are duly, but  not forcibly  relieved
of their always depraved contents, ought to
constitute the  chief  resources  of the  do-
mestic management of fever.
  Again it is  repeated, fever is not a disease
to be cured, but to  be guided to a safe ter-
mination.   If many of the symptoms which
arise,  or may arise, in fever, or if minutiae
of treatment  are here omitted, it is because
eitlier  their enumeration would have  been
useless, or that a judicious reference to va-
rious  parts of  this work will  furnish  ade-
quate guidance.  As regards  the causes of
fever, the first,  "Contagion,"has been fully
treated of in its special article, and the rest
are so fully pointed out in the various sani-
tary  articles, such  as " Air"  and "Atmo-
sphere," "Bedroom,"  "Chlorine," "Disin-
fectant," " Drainage," &c. &c.  that it would
involve  needless repetition to  go over them
here.  They may be summed up : Predispos-
ing— whatever lowers, either temporarily
or permanently, the standard of the gene-
ral health ; and Direct—contagion and the
products of animal  or vegetable  decompo-
sition.
  Fever in children in this country [England]
is  more generally of  a remittent character
than it is in adults.
  This article cannot be closed without re-
ference  to the employment of fresh yeast in
cases of fever, particularly of  a low, malig-
nant, or putrid tendency, in which it is most
useful.  It is given  in tablespoonful doses,
repeated every  three or four hours.
  Refer to Ague—Bedroom—Contagion—Dis-
infectant—Disease—Debility, Sfc.
  FIBRIN—Is that  constituent of the blood
which—along with the  entangled globules—
forms the clot.   It also constitutes the fibre
of flesh or muscle.   It is identical in com-
position with  albumen, to  which  state  it
must be reduced in  the process of digestion
in the  stomach, for the purposes of nutri-
tion; but it is in a  much  more "vitalized
condition  than the former  substances ; in
other  words,  is much more  fit to become
incorporated  with the tissues of  the living
body.
  Refer to Albumen—Blood—Digestion —
Food,  Sfc.
  FIBULA.— The small bone of the leg.
  FIGS—The well-known fruit,  contain a
wholesome and somewhat aperient pulp, but
the thick  tough  rind is indigestible, and
should not be eaten.
  FILBERTS—Are  liable to the objection
to nuts  generally, and  are  difficult of di-
gestion.
  FILTER—Is an agent for separating solid
impurities  from  fluids.   Filtering papers
made for  the purpose, or  white  blotting
paper, are  most usually used  as medical
filters, being supported  by  the  well-known
funnel or  tundish,  which ought to be of
glass  or  porcelain,  and  ribbed inside, (fig.
lxix.)  To make a  paper filter, the paper
used must be  square, (fig. lxx.)  By the
first fold the corners (1,1) are put together,
at the next (2, 2) are put  together, thus
forming  a triangle, (1, 3, 2;) 1 and 2 are
next put together, making a triangle,(4,3,2;)
and one more fold (5, 3, 2) completes.  The
                 Fig. lxx.
top being squared off, the filter is made, and
may be opened out  and placed  inside the
supporting  tundish.   In filtering through
paper, it is always desirable to pass the first
few  ounces of the fluid through a second
time, as  a small amount of impurity gene-
rally escapes  at  first.  When  the solids to
be  separated  by filtration are not in very
fine powder, the  operation is more quickly
done through  linen  or flannel.   Of the va-
rious  filters  sold for  the purifaction of
water, it is unnecessary here to speak.  But
as the purity  of that element  is one  of the
essentials for  health, and as, 'n  those sitn- 
                    FIN

   ations  and circumstances in which it is used
   in its greatest impurity, almost any kind of
   bought filter is unattainable, the  following
   suggestion from the Proceedings of the British
   Association is most valuable :—Any common
   vessel  with a hole below,  such as a flower-
   pot,  may be used.  Its lower portion is to be
   filled with coarse pebbles, over which should
   be placed a layer of finer ones, and on these
   a layer of clean coarse  sand ; on the top of
   this, a piece of burnt clay, perforated with
   small holes,  should  be put, and on  this a
   stratum, three or four inches thick, of well-
   burnt pounded charcoal.  A  filter thus formed
   will  last a long time, and not only separates
   solid impurities, but  purifies the water, by
   meams  of the charcoal,  from  the putrescent
   and  other  noxious substances held in solu-
   tion, which cannot be separated by ordinary
   filtration.
      Refer to Water.
      FINGERS—From their constant exposure,
   are liable to many accidents  and diseases—
i  fractures, dislocations,  whitlow, separation
   of the  nail—all which are  treated of  under
   their respective articles. There is, however,
   one mishap which does  not fill under  any
   particular head.
     A  ring which cannot  be  removed.—When
   this  occurs,  the  use  of cold  to the  finger
   and  hand, the hand and arm being elevated
   at the  same  time,  may  cause   sufficient
   shrinking to permit the removal.   If  this
   does not succeed, the  following may :—A
   piece of fine pack-thread, or linen thread, is
   to be wrapped evenly  and firmly round  the
   finger,  from the tip  as far as  the ring,
   through  which its  end is to be  inserted,
   which  being done, the packthread must be
   gradually unwound  by means of the  end
   thus placed.  If  this process does not suc-
   ceed, the ring should be filed  off.  It cannot
   remain  without risk.
     FIRE.—See Heat.
     FISH—As an article  of diet, is generally
   wholesome.   It is neither so nutritive nor so
   heating as  animal food, and on these ac-
   counts  is often to be  permitted when  the
   latter is not.
     Fish  are classed  as fresh-water, salt-
   water,  and  shell-fish.   Dr.  Paris  remarks,
   " Turbot, cod,  whiting, haddock,  flounder,
   and  sole are the least  heating of the more
   nutritive species ; and  the tiakiness of the
   fish, and its opaque appearance after  being
   cooked,  may be considered as true indica-
   tions of its goodness ;  for when the muscles
   remain  semi-transparent and bluish, after
   sufficient boiling, we may reject  it as infe-
   rior in  value, and not in season.   AVhen  fish
   is  in high  perfection, there is also a layer
1                 FIT

 of white curdy matter, resembling  coagu-
 lated albumen, interposed between its flakes.
 The whiting ("the chicken of the  sea") is
 well adapted for weak stomachs, on account
 of  the  little  viscidity which it possesses.
 It is  at the  same time tender, white, and
 delicate, and  conveys  sufficient nutriment,
 with but little stimulus, to the system.   The
 haddock is firmer in texture.  Cod is not
 quite so digestible as tin two former, but it
 is nutritious.  Turbot is wholesome, without
 lobster sauce.   Sole is  tender, and yet  suf-
 ficiently firm; it is, therefore, easy of di-
 gestion,  and  affords  proper  nutriment to
 delicate stomachs.  Salmon is very nutri-
 tious, but, being one  of the  oily fishes, is
 less digestible than  many  others—vinegar
 in some degree corrects the fault.  Eels are
 always  indigestible."   From  these observa-
 tions the value of fish  may be  appreciated,
 and the qualities which entitle  them to
 election easily understood.   [In the United
 States the rock-fish is most esteemed, but the
 shad, cat-fish, sun-fish, perch, pike, trout, and
 herring are also excellent articles of food.]
 Firmness of  texture, whiteness of muscle,
 and the absence of  oiliness  and viscidity,
 are the  circumstances which render them
 acceptable to weak stomachs.   The flesh of
 fish contains.kreatine.—See Kreatine. Shell-
 fish may, without exception, be considered
 as indigestible.   Oysters eaten raw are un-
 doubtedly nutritive,  but by  some they are
 not easily digested.  Many persons are lia-
 ble to cutaneous  eruptions  after the use of
 some  descriptions of  shell-fish, and some
 suffer from diarrhoea.
  In  such places, as the coast of Norway
 and Sweden, where  a  diet of fish alone is
 habitual, the people are very liable to chro-
 nic cutaneous diseases.
  The most  wholesome method of cooking
 fish is by boiling; frying is not suitable for
 the invalid.   It is well known  that certain
 species  of fish are poison at all times ; others
 appear   to  be so only  occasionally,   and
 under peculiar circumstances.   Of these,
 the common mussel has proved more inju-
 rious than any others.   The oily fishes  also,
 such as salmon, herring, &c. when too  long
 kept,  have  also  given  rise to symptoms of
 irritant poisoning.
  Refer to Mussels, Sfc.
  FISTULA—Is a canal or passage formed
 by disease, and healing with difficulty, which
 opens from  the  surface of the body.   The
 word  fistula,  alone, is generally used popu-
 larly  with  reference to the disease  when
 situated at the fundament.—See Rectum.
  FITS.—The term is  applied  popularly tc
 any form of  convulsion or  spasm  of tha
2c 
FIX
52
FOM
voluntary muscles, such  as  Epilepsy, Hys-
teria, and Convulsions generally, either  in
adults  or children.   To  these  heads the
reader is referred.
  FIXED AIR. — The  name given by Dr.
Black to carbonic acid gas.
  FLANNEL—A  woollen  texture, is an ar-
ticle of clothing which should be worn next
the skin by every man,  woman, and  child
in every country, notwithstanding its pro-
hibition (!) by Preissnitz, amid  other hy-
dropathic regulations.    Under the  head
of flannel is included, of  course, woollen
clothing generally.   AVool being a bad con-
ductor of heat, is, in consequence, the best
protection  against  sudden  vicissitudes  of
temperature, such as occur in most climates,
and especially against chills, which may su-
pervene upon the  profuse perspiration in a
warm one.   Of course, the thickness of the
woollen material  worn next the skin may
and ought to be varied, but wool it ought  to
be, if of no stronger texture than gauze.  The
experience  of our military and naval sur-
geons  all tends to prove that there is no
greater preservative from the dysenteric and
febrile affections of  hot climates than wool-
len clothing  next  the skin, and every medi-
cal man's experience in this country con-
firms the fact of its protective power.  Not-
withstanding, it  is  astonishing how many
carelessly neglect this indispensable article
of clothing.  Some few persons with extreme-
ly irritable  skin  cannot  wear flannel next
it.  In  such  cases,  a dress of thin  cotton
[or silk] should be worn, with flannel over  it.
Flannel should be worn in summer, but of a
thin  texture.
  FLATULENCE—Or the collection of gas
in the stomach and bowels, is very commonly
the result of indigestion; but it is often
also the effect of  nervous  disorder.   In the
former  case, it is probably chiefly due  to
the extrication of gas from the badly-di-
gested food  mass in a state of partial fer-
mentation.   In the latter, it is only possible
to account for the  enormous quantities  of
"wind" which are discharged by its forma-
tion  ("secretion") in  the bowels.   Toward
the termination of fever, and other acute
diseases, flatulent distention of  the bowels,
or '♦ tympanitis," as it is called, is always
an unfavourable symptom.
  Persons who suffer from flatulence require
sedulously to avoid most kinds of vegetable
food and fruits. Individual experience, how-
ever, is the best guide on this head.  When
a severe attack of- flatulence comes on, car-
minative (see Carminatives) and stimulating
remedies  are generally  resorted  to,  and
often prove  useful.   But  in  many  cases,
particularly in  nervous individuals,  witfc
pale tongue, the mineral  acids  will often
be of more service—either twenty to thirty
drops of dilute nitric acid in a wineglassful
of infusion  of  orange-peel, or some  other
warm bitter ; or, better still, aromatic sul-
phuric  acid, in ten drop doses,  in  a  wine-
glassful of  water.   In general  flatulence
of the  bowels,  with difficulty of expulsion,
the clysters  of assafoetida or rue are most
useful.
  Refer to Children—Clysters—Indigestion.
  FLESH.—The muscular substance of ani-
mal bodies composed of fibrin.   It  is a po-
pular error  to suppose that flesh is merely
present in the body "as flesh," and  it is not
understood  that* every particle of the  sub-
stance  is muscle, and  employed  as  such in
the movements  of the living body.
  Refer to Beef—Fibrin—Mutton, Sec.
  FLESH-BRUSH.—A brush  for brushing
the skin.—See Skin.
  FLOODING. — Hemorrhage   from  the
womb.—See Abortion—Childbed—Menstrua-
tion, §c.
  FLOUR.—See Grains—Farina.
  FLOWERS  of  SULPHUR.—Sublimed
sulphur.—See  Sulphur.
  FLUCTUATION—In medical language, is
the movement  given  to fluids  in  cavities
(either natural or diseased) by  the fingers
of the  medical  man, while at the same time
he endeavours to make  himself  acquainted
with the various peculiarities which charac-
terize the  collection.
  Refer to Abscess.
  FLUOR  ALDUS,  [The  WniTE8.]-See
Menstruation.
  FLUX. — An  increased  discharge from
any  of the passages of the body,  such  as
the bowels,  lined by a mucous  membrane.
The term has gone out of use.
  F(ETUS —The term is  applied to the in-
fant from  the fifth month  till the period  of
birth.
  FOMENTATION—Is  a  method of apply-
ing heat and misture to any portion of the
body.  It is a  most useful remedy, if well
done, but  is so  often badly  performed  as  to
do more harm than good ;  for this reason a
bran-bag poultice, properly made (see Bran)
is in most cases preferable.  AVhen fomenta-
tion is to be performed, the bed or clothes
should  be guarded by some waterproof ma-
terial if possible.   Two  good-sized pieces
of coarse  flannel are to be employed, one
being  in  preparation while the other  is in
use.  The flannel  being wrung  out of hot
water,  should be  shaken up loosely,  and laid
upon the  part  under treatment.  The size
of the  flannel  must, of course, be proper- 
FO M
253
FOO
tioned to the case, but it should be ample.
Simple warm water  is generally sufficient
for fomentation, but in  some cases the de-
coction of  poppy  capsules  may be more
soothing.   Other additions are of no service
beyond insuring the greater attention  and
confidence of many ignorant persons,  who
will not use, either with care or confidence,
bo simple an application as water.
   Refer to Bran—Heat—Poultice, $c.
   FOMITES.—See Contagion.
   FOOD—That by which the living body is
nourished, in its widest sense, comprehends
both liquid  and solid aliment.   In the fol-
lowing article, the subject will  be consider-
ed chiefly with reference to  the principles
which regulate,  or ought to regulate, the
food of man, and on which, as  far as ascer-
tained, the nutriment of his material frame
is  conducted.   Much  special information
connected  with the  subject  is  scattered
through this work in the papers which treat
of the individual articles used as  nourish-
ment ;  and such  papers as  " Alimentary
Canal," " Digestion," &c. bear directly up-
on it.
   AVater is not only the medium by means
of  which  most of the operations which go
on in  living bodies are conducted, but it
also enters  so largely into the composition
of these bodies, that it must be regarded as
one of the alimentary principles, a due sup-
ply  of which  is  necessary, not  only for
health, but  for  life; and this  supply must
be constant, in order to compensate for the
loss of moisture which is continually going
on from the surfaces, exterior and  interior,
of  the living body.
   The food  taken by man and animals has,
or  ought  to have reference in  its composi-
tion to two distinct ends, the  nourishment
of  the bodily tissues, and the  maintenance
of animal temperature.   Milk  is the only
single article of diet which in itself con-
tains this essential combination in  properly
balanced  proportion.  We know that it is
capable, not  only  of  sustaining,  but of
nourishing  in growth  the  body  of  the
young animal;  and thus we have plainly
set before us,  what He who  made and sus-
tains all things has provided as necessary
for  the sustenance of  the creature, when
that creature is  confined to one means of
nourishment solely.  In addition to  water
and saline ingredients,  milk  contains three
distinct sets of principles: the  albuminous,
represented  by the curd; the saccharine, (in
which  is included the farinaceous,) repre-
sented by the  sugar, and the  oleaginous,
or fatty, by the cream.   Of these, the albu-
minous principles and salts are  requisite for
      AV
the building up of the frame ; the saccha-
rine and  oleaginous for, so to speak, sup-
plying it with fuel; they are what has been
called  "respiratory food,"  because  they
chiefly furnish materials, carbon and  hy-
drogen, which  may combine with the  oxy-
gen taken in from the air by the lungs, and
burn, as it were, within the body by a slow
and gentle process.   It must not, however,
be imagined that the saccharine and oleagi-
nous principles are solely devoted to pur-
poses of  fuel,  they also serve important
ends in  the  nutrition  of the body; but as
they contain no azote  or nitrogen, it is evi-
dent they cannot afford proper nutriment
to tissues of which this  element forms an
essential component.   They cannot, there-
fore, form muscle ; but they can form fat,
which  contains no nitrogen,  and requires
none.   In truth, the  sugar,  starch,  and
probably the fibre and gum of vegetables,
must constitute  the chief sources for the
formation of fat  in graminivorous  or vege-
table-feeding  animals.   The  albuminous,
the saccharine, and  the  oleaginous princi-
ples must each be taken  as the representa-
tives  of  a peculiar  class  of  substances.
Under the head  of  albuminous principles
falls the caseine,  or curd of milk ; albumen,
as we  see it in the egg; and  fibrin,  as it
coagulates from  blood, or  forms  part  of
animal  muscle.   These  are  principles  all
identical, or  nearly so, in composition, but
in different  states of vital organization.
They are composed of carbon, hydrogen, ni-
trogen, and contain phosphorus and sulphur
in small proportions.   They are, therefore,
adapted to afford due  nourishment to such
portions of the  living  animal  body as are
similarly constituted.   The milk curd is the
only substance contained in that fluid  from
which the young animal can  form  its blood
and its muscle.   From the albumen of the
egg  alone  all the tissues  of  the chick are
constructed,  and the  carnivorous   animal
subsists upon the muscle (flesh) of its vic-
tims.  These principles  are, therefore, in
themselves capable of sustaining life.  Not
so the oleaginous and the saccharine, which
represent, the one the fats and oils,  and the
other the starch  or fecula, the sugar, and
the gum.  These being deficient in nitrogen,
in sulphur, and  phosphorus, cannot yield
them, and, therefore, an  animal fed upon
them alone, will die of starvation, as regards
certain  essential components of its body
at least.   It was,  for a long time, a paradox,
how animals which lived on vegetable food,
formed from it  the albuminous principles
contained within their bodies,  because it
was thought that in the vegetable kingdom 
                F 00

these azotized compounds  did not  exist.
Chemistry of late  years  has solved the dif-
ficulty, by proving that vegetables do contain
albuminous  principles answering to those
found in animal substances;  not, it is true,
in the same  large proportion, but quite  suf-
ficient  to afford all necessary nourishment,
even to  the  muscular bull or  the gigantic
elephant.   These  principles,  and  indeed
their own entire structure, plants elaborate
" from carbonic acid, water,  and ammonia ;
that is, from the  constituents of the atmo-
sphere,  with the addition of sulphur,  and
of certain constituents of the  crust of the
earth."  Plants, therefore, may truly be  said
to produce the blood of animals.  Certainly,
animals which live upon vegetables have to
consume a very much larger bulk of mate-
rial than animals which live upon flesh ; but
for this, their habits and the nature of their
digestive organs have been arranged by the
Creator. Vegetables, therefore, are the  ori-
ginal formers of these  albuminous  princi-
ples, which they present ready prepared to
the digestive organs of the vegetable-eating
animal; the latter have  simply the  task of
fitting them  for intermixture with the blood,
previous to their becoming component con-
stituents of  the animal  body.  In the  ani-
mal, however, it must  be evident that they
exist  in a much  more  compact condition
than in  vegetable substances, and that  the
flesh-eating  animal will require to consume
a  much smaller  proportion  of its  natural
food than  the  vegetable  feeder.   Both
classes of animals,  however, breathe, that is,
take in oxygen by the lungs, which, in main-
taining their animal temperature, must com-
bine with the respiratory elements, (carbon
and hydrogen.) These  the vegetable feeder
receives in  abundance, in the  starch,  the
saccharine  ingredients,  the  woody  fibre,
&c. which make up the mass  of vegetable
substance ;  sources evidently  not  open to
the animal living  on flesh alone.  This,  it
is  true,  will  receive some amount of respira-
tory food in the fat of its prey ; but it  will
also require to make more violent muscular
exertion than the vegetable  feeder, so that
using up its muscle in so  doing, it  may
obtain the carbon and hydrogen (which are
contained in muscular substances as well as
in other albuminous principles) for the pur-
poses of animal fuel.  In accordance with
this, we  find that the carnivorous  animals
expend  much more  muscular force in ob-
taining  their sustenance, (in hunting,) than
the graminivorous animal.
   What is applicable to the food of animals
is  also true  in that of man, as regards the
nutrient principles; the bodies of both stand
4                 F O 0

 upon the same  level,  but man  has the will
 and the power to consume both vegetable
 and animal food,  either mixed  or  singly,
 as  may suit his  habits.   Existence  upon
 animal flesh alone is not common, but it is
 practicable and practised by  the  Indians of
 the  South American pampas, and by many
 people  who live by hunting;  but all these,
 like the carnivorous animal, make long-con-
 tinued  muscular  exertion, without  which,
 indeed, under the  peculiar diet, they could
 not  preserve health  or life.  Sir Francis
 Head relates, in his Journey over the Pampas,
 that while making immense  exertions, he
 lived for  months  together  exclusively on
 beef and water, this being the diet  of the
 roamers  over these  immense plains,  who
 spend most of their time in active exercise
 on horseback.
  Existence upon vegetable  food alone ia
 much  more common  than  that  upon ani-
 mal food  alone ;  and,  indeed, is the  rule
 with many  nations  and people, who un-
 questionably  maintain  high  strength and
 vigour  upon it.  It is, in fact, only requisite
 to look at  the grass-eating bull to feel con-
 vinced  of the possibility of  the  fact, and
 did  space permit,  it would be  easy  to cite
 abundant  confirmatory examples;   but if
 mart lives on vegetables he  must, like the
 vegetable-eating animal, consume a com-
 paratively  large  bulk  to obtain sufficient
 nutriment; and so it is the  Irishman and
 the  Hindoo must eat seven or eight pounda
 of potatoes, or of rice,  at a  meal.   These,
 however, are extreme instances, for potatoes
 and rice are comparatively non-nutritious,
 containing much starch and—especially the
 latter, when cooked—much water; the cereal
 grains  and pulses, on the other hand, pos-
 sess albuminous principles largely—the glu-
 ten  of  the former  corresponding  to the
 animal fibrin, and the caseine of the latter
 to the curd of milk.   Those persons, there-
 fore, whose  vegetable  food   is  composed
 chiefly of the above, require, of course,  to con-
 sume less, and there cannot be the slightest
 doubt  that man may lead a most active and
 healthy life upon  a  grain diet alone, and
 especially if it be  combined with milk.  But
 what is possible may not always be expe-
 dient,  nor suited  to man's  circumstances,
 and on this hinges the argument respecting
 the  nature of food on which  man ought to
 live.  No  physiologist would dispute,  with
 those who maintain that man ought  to live
 on  vegetables albne, the possibility  of his
 doing  so,  or that many might not be is
 well or better under such u system than any
 other;   but no physician acquainted  with
 the  requirements  and constitutions of men 
FOO
255
FOO
generally, who live according to the usages j
(certainly it may be allowed too artificial) |
—of this  and other civilized countries, will
allow that a vegetable diet could become the
rule to the majority without serious  injury.
The healthy,  active countryman, constantly
exercised in  the open air, will  do well on a
vegetable diet, under which the city artisan
or man of business, the delicate female, the
pale, perhaps scrofulous child, would  be-
come  diseased,  or  sink  and  die.   Their
organs of digestion and assimilation cannot
extract from  the  vegetable mass  sufficient
blood-nourishment, neither  do  they receive
sufficient stimulation from  it.  It may be
contended that the evil is  an artificial one,
engendered by artificial life.   That may or
may  not be  the  case, but  so  the question
stands at present; and, as man generally is
circumstanced at the  present  day,  he  will
best  consult his  own comfort,  convenience,
and usefulness,  by using a mixed diet, the
power to use which has been bestowed upon
him  by his Creator.  He  will, if possible,
consume albuminous material, (animal food,)
in  quantity sufficient  to supply the waste
of  his bodily, especially muscular, tissues;
but will  mingle it  with such respiratory
food, that is, saccharine,  or  starchy,  and
oleaginous substances, as  will supply the
carbon and hydrogen requisite for animal
temperature, without his being compelled to
undergo the  muscular exertion of the half
savage hunter.
   In the  consideration of  the principles
which  ought to regulate  man's food,  and
which  do regulate the nourishment of  his
material  animal body, there has been omit-
ted—for  the  sake of  avoiding confusion—
all notice of an  important and  generally
distributed component of the animal frame,
the gelatinous, or  jelly,  principle.  This,
which  enters mainly into the composition
of  the skin  and tendons, and  which forms
the animal constituent of the bones, belongs
to  none of the principles  already enume-
rated, although it contains nitrogen, and is
much simpler in composition than albumen.
In  the form of  isinglass, gelatine, or glue,
it is familiar to  all.   As  gelatine enters
largely into  the constitution of the  animal
body, it must, of course, be a valuable, if it
is not an essential, addition to its means of
nutriment,  when  taken in  the food,  and
especially as a substitute  for albuminous
nourishment,  which  must, in   its  absence,
be  used up in supplying nutriment to  the
azotized gelatinous tissues.   The only other
constituents of food  it remains to notice are
the mineral elements—salts of iron, potash,
soda,  lime, magnesia, &c, and with them
sulphur and  phosphorus;  these must  be,
and they generally are, afforded to the sys-
tem, along with nutriment generally.
  To  review the principles which regulate
food and nourishment:—We have vegetables
as the first agents for taking up the ele-
mentary forms of matter, and combining and
transforming them into such components as
are suited to the digestive organs  of  the
vegetable-subsisting  animal which consumes
them, and in which  they are built  up into
the blood-filled  animal frame,  of  muscle,
nerve, and bone, ready for the consumption
of the  carnivora, or flesh-eaters,  and  to
yield sustenance  suited to the  wants  of
man.   We have these nutrient principles,
consisting of albuminous compounds, fitted
to nourish  albuminous tissues, gelatinous
to nourish gelatinous, and  saccharine and
farinaceous to supply the matter  of  fuel,
and to take part in all the other operations
of the  system, or to be stored up  as  fat.
Lastly, we have  water, the aqueous prin-
ciple,  as the  necessary  medium  without
which these varied operations  could not be
carried out.
  To apply these principles to man, we find
him so constituted as to be able to maintain
health and life on animal food alone, or on
vegetable food alone; but we also find him
fitted by  organization to subsist on a mixed
diet,  such as is most in accordance with the
habits and usages of all civilized communi-
ties.
  In  the  selection of food, however,  it  is
not sufficient that it contains the principles
necessary for the nutriment  of the body,
but these principles must be reducible by
the  digestive powers. It matters not that
wood fibre nearly approaches starch or gum
in composition, or that horn contains albu-
men largely, if the firm texture is not solu-
ble in the stomach;  and the same argument
modified, applies to  food  generally—forms,
indeed,   that  copsideration  with   respect
to  it  which comes  under the  designation
Diet—that is, the  facility or  the  reverse
with which certain articles used as food are
digested.  To the strong and  healthy, this
is within certain  limits a  matter of com-
parative  indifference; to those who suffer
from  weakened  digestion—and  they are
very  many—it becomes a matter  of para-
mount importance,  as one  on which  com-
fort  and even  life  depends.   The  subject
has engaged a large share of the attention
of  medical  men, and is  too extensive  to be
fully treated here.   The aim of the author,
therefore, is rather to point out  the princi-
ples on which diet should be regulated, than
to descend to special minutiae, and these he 
                 F 0 R

is more willing to omit, from the fact that
these minutiae are  greatly matters of indi-
vidual peculiarity, which vary in each one ;
and which must and ought to be matters of
well-ascertained personal experience.
  Thus, we  find  that  some  stomachs  are
perfectly unable to cope with fatty matters,
but do well with  the acid or saccharine; a
certain class  again  seem quite at ease with
milk, which  throws others into a ferment;
even  mutton, the  most  digestible  of all
meats, has,  in a case within the author's
knowledge, invariably  produced vomiting
when eaten,  however disguised.
  It might  be  expected  that  something
would  be said  as  to the digestibility  of
various articles;  but this is  sufficiently
treated of under their  individual  heads,
and  the tables on  the subject which have
been drawn up are not to be depended upon.
As  a general rule,  food  is  digested  with
more difficulty in proportion to the tena-
ciousness of its structure, whether owing to
natural conformation, or insufficient masti-
cation, or faulty  preparation or cooking.—
See  Boiling,  Roasting,  $c.  Vegetables re-
quire more digesting than animal substances,
but they remain a shorter time in the stomach
itself, undergoing a  great portion of the pro-
cess after they have passed from that organ,
whereas  animal  food  leaves it perfectly
digested.  This is partly the reason why a
meal of animal food satisfies hunger longer
than one composed  of vegetables, but some-
thing is  also due to the position which the
stomach  holds with respect  to  the  system
generally.  If the desire for food is sympa-
thetic with the wants of the  body at large,
the animal food, which better supplies those
wants, must do so for a longer period than
the other.
  Variety in  diet is requisite for health.  A
single  article of nutriment,  even  though
it contain all the  requisite  elements,  can
scarcely be  long used exclusively as food,
without injury to the digestive organs, or
even  danger to  life.   Brown  bread  with
water is perhaps an exception.  For further
information  upon food,  the reader  is re-
ferred to  the various articles in  this work
connected with the subject, the substance of
which could not have been introduced here
without needless repetition and  occupation
of space which cannot be spared.
  FOOT-BATH.—See Bath.
  FORCEI'S—Are instruments used in ob-
stetrical and surgical practice as substitutes
for the hands or fingers,  not only for the
sake of cleanliness, but as being capable of
introduction into positions where the  hands
or fingers cannot go.   A  pair of the  com-
6                F R A

mon  dressing  forceps (see  fig.  lxii., arti-
cle Dressing)  would be  found  useful for
many purposes in domestic management, if
for nothing else  than taking  off plasters,
and it would be well if responsible persons
generally,  who reside at a  distance  from
medical assistance,  were provided with  a
pair of artery spring forceps.   This instru-
ment, which somewhat resembles the other
in shape, is provided with a spring catch
which keeps   its  points  perfectly closed
when required.  In many cases  of wounds
involving  the severance of  an artery, an
unprofessional person  could not perhaps
employ any means for stopping the bleeding
with such probable certainty and ease.
   Refer to Hemorrhage—Artery.
   FORE-ARM.—The lower  arm, between
the elbow  and the hand.  It contains two
bones, the  radius   (fig.  lxxi., 1) and the
Fig. lxxi.
ulna, (2.)   These are articulated or jointed
at their upper extremity (3)  to the single
bone of the arm ; and at their lower extremi-
ties to the small bones of the wrist.  The
bones of the fore-arm are very often broken,
and in  children are often bent by accident,
without fracture.
  Refer to Fracture.
  FOWL.—See Poultry.
  FOX-GLOVE.—See Digitalis.
  FRACTURES op  the Bones—Are acci-
dents which, from their nature, can only be
treated with certain efficiency and success
by the  educated surgeon ; but on the other
hand, from  their frequent occurrence, par-
ticularly  in situations where no   surgical
assistance can be  readily  procured, it ie
highly desirable that unprofessional persona
•25 
FR A'
257
FR A
 should be able to manage  them  in some-
 thing like an intelligent manner.
   The existence of a fracture is, in some si-
 tuations,  made  out with  difficulty, even by
 the skilful.   This is particularly the case in
 the vicinity  of joints, such as the  ankle,
 hip, shoulder, &c; but in others, as in the
 middle of the  long  bones,  such  as those
 of the leg, thigh,  forearm or arm, the  fact
,is often  too obvious  to  be overlooked by
 the most careless.  The general symptoms
 of a fracture having occurred, are pain and
 loss of power over the  injured  limb, which
 is altered in  shape or crooked, and probably
 swollen  and  shortened.    Its  lower  ex-
 tremity hangs  loosely, and is  more mov-
 able  than  it  ought to  be,  motion being
 generally accompanied with a sensation of
 grating, perceptible both  to the  sufferer and
 to the person  handling  the  limb.   The
 broken  ends—generally  the upper one—
 probably project  against the  skin, or,  it
 may be,  protrude entirely  through it, con-
 stituting a compound  fracture.  Much of
 the  displacement  of  the  fractured ends of
 a bone is due  to  the  contraction of some
 of the muscles of  the limb, which are, from
 the  nature  of the injury,  freed  from the
 controlling counter-action of other muscles.
 This fact it is important to remember in the
 treatment, during  which,  when it  can  be
 done without  sacrificing to too great an ex-
 tent other essential points, the injured limb
 should be placed in a position which allows
 the muscles generally to be in a relaxed con-
 dition.   In  addition to these local signs, a
 person who has suffered  from severe frac-
 ture is generally  faint and depressed for
 some time after.
   In many cases of fractured bones, how-
 ever, the symptoms are far from  being so
 plainly marked as described above.
   The  fracture of a  bone is, of course, in
 itself,  a severe injury; but it  is rendered
 infinitely more so, by the  wounding  and
 tearing of the soft parts of the limb by the
 generally ragged  ends of the bone.  This,
 therefore, it is desirable to prevent, as much
 as possible,  both  in  removing  the sufferer
 and afterward.
   It being ascertained that a fracture has
 occurred, if  surgical assistance is not im-
 mediately at  hand,  the  removal  of  the
 sufferer will  probably be  requisite.   If the
 upper  extremity be  the  part  involved,  it
 should  in the mean time  be well supported
 by a sling, and  the sufferer will find walk-
 ing a much easier  and less painful  mode of
 locomotion than any  other.   Much  injury
 and  suffering   are  often  inflicted upon
 persons  who  have fractured a lower ex-
     w 2                                1
tremity, by hasty and injudicious manage-
ment in the removal; the lower end of the
limb  being left entirely unsupported, or at
best carried  by some of those around, thus
causing  great pain, increasing the wound-
ing of  the soft  parts  within, or, it  may
be, occasioning the protrusion of the bone
through the skin; and thus, especially if the
last should occur,  diminishing greatly  the
chances of a good recovery.  A person who
has fractured the leg, if he be not already
lying on  the  ground, should  be  placed
there till a shutter, a door, or flat board of
some kind can be procured ; this  should  be
placed  alongside, covered of course with
coats or the like,  and the sufferer gently
slid, rather than  lifted, upon it.  On this he
is to be hand-carried, even if the distance is
considerable, as preferable either to cart or
carriage  conveyance.   Before  lifting him,
however,   the  fractured  limb  should   be
secured  from motion as much as possible,
either by  tying  it  to  the sound one  by
means of  handkerchiefs, or  by   straw  or
other material placed  about it.   In  the
mean while, a firm bed  should be  prepared
for the patient;  a mattrass is most suitable,
if procurable—if not,  a board of  sufficient
length, passed  under the ordinary bed, will
do:  the object of  this is to prevent  the
sinking   which  inevitably occurs  from  a
person lying long  in  one  place  in bed,  a
circumstance which interferes much both
with comfort and treatment.
   The object in view in the treatment of a
fractured bone  is  to  preserve the broken
ends in  contact, in their proper relative po-
sitions, as steadily and as exactly as possible,
so that the curative and consolidating pro-
cess may proceed without disturbance; and
that when this is complete, the symmetry of
the limb may be unaltered.   In giving direc-
tions  as to  the management of fractured
bones by unprofessional persons, the author
feels  how  difficult  the  task   of  conveying
the information is to himself, and how much
more  difficult it must be to  those  unaccus-
tomed to deal with  such matters,  to treat
them  at all satisfactorily from a written de-
scription.  At the same time cases do occur,
in which the choice lies only between perfect
ignorance and some amount of information of
the methods to be adopted.  For such cases
this article  is written;  for  certainly  no
sufferer from fracture, in his senses, would
submit  to, nor any unprofessional  person
undertake  the  treatment, if skilled assist-
ance was in any way  procurable.  In  ad-
dition, the  author would  strongly advise
any who are likely, in their course  through
life, to be thrown much in out-of-the-way 
FR A
258
•" F It A
circumstances, and  who would wish to be
u*eful, to see for themselves  in some hospi-
tal the mode of putting up fractured bones.
A few hours,  even,  of observation,  would
teach them more than all written descrip-
tions, though these might afterward refresh
the memory.
  Eitlier  after   or  before  the  patient  is
placed in  bed, the clothes must be removed,
cut  off the injured limb; of course by the
seams if possible. The proper applications
must  meanwhile be got ready as  quickly as
may  be.   These  are  splints, such as are
recommended  in  each particular  form of
accident, with their cushions and bandages.
—See Bandage.   Some  surgeons  delay the
application of the splints for some days, till
the swelling, which  always occurs more or
less after  fracture, has subsided,  and some
cases may occur in which this is  desirable ;
but the majority of  practitioners put the
splints on  as soon as  possible after the acci-
dent, and this is certainly  the  preferable
practice.   There almost  always exists  a
tendency  to  spasmodic starting  of a limb
which has been  fractured, for  some  time
after  the accident, and this constantly tends
to  displace the bones, and to increase the
laceration  and swelling of the soft parts;
this may in great measure  be  prevented by
the early steadying  of the whole limb  by
the splint,  which, however,  need not  be
bound tightly, and may be so applied as to
be loosened at once if  requisite.*
  A splint is simply an agent which can be
bound to  a fractured  limb, and  which  will
keep  it in the straight position;  it may,
therefore, be made of wood, iron, leather,
or even straw.   The  variety of splints  is
very great, but as this article is written for
use in situations where only the simplest
means are supposed to be  at hand, the sim-
plest  modes of management only will be ad-
verted to.  Moreover, fractures  may  be
treated without  splints, properly so called,
as by starch bandages or the like, or by po-
sition simply.   As the continued  contact of
hard  splints would occasion pain, they are
usually cushioned or padded.  This may be
effected by any  soft  material,  care being
taken that the padding projects everywhere
beyond the edges of the splint, to which  it
may,  if convenient,  be attached by  tapes,
(fig.  lxxiii.)
   Lastly,  all things being  arranged, the
Betting of the  fracture  remains to be  ef-
fected.  This, which is always painful, con-
  * The elastic split cushions of M. Bourjeaurd en-
tirely obviate this objection.  These are made of vul-
canized India rubber, and are inflated with air, which
can be increased or diminished, as required.
Fig. lxxii.
sists in bringing the broken ends into con-
tact, as much as possible in their proper re-
lative  position.   In  some  few cases,  as in
the leg, it may happen that although  there
is  fracture, there is no displacement;  but
in  the majority of instances the broken ends
overlap one  another,  being drawn  by the
action  of the muscles ; the main requisite,
therefore, in the reduction of a fracture, is,
by gentle but steady drawing down of the
lower  extremity of  the  limb—while the
upper is fixed—to bring the ends to  a level,
and, if possible,  place them one against the
other.   In the drawing down, however, the
hand should not grasp the extremity of the
fractured bone, but should be applied below
the joint.   Thus,  in setting  a fractured
thigh,  the surgeon grasps  the leg,  not the
lower part of the thigh, &c.  After a frac-
ture has once been set, it should never, if
possible, be  disturbed again.   This  does
not mean that the  appliances are not to be
removed, and the progress of  the  case in-
spected ; for if this be not done, and if  by
any chance the proper position should have
been disturbed, the bones  may become so-
lidly fixed  in  an  improper manner, and
deformity result, or  the  skin  may become
ulcerated.  But the appliances should not
be removed, if possible, before the  end  of
the first week, and if all seems going  on
well, not moved  again for ten days at least,
unless  for some special purpose.  If  a frac-
ture is often disturbed  or pulled  about
during the  process of consolidation, it may
chance that  this will only  be  effected im-
perfectly, and what is called a false  joint
formed ; that is, the broken part, instead of
being firm, moves like a joint, and the limb
is  useless.    It had  better be crooked  or
shortened.
   Lastly,  much  care is  always required
that a  limb which has been fractured is not
used too soon after the accident; otherwise
it  may be either snapped  again, or it may
be  bent.   The  first  advance  toward  the
cure of a broken bone is  the throwing out
of a jelly-like matter around the ends; this 
FR A
259
FR A
gradually becomes more solid, and, at last,
is converted  into a thick ring of bone ;  but
for  this  latter change the lapse of some
months is  requisite.   Although,  therefore,
the uniting material, or "callus,"  as it is
called, may be strong enough for ordinary
purposes a considerable time before  ossifi-
cation has been  effected,  it will not bear
extraordinary efforts.
  With respect to  the  general treatment of
a person who has suffered  from fracture, it
is  always  advisable  that for  some little
time after the accident the diet should be
lowered, but that  when the inflammatory
stage is passed, the individual should return
as  much as possible  to his  ordinary food.
Care  must be taken, if the person has been
accustomed  to much alcoholic stimulant,
that it is not unduly  abstracted, otherwise
the powers  of the constitution will  be so
reduced  that the  reparative process  can-
not  take  place, and the  fracture  will re-
main ununited.   In fractures of the  lower
limbs, the use of  a bed-pan and  urinal of
some  kind will be required, and  attention
must be given to  the back, that it  does not
get sore.  An elastic horse-shoe cushion  (see
Elastic) will  be a great  comfort  in such
cases.
  Fractures of the  skull  have been already
alluded to under the article Brain.
  Fracture of the  lower jaw is generally to-
lerably evident.  The simplest treatment is
that recommended by Professor  Fergusson.
Two narrow  wedges of cork, about an  inch
and a half long, a  quarter thick at the base,
and sloping away  to a point, are placed be-
tween the  teeth, one on each side; a piece
of pasteboard softened in warm water, or of
gutta-percha, is then to be moulded round the
jaw, and fixed, either by a  bandage or hand-
kerchief going over the crown of the head.
By this method, space is  left between the
front teeth for the administration of liquid
nourishment.   The sufferer should rinse the
mouth frequently with  tincture of  myrrh
and water.
  Fracture of the bones of the spine is  a  rare
accident.   It may be suspected, when, after
injury to  the  spine, loss of sensation in, or
of power over the part, ensues  below the
site of the accident.  In such a case, nothing
could be done by unprofessional persons be-
yond  placing the  sufferer  in as easy a po-
sition as possible.
  Fracture of the ribs is known by the pain
which is  felt at the injured spot in  every
motion  of the body, even  by breathing.
The sufferer feels a grating sensation, which
may be felt by another  person  laying the
hand  on the place.  The chief risk involved
in fractured ribs is from injury to the lungs
by the sharp ends of the bone ;  and when
this occurs,  it is apt to give  rise to inflam-
mation, which will require the usual treat
ment of this affection,  from whatever cause
arising.   On  this  account,  an individual
who has suffered from fractured ribs should
be especially careful,  and for some little
time after the accident should reduce  his
usual diet considerably.   The application
of the hot bran bag for some days after the
accident will afford much relief, and it may
be used over the usual  bandage.  When ribs
on both sides of the chest are injured, this,
with leeches if requisite, should be the sole
application; the  patient being confined to
bed for at least a fortnight or three weeks,
in the posture found to be the easiest, which
will  probably  be a half-sitting  one,  sup-
ported  by pillows, or some other means.
— See Bed.   When  the ribs  on one side ■
only  are  injured, less confinement is re-
quired, but  the  chest  should be encircled,
as firmly as can be borne comfortably, with
a band of  stout calico, from eight to ten
inches wide, and double;  this should  go
once  and  a half round, and be sewed.  A
month will  probably  be  required for the
cure.
  Fracture  of the collar-bone is a frequent
accident, usually from falls on the shoulder.
It is generally easily detected.  As the use
of the collar-bone is   to keep the shoulder
back,—the shoulder of the injured side falls
forward when  it is  broken, pushing  the
broken ends over one  another.  The object
of treatment,  therefore, must  be to keep
back the shoulder by artificial means, until
the bone  has  recovered its solidity.   This
might be done by keeping a person confined
to bed, and in  such   a position  that  the
weight of  the shoulder  falling  backward
would pull  the bone  into position  without
any other means being used ;  few persons,
however,  will  submit  to the  confinement
necessary, and other methods are resorted
to; they are varied, but that recommended
by the late Mr. Liston will most easily, and
with best prospects of success, be  adopted
by  the unprofessional.   A  wedge-shaped
pad, of any  firm material—(a pair of stock-
ings folded  will do)—is to be enveloped in
the middle of a soft shawl or handkerchief
of suitable  size.   The pad  is then to  be
placed in  the arm-pit of the  injured side,
(fig. lxxiii. 1;) the  ends of the shawl must
next be crossed over the opposite shoulder,
(2,) and tied in the arm-pit, as represented,
a folded cloth of some kind being interposed
to prevent the chafing of the skin.  Another
handkerchief or band  of some  kind is next 
260
to be applied (3)  so as to bind  the  arm
down to the side in such a manner that the
pad  in the  arm-pit  acts as  a fulcrum, or
gives such a "purchase" as allows the outer
end of the  broken collar-bone to be  pulled
outward, as the arm is bound to the side ;
a  sling enveloping  the whole forearm  is
next to be applied, and completes the appa-
ratus, which should be worn for a month at
least.  If carefully attended to, this appa-
ratus will   prove  very  effectual,  and  the
means for  it can always be  procured.   It
should be understood that the  principle of
the treatment is extending the broken bone
by means of the pad in the  arm-pit.  It  is
sometimes  requisite  to  apply a  bandage
from the fingers upward to prevent swelling.
  Fractures and other  injuries about the
shoulder-joint are often so obscure that no
uneducated person could distinguish them.
The best management until surgical assist-
ance  can  be procured,  if it  is far distant,
will be perfect rest.  Probably much com-
fort may be derived from the use of the pad
in the arm-pit, as recommended for broken
collar-bone, and also of a sling supporting
the forearm, wholly  or only at the wrist, as
may be most easy to the patient.   The con-
fining band (fig. lxxiii. 3) must not, how-
ever,  be used.
  In fracture of the  shaft of the arm-bone it
is better to  put the whole  limb in  a sling
at once, and if the person has  to go to the
surgeon, he will find it easier  to walk  than
to ride in any conveyance.   Confinement  to
bed will be requisite for some days at least
after the accident.   The injured limb being
laid in an  easy position  on a pillow, if there
is much swelling,  it mast be lightly band-
aged  from  the fingers to the shoulder, and
a couple of splints  of wood or other firm
material, two and a half inches wide, ap-
plied one on each  side of  the limb (fig.
Ixxiv. 1) and secured  with  jiust  sufficient
firmness to prevent movement, by means  of
two or three looped  bandages.  This band-
age (fig. lxxv.) is made by taking a doubled
length, sufficient for the purpose required,
of the common roller bandage; one end, or
" tail," of the bandage (1) is passed through
Fig. lxxv.
the looped extremity, (2,)  and may then be
tied  to  the  other  tail,  (3.)  This form of
bandage has the great advantage of being
easily loosened, if  requisite, on account of
swelling.  After the first few days, when the
swelling has subsided,  the fracture of the
arm  may be put up more firmly and perma-
nently.   After  bandaging  the  limb  tole-
rably firm,  a  splint of pasteboard or of
gutta-percha,  or leather, or indeed of any
firm  material, is to be put on each  side of the
limb, (fig. Ixxiv.)  These ought, however, to
be shaped as represented by the dotted line
2, to come  a little way  along  the  fore-
arm, and, having been previously  shaped on
the sound arm, instead of the looped band-
age, should  be well fixed  by means of the
common roller, which  may be  kept from
slipping by  the addition of starch or paste
as it is  put on.   Instead of the Bplints, how-
ever, the starch bandage alone, if the  indi-
vidual is not very muscular, may be  used.
But  in this case, both the  inner  and  outer
bandage must be well saturated with strong
starch,  flour paste, or gum, or white of egg,
and  it is well to make the addition of strips
of stout paper, pasted down over the inner
bandage, and covered by the outer one, to
give additional firmness.   In this case, it 
                FR A

will be requisite to keep the arm very quiet
till the paste has dried, or a wooden splint
may be tied outside  the bandages till  this
has taken place.    A sling will be requisite
to support the hand  and wrist, but not the
elbow,  which should be allowed to hang, the
weight tending to keep the bones straight.
   Fracture of the forearm is a  very com-
mon accident.  In children  the  bones are
most frequently  partly  broken and partly
bent.  In adults both bones or one only may
be broken; in the latter case,  the  sound
bone acts  as a splint  to hold the other in
place,  and, should the accident be detected,
a perfectly straight  splint of light wood,
applied to the inside of the arm, and ex-
tending from the elbow to the tips  of the
fingers, fixed by  a common  roller,  or  by
some  looped bandages, is  all  that is re-
quired ;  and, indeed, when both  bones are
broken,  the  same treatment  will be  suf-
ficient, though some apply a  splint on each
side.  After  the  lapse  of  a  fortnight, in
adults, the  splints may be taken off, and a
starch bandage used ; but in children  who
are liable to falls it is  better  to give them
the  protection of the wood for  some time
longer.   In  fracture of  the forearm,  the
sling ought to give support from the elbow
to  the ends of the fingers,  and the limb
must,  of course, be kept  bent at the elbow
during the period  of cure.
   Fracture of the fingers is  treated by a
narrow,  straight  wood-splint, or  by  the
starch bandage.
   Treatment of a fracture of the lower ex-
tremity by an unprofessional person must
be a most unfortunate contingency; but the
simpler  the  means used, the more  likely
will its management be conducted with some
efficiency.
   In a case of fracture of the thigh, the re-
moval  and preparation of the sufferer having
been effected as already pointed out, the fol-
lowing apparatus  is  such as an unprofes-
sional  person might, with a little care,  ma-
nage efficiently; and  the materials for its
construction can scarcely ever fail to be pro-
curable.  Three pieces of wood,  about three-
eighths of  an inch in  thickness, will  be
required,  the measurement  as  to length
being made on the sound extremity.   One
of the pieces must be sufficiently broad to
extend  completely under  the  limb,  and
sufficiently long to extend from  just above
the middle of the  thigh  (fig.  lxxvi., Ixxvii.,
1,1) below the calf of the leg, being edged
off at either end.   The next piece, (2, 2,) to
be fixed on the outer side of the under one,
should  extend from just  above  the  hip to  a
little beyond the foot, and must be pierced
FR A
Fig. lxxvi.
Fig. Ixxvii.
with two holes  at  the  upper end.  The re-
maining piece  (fig. lxxvi. 3) should  extena
from about two-thirds up the thigh to a little
beyond the foot,  being  fixed to the inner
side of the under piece, and connected with
the outer piece at  the  lower end (fig. lxxvi.
4).  A slanting support for the sole of the
foot, and about the  same width, should also be
fitted in, so that it will admit of the limb being
extended to quite its full length, this being
ascertained by measurement of  the  sound
leg.   The middle of the apparatus forms a
kind of box.  A soft handkerchief padded
must now be placed between the thighs,(fig.
Ixxvii. 6, 6.)   At  this  stage the limb must
be set.  One person should hold the body of
the sufferer firmly at the hips, while another,
grasping the leg just above the ankle, by a
gentle and steady pull, straightens the in-
jured limb to the same length as the sound
one ;  the broken  ends of the bone being
by this means  brought into  contact.  The
apparatus   having  been previously  well
padded with any soft  material, (even chaff
or dried leaves will do,) the  broken limb,
still kept on the stretch, should  be  gently
placed in it. The foot must then be secured
to the padded foot-board  by means of  a
bandage or handkerchief, (fig. Ixxvii. 7,) the
heel being also well supported  by the same
or some similar application.  The heel may
be still further supported by means of a
double tape sewed  to the toe of a sock, pre-
viously put upon the foot; the  tape being
carried over the top of the foot-board, and
tied  to a  nail  or peg fixed  to  the  back.
The  ends of  the   band  (6, 6)  passed be-
tween the thighs are to be passed through
the holes in the upper  part of piece  No. 2,
and  tied  with  sufficient firmness to keep
the limb on the stretch.  This is the essen-
tial part of the treatment—the foot bound to
the foot-board, and the  band tied through
the holes in the upper part of piece 2, act
against one another, and keep the limb ex-
tended.  The  upper end of 2  must next
be secured by a band (8) passed round the
2( 
FR A
262
F R A
body, and  the fixing  of the npparatus is
complete.   It will be well, however, to fill up
all the interstices between it and the limb,
by means of some soft material stuffed in,
and when  this is done, as a further means
of security, to fix one  or  two bandages or
handkerchiefs (10,  10) round both  the  ap-
paratus and limb.
  The above  contrivance is a  modification
of the one most used  by  surgeons for  the
treatment of fractured thigh, but requires
much less bandaging, and is, for this reason,
preferable.  In the  usual form of long thigh
splints,  the entire efficiency of the arrange-
ments depends upon the application of the
bandage, and no unprofessional person is
likely to put it on properly.  The apparatus
may be  used for fractures of the upper part
of the leg, as well as for the thigh. Another
simple mode  of  treating  fractures  of  the
lower part of the thigh, or upper part of
the leg, is  by means of two pieces of wood
similar  to  No. J, fig.  lxxvi.,  but  shorter,
and a large cloth, such as a table-cloth, in
each side of which one of the pieces is to be
folded up, until there  is just  space left to
contain the  limb,  which  being  set,  and
placed  in the space so left, the  boards  are
to be tied up to it on each side by means of
handkerchiefs, or stout tapes.   Again, the
sound limb may be made to act as a splint
to the broken one.   Pads  of some soft  ma-
terial  should be placed between  the most
prominent points of each, such as the knees,
ankles,  great toes, &c.; and padded bands,
two or three  yards long,  are  to be wound
round the legs as they are  placed  together,
just above the ankle, and just below  the
knees.  Or the broken thigh may be laid on
a pillow, on its outer side, in the easiest po-
sition for the patient.
   Under the  former of the two last-men-
tioned  modes of treatment, a short splint,
extending the length of the thigh, of wood,
tree-bark, or  any other firm material,  may
be applied on the outer side, and will  give
additional  support.  Under  the last-men-
tioned,  such  a short splint may be used on
each side.
   In fractures of the  leg, particularly of
the lower portion of it, a different apparatus
must be used, although  in  many respects
the  mode of management  as regards pad-
ding, &c. &c. is the  same.   In setting the
limb, however, the thigh  must  be  grasped
by one  person, and the foot by  the other.
The easiest  position for  the  limb  will be
with the knee bent,  (figs. Ixxviii. Ixxix.,) and
either of the contrivances  figured  may be
easily constructed  of any  common wood.
The upper one (Ixxviii.) is merely a board
Fig. Ixxviii.
Fig. Ixxix.
 .dapted to the size  of the limb, with  side-
pieces (1) and foot-board (2) fastened to it,
and slung by ropes from the corners, so that
it can be suspended, as represented,  from a
rafter or any other convenient support.  This
is a very easy kind of  apparatus, especially
on board ship.  The other apparatus (Ixxix.)
is  also to be constructed  from  boards, as
represented, with side-board and foot-board,
(1  and 2.)   In both these, it will be an ad-
vantage to scoop out a hollow for the  heel,
and  pad  it  as well  as   the  whole  con-
trivance, with soft materials.  Reference to
the foregoing portions of this  article, es-
pecially that  on  fractured  thigh, will suf-
ficiently  explain  the  general management
of these cases.
  To recapitulate :  the first removal of a
patient who has suffered a fracture should
always be conducted with the care enjoined
in the first part of this article.   The bed for
a  patient suffering  from fracture must al-
ways be a firm one.   The adjustment and
"putting up" of a fracture should be ef-
fected  as quickly after the accident as may
be, allowance being made for swelling—and
if this becomes extreme, loosening of the
apparatus resorted to. In setting, the bopea
above and below the injured one. not th* in-
jured one itself, are to be grasped; parts,
such as the heel, &c. are  to be  relieved as
much as possible from the effects of the con-
tinued pressure which they must necessarily
undergo  during  the  treatment.   It  must
always be borne in mind, that whatever ap-
pliances are used  in the treatment of frac-
tures, they are all but different means to the
one end—that of keeping  the  broken ex-
tremities of  the  bone in  continued steady
contact, with as much ea?e to the patient ax
possible; that when  this  has been done for
three  or four weeks, lighter applications 
                 FRE

than  those used at first may be employed,
such as the starch bandage, &c.
  In  conclusion, the  foregoing article will
be of small  benefit to those dwelling in the
niidst  of civilization;  but its hints  (and
our space admits of but little more) may
prove  invaluable to those dwelling,  or who
may be  destined to dwell, in a thinly-peo-
pled country, or in such situations as  on
board  ship,  in  which  fractures are  far
from being uncommon accidents. Even if
proper assistance be ultimately procurable,
the intelligent management  of a case for
the first few  days may be of the highest
importance ;  and if it should happen, that
throughout,  it has been left  to unprofes-
sional management alone,  even should  a
limb somewhat deficient in symmetry be the
result, its cure is not  likely to be more
tardy or less painful,  because those  around
are not  in total  ignorance of  how it ought
to be conducted.
   Compound  fractures are  those in which
there  is a wound through  the  skin,  per-
mitting  access of the external  air  to the
seat of the fracture.   The contingency is a
truly serious one  to be without the  assist-
ance  of a surgeon.   Sometimes the  bone
protrudes considerably  through  the skin,
and its  end  requires  to be sawn off before
it can be returned to its  proper position.
The great object  is  to heal  the external
wound as quickly as possible;  and probably
as  good a plaster as any will  be a piece of
linen soaked  in the blood, [or in white of
egg] and when this is separated by the dis-
charge, the simple water dressing.
  FRECKLES — The   well-known  brown
spots on the  skin, are most frequent upon
those  parts   exposed  to the  influence  of
light,  such  as the face, neck, hands, &c,
and in  persons of fair complexion, espe
cially with red hair.   Water, weakly acidi-
fied  with lemon-juice, is sometimes useful
as a  wash.   Mr. Erasmus  Wilson  recom-
mends the liniment of lime-water and oil,
with the addition of a little ammonia.
  FRICTION—Or rubbing a portion of the
body,  either   with the hand or  with some
interposed material, is of much importance
as a curative  agent.   Applied to the skin
by means of rough towels, hair-gloves, &c.
it excites its nervous sensibility, and the
circulation of blood  through  its capillary
vessels.  Friction with the hand in thicken-
ings and  congestion  of parts  beneath  the
skin is often  of much service,  and in none
is its  beneficial effect more obvious than
where  the  breasts are painfully distended
with milk  after  childbirth.    The various
oils, &c. used along with friction are gene-
13               FUR

rally secondary in their effects to the me-
chanical effect, and  are chiefly serviceable
in facilitating  the movement of the hand:
some,  however, are really beneficial—the
stimulant applications  by exciting, and the
anodyne by soothing. Moreover, some,  such
as codliver-oil,  turpentine, &c. appear to ex-
ert a specific effect.—Refer to Liniment, §c.
  FRIGHT.—See Fear.
  FROST.—See Cold.
  FRUITS.—See the individual articles up-
on the various fruits.
  FRYING—Is a mode of cookery very ill-
adapted for persons of weak  digestion.
  FUMIGATION.—See Contagion,  Disin-
FECTANTS & C
  FUNCTIONAL  DISORDER.—See  Dis-
ease.
  FUNGI.—See Mushrooms.
  FUNIS.—The navel-cord.
  FUR—As an article of dress, maybe either
extremely beneficial  or the reverse, accord-
ing  to the manner in which it  is used.
When  worn over other clothing in  the  open
air,  or as a regular fixed article of clothing
in itself,  the bad  conducting power of fur
renders it  one of the  most  efficient  pro-
tectors against cold, or rather preservers
of heat, we possess; but when it is used  as
an occasional article of dress,  it is a danger-
ous  one, and has  proved so  in the various
forms in which it has been worn by females.
When  kept close  to the skin—as  of the
neck or throat—for  any length of time, it
produces  excited action and perspiration,
which   is liable  to  be  suddenly  checked
the  moment the boa or victorine is thrown
back, and cold  and sore-throat are the  con-
sequences.  Very  many cases  of this  kind
occur;  and, the cause being unsuspected, is
repeated  again and again with the same
effect,   laying  the  foundation perhaps  of
serious disease by the  improper use of the
very means employed  to guard against  it.
Many  females liable  to cold and sore-throat
have been surprised to find how that liability
has vanished with the laying aside of the use
of fur  round the throat.  The change must,
however, be made at first with caution.  It
is not,  however, the fur which is  at fault,
but  the uncertain mode of using it.  More-
over, its power of exciting the skin renders
it a  valuable'agent when worn permanently
next it, particularly  upon the chest in  win-
ter,  by persons with  delicate  lungs.  It not
only protects from cold but  keeps up  mild
counter-irritation.   A  prepared  hare  or
rabbit-skin, lined,  makes  as  good a fur
chest-protector as any  other.
  Refer to Clothing, §c.
  FURUNCLE.—A boil—See Boil.
2( 
GAL
264
G A  L
  GALBANUM—One of the  gum resins, is
procured from  an umbelliferous  plant, and
is  brought chiefly from Persia and  India.
It  is stimulant and  carminative, but is not
much employed in medicine at present.  Its
best preparations  are the  plaster, which is
stimulating, and  the compound galbanum-
pill—dose, ten grains twice a day in nervous
affections, flatulence, &c.
  GALL.—The bile.
  GALL-BLADDER—The receptacle for the
bile, is situated beneath the right lobe of
the liver, almost  exactly at the boundary
line between the epigastric and right hypo-
chondriac region.—See Abdomen.  It is pear-
Bhaped, (fig. lxxx. 1;) from its smaller end
Fig. lxxx.
proceeds a duct, (2,) which shortly joins a
similar duct from  the liver, (3,) the two to-
gether forming the common bile duct, (7,)
which  enters  the  duodenum (4) in its de-
scending portion;  [5 and  6 are arteries.]
During its retention in the  gall-bladder, the
bile becomes thicker from the absorption of
part of its water.
  GALL-STON1 S—Are concretions formed
from the peculiar crystalline ingredient of
the bile—the cholesterine.  The concretions
are of every variety in point of size, up to
that of a walnut; when small, the number,
either passed by  the patient or found in the
gall-bladder after death, is often very great.
These concretions may, and often  do, exist
in the gall-bladder, without giving rise to
any  unpleasant  symptoms,  their  presence
only being discovered on  examination after
death.  But should one of them, from any
cause, pass into  the  duct,  it gives rise  to
most violent spasmodic  puin,  which con-
tinues with  little  intermission  until the
stone has descended into the bowel through
the ducts.
  The ordinary calibre  of  the gall-duct is
about that of a goose-quill,  and  the stone is
generally of much  larger size;  the opera-
tion, therefore, is often a protracted one.
  Symptoms of gall-stone often supervene
suddenly.  The person  is  seized with the
most agonizing pain  in  the region of the
gall-gladder; probably, there is severe shi-
vering and vomiting,  and these  do not dis-
appear until the  stone has passed.   There
may or may not be jaundice—probably not,
as long as the obstruction does not pass into
the common duct (2) and so stop the flow of
bile  from the  liver,   ft' jaundice comes on,
the  evacuations  from  the  bowels become
white and chalky in appearance.  The fact
of there  being no fever  present,  and that
the pain caused  by a  passing gall-stone is
relieved,  instead of aggravated, by pressure,
is sufficiently indicative of  the  absence  of
inflammation.   After  the occurrence of the
above symptoms, it  is always  proper  to
examine  the evacuations from the bowels,
to verify the disease by finding the cause.
Gall-stones  are easily detected  in the eva-
cuations, as they float upon water.
  When  an individual  is  suddenly seized
with symptoms of gall-stone, no time should
be lost before making hot applications over
the seat of the pain, or getting the sufferer
into a warm bath. Opium ought to be given
at once;  the first preparation at hand-
probably  laudanum—in full and repeated
doses.  If  laudanum is used, thirty drops
may  be  given  immediately, and  the  dose
repeated, by twenty drops at a  time, every
half-hour,  or  oftener,  till  the  unbearable
pain  is suhdued.   As  the retching is  often
severe, and liquids of every kind are vomit-
ed as soon as taken, pills of solid opium-
one  grain  each—are  more likely to be re-
tained, and are, therefore, preferable ;  they
may not, however, be at  hand in  an unex-
pected attack.   Persons  who are liable to
repeated attacks of gall-stone should  keej)
these pills beside them.   There is generally 
GAL               265               G A  R
 much  distressing acidity of stomach  while
 a gall-stone  is  passing,  and  Dr.  Prout's
 plan of giving full and frequently-repeated
 draughts of hot water,  containing  in each
 pint a full teaspoonful of carbonate of soda,
 affords much relief, whether vomited or not.
 Of course laudanum may be added to the
 soda solution if requisite.  If the stomach will
 not  retain the remedies, the opium must be
 administered by a clyster: as a pint or more
 of gruel, with forty drops of laudanum, re-
 peated if requisite.  Mustard-plasters over
 the  seat of the pain may be useful,  but are
 much  inferior as an application to the hot
 bran-poultice, on the surface of which lau-
 danum may be sprinkled.
   The  suddenness  of  an attack  of  gall-
 stone  nnd  the agony of the pain, render it
 one of the diseases in which unprofessional
 persons may afford most valuable assistance
 by judicious management; and, by follow-
 ing the above directions, they Will certainly
 give relief,  perhaps from  many hours of
 suffering,  if  medical assistance is  distant.
 A person who has  once suffered from gall-
 stone,  ought, of course,  to  be examined
 medically.
   Refer to  Bile, Sfc.
   GALLS, or Gall-nuts—Are excrescences
 produced  upon  the  twigs of a species of
 shrubby oak, by the prick of an insect for
 the  purpose of depositing its eggs.   They
 are  brought from the shores  of the Levant
 and from  Asia.  Galls are powerfully astrin-
 gent,  owing  to  the tannin or astringent
 principle  they contain, which, in its sepa-
 rated  form, is now largely used in  medical
 practice.   Gall ointment is a useful appli-
 cation  in  piles,  in persons of relaxed or
 enfeebled constitution, but  is quite  the re-
 verse  in those of full habit, in whom the
 piles are  in a state  of active  inflammation.
 The best  form  of  ointment  is: Galls, in
 very fine  powder, two drachms  ; Opium, in
 powder, one drachm; Lard, one ounce ; well
 rubbed up together.   The infusion of galls is
 the  best  antidote to poisoning  by  tartrate
 of antimony.
   GALVANISM.—See Electricity.
   GAMBOGE—See Cambooe.
   GAME.—Wild animals  used as food, the
 flesh of which is for the most  part easily
 digestible, and suited to  many persons on
 account of  the less proportion  of fatty or
 oily substance which it contains.  Of  course,
 game,  like  other articles of food,  may be
rendered  hurtful by sauces  and modes of
dressing.
  GANGLION—In  anatomy, means  an ag-
gregation  of nerve substance.   In surgery,
it  is applied to  the  elastic swellings which |
 appear upon  the  wrist or top of the foot,
 generally about  the size of a  hazel-nut.
 These may often  be removed by  bursting
 the  small  bag or cyst of which they con-
 sist, and thus effusing the contents—which
 resemble the  white  of  egg—into the sur-
 rounding  parts, a bandage  being applied
 afterward.  The case is  best submitted to
 the surgeon.
   GANGRENE.—See Mortification.
   GAPING, or Yawning—Is  a  nervous af-
 fection, indicative of nervous exhaustion and
 depression of the circulation.  Persons in
 health are,  as is well known, liable to gape
 when tired; like other nervous affections, it
 is apt to give  rise  to imitation in others.
   Gaping  is, however,  a not  unfrequent
 symptom  of disease—functional or organic
 —particularly of  the chest.   Attacks  of
 hysteria accompanied with fainting, or  of
 spasmodic  asthma with depression of the
 action of the heart,  are often ushered in by
 gaping.  Persons who suffer from disease of
 the heart are also  liable to "fits of gaping."
   GARGLES—Are liquid applications to the
 throat and upper part of the gullet, &c. used
 in affections of these parts.  Gargles  are
 too often  used as  astringents, particularly
 in the first stage of inflammation of  the
 tonsils. &c. or sore-throat.  In these cases,
 the warm water or gruel gargle is  a much
 better remedy, with  the addition of a small
 quantity of vinegar.   The common domestic
 gargle of " sage-tea and  vinegar"  answers
 very well.   As a general  rule, in the first
 stages of  "sore-throat," it is better to use
 the simple soothing gargles, nearly as warm
 as can be borne;  in  the latter stages, when
 there is often much  stringy phlegm  about
 the throat, the more  stimulating  and astrin-
 gent gargles will be useful.  For  the latter,
 from four to five drops of muriatic acid  in
 the ounce of  water  is as  good  a  form as
 any ;  or  the infusion of roses, with ten  to
 fifteen drops of dilute sulphuric  acid to the
 ounce.  Another  very  useful  gargle,  in
 cases of relaxed sore-throat, is made with a
 drachm of alum, half an ounce of tincture
 of myrrh, and water sufficient to make up
 the pint.  Cayenne-pepper infusion is also
 used as a gargle.—See Capsicum.   In cases
 of chronic  weakness of  the  throat, with
 tendency to frequent swelling and inflam-
 mation, a gargle of oak-bark decoction or
 of salt-water is of much service,  used every
 morning  for some time.   Gargling is  ef-
 fected by throwing the head back, and, con-
 sequently, the fluid back in the throat, and
expelling the air through it from the lungs ;
it is thus worked as it were into  every part
of the throat. 
G  A R                266                G I D
  GARLIC—See Onion.
  GAS—Is an  elastic fluid, which is per-
manently aeriform in all ordinary tempera-
tures,  being distinguished from vapours,
which  are  only temporarily  elastic and
aeriform.   The  gases  alluded  to in  the
course of this work are—
     Ammonia.
     Azote, or Nitrogen.
     Carbonic Acid, and
     Carburetted Hydrogen.
     Chlorine.
     Hydrogen,  and
     Sulphuretted Hydrogen.
     Oxygen.
  Refer to  separate  articles.
  GASTRIC  JUICE —Is  the  acid  viscid
fluid secreted  in the  stomach  when that
organ is excited by the presence of  food;
the office  of  this peculiar secretion  being
the solution of  the nutriment, or  rather the
reduction of  its albuminous and  gelatinous
portions to a state in which they are  fit for
absorption  into the system.
  Refer to Digestion—Food—Indigestion.
  GASTRITIS.—See  Stomach,  Inflamma-
tion of.
  GELATINE,  or  Glue—Is  an azotized
component  of  animal bodies,  of  simpler
constitution  than the  azotized albuminous
compounds.—See  Food.   It may  be  ex-
tracted  from tendons,  skin, &c. by long
boiling,  and  from bones by dissolving  out
their earthy matter by acids:  it occurs pure
in many fishes, the  air bladders of which
are formed of  gelatine: isinglass,  so well
known  as  a jelly-making  compound,  being
the prepared  swimming or air bladders  of the
sturgeon, cod, ling, &c.  The gelatine sold as
such is generally prepared from bones.
Many persons have a prejudice  against this
gelatine, and imagine it not so good as that
which they extract  from calves' feet, &c.
As  regards  the  amount of nutriment,  it
must be precisely the same, and as there is
no reason  to  believe that the  manufacture
is otherwise  than properly conducted, it is
a pity that many should deprive themselves
and others of so  convenient an  addition to
sick cookery.—See Cookery, Food, §c.
  GENERAL HEALTH.—By this term is
meant the state of the body and its functions
collectively, in  contradistinction to the con-
dition of any special portion of the frame.
The  state of the general health is always
an important consideration, with respect to
local maladies,  both as regards their  treat-
ment and ultimate prospects.   The  latter
must  always be more serious  when  the
general health begins to suffer.
  GENTIAN  ROOT—Is obtained from  the
i  Gentiana  lutea,  or yellow  gentian,  which
  is a native of  the  more elevated ranges of
  the Alps,  Pyrenees, &c.  The root is  brown
  externally,  irregular,  knotty,  ringed,  and
  from half an inch  to nn inch in diameter: it
  is yellow within.   Like the gentians gent
  rally, it is extremely bitter, and on account
  of this property  it constitutes one of our
  most extensively used and  most serviceable
  tonics  and  stomachics.   The  most  useful
  medicinal  preparations of gentian  are  the
  extract,  the infusion,  nnd the  compound
  tincture.   The extract  is  chiefly  used in
  from  five to ten grain (or more) doses, as
  an ingredient in  tonic  or  aperient pills.
  The  compound tincture may  be taken in
  one  or two teaspoonful  doses,  in  water.
  The  best preparation,  however, for general
  use, is the  infusion prepared  in a  concen-
  trated form,  according to  the following
  process:—To every ounce of sliced gentian-
  root  add  a quarter of an  ounce of dried
  orange-peel, and  infuse  these (not boil)
  with successive quantities of boiling  water
  poured over them,  until their strength is en-
  tirely exhausted.   The whole  of the infu-
  sion thus  made, being separated from  the
 root and  peel,  must next be  concentrated
 by boiling  in  a well-tinned or porcelain-
 lined saucepan, until the quantity is so far
 reduced that there is left  half a  pint of
 the concentrated infusion  for  every ounce
 of gentian used.   To each  half-pint of this
 concentrated infusion half an  ounce of al-
 cohol  is  to be added.  The effect of this
 addition of  spirit is to coagulate a quantity
 of jelly-looking  substance,  which must be
 separated  by  straining  through  flannel.
 The infusion will thus be got clear, and will
 keep  for  a great  length of time, the dose
 being one teaspoonful in an  ounce of water.
  When the fresh infusion is required for im-
 mediate  use,  a quarter of  an ounce of
 gentian-root sliced, with the addition of a
 little orange-peel,  to the pint of water, will
 be a proper strength, if infused for  an hour
 or two.
   GESTATION.—See Pregnancy.
   GIDDINESS —  Dizziness — In  medical
  language  "vertigo," is a sensation of con-
  fusion, and loss of the power of balancing
  the body,  which is frequently momentarily
  experienced even by persons in good general
  health, and is unquestionably often attribut-
  able to stomach derangement solely.  Dis-
  order of  the circulation of the blood in the
  head is a probable direct cause  of giddiness,
  and this is most palpable after persons have
  been confined  to bed  or to the  horizontal
  position for a short time:  on first assuming
  the erect posture, giddiness  is generally 
*
                  GIN                2

 experienced.   Intoxication is an  example
 to a certain extent of the same thing.   A
 mere passing giddiness is probably  owing
 to  some  cause which a little attention to
 the  state of the  stomach will correct; but
 repeated attacks, especially if accompanied
 with palpitation of the heart, or pain and
 heat about the head,  require medical ex-
 amination without delay.
   GIN—The well-known liquor, also known
 as Geneva, or Hollands, contains oil of juni-
 per, and  when first introduced was  used
 simply as a diuretic medicine ; it ultimately,
 however,  became an object  of trade,  and
 of  general—too general—use.   It certainly
 often increases the flow of urine in a marked
 degree.
   GINGER—This well-known spice, is the
 creeping root of a tropical  plant.  That used
 in  Britain is chiefly brought from  the East
 and West Indies.  Two kinds of ginger are
 met with,' the dark-coated  and the  pale-
 peeled ginger; the latter is the best.  "The
 rhizomes, or root-pieces, of ginger of good
 quality,  have no epidermis, or outer skin
 —are  plump,  of a whitish  or  faint  straw
 color,  soft  and mealy in  texture, with a
 short fracture,  exhibiting a reddish resinous
 zone round the circumference:  the   taste
 should be hot and biting, but aromatic.  The
 rhizomes  of ginger of  inferior quality are
 frequently coated with epidermis,  are less
 full and  plump, often contracted and  shri-
 velled ; of darker colour, being of a brownish
 yellow; of harder  texture, termed flinty;
 and more fibrous, while the taste is inferior
 and less aromatic."  Ginger-root is chiefly
 adulterated by means  of processes used to
 give the inferior quality the  appearance of
 the best;  for this purpose, whitewash,  chlo-
 ride of lime, sulphur-fumes, &c. are used.
   As an  aromatic,  especially when added
 to medicines to correct their griping pro-
 perties, ginger  is peculiarly useful.    For
 persons of relaxed habit it is well suited as
 a spice, but by those of full habit, especially
 with tendency  to  the  head,  it  should  be
 sparingly used in diet.
  GLANDERS—The  malignant disease  to
 which the horse, the ass, and the mule are
 subject, is also capable of  being communi-
 cated to man, certainly by  inoculation, per-
 haps by simple contact with  the skin.   In
 the above animals, the,disease is manifested
 by a yellowish, bloody, fetid,  adhesive dis-
 charge from the nostrils,  the lining  mem-
brane of which is ulcerated.  Should any
of this discharge come in  contact with  an
abrasion of the skin, or even get lodged  on
the sound skin, as of the hands, or be snorted
upon the nostrils or eyes of man, it  is ca- I
37               GOD

 pable  of originating  this horrible disease
 In from two  days to  a week after inocula
 tion,  the  attack is  ushered in with fever
 symptoms, or  by vomiting  and diarrhoea;
 small tumours which ulcerate and discharge
 form under the skin in various situations,
 and there is yellow viscid  discharge from
 the jiostrils,  &c.   Almost every case of  this
 fearful disease  has proved fatal. The object
 of mentioning it here is to  impress caution
 upon all who may be  exposed  to  the  con-
 tingency.    The  immediate destruction of
 an affected animal should, of course, be ef-
 fected, and its  entire body at once buried.
   GLANDS—Are bodies situated in various
 parts of the  animal frame, their office being
 either the alteration  of some  fluid or the
 separation of some secretion from the blood.
 Of the former,  the mesenteric  glands (see
 Absorbents, Digestion, Sfc.) are examples; of
 the latter, the liver, salivary glands, &c.
   GLAUBER SALTS, or Sulphate of Soda
 —See  Soda.
   GLOBUS HYSTERICUS.—See Hysteria.
   GLOTTIS.—The superior opening of the
 larynx.—See Larynx.
   GLUTEN—Is an azotized  principle which
 exists  in the  grains, and corresponds to the
 fibrin of animal bodies; it is therefore highly
 nutritious.—See Fermentation, Food, $c.
   GLYCERIN—Is  a  product  from  fatty
 matter, and is obtained in the  manufacture
 of lead-plaster.   It is  a fluid of thin syrupy
 consistence, very sweet taste, faint mawkish
 smell,  and should be like  pale sherry in
 colour, or even lighter.   It is  now a good
 deal used in medical practice on account
 of its powerful retention of  moisture, either
 alone or mixed with  other  substances.   In
 diseases  of  the  skin, accompanied  with
 harshness  and  dryness,  a lotion composed
 of one part  of glycerin to  fifteen of water
 is very serviceable.   The following lotion,
 as  recommended  by  Mr. Startin, will  be
 found  very serviceable in chapped hands,
 &c. :—Take of  pure glycerin half an ounce,
 borax  two scruples, distilled water or rose
 water  enough to make up half a  pint.   In
 deafness and affections of the  ear it is also'
 used.
   Refer to Cerumen—Ear, <$•<>.
  GODFREY'S. CORDIAL--Is  one  of  the
 dangerous  quack carminatives frequently
 given to children.  It contains opium,  and
 fatal consequences are often the  result of
 its administration.  In February of the pre-
 sent year  (1852) one fatal case, at least, of
 poisouing  by this  compound was  reported,
 and it was stated at  the inquest  that  ont
 teaspoonful of  that used would contain five
 drops  of  laudanum.   The  remarks made 
                 G 0 I                 21

upoi<  " Dalby's Carminative" apply equally
to this legalized but dangerous compound.
  GOITRE.—See Bronchocele.
  GOOSE.—See Poultry.
  GOOSEBERRY.—One of our most whole-
some  fruits.  It is aperient, and the seeds
of ripe gooseberries add to this property,
by their mechanical action upon  the bowels.
  GOULARDS EXTRACT—Is a saturated
solution of sugar of lead, which, when di-
luted, forms goulard-water.
  Refer to Lead.
  GOUT—Is a disease of  the  blood.   Its
exact nature is disputed, but it has been
positively proved by Dr. Garrod that  the
blood of  a gouty patient  contains an undue
quantity of a peculiar acid named uric acid.
This acid is  contained in small proportion
in healthy blood, but,  in  the  disease  in
question,  that  proportion  is  found to be
considerably  increased.   By some,  the  ex-
cess  of this  uric acid is  thought to be  the
effect, by  others the  cause, of the malady;
however  that may be, the  fact  of  its  pre-
sence is undoubted.   Moreover,  the proper
outlet for this acid is by the kidneys, in the
urine, which, as a rule, contains it  in cer-
tain  proportions, but in greatly increased
proportion in some  peculiar conditions of
the constitution, when  it  constitutes one
form of gravel.  It is even a matter of po-
pular observation that gravel  and gout are
nearly connected. They often alternate with
one another in  the same  person, and in the
same  family are found affecting  the various
individuals of it—the gout  the  males,  the
gravel the females.   There is  no  disease,
perhaps,  the hereditary  tendency of which
is more thoroughly established  than gout.
Generally it occurs in persons of full habit,
especially if they consume much  stimulating
food and drink, and take little exercise ;  but
it also shows itself  in the weak and debi-
litated.  The attack is  generally preceded
by symptoms indicative of  derangement of
the general  health,  and particularly of the
digestive organs.   Dr. Gairdner—one of the
best  authorities on the subject—enumerates
dull  pain in the side,  headache, confined
bowels, high-coloured urine, and  scaly erup-
tions  on  the  skin, as among the most fre-
quent warning symptoms.  The attack itself
generally  comes on  in the  night,  and  the
sufferer is awakened by the  pain  in  the
foot, having,  perhaps, previous to awaking,
passed through a night-mare, or "sugges-
tive"  dream,  (see  Dreams,)  in  which  the
scenes are connected with  the  uneasiness
experienced.   The ball of the great toe  is
the part  most generally attacked,  though
not invariably; the pain  is very  severe.   A
                G O II

French  author, in  describing  it,  says—
" Place your joint in a vice, nnd screw the
vice up until you can endure it no longer;
that may  represent rheumatism : then give
the instrument another twist, nnd you will
obtain a notion of the  gout."*  The part
attacked by the gout becomes swollen, hot,
red or bluish-red, nnd shining;  these symp-
toms  continue  with  more or less intensity
for some  days,  and  then  subside.  Along
with the local symptoms there occurs more
or  less feverishness  and disorder of  the
bowels and urine; but when the attack has
passed away, the individual is left  in  a
better state of health  than before.   This
fact has given rise to many erroneous ideas,
and much erroneous practice in connection
with gout, and by those subject  to it; re-
garding it as a salutary affection, they have
rather encouraged  it  than  otherwise—the
more  so that  the encouragement involves
indulgence rather than self-denial—forget-
ful that, although the  outward manifesta-
tion of a fit of gout  may end in a salutary
effect, from  its being the disturbance occa-
sioned by  the  constitution endeavouring  to
free itself from morbid matter, it must be
far better  if no such disturbing effort is re-
quired at  all;  and, further, it  is certain
that no constitution can be the subject of these
repeated, violent perturbations, without its be-
coming permanently weakened or wholly broken
up.  Let none, therefore, who have a gouty
tendency,  and  are periodically renovated,
as it were, lull themselves into security by
the idea that they suffer no  injury ; for the
constitution cannot  fail to be  impaired by
the repeated  trials.   Their  only security
rests  with  themselves, in  avoiding  those
habits and  modes of  life which engender
that state of system and  blood that winds
up with a fit of the gout.   Moreover, al-
though these fits may at first be more pain-
ful than dangerous,  this is  far from  being
the case as life advances, and the constitu-
tion suffers;  then gout may, and often does,
attack some more important part than the.
great toe; and  the  stomach, the heart,  or
brain are  apt to become its  seat, with fatal
consequences.
   The most undoubted predisposing  cause
of gout is  hereditary tendency, and it is one
very widely distributed, though not always
actively developed. , The  other causes are
luxurious  habits, the habitual consumption
of a larger quantity of food—especially of
animal food—than is required by the sys-
tem, and  undue consumption of wine and
malt  liquor,  especially the former.  These
* Watson's Lectures.
;s 
G  O  U               269               G 0 U
 of  themselves  will  develop gout  in  the
 predisposed:  but  if  their  use  is coupled
 with  deficient exercise in the open air, the
 exciting  power  becomes  much  increased.
 Moreover, the same acting causes give rise
 to attacks of red or uric  acid gravel, that
 is, to the excretion of this from  the  blood,
 by the kidneys, in the urine.   Hard  malt
 liquor has  a  peculiar tendency  to produce
 in those  consuming it, this  uric acid,  even
 in spite of regular exertion  in labour; and
 the  author has  found brewery labourers,
 who often consume a considerable amount
 of hard ale, suffering from alternate attacks
 of gout and red gravel. In the country, gout
 is not a common disease, for the  population
 generally, while they do  not consume ex-
 cessive quantities of meat and malt liquor,
 have  also  the  constant   counteraction of
 plenty of fresh air and exercise.  When  gout
 is met with in the country, it is generally
 in those  connected with  inns and  public-
 houses, who  consume malt liquor largely,
 and take  little exercise.
   From  the above, it is evident how much
 any one with a liability to  gout has it in his
 own power to prevent its occurrence.    Malt
 liquor he should  never  touch,  wine  very
 sparingly, or  if he must have some  stimu-
 lant,  though he is much better as a general
 rule without any, a little gin or brandy and
 water.  Meat should be eaten sparingly, and
 only once a day;  never at night.   Bread
 made with the bran in it,  vegetables gene-
 rally, cooling fruits, and milk preparations,
 are the safest articles of diet for those predis-
 posed to gout; but tea, and especially  coffee,
 should not be taken strong.  Further, early
 rising, attention  to  the condition of the
 skin by frequent washing, and regular daily
 exercise  are the best adjuncts to temperate
 diet.   It  is, perhaps, not  saying too much
 to affirm  that persons  predisposed to  gout
 may  almost  wholly escape  its  attacks by
 attention  to the above rules of health.  In
 advising exercise, however, the caution must
 be given,  that it is not violent and fitful ex-
 ertion which  is recommended—this  being,
 in fact, more  likely to  develop the disease
 than  to  prevent  it.   The  regularity  of a
 sufficient  amount of daily exercise  is the
 essential; indeed, not only does violent phy-
 sical exertion, especially of an unusual kind,
 tend to excite a fit of gout, but even strong
 mental emotion or violent passion has been
 known to  do the same.
  Regarding  the  best treatment  of gout
during the existence of the attack, there is
considerable diversity of opinion.  Little is
to be  done to  the inflamed part; certainly
cold  applications, which have been recom-
      x 2
 mended  and  used,  are dangerous;  but a
 piece of flannel, wrung out of warm water,
 laid lightly over the joint, and covered lightly
 with a piece of oiled-silk, will give relief; or
 the  lotion of  sugar  of lead and  laudanum
 may be used warm :  perfect rest it is almost
 superfluous to enjoin, as  the  pain makes
 that compulsory.  As regards  constitutional
 treatment, where  the powers  of the consti-
 tution are  vigorous, a  perfectly low diet
 should be observed.   In some cases an ac-
 tive purgative answers well; in others, but
 chiefly old  standing cases, it so certainly
 aggravates  the  attack,  that patients from
 their own experience will not resort  to the
 remedy.   Ten to fifteen grain doses of car-
 bonate of potash may be given three times
 a day,  dissolved  in half  a tumblerful  of
 water, either  simply or made to  effervesce
 by the  addition of  lemon-juice.   The re-
 medy, however, for  gout is colchicum.  A
 medical  man  may, of course,  give it more
 boldly than an unprofessional person; but
 still, should it so  happen  that the person
 suffering  from gout  is not under medical
 treatment, ten drops of colchicum-wine may
 be given  safely three times in the twenty-
 four hours.   The  power of  colchicum  in
 subduing both  the  pain of gout and  the
 disease  itself  is often most striking.   The
 following instance  will exemplify  it:^-A
 lady suffered from repeated attacks  of se-
 vere shooting pain  through the  region  of
 the  heart, and was  treated without relief;
 at length one of the  joints of  the forefinger
 became  suddenly  affected  with  gouty in-
 flammation ; this gave an  immediate clue;
 colchicum-wine was  prescribed in ten-drop
 doses twice a day,  and  before  six  doses
 were taken, both the pain at the  heart and
 the  inflamed joint were cured;  the same
 thing has occurred repeatedly since in the
 same patient.
   It is undoubtedly  better, safer, quicker,
 even in mild attacks  of gout, for the case to
 be treated by  a medical man;  but patients
 who know  what  the disease  is  will not
 always  have recourse to his  aid:  in such
 cases,  the perfect rest both  of  body and
 mind, the  warm  moist  flannel,  low diet,
 gentle regulation of  the bowels, the cooling
 saline, and  the small doses  of  colchicum
 will  be the safest measures; but  safer still
 will  be  attention to  those  preventive mea-
 sures already  pointed out, which  any may
 follow  by  the  aid of their own common
 sense—a faculty which  ought to  show the
 reason for and the reasonableness of such
 a course.  Many persons who  have suffered
from repeated  attacks of gout become af-
fected with  chalk-stones, (see  Chalk-stonex,) 
GR A
270
GRA
which  impede greatly the usefulness of the
hands; the constitution too gives way.   In
these cases, medical assistance ought never
to be dispensed with, and there are few old
sufferers from gout in whose power it is not
to procure it of the best.   A much less reduc-
tion in diet will be required than in more
recent  cases and stronger subjects; the medi-
cines must be of a warmer character. Fifteen
grains  of calcined  magnesia, ten of rhubarb,
and forty drops of sal-volatile, in a wine-
glassful of water, will form a draught which
may be repeated twice a day.   It may also
be  given with  advantage with double  the
quantity of sal-volatile, and twenty or thirty
drops  of laudanum,  in the event of gout
receding to the stomach, as evidenced  by
pain and  other  signs  of disorder  of  the
organ,   and by  the  sympathetic  faintness
accompanying the attack.  A glass of brandy
may be substituted for the above with good
effect;   these  stimulants,  however,  being
given  under  the  caution  that no extreme
tenderness, indicative of inflammation,  ex-
ists  at  the pit of the stomach.  In addi-
tion, in an attack of " retrocedent" gout,
either  to  the stomach,  or  elsewhere,  the
feet should be immersed in hot water, with
mustard, or  a mustard-plaster should  be
applied to them, with a view of attracting
the disease to its more usual  site.  These
attacks of  gout shifting to internal  organs
are often so quick in their  seizure, and so
rapid  in their progress,  that  it is  highly
desirable  that such  measures  should  not
only be understood, but thoroughly carried
out. The aged and debilitated sufferer from
gout must not at any time reduce much his
usual  mode of living.  Gout has been,  and
is, confounded with rheumatism.  The gene-
ral distinctions are the occurrence of gout
most frequently after the thirty-sixth year;
most often in males, especially those who
live  highly,  affecting the  small  joints—
generally but one at a time.
  Refer to Colchicum—Gravel—Rheumatism
— Urine, SfC
  GRAINS—Or,   as  they  are sometimes
called,   the " cereals," are  the seeds  of
plants  which  belong to the  order  of  the
grasses.  They constitute a large proportion
of the  food consumed by the human race,
and likewise form  no inconsiderable amount
of the  nutriment  of vegetable-feeding ani-
mals generally.  They are, perhaps,  in  one j
sense,  the most direct link between the ani-
mal and mineral kingdoms, for in them the
nutrient compounds prepared  by the vege-
table from the mineral elements of the soil,
and  from  the  gaseous constituents  of  the
atmosphere, are of such  a nature, and  are
so compacted, that they are presented to tin
digestive organs and assimilating powers of
animals in forms more fitted for affording
direct  nourishment to their tissues,  and
more direct support for their bodily func-
tions, than any other kind  of vegetable nu-
triment, with  the exception of that yielded
by the pulses—beans, peas, &c.—which are
not,  however, so universally  employed as
food.
  The grains chiefly used by man are wheat,
oats,  barley,  rye, millet,  maize  or  Indian
corn, and rice : the nutritive power of these,
however, differs  greatly.  The nourishment
afforded by the grains to animal bodies may
be classed under three distinct heads—the
azotized  nourishment,  represented by  the
gluten, which is adapted to build up and sup-
ply the waste  of the muscular, or fibrinous
and  albuminous tissues;   the non-azotized
nourishment,  represented  by the starch,
which goes to  supply respiratory food, forms
fat, &c.; and  the nourishment, principally
phosphates of  the alkalies and  earths, which
supplies the mineral elements  to the  bones,
the' nerves,  and to  the tissues  generally.
Upon the  proportions, therefore,   in which
these different  kinds  of  nourishment  are
contained in the grain, depends its nourish-
ing power.  Wheat, of  all  the grains,  con-
tains gluten most largely in proportion to its
other constituents.  Oats are next to wheat
in this respect.  Barley and rye are inferior
to both wheat and oats, and maize and rice
are very far  below any of the above;  the
former of the two not containing above 5 per
cent, of azotized matter; the latter not above
3 or 4 per cent.  Vice versa  to the  above, the
starch constituents are in much larger pro-
portion in rice and maize, than in wheat and
oats.  The mineral constituents of the grains
vary considerably  as regards proportional
amount, but   they consist  chiefly  of phos-
phates, with oxide  of iron. They are  con-
tained most  largely  in the  seeds  of  the
cereals and of the pulses, and appear to be
no less necessary to the perfect  formation
of the seed, than they $re to the blood of
animals,  which  cannot  be properly nou-
rished, unless the  food from  which it is
formed contains  these mineral constituents
in certain proportion—a beautiful instance
of the harmony and universal adaptation
of all things which prevails throughout the
works of the Creator.
  The grains also contain a certain propor-
tion of fatty or oily matter.  Maize does so
largely, and oats in very considerable  pro-
portion.
  The grains, therefore, from their  consti-
tution, are capable of supporting, with the 
G  R A
271
G R A
addition of water, the  animal frame  and
functions.   It is evident,  however, from
science,  and experience confirms the fact,
that a larger proportion of barley,  and still
more  so of rice or maize, is required to
sustain the muscular development, than of
either wheat or oats, which contain a greater
amount of the gluten,  or nitrogenized, or
plastic element of nutrition.  For further
information on these points  refer to  Blood,
Digestion, Farina, Fecula, Food, Gluten, §c.
   The flour, or meal, prepared from  grain,
partakes of course of the characters of that
from which it is  formed, and is  also modi-
fied by the mode of preparation,  whether
ground fine or coarse,  whether entirely de-
prived of  bran or not.—See Bran,  Breadt
Farina,  Sfc.    Under  the  microscope, the
various  kinds of flour, particularly their
starch granules,  present very different ap-
pearances ; this agent therefore has become
valuable  as a means of detecting  adulte-
ration, which could  not otherwise  have
been  discovered  with  certainty.  At  pre-
sent, owing  to  the abundance and cheap-
ness of wheat and wheat flour, there is no
temptation to its adulteration.—See  Bread.
May that temptation  never be again  in ac-
tion !  Besides being ground into  flour, some
of  the grains  are otherwise prepared artifi-
cially for food, as in the case of pearl-barley
and groats formed from the oat.
   See Barley—Oat, $c.
   GRANULATIONS—Are the  small  red
rounded points which cover  the  surface of
a  healing  sore.   They are  very vascular,
and bleed  easily.  When  the granulations
are deficient,  the sore is depressed, smooth,
and glazed-looking, and is not healing well.
When the  granulations  are  excessive, they
constitute  what  is  called  "proud  flesh."
In this state they are paler than they  should
be, and require depressing or astringing by
some caustic  or  astringent agent, such as
lunar caustic, blue vitriol, &c.
   See Caustics, Ulcers, §c.
  GRAPE.—The fruit of the vine, one of,
if not  the most wholesome of fruits.  When
ripe it contains sugar abundantly, vegetable
jelly and mucilage, and the  characteristic
tartaric acid  in combination with potassa;
also an azotized albuminous  constituent, or
gluten, on which  depends its property of
ready  fermentation, in  which respect the
juice of the grape excels all other vegetable
juices; undergoing spontaneously the  neces-
sary change, and becoming  converted  into
true wine by its own inherent power of fer-
mentation.   The juice, if kept a few hours,
will spontaneously ferment.   As a cooling
article of diet, ripe grapes are most whole-
some, and invaluable in many cases „f ill-
ness ; but must be forbid when their  ape-
rient  properties may prove injurious.   Of
late years, what is called the " grape-cure"
has been introduced into Germany; the per-
sons undergoing it living chiefly on  grapes
—of which  they  have to  consume many
pounds' weight per day—and  bread.   It is
probable that in some states of constitution
this  cooling system of diet  may be useful;
it has, however, at least one serious draw-
back :  the continued application of the acid
of the fruit to  the teeth completely dissolves
off the enamel.
  Refer to Fermentation—Raisins—Wine, Sec.
  GRAVEL.—See Urine.
  GRAVE-YARDS.—Receptacles  for   the
dead, which are often  so arranged  in this
country  as to be  a  disgrace to a civilized
community.   Like  the  imperfect drainage,
and  the other deficient sanitary arrange-
ments, the grave-yards of our large towns in
the first half,  at least, of the present  cen-
tury, will probably afford material for  com-
ment for its historians of a future age.  It
will be regarded as a curious anomaly, that
the people of  England could, in  spite  of
warnings without  number,  continue to in-
ter the corrupting remains of mortality in
the midst of  the  abodes of the living—a
practice in itself reprehensible,  but  doubly
and  trebly so, when the fearfully crowded
condition of the grave-yards of large towns
is considered.   It would be difficult perhaps
to estimate the amount of injury  to the
living which has resulted from the  abomi-
nable custom of city grave-yards, for which
the only excuse, in times gone by, was igno-
rance.  This excuse, however, no longer ex-
ists, and the  investigations of Mr. Walker
and of others  have made the injurious and
culpable nature of the  practice  sufficiently
apparent.  This reason might be enough to
prevent interments in situations where  they
are likely to  prove a source of disease and
death to others; but there is another reason,
in the  natural  feeling  which all  must  have
toward the remains of those who have  been
near and dear to them,  that they should  be
undisturbed—so long at least as they retain
the semblance  of the material body;  but un-
disturbed they cannot  be in  the festering
soil of some city burying-places.  The words
of Mr. Walker, not five years since, respect-
ing one grave-yard in the heart of London,
will  best place this subject in its  proper
light.  Of it he says—"Indecent,  pestife-
rous in every respect, because when a  pro-
portion of 3073 corpses are annually interred
in an acre of land, it follows  as an inevitable
consequence that the bodies of the deceasec7 
GRE
272
G U A
can remain in the ground only five months,
instead of ten years.   Hence the stacking
of coffins  in  deep pits, the brutal dismem-
berment of bodies, the consumption of coffin-
wood in many localities, the absolute super-
saturation of the soil,  which can neither re-
tain nor dissolve the putrescent matters with
which it is loaded.  Hence the daily scenes
which outrage  every  moral  and religious
sentiment—hence  the  danger  to  mourners
from attending funerals in such places—hence
the insidious  infection which poisons the at-
mosphere ; and thus, by undermining health
or begetting  disease,  hurries thousands  to
an untimely end."
  Here, surely, are arguments,  both selfish
and  unselfish, sufficiently  cogent to induce
all to lay the  remains  of their friends where
they will not be disturbed, and where they
cannot prove  injurious to the  living.
  Refer to Burial—Death, Src.
  GREEN-SICKNESS.—See Chlorosis.
  GREGORY'S POWDER, or Mixture.—A
compound of two parts of rhubarb, four
parts of calcined  magnesia,  and one part
of ginger.   It  is taken  either simply, in
water, or with water  along with some sti-
mulant, such as a  teaspoonful  of sal-vola-
tile : it is a good stomachic and gentle ape-
rient ; but  persons sometimes  get  in  the
habit of taking it regularly, and injure  the
tone of the stomach by. the undue  amount
of magnesia.
  GRIPING—Is  pain produced  in  some
portion  of  the bowels, in consequence  of
irregular contraction of the muscular coat;
it is in fact a minor form of colic, or spasm,
and is to be  relieved by the management
recommended under  those heads.    Some
medicines are  more  liable  to gripe than
others, and some  individuals are more than
others susceptible of  these griping  proper-
ties.   The inconvenience  is generally and
successfully remedied by  the addition   of
some carminative or  aromatic,  such as one
of the  essential oils—clove, cinnamon, &c.
—or by ginger, &c.  Pills which are apt to
gripe are more effectually corrected  by  the
addition of one or two grains of extract of
henbane, when that medicine  is admissible.
Some medicines  are  rendered griping by
faulty preparation.   This is especially  the
case with senna.—See Senna.
  Refer to Colic—Spasm, 3fc.
  GRIPPE.—The French name for the epi-
demic influenza.
  GROATS —Are  oats  deprived   of   the
husks:  "Embden groats," when they  are
bruised also.   They are used  and useful for
making gruel, &c.
  GROWTH—Or increase of size  of  the.
 body, as a whole, or of any part of it, is de
 pendent,  as a  healthy process, first  on o
 proper amount of nervous  excitation, and
 second on a due supply  of healthy  blood.
 When any part, such as the arm of a work-
 man, is regularly and vigorously exercised,
 the nervous power and  the  flow of blood
 are directed to it in increased proportion, and
 it acquires additional substance, or grows ;
 but should the same arm  become paralyzed,
 how quickly will  it diminish  in bulk!   Up
 to  a  certain period of life the body grows;
 in  animals this varies with the species ; in
 man,  the  process continues,  generally, up
 to  the  twentieth year,   or  even beyond.
 When growth ceases, it is not that new ma-
 terial ceases to  be  added to  the  body, for
 this is unceasingly being  effected  to supply
 the place of those constituents of  the frame
 which  are continually being used up; but
 the balance between the food taken and as-
 similated,  and  the  waste of  the body, is
 equalized ; and after growth has ceased, this
 balance (with  the exception  of  fatty de-
 posites) is, during health, maintained with
 but little variation during the years of life's
 prime.  When old age comes on, that is,
 after the sixtieth  year, the balance inclines
 the other way ; the waste now exceeds the
 reparative  nutriment which it is  in the
 power of the system to receive and elabo-
 rate, and the tissues  all  diminish in bulk,
 the stature, even, becoming less.
   Young persons require  nutriment,  not
 only  to sustain the wasting processes of re-
 spiration,  and  of motor  change  or  move-
 ment, but  they require,  also, sufficient to
 supply the growing tissues of their  entire
 body with the various elements which go to
 perfect their composition.  If these elements
 are not supplied,  development is either ar-
 rested, or,  the  tendency to growth  conti-
 nuing, the  bones  and  tissues  generally
 lengthen, without acquiring  their healthy
 substance.   As a rule,  the appetite of a
 healthy, growing child for plain and whole-
 some  food,  ought  never to be stinted.—See
 Children, Digestion, Food, Jrc.
   GRUEL.—See Cookery.
   GUAIAC [Guiacum].—The wood and gum
 resin of a tree which is a native of the West
 Indies.  They  are both used in  medicine.
 The wood is extremely hard and tough, of a
 striped yellowish green colour; the resin is a
 greenish brown.  Guaiac,  as a  medicine,
 acts upon  the skin, and  is often extremely
 useful  in chronic rheumatism.    The  most
 convenient  form  of  administration  is the
 tincture, which may be given in one or two
 teaspoonful doses at bedtime;  milk is  the
I best  vehicle for  its  administration;  when 
G  U I
273
G  U L
 taken in water, it must be drunk as soon as
 mixed,  otherwise  the resin separates  and
 floats on the top.
   Guaiac sometimes  occasions sickness, in
 which case is is better abandoned.
   GUINEA  WORM—Is a  parasitic, long,
 round worm, about the thickness of a violin
 string,  which  burrows  beneath the skin,
 chiefly of the feet and calves of the legs. It
 is met with principally in tropical climates,
 particularly on the African west coast,  but is
 sometimes  brought to this country by indi-
 viduals  who have  resided  in the  tropics.
 The length of the animal varies from a  few
 inches to five or six feet.  After  remaining
 under the skin for a longer or shorter time,
 the head  protrudes  through a small  boil
 which forms  on the skin.  The only  treat-
 ment is seizing  the head when this occurs,
 and gradually,  from  day  to day, winding
 out the worm, care being taken that it is
 not broken, for  should this happen,  the
 portion  which  remains is apt to occasion
 severe irritation.   Persons  native to  the
 situations where these  parasites prevail,
 will always be found skilled in the mode of
 extracting it.
   GULLET—The  Gullet,  or  "Esopha-
 gus"—Is a tube which  extends from  the
 throat or fauces to the stomach.   Down, or
 through it, the food is propelled by the  ac-
 tion of the  muscular  fibres which form  one
 of its coats.   It is narrowest at  its upper
 end, and it is here that choking from food
 most generally occurs.
   Choking may occur  from various causes :
 either the gullet may be contracted  from
 some cause or other at a particular  point,
 or the morsel of food  may be too large, or
 of such  a hard irregular character that it
 cannot pass down easily, or the cause of  the
 impediment may be spasm, more especially
 of an hysterical character.   Impediment to
 swallowing  from contraction  of the  gullet-
 tube is  generally a serious  matter;   the
 cause  should, as  soon as possible, be exa-
 mined by a medical  man ;  sometimes it fol-
 lows recent injury to the lining membrane,
 such as scratching by a sharp-pointed bone,
 or after poisoning by irritant agents.  In a
 case under  the author's care,  it followed
 upon a damson-stone having been swallowed
 some months  previously,  scratching  the
 throat in its descent;  the power of swal-
 lowing,  which was  nearly lost,  in conse-
 quence, probably, of thickening of the tis-
 sues immediately beneath the lining mem-
 brane,  was restored by the administration
 of codliver-oil for a few weeks.  When a
large morsel of food gets fast in the gullet,
it may occasion death by pressure upon the
 windpipe;  at all events,  it causes much
 distress for  the  time.   If at  all withir
 reach of the fingers,  of course they may be
 used for its extraction at once: if too far
 for this, a  surgeon's  assistance will be re-
 quired to push the morsel beyond the upper
 narrow portion of the gullet into the wider;
 this he will effect by  means of the  probang,
 (fig. lxxxi ,) an instrument consisting of a
                Fig. lxxxi.
   t—                           @

 piece  of round whalebone  about two  feet
 long,  to one  end of which a portion of
 sponge, about the size of a  large marble, is
 firmly attached, and  which requires oiling
 or greasing before use.  In  passing the pro-
 bang,  care has to be observed that it is kept
 well to the  back of the throat, and the  pa-
 tient's  head well  thrown back at the same
 time;  it is then to be pushed steadily  but
 quickly down till the obstruction is felt to
 pass readily before it, and away from it.
   These particulars  are  mentioned, not to
 induce unprofessional persons to attempt the
 operation when a  medical  man is procur-
 able ;  but if he is not,  an unprofessional
 operator and an extempore probang, made
 from an umbrella whalebone,  a  cane, or
 even a curved stick, with a small bunch of
 some soft material securely fastened to  one
 end, would be preferable  to choking  en-
 tirely, or partially even, for any length of
 time.  A few smart blows on the back will,
 in  the  case of children especially, often
 dislodge a  morsel sticking in the upper
 part of the gullet. Sharp-pointed  or irre-
 gular  bodies, such as pins, fish-bones, or
 other bones, may  get fixed in the throat,
 and it is generally in  the upper part of it;
 the fingers may be able to remove them, if
 not, a  piece  of bread, coarsely masticated
 and swallowed, will often, especially if fol-
 lowed  by a draught  of water, carry down
 the impediment.   In some cases, an emetic
 may be useful.   Frequently, after  a sharp-
 pointed body  has  stuck  in  the  gullet, and
 has scratched its lining membrane, the sen-
 sation of its still remaining  may be felt for
 some time after it has passed  away.  It is
 well to  keep this  in  mind,  that continued
 unnecessary  efforts to relieve may  not be
 persevered in.   If a   sharp body remains
 fixed in the upper part of the gullet, press-
 ure at some  point or  other will almost cer-
 tainly  cause a pricking  sensation.   The
 gullet is sometimes spasmodically affected,
 the food being either stopped in the passagi
 downward, or passed with  pain and diffi-
culty ;  this affection falls partly under  the
head of Spasm and Hysteria, but it is some- 
V
                  G U M               2

times the result of too great haste in eating
and swallowing. As explained under article
Digestion, the food does  not simply fall into
the stomach down the gullet-tube, but it is
conveyed into  the digestive  organ  by the
regular action of the muscular fibres of the
tube,  which, while  they  propel  forward,
also  close  behind the  morsel being swal-
lowed.   It must be evident, therefore, that
if morsels follow one another in too quick
succession, this action  must be  interfered
with; and if it is, spasmodic pain, at least,
is produced, and not improbably choking.
   Choking, from things getting fixed in the
gullet, must  not  be  confounded with  the
sensation of suffocation  produced by foreign
bodies getting into and  irritating the upper
portions  of the windpipe which lies in front
of the gullet.—See Lungs.   In the  latter
cases  sudden,  violent, spasmodic  cough en-
sues,  and the appearance and dread  of suf-
focation is generally much more quickly and
strongly  marked.
   Refer to Alimentary Canal, and more espe-
cially to  Digestion—Lungs, Sec.
   GUM ARABIC,  or Gum Acacia—Is the
produce  of certain species of acacia, and
is brought chiefly from Northern Africa,
Egypt, Nubia,  Barbary, &c.   Gum is con-
tained in greater or less proportion in the
juice  of most  plants, and, by many,  it is
exuded in the form of round concrete drops
or " tears," as they are called, such  as the
gums  of  cherry and  plum  trees, which are
familiar to all.   The gum of the  acacia is,
however, most generally used and esteemed
as a demulcent in affections of the  throat
or air-passages, in irritations of the urinary
organs,  &c.   When  gum  is dissolved  in
water the solution is named mucilage;  and,
in this form, it is one of the most convenient
vehicles  for other medicines,  particularly
those  which require some degree of suspen-
sion in liquid, as, for instance, in the com-
mon  chalk mixture.   It is also useful for
facilitating the  mixture of oils, camphor,
kc. in watery  mixtures; but  for this  pur-
pose milk  is preferable.   The  powder of
gum  acacia, when genuine, is probably the
best form for keeping, as it is dissolved in  a
few minutes, whereas gum in its  ordinary
form takes a considerable  time, and, when
made  into  mucilage, on the  other hand, is
very apt to spoil.   Gum  is nutritive in some
degree,  probably  in  the same degree as
starch or sugar, and is used as an  article
of diet in the countries whence  it is  pro-
cured.  It is much more  used in medical
practice  in  France than in this country,
both for its nutritive and its demulcent pro-
perties.
n               GUM

   Gum tragacanth, another species of gum
 brought chiefly from Asia Minor, Persia, &c,
 is procured from a tribe of plants belong-
I ing, like the  acacia, to  the leguminous or
 pod-bearing family.  It  possesses many of
 the properties of acacia gum, but not being
 so  soluble, is not nearly so convenient for
 use.
   Mucilage of gum acacia maybe conveniently
 made, by dissolving ten ounces of the  gum
 in  twenty fluid ounces of water,  either by
 gentle heat or by suspending the gum—tied
 in  a muslin-bag—in the water.
   GUMS.—The  gums which closely invest,
 but do  not adhere to  the teeth, are com-
 posed of mucous membrane of a dense in-
 sensible character.  In the investigation of
 disease, the gums frequently afford valuable
 information respecting general constitutional
 disorder.  In sea-scurvy, the gums become
 spongy and swollen, extend over the teeth,
 and bleed easily:  the  symptom is always
 strongly corroborative  of the  bodily disor-
 der.  In persons who  have been long sub-
 jected  to  the  action of lead, slowly intro-
 duced into the system, either in the course
 of their occupation, or,  as sometimes occurs,
 from the  ordinary drinking-water having
 become  impregnated with the  metal  from
 lead pipes, a  blue line is often observable
 along the edge of the gum.  A pink line in
 the same  situation has  also been pointed
 out as  showing  itself  in persons affected
 with pulmonary  consumption.   In constitu-
 tional affection by mercury, it is well known
 that the gums become inflamed,  sore, and
 spongy; in some cases of disease affecting
 the mouth, the gums become dark or black
 in colour, and the breath  is extremely fetid.
   Of course, in cases where the state of the
 gum is  indicative of constitutional affection,
 that must be attended to,  (see Scurvy, Sfc.;)
 but the condition of the  gums  in  any case
 may generally be much relieved by the use
 of  astringent  substances in  the  form of
 washes; none, perhaps, is better than the
 tincture of myrrh,  but camphor dissolved
 in alcohol may also be  used, or, indeed, al-
 most any one of the astringents.  A drachm
 of  alum dissolved in a  pint of water makes
 a very good and  cheap  wash.
   In  the case of black-looking gums, with
 fetid  exhalation,  a  wash  made of  two
 drachms of  muriatic   acid to  the pint of
 water will be  found most especially useful,
 or two drachms of the  solution of chloride
 of  soda may  be used with  equally  good
 effect.   Such a case, however, must require
 medical attendance. The gums in the teeth-
 ing of children  require  much  attention  —
 See Children. 
GUM
275
H AI
  GUM-BOILS—Are small abscesses form-
ed in consequence of inflammation of the
gum, generally the result of decayed teeth
or their stumps.  The abscess generally dis-
charges between the gum and the lip.
  GUN-SHOT  WOUNDS—See Wounds.
  GUTTA-PERCHA.—This substance,  now
familiar to  all, and so extensively used in
so many different  ways, is obtained from a
tree which is native to the Malay peninsula.
In medical and surgical practice it has been
adopted for many purposes, such as splints for
fractures, &c.  Probably, its  most valuable
property, in a domestic point of view, is its
being waterproof,  and forming a cheap and
efficacious protection to bedding, in many
cases in which this is apt to be spoiled by
the  discharges, natural or otherwise,  from
the sick.
  Refer to Bed, Sec.
  GYMNASTICS—Are  exercises  for  the
body which  are too often practised in an
injurious manner,  causing violent straining
of the limbs and joints, for which there is no
necessity, as a perfectly  adequate amount
of muscular exercise of all the limbs  may
be obtained without it.  These observations
apply, of course, to gymnastics as an exer-
cise  simply; when  their object  is  to  give
Btrength,  agility, and fearlessness to those
whose future  occupations may,  probably,
call  especially for  such qualities, gymnastic
exercises  are, of course, highly desirable.

  HABIT. —The connection existing between
the influence of the will  and  certain sensa-
tions and motions in the  living  body,  is a
fact of which every one must be  conscious
from personal experience. When, however,
the actions  resulting from these sensations
and  motions are, after frequent  repetition,
performed without a distinct and  conscious
exercise of  the will, they are  said to be the
result of habit.  These habits, however, are
of the body, and are distinct from habits of
the mind, influences which act upon the will
itself, with  lesser or greater power,  and
impel the individual to certain acts.
  It is, perhaps, needless  to  advert to the
proverbial power which habit exercises, not
only over man, but animals, becoming to
them a "second nature," and to their off-
spring a natural tendency.  So powerful an
agent, both  mental and  physical, as habit,
cannot fail  to  be  largely implicated in the
consideration of the nature and treatment
of disease.  It is  sometimes of the greatest
consequence, not only to break the influence
of habits of which the mind is  conscious, but
even of habits of disease over which the mind
has generally no control.  This is particular-
ly the case with respect to periodic diseases
of the nervous system, such as ague, &c,
which, after a time, appear to be continue!?
rather from  the  habit of the  constitution
than from any other cause.
  Still more widely connected with the treat-
ment of disease, is  the acquisition of good
habits in  the room of bad ones, which  are
often the causes of  impaired health.   Some
individuals  constantly  eat  and drink  too
much from mere habit; others take little or
no exercise "from habit;"   and, although
conscious  of these  and other  negligences,
often require considerable exertion  of  the
will,  aided by the almost   despotic com-
mands of a medical attendant, before they
can break  through  them. The good effects
of habit, in persons liable to constipation,
have already been pointed out in the  article
on that subject;  in this case the  habit  ori-
ginating in the will becomes, after a time,
partly or wholly involuntary.
  There is, however,  another state  of  dis-
order, and a more intractable one, in which
the influence of habit may  be  most  benefi-
cially exercised.  It is that  state of hypo-
chondriac unrest called the '' troubled  mind."
In such a  condition, nothing is more valu-
able than the habit of daily, and at certain
fixed times, foraing the mind to bend itself
to some definite continuous employment,  one
which it will require some degree of  mental
exertion to carry on, and which will main-
tain  its interest, perhaps an increasing one,
from day to day.
  HAEMORRHAGE.—See Hemorrhage.
  HAIR—Is a  development from,  or it
might be called a prolongation of, the outer or
scarf skin.   Each separate hair (fig.  lxxxii.
1) is contained in a  pit which passes into the

                Fig. lxxxii.
 
H AI
276
H AI
true skin, (fig. lxxxii. 3,) or through it, into '
the tissues  beneath,  (fig. lxxxii. 4.)   Into
this pit the outer or scarf skin (2) is folded,
and from this folding the hair is developed,
consisting of an external or denser portion
composed of flat over-lapping scales, and
an  internal  porous "pith," which contains
the colouring matter.
  The  condition of the hair is often highly
symptomatic of the bodily condition;  at the
same time, it is, of course, liable to altera-
tion from local influences.
  The hair is apt to become split, or forked,
in consequence of weak growth ; this gene-
rally occurs in persons in a debilitated con-
dition.  Keeping it cut tolerably short is a
good preventive;  but, of  course, removal of
the bodily weakness  of  which the  state of
the hair is symptomatic, is essential.  The
colour of the hair is indicative of consti-
tution and temperament.—See Temperament.
Its  changes  in colour indicate generally the
advance of  years, but sometimes the pre-
mature  gray speaks of continued mental
toil and trouble; and it has followed at once
upon  violent mental  emotion, a  few  hours
sufficing for the change.
  The  unfortunate queens, Mary of Scot-
land, and Marie  Antoinette,  are  both said,
amid many  others, to have been instances
of this  effect of mental  emotion upon the
hair; and the fact of this direct connection
between the condition of the body and the
colouring matter of the hair, renders it pro-
bable that permitting the hair of  children
to be kept long is really  subjecting them to
a source of constitutional weakness.
  Falling out of the hair occurs from  weak-
ness,  either  of the  body generally  or  of
the hair-bulbs,  or " follicles," themselves.
Various local  stimulant applications  are
used in such cases, of which Balsam of Peru
—a drachm stirred well into an ounce  of
simple cerate when melted—is said to be a
good application.
  Baldness,  or loss or deficiency of the hair
on parts usually covered by it, is sometimes
seen in infants.   It frequently occurs  in
adults of the male sex,  even  in  the  prime
of life, and  almost universally, in a greater
or less  degree,  in  old age.   The direct oc-
casion of baldness is  defect in the hair fol-
licles from  which  the  hair is  developed;
and this defect  may arise from diseases af-
fecting  the  skin itself, from acute general
disease, as fever;  or chronic constitutional
disease, such as consumption; it may also
arise from constitutional  peculiarity, or the
diminished  circulation of blood,  such  as
occurs in advanced life.  Some families ap-
pear to  be peculiarly liable to  become the
subjects  of baldness  even  early  in  life.
those who perspire much about the head are
often bald.  Generally, however,  whatever
occasions a diminished supply of blood to the
scalp or  skin,  gives the hair a  tendency  to
shed, and the treatment must be directed to
stimulating the skin as much as possible (see
Skin).  After acute disease, if the hair falls
off, shaving the part two or three times in suc-
cession will probably strengthen the growth.
In other cases,  much covering upon the
head, which causes perspiration, and conse-
quently weakens the skin, must be avoided ;
and the head should be well washed with cold
water  every morning, and afterward rub-
bed and brushed to promote reaction.   Va-
rious applications are  recommended to pre-
vent or cure baldness; they are all stimu-
lant.   Those of which cantharides, or Spa-
nish blistering flies, form  an ingredient, are
generally most serviceable.   A drachm of
the tincture of cantharides, rubbed up with
an  ounce  of lard, will form a  sufficiently
stimulating ointment.  [Hartshorn, or water
of ammonia, combined with castor-oil, is an
article often sold to prevent baldness, or as a
" hair tonic" and is an excellent application. ]
The infusion of the leaves of the Asarum Kit-
ropaeum,  [Asarabucea,] a plant which occurs
wild in the woods in  England, is a very effi-
cacious stimulant to the hair follicles: the in-
fusion may be used as a lotion to the scalp.
Falling off of  the hair, which is occasioned
by eruptive disease, or  which is accompanied
with inflammation  of the  skin, of course
requires  a different and more soothing treat-
ment ; probably  medicine is required,  and
the case is better submitted to the treatment
of a medical practitioner.
  In  the baldness of early life,  the hajr
drops off without the previous change of
colour which occurs in age ; in the latter
case, of course, no treatment is either likely
to be resorted to, or to be of service.
  Removal of the hair is a proceeding fre-
quently called  for in  the treatment of dis-
ease, especially of febrile and inflammatory
affections  affecting  the  head.    In these
cases, it  may be entirely removed, at once,
without risk, and should be shaved off when
the full effect of  the procedure  is required.
Some persons, especially females, are often
much vexed at the  shaving of  the head  in
fever,  &c.   Its necessity  is,  of course,  or
ought to be, answer sufficient;  but  it often
happens, that if the hair has not been taken
off during the course of disorder, it must,
from tendency to  shed afterward, be shaved
off during convalescence.
  When  the hair is removed  in  persons not
suffering from acute  disease,  it must  be 
HAN
277
HE A
 done cautiously, especially  if this  natural
 clothing has been somewhat long and thick.
, Where it must be taken off entirely, and at
 once, the head should be protected by a cap
 of flannel, otherwise  neuralgic or rheumatic
 attacks may be the consequence.
   Frequent cutting undoubtedly strengthens
 the growth of the hair, and frequent brush-
 ing and washing are the best methods  for
 preserving its health and cleanliness,  and
 ought,  along  with the assistance of the one-
 sided comb, to be solely trusted to—the irri-
 tating  "small-tooth  comb" ought to be ba-
 nished from use entirely.
   In Poland,  a peculiar disease is  met with,
 in which the  hair  becomes  thickened, suc-
 culent  as it were,  and matted together by
 a peculiar glutinous sweat.   It  has  been
 erroneously reported that the hair, in  this
 condition, not only bleeds, but possesses feel-
 ing—the latter idea having doubtless arisen
 from the irritability of the skin at its roots.
   Refer  to Skin.
   HAND.—This wonderful  agent  of  the
 human  mind is much  exposed to injury.
 When this occurs, as it often does, at a dis-
 tance from medical aid,  one principle must
 ever be remembered—that the preservation
 of as much of the member as possible, even
 of a single finger, or of part of one, is of
 the highest moment with reference to future
 usefulness.   In a crush of the hand, when
 bleeding is not great,  the  best treatment
 will be to place it in  a large warm poultice,
 and keep at  rest until medical aid is pro-
 cured.   The  management of various  acci-
 dents,  &c. will be found under such heads
 as Artery, Dislocation, Wounds, Sec.
   HANGING—Suspension of the body by
 the neck, may cause death in three distinct
 modes: by compressing the windpipe, and
 producing suffocation ;  by compressing the
 veins of the neck, and causing apoplexy;  or
 more rarely  by dislocating the neck.   The
 two former modes may be mixed up  to-
 gether.  The latter, when it does occur, is in
 consequence of a " fall," such as is given at
 a public execution  ; it of course causes in-
 stantaneous death.  Recovery from hanging
 must,  in  some degree, depend upon the com-
 pleteness or not of the  interruption to the
 passage of air through the windpipe  for
 any time : it  is  not likely that resuscitation
 will be effected if this  has  continued four
 minutes.   The first  thing to be done when
 a person  is found hanging  is, of  course, to
 cut them down at once, to loosen the mate-
 rial around the neck, to  dash cold water
 over them, and to bleed.  In such  an emer-
 gency,  a person would be quite justified  in
 cutting across the temple, where the artery
| beats, (see Artery,)  with  a penknife, and
 allowing blood to flow to the  extent of ten
 or twelve ounces.  The bleeding could  be
 controlled until the arrival of a surgeon,  by
 means of pressure  against the  bone.   In
 most respects, the treatment of a  person
 hanged must  be similar  to that of one
 drowned,  except  that the  application  of
 heat would scarcely be requisite in the same
 degree.
   HARE—Like other game,  is  extremely
 easy of  digestion, apart from the  various
 dressings and stuffings.
   HARE-LIP, or Cleft-Lip—Is a deform-
 ity  with  which  infants  are  occasionally
 born ; the lip being cleft at the  furrow, to
 a greater or  less extent.   Sometimes the
 fissure extends through the  roof  of  the
 mouth.  The  case ought to  be  very  soon
 submitted to  the surgeon  for remedy  by
 operation.
   HARTSHORN.—See Ammonia.
   HAY-ASTHMA.—(See Asthma.) —Also
 called " Hay-Fever, or Summer Bronchitis."
 It may be caused by other powerful odours,
 as well as by  that of  hay.   Quiet, tolerably
 good diet, quinine, or bark, and  paregoric,
 will probably  relieve.  A cup of strong coffee,
 without milk, or sugar, frequently repeated,
 is said to be an excellent remedy.
   HEAD.—See Brain, Giddiness,  Skull,
 Wounds,  &c.
   HEADACHE — " Cephalalgia"—Is one
 of the most  frequent ailments,  the result
 of a great variety of causes ; consequently
 many varieties of headache  are enumerated
 by medical writers;  the consideration  of
 all these  in a work like  the present would
 tend rather to confuse than  to  enlighten.
 The subject will probably be rendered most
 clear and useful to the unprofessional reader
 by considering it generally under the  divi-
 sions of—
   Headache from overfulness of blood.
   Headache   from deficiency of blood,  or
 debility.
   Headache  from excited  or inflammatory
 action.
   Headache from sympathy;  and
   Headache from anomalous causes.
   Headache is so frequent an ailment that
 people generally seem almost to forget  its
 connection with  so important an organ  as
 the  brain.  There are,  it  is true,  many
 transient  slight headaches,  and even severe
 ones in the predisposed, which do not call
 for much  attention ;  but it must be remem-
 bered, that  there are others which  it is
 dangerous to  neglect;  and an  individual
 who becomes subject to headache,  frequently
 recurring, should consult a  medical man on 
H E A
s
I1EA
the subject.  This is  more imperative from
the fact that there  is often considerable
difficulty in determining the real nature and
cause of some headaches, and that an error
in this respect—in diagnosis—may, by lead-
ing to erroneous treatment, cause the most
serious  consequences.  The  most  diverse
line of treatment may be requisite, in two
different individuals;  in one, abstraction of
blood may, if had recourse to, save from
a  fit of apoplexy;  in the  other, the same
treatment  might induce paralysis,  or epi-
leptic convulsion.   The lowering measures,
in fact,  which  cure the  one, may kill  the
other.    From  these  considerations,  a few
general   remarks on  the  subject of  head-
aches will  probably be more safe and use-
ful than an elaborate  and detailed account.
   If a person who suffers from headache is
of full habit generally, if he is sleepy, dull,
the vessels of the face full;  if the  uncom-
fortable sensation in the head is aggravated
by stooping, by an abundant meal,  by sti-
mulants, or  by sleep,  overfulness  is the
probable cause,  and reduction of the diet,
purging  the bowels with  calomel and colo-
cynth, and with occasional doses of  saline
medicine, exercise, bathing  the head with
cold water,  and,  if  the symptom  is very
severe,  the application of a few leeches  to
the temples, will be beneficial.   If the urine
is deficient, cream  of tartar in some form
may be  taken with  advantage.  The  above
species  of  headache,  the result of general
overfulness of  blood, may  also be  occa-
sioned by  whatever  impedes the circula-
tion, such as affection of the heart or  liver;
when the  latter is the cause, the  pain is
frequently  most severe at the back of  the
head.  When, on the other hand, headache
occurs in  a  person  of weak constitution,
when it  is produced  by, or aggravated  by,
exertion of mind, much talking, &c, when
there is listlessness, both of mind and body,
rather than oppression—the  face pale,  the
pulse weak—debility is the probable cause,
although at  the  same time  there may  be
overfulness of blood in the interior  of  the
head  itself;  very frequently,  however,  in
this kind of headache, the head is hot, with-
out there  being any particular flushing of
the countenance.   This form of headache
also is frequently accompanied with indiges-
tion,  and is  very common in students and
anxious  men of business.   Any thing like
abstraction of  blood will  certainly  prove
injurious;  but  cold  to the  head may  be
of service,  not only as a temporary remedy,
but habitually used  by means  of washing
with cold water.   Exercise, attention to the
Btate  of the bowels, without purging, some
care in diet, and  relaxation of mind, par-
ticularly by means of change of scene and
air, will be most useful.   In such cases, the i
whole  system is weakened—the brain and
nervous system, the circulating  system, the
digestive organs—and they act and react on
one another.
   Headache  from  excitement or inflamma-
tory causes  is such  as occurs  in  the first
stages of inflammation  of  the  brain, and
in some forms of  fever,  or it follows vio-
lence to the head.   It of course  falls to be
treated under  the articles on  these con-
tingencies generally.
   Sympathetic  headache  is very common,
and  is evidently  connected with  disorder
in some organ of the  body, such as the kid-
neys,  womb, &c.   Headache, sympathetic
with disorder in the stomach,  or some part
of the alimentary canal, is,  however, the
most frequent form.   The presence of bile,
or of  indigestible food  in   the  stomach,
almost certainly occasions dull pain  in the
forehead ; an alkaline, or too acid condition
of the  contents of the  organ exerts the same
effect.   The various symptoms of indigestion
will  generally  point  to the cause.  In the
first two, an  emetic, or some  aperient, such
as the compound  rhubarb pill,  or a stimu-
lant, will probably remove the disorder.  A
vegetable acid, such  as vinegar, many per-
sons know from experience, will at once cure
headache, especially  if it occurs from the
use of oily or greasy food ; and again, when
acid eructations,  heart-burn, &c.  indicate
the presence of superabundant acid, a dose
of soda, potash, or magnesia, will correct
the cause, and  remove the effect.
   Under the  head of  anomalous headaches
may here be classed all such  as  are not
referable to  any distinct cause.   They con-
stitute a considerable  proportion of the cases
of headache generally, and frequently baffle
both the investigation and treatment of the
medical adviser.
   It would be possible, did space permit, to
extend this article to much greater length,
but  its intention  is rather  to convey some
idea of the  general causes of this common
ailment, than to enter into the  minutiae of
its symptoms, relations, or treatment.  Most
are aware of the cause, and consequently of
the best mode of managing their occasional
headaches, and when  the affection assumes
a severe character, the medical  man should
invariably be consulted.   Bleeding, blisters,
setons and issues, cutting the hair or shaving
it off,  cold to the head, shower-baths,  snuff,
purging,  acids and   alkalies,  stimulants,
brandy, sal-volatile,   emetics,  and  many
| other  remedies, are used and may be used 
HE  A
279
HE A
in the treatment of headache;  but it would :
be quite impossible here to undertake their
consideration.
  Refer to Brain—Fever—Indigestion, Sec.
  HEALTH.—See General Health.
  HEART.—In connection with this article
the reader is referred to Artery, Aorta, Chest,
Circulation.  The heart, (fig. lxxxiii. 1,)  the
Fig. lxxxiii.
 central organ  of the circulation, is placed
 obliquely in the chest, the base upward, the
 point, or  apex,  being  so situated as, in
 the  living body, to strike the side of the
 chest, or  "beat,"  between  the fifth  and
 Bixth ribs, about two inches  below the left
 nipple ; this point, however, and indeed the
 position of the heart generally, is liable to
 alteration according to the position of the  body.
 The size of the heart is generally computed
 to be a little more than  that of the closed
 fist  of the  individual.   The  organ is  con-
 tained in its own proper bag, or "pericar-
 dium," which  in the healthy state  is  lined
 by an extremely smooth  moistened mem-
 brane; this membrane is  also  "reflected,"
 or  carried  over  the surface  of  the  heart
 itself; and thus during the constant motion,
 the  two  surfaces glide easily, and  without
 friction,  over each  other;  the heart lying
 sufficiently loose  in its bag to permit of free
 movement.   The heart is often described as
 a hollow muscle.  It consists of four cavities,
 surrounded by muscular walls, and is in fact
 a double heart; this being requisite for the
 Derformance of  the double   circulation-
 through  the body and through the lungs.—
 See Circulation.   Of these four cavities, the
 left auricle (2)  and ventricle (3) are devoted
to the circulation of the blood through the
body, after its return in a purified state  from
the lungs; the right ventricle (4) and auri-
cle (5) being devoted to the lung circulation.
In fig. lxxxiii., 6,  6,  represent  the great
veins by  which the  blood returns to the
heart from  the body generally,  7,  7 the
great blood-vessel, or  aorta, by which  it
leaves the heart to be passed through the
body, having,  between entering the  right
auricle (5) and leaving the left ventricle (3)
been  passed through and  purified in the
lungs.  The  auricle  and ventricle  on the
right side of the heart have not,  when pro-
perly formed, any communication with the
corresponding cavities on the left side; but
the auricle  and ventricle on each side are
separated from each  other, and  from the
blood-vessels with which they are  connected,
by means of  valves—so  arranged and go-
verned in the motions of the heart, that the
blood can only pass in the right direction
when the valves are in a healthy  state; but
should these valves become diseased in any
way,  the proper currents  of the blood are
interfered with, and  disease is  the result.
Thus, the passage from the great blood-ves-
sel, the aorta, (fig. lxxxiii. 7,) to the heart,
is closed by three " semilunar" valves, (fig.
Fig. lxxxiv.
lxxxiv.,) which allow the blood to pass freely
into the vessel, but should it attempt to re-
turn, these bag-like  valves instantly close
the passage—the blood itself acting as  the
closing agent—and this action  takes place
once for every beat of the heart.   If, how-
ever, from any cause, one or more of these
valves should become deficient, it is evident
that each  time  they close, a small  portion
of blood will pass  back, or " regurgitate,"
into the heart—and this  actually occurs in
cases of disease.  And the consequence of the
long-continued and constantly-repeated dis-
ordered  action  is to  cause  stretching, or
" dilatation," of the  cavity which receives
the regurgitated blood.   This  one instance
will  explain how one  slight derangement
in the nicely-balanced  machinery  of  this
important organ gives rise to another. From
somewhat  analogous causes, the blood may
regurgitate into, or be  dammed up in  the
lungs, or in other parts of the body, causing
hemorrhage, dropsy, &c.
  Again, there may be impediments to  the
circulation; the valves  above alluded to, or
others, may not yield as they should do, or 
H K A
280
II E A
there may be  other causes which render it
difficult for the heart t> propel  the  blood
through  the  body.   In  such  a  case,  the
heart, line any other  muscle under similar
circumstances, acquires  increase of  sub-
stance,  in consequence" of the  continued
increased  exertion demanded of it, to main-
tain the proper circulation ; and thus we
have a cause and effect, producing enlarge-
ment of the heart—an evil certainly, but a
lesser evil to prevent a greater, for in this
very enlargement—this strengthening,  as it
were, of the  heart to do its extra work—
the patient's safety lies.
  There are, of course,  many  other forms
of heart disease, but the above instances
will convey some rational idea of the nature
and  peculiarities  of  the disorders of the
organ in general.   It would be quite pro-
fitless in this work to enter into  any thing
like  detail respecting diseases  of the heart
or their treatment; disorders so varied in
their nature   and symptoms can only be
properly investigated and  managed  by a
medical man,  conversant with  the mecha
nism and the functions of the human frame
at large, and  in their  relations of mutual de-
pendence.
  As might be expected, affections of  the
heart, generally, are  evidenced by pain in
the chest, difficult breathing, cough, palpi-
tation, &c. ; and at other  times by faintings,
giddiness, irregular pulse, &c.;  but there is
not  one of  these symptoms, or  any com-
bination of  them, which  may  not be  de-
veloped under certain bodily conditions, al-
though the heart is perfectly sound.  None,
therefore,  need alarm  themselves merely
because such symptoms occur ;  they happen
at times more  or less to all; still they ought
not to be neglected : if they continue to recur,
a medical man should be consulted.  If there
is no disease the mind  is set at rest, and any
general disorder which may have caused the
symptoms will probably  be rectified.  The
above cautiens are given, because there is
no  class of diseases  of  which  people are
so apt to  fancy themselves  the subjects as
those of the heart; and the more they think
of the symptoms, the more likely are  they
to continue or increase,  from an  organ so
intimately connected  with the  emotions of
the miud  as the heart.   Again, even if the
heart be unaffected, it is  by no means ad-
visable to permit it to continue to be func-
tionally disordered, either by mental  emo-
tion or by sympathy with other organs, for
the functional disorder may end in organic
disease;  that it does so sometimes is evident
from the fact that there  is no  more fertile
source of heart disease than those convul-
sions, either commercial or political, which
occasionally agitate society.
  If disease of  the  heart, either incipient
or confirmed, does exist, it cannot too  soon
be discovered by examination, nor the neces-
sary precautions and regulated mode of life
too soon adopted;  for  with  these precau-
tions, a large  majority  of persons who are
the subjects  of  heart  affection  may  not
only continue  to live for years, sometimes
many years, but to enjoy life.   True, the
knowledge  to  any one that he  is himself
the subject of heart disease may be  un-
comfortable,  but  it cannot  be  unprofit-
able.   He  may be  aware  that  heart dis-
eases are sometimes apt  to have a sudden
termination, and  that his life may be some-
what  more in  jeopardy  than that of an un-
affected person; but surely to every right-
thinking man, this fact  would rather be an
argument why he should know his real con-
dition.  The possibility of his being called
away from the affairs of this life without
warning, should be a reason for his keeping
them well arranged; and still more import-
ant, should it be a reason that in conducting
his earthly stewardship, he should do it, not
only with reference  to  this world, but  to
give  account of it in another.   And when
the many chances  and contingencies of life
are considered, the consciousness of  being
the subject of heart disease amounts to little
more  than  such contingencies assuming  a
more  prominent position in the mind; and
to the individual it may be a merciful dis-
pensation.   It may seem  to  some that in
thus writing  the  author is  assuming  the
character of the clerical rather than of the
medical adviser;  it is  not  so—it is  but
taking advantage  of the  privilege which
falls to the lot of the physician,—when he
has in his power times and opportunities in
his relations with society,—when the word in
season cannot be out of place, as far as the
welfare of  those intrusted to his care is
concerned.
  The causes of affections of the heart are
very numerous.  As already noticed, mental
disturbance and agitation is a most frequent
one; also mental depression and grief, which,
if long continued, appear to exert  much
influence over the organ, and to make the
phrase  " a broken heart"  not altogether  a
poetical fiction.   Violent  passion  strongly
affects the heart—its  indulgence may lay
the foundation of disease, which  its repeti-
tion  strengthens, and may bring to a fatal
termination.   Rheumatism, or rather rheu-
matic fever, is probably another of the most
fertile sources of heart affection.  In  this
disease, inflammation of some portion  of the 
Pi H iIL  IB |
 
 
                  HE A

membranes covering  or  lining  the  heart,
(see Carditis,)  is  apt  to  occur,  and to be
followed by such  effects  as induce  perma-
nent change.   Violent physical exertions,
dissipation  of  all  kinds,  particularly the
abuse  of spirituous liquors, are all origin-
ators of the above affections.   It has been
said that persons with heart affections may
continue to live and enjoy life, but it must
be under a more  regulated and restricted
Bystem of living than is imperative on per-
sons in  health.   Every thing which may be
a cause of heart affection  must also be a
source of aggravation; all mental  or phy-
sical excitement especially so.   When these
are  guarded   against, the  rest  may  be
summed up in—strict attention to the gene-
ral  health.  Whenever an  old  symptom
becomes aggravated, or a new one, such as
swelling of the legs, &c.  appears, medical
advice should  always  be taken.   The great
secret in these affections  consists in main-
taining the  balance of the various func-
tions,  and  this can only be  done  by the
judicious  management of a medical  at-
tendant.
  Refer to Angina  Pectoris—Carditis—Circu-
lation—Hysteria—Palpitation, Sec.
  HEARTBURN.—A  burning or irritating
sensation, felt either at the pit of the stomach
or top of the throat, and occasioned by undue
acidity, or by acrid matters, in the stomach.
It is generally  relieved by an alkali—potas-
sa,  soda, magnesia, or chalk—which neu-
tralizes the acid.   It is not, however, advis-
able to have too frequent recurrence to these
palliative remedies, for they are only pal-
liatives,  they  cannot  be  taken  habitually
without weakening, not only  the stomach,
but the system  generally.  Heartburn can-
not continue to  recur without there being an
error somewhere;  either  the  diet is badly
regulated,  or  the  digestive organs require
something  more than  simple neutralization
of the superabundant  acid.  This acid is a
badly-formed gastric juice, and if it is neu-
tralized, whatever digestive power it might
possess is  destroyed;  consequently the sto-
mach is called upon to secrete another supply
before the food  can be  digested—a call upon
its powers which cannot fail to be injurious.
Moreover,  persons  finding how quickly a
dose of alkaline medicine removes the un-
comfortable sensation of heartburn, are very
apt to  trust to  the palliative, and continue
their indulgences,  rather than  to  practise
the self-denial  requisite to effect a cure of
the cause.
  Some persons  find  Spanish  liquorice a
good palliative  in heartburn.
  Refer to Indigestion,  Sec.
      v 2
II                H  E A

   HEAT.—The imponderable agent  which
 gives to our senses the feeling of heat, is in
 scientific language called caloric, to distin-
 guish it from the term heat, used to  desig-
 nate the sensation.   In  this article,  how-
 ever, the one term heat is employed.   It is
 not requisite here to enter into a considera-
 tion of the nature of heat.   Its sources, as
 best known, are the great fountain of it, the
 sun;  there is  also  the  heat developed in
 the interior of  the earth ;  that produced, or
 at least manifested, by friction, and also by
 combustion, chemical  change, and in the
 bodies of animals, (see Animal Heat,)  and
 in some plants.
   Heat is interesting in a medical point of
 view ;  first, from its effect upon the healthy
 body—its physiological effect;  and second,
 from its effects as a remedy in disease—its
 therapeutical effect.
   Of the first,  the physiological effects of
 heat, much has  been  said  under Acclima-
 tion, Animal Heat,  Bile,  &c, which it is
 unnecessary to repeat here : these articles
 sufficiently point out the effect of continued
 high temperature, (from 80° to  110°,) such
 as occurs in tropical climates, upon the hu-
 man body.
   When the heat becomes very intense, par-
 ticularly if there  is direct exposure to the
 rays of the sun, more immediate and marked
 effects result;  the brain may be affected,
 and sun-stroke, or " coup de soleil," as it
 is called,  be   the consequence.   This af-
 fection, which  is not uncommon  among the
 European residents in India, and especially
 amid troops  on  march,  is  sometimes  also
 witnessed  in the  case of harvest-labourers
 in this  country, in very  hot summer wea-
 ther.  The affected  person falls  insensible,
 the face flushed and swollen, and the ves-
 sels beating violently.  The most efficient
 remedies  are said to be pouring cold  water
 on the head,  and  the  administration of
 a  small quantity of stimulant, ammonia or
 brandy.
   The skin of persons exposed to extreme
 heat  is liable  to be affected with what is
 called " prickly heat;" an eruption of small
 pimples, or of minute blisters.   In  either
 case, the  use of  a tepid  bath, with a little
 lead lotion, will allay the symptoms,  and
 it may be well  to take some cooling  saline
 aperient.
   Although continued exposure to heat pro-
 duces  these effects,  it is  now well known,
 that the living human body is  capable of
 supporting, with impunity, exposure  to an
 atmosphere of very elevated temperature,
 considerably abov.e  that  of-boiling water,
 provided the air be dry.   The  development
2 
H EC
282
II  E M
 of urusual heat at any part of, or over the
 whole body,  is usually an  attendant on  fe-
 verish and inflammatory attacks.  In scarlet
 fever, and in inflammation of the  lungs, this
 is particularly the case.
   The use of heat in the treatment of dis-
 ease  is very frequently alluded to in this
 work, more especially because it is not only
 one of the most extensively useful, but also
 one of the safest and most generally appli-
 cable remedial agents which can  be placed
 in unprofessional hands.   Heat may be used
 as a remedial agent, simply as a soother, or
 —if we may  be allowed the expression—an
 anodyne.   It may be used as a derivative,
 or as a  counter-irritant.   Its application
 in the latter  form will be found alluded to
 under the article on  the  subject.   In cases
 of severe pain  such as colic, gall-stones,
 gravel, &c. heat properly applied, seems to
 act as heat simply, upon the nervous system,
 exerting an anodyne  effect,  and relieving the
 spasm.   For  this purpose  it may be used,
 by means of  bottles  or  tins filled with hot
 water, hot bricks, &c. &c. ;  but these  solid
 bodies are not so useful or pleasant as other
 more yielding agents ;  and bags filled  with
 heated grain, oats, salt, bran, or some  such
 material  are to be  preferred.   Hooper's
 elastic cushions, which can be filled  with
 hot water, are also admirable  for the  pur-
 pose.  AVhen a derivative (see  Derivative)
 action is required, as  it is in inflammation and
 inflammatory pain, then heat with moisture
 must be  used, and nothing answers better
 than  the  agency  of moist, heated bran.
 The great effect of the heat and hot vapour
 when used,  in  these cases, is to produce
perspiration  from the  part, and thus  to
combine this  means  of relief with the  ano-
dyne  action of  the  elevated temperature.
 The  use  of heat, especially of moist heat,
in the treatment of disease, is  especially
pressed upon the  attention of the  unpro-
fessional reader, for  it  is a remedy  almost
 always procurable, and almost always safely
usable.    There  are, however, a few ex-
ceptional cases,  in which the use  of heat is
not desirable.   These are such as call for
astringing rather than relaxing.  Bleeding
from, and swelling of various parts may be
increased  by  heat, which must,  therefore,
be avoided.
  Refer to Animal Heat—Bran—Fomentation
—Poultice, Sfc.
  HECTIC, or  Hectic Fever—Is an inter-
mittent form  of fever which occurs  in the
latter  stages  of consumption, and  also of
other diseases of a slow wasting  character.
 The  paroxyrsm  of  hectic usually comes on
 toward six  o'clock  in the evening — the
I person becomes heated, perhaps thirsty, the
 eyes are brighter than  usual, the  cheeks
 reddened, (sometimes beautifully coloured.)
 and  display  the  circumscribed  " hectic
 flush," at the same time, an almost morbid
 elevation of spirits  is not uncommon.   To-
 ward  midnight the stage of fever is  suc-
 ceeded by  that  of perspiration,  which in-
 creases as morning approaches, till toward
 four or five o'clock the patient is completely
 soaked in moisture, and is left in a state of
 painful exhaustion.
   Refer to Consumption, Sec.
   HELLEBORE,  Black  Hellebore,  or
 Christmas  Rose.—The root has been used
 as a purgative since ancient times, particu
 larly in cases of  insanity, &c.
   HEMATEMES1S.—Bleeding, or vomiting
 blood from  the stomach.
   HEMATURIA.—Flow  of blood from  the
 bladder.
   HEMICRANIA.—Pain confined  to  one
 side of the head.  It is generally of a neu-
 ralgic or rheumatic  character, and is often
 relieved by hot fomentation.
   HEMIPLEGIA.—See Paralysis.
   HEMLOCK—Conium  Maculatum.—This
 well-known  native  plant  belongs to  the
 umbel-bearing tribe.   Persons frequently
 call  all plants of this tribe " hemlock," but
 erroneously. The true hemlock may at once
 be distinguished by its being the only British
 plant belonging  to  the  umbelliferae  which
 has  a smooth spotted stem.  The knowledge
 of this fact may be useful in case of alarm,
 not  unfrequent, from children  having eaten
 the  leaves of  such plants in mistake for
 parsley.   The leaf of  the hemlock is a very
 deep green,  and, when bruised,  emits  an
 odour like that of mice. Hemlock is used by
 medical men as an occasional substitute for
 opium.    Domestically, the leaves  may  be
 used externally,  as  a poultice, in painful
 ulcerations or tumours.
   In persons  poisoned  by hemlock,  the
 symptoms are giddiness  and dimness  of
 sight, convulsive  twitchings,  paralysis, per-
 haps vomiting. The same treatment as that
 recommended in poisoning  by belladonna
 may be adopted  until medical aid can  be
 procured. The use of strong  coffee or green
 tea will also be advisable.
   HEMOPTYSIS.—Bleeding from the lungs,
 or " spitting of blood."
   HEMORRHAGE—Bli:i:imn(j—Is  the  es-
 cape of blood from its own proper vessels,
 but the term is usually applied to cases in
 which the effusion takes  place in consider-
 able quautity, and is rapidly  poured out.
 Hemorrhage may be either external or  in-
 ternal.   In the former instance, it is almost 
                 HE M

invariably  the  result  of wound  of  some
blood vessel,  eitlier artery or vein ;  in  the
latter, the blood may also be poured out by
a large vessel,  but generally it is exuded
through  the  lining membrane, or  into  the
tissues of the part in which  it occurs, from
the minute vessels, so minute  indeed, that
after fatal cases of internal hemorrhage, the
closest examination may fail to detect  any
visible opening, or  openings,  from which
the blood can have escaped.
  For information respecting  external  he-
morrhage, or such as occurs from arteries or
veins, the reader is referred to the articles
under these heads.
  Internal hemorrhage, when it does occur
from  a large vessel, is  the result of that
vessel having been opened by disease, such
as aneurism, (see  Aneurism,) or by ulcera-
tion, but these instances are comparatively
few.  The head is  an exception, however, to
this remark, for hemorrhage withinits cavity
is almost always occasioned by the rupture of
a vessel.—See Apoplexy, Brain.'  Hemorrhage
from  piles is  also exceptional.—See Piles.
  Internal hemorrhage may be either of an
active or of a passive character; that is, in
the former case,  the  effusion  of  blood is
preceded   and  accompanied  by  feverish
symptoms, quickened pulse,  thirst, with a
sensation of  fulness and  heat  in  the  part
whence the blood flows ;  in the latter, these
symptoms are absent.  The  effect  of active
hemorrhage  is, generally,  to  give relief,
eitlier to the  constitution at  large,  or to the
particular  part.   Indeed, by  some, active
hemorrhage  is regarded  as a natural  cure
of what might otherwise prove an attack of
inflammation.  Passive hemorrhage, on the
other hand,  almost  invariably  weakens; it
is the result of weakness and relaxation,
which its occurrence tends to increase.
  As  may be imagined, in the treatment of
hemorrhage generally, medical men have to
keep  these  differences  distinctly  in mind,
lest, by interfering with, too precipitately,
or checking too soon an active hemorrhage,
they may thwart the natural curative effort;
or by permitting  passive loss of blood to
continue, they allow a patient  to  be  unne-
cessarily, perhaps irremediably weakened.
Moreover, it  is necessary in the treatment
of hemorrhage, to consider whether the flow
may not be what is called " vicarious," that
is, a substitute for some  natural discharge
which has been checked, or whether it may
not have  become  an habitual safety-valve.
The  danger  of checking long accustomed
discharge of  blood, such as that from piles,
is a matter not only of popular belief, but
(and perhaps justly) of strong popular pre-
13                HEM

judice, having become so from  the notable
frequency with  which  attacks  of  other
disease, particularly of apoplexy, have fol-
lowed the suppression of  accustomed  dis-
charges.   Medical experience  abundantly
supports the general  opinion on this  head,
and it is a well-understood rule, that habi-
tual hemorrhages should never be interfered
with so long as they do not touch the gene-
ral health and strength.
   As regards the management of or  inter-
ference with continued cases of hemorrhage,
therefore, unprofessional persons ought not,
and cannot, with any propriety, have  any
thing to do ; but, when the occurrence itself
actually takes place, a knowledge of the best
mode of proceeding may be of much service;
for, though in the case of active hemorrhage,
benefit  may, up to a certain  point,  be de-
rived from  the circumstance, the process
might possibly, especially if improperly ma-
naged, run  on to an undue extent, and even
affect life.
   Hemorrhagic exudation of blood is more
liable to occur from some parts of the body
than others, and particularly from the mu-
cous membranes which  line  the nasal  and
air-passages generally, from the alimentary
canal, and genlto-urinary organs.  " Another
important fact  in  respect to hemorrhages
by exhalation is, that they proceed more fre-
quently from certain parts of  these mucous
membranes than  others, according  to the
differences in age.   Thus, in children, they
are most common from the  membrane that
lines the nasal cavities;  in youth, from the
mucous membrane of the lungs  and  bron-
chi."  In middle  life, from  the bowels or
bladder, or  in the head.
   When an  individual  is suddenly  seized
with bleeding or hemorrhage from any part,
as a general rule, perfect quietude of body
and mind should be  observed, and cold  is
the simplest  and  readiest  astringent, ap-
plied in the various forms of cool air, cold
water, &c. &c.  Medicinal astringents (see
Astringents) may be resorted to,  and  should
the resulting  depression be extreme, stimu-
lants may be required,  but their adminis-
tration calls for the greatest  caution;  and
it  must be remembered  that the state of
depression  may be the chief security to the
patient against an immediate return of the
bleeding.
   The causes of hemorrhage are various.
As might be expected, general plethora, or
superabundance of blood, is a common one ;
hence, persons who take but little exercise
and live  freely  are liable to  it more than
others.   Perhaps the most general cause of
hemorrhage is congestion, or accumulation
2£ 
II E M
284
II K  M
Df blood in  any one part or organ  of  the
body, in consequence of some  impediment
to the  circulation;  thus,  disease of  the
heart,  by damming  up  the  blood  in  the
lungs, or disease of  the  lungs  themselves,
which  impedes the  flow,  may,  either of
them, cause  spitting of  blood: or disease
of the liver may cause hemorrhage from  the
bowels.   In some particular states of con-
stitution, there  appears  to exist  a  strong
tendency to  effusion  of blood;  this is seen
in scurvy, and in the  disease called purpura,
or, popularly, the "purples."   Moreover,
there is a certain constitutional  tendency,
or "diathesis," called the "hemorrhagic,"
in which a more than usual liability to bleed
from slight wounds exists.  In persons who
possess this diathesis, even the extraction of
a tooth may, and has proved fatal, in con-
sequence of  uncontrollable bleeding.  The
tendency is  hereditary,  and those who  in-
herit it must be extremely cautious before
submitting to even trifling operations, which
involve breach of surface  and effusion of the
vital fluid.
   Bleeding  from  the nose  (Epistaxis)  is
Bometimes very profuse, and,  either on this
account, or  from frequent  repetition, may
be the  source of great weakness,  in  consti-
tutions that can ill afford the drain, for its
occurrence   is not uncommonly associated
with tendency to chest  affection.   Many
various methods  for its suppression  are
had  recourse to, but  cold  applied  to  the
forehead, spine, or other  parts of the body,
is the  most  general.  Raising  both arms
above the head has  been said  to stop  the
flow quickly, or a small quantity of solution
of alum, as strong as it  can be made, may
be thrown up with a syringe; or  a piece of
linen, soaked in the solution, may be stuffed
up the  nostril.  From ten to fifteen drops
of dilute sulphuric  acid may  be given in
water at intervals, according to the nature
and persistence of the attack.
   Bleeding  from the nose, in  persons  ad-
vanced  in  life, must be much  more cau-
tiously interfered with than  in the  young.
In the former, it is  generally preceded by
symptoms indicative of congestion about the
head, and, consequently,  is a natural relief.
It may, of course, go to  an extreme  extent,
and require checking.
   Bleeding  from the lungs,  or spitting of
blood,  is generally preceded by  symptoms
indicative of  undue  determination or con-
gestion of blood to, or in  these organs.   Op-
pressed breathing, cough, pain  in the chest,
and feverish symptoms usually precede the
attack,  and just previous to  it  a  saltish
taste is generally perceived.  Bleeding from
' the lungs may occur in every degree, frorr
 a mere  tinge of the expectoration,  to  the
 copious  coughing up  i-i  fluid bb od.  The
 blood is  coughed up, whereas, when it comes
 from the stomach, it  is vomited, a distinc-
 tion which appears evident enough, but which
 is not always rendily made in practice. The
 management of hemorrhage  from the lungs
 must be that  recommended for hemorrhage
 generally.  Until medical assistance  can be
 procured, perfect quiet is to  be observed,
 cool  air, especially on  the chest, freely  ad-
 mitted,  and cold,  or  iced and  acidulated
 drinks given plentifully.  Alum will also he
 found useful.—See Alum. Should the attack
 continue,  and medical  assistance still  be
 absent,  cupping  on the  chest, or between
 the shoulders, might be had  recourse  to.
 Sulphuric acid  may  be  given  as  recom-
 mended  for bleeding  from the nose,  or in
 an extreme case, when medical aid is  far
 distant,  one grain and a half of sugar of
 lead  may be  given,  made  into  pill with
 crumb of bread, every two, or three, or four
 hours, being washed  down by  a draught of
 vinegar  and  water.   The expressed juice
 of the common  nettle is sometimes popu-
 larly used, and,  it is  said efficaciously, to
 check bleeding from  the lungs;  the dose,
 one teaspoonful  three times  a  day.  The
 inhalation of the smoke from the burning
 leaves of  the belladonna is said to check
 the immediate flow of blood from the lungs.
 For this purpose  one drachm of the  cut
 and  dried leaves  is  to  be  thrown  upon
 glowing coals.  In tendency to passive  he-
 morrhage from  the  lungs,  Dr. Theophilus
 Thompson recommends the following lozenge
 to be used as occasion  may require:—Take
 of powdered gum arabic and  of white sugar,
 each three drachms;  powdered tragacanth
 one drachm and a half, alum two drachms,
 catechu three drachms, rose-water sufficient
 to form  a mass,  which is to  be divided into
 sixty lozenges.   When the cough is trouble-
 some, it will be best allayed by a few drops
 of laudanum.
    The causes of hemorrhage from the lungs
 are such as have been named above; per-
 sons of  scrofulous constitution, or who have
 any  malformation of the chest,  are most
 liable to suffer from  it.   It  rarely  occurs
 in children.  The  exciting  causes  of this
 form  of hemorrhage  are such as call  the
 lungs into active,  strong, or continued  ex-
 ertion,  such  as  violent  bodily movements,
 much loud  exercise  of  the voice,  playing
 on wind  instruments, &c.;  these  things
 must, therefore, be  sedulously avoided by
 those who have  any tendency to the  dis-
 order.  Temperance and moderation, strict 
                  HEM

attention to the condition of the bowels, and
to any  accidental  disorders of the  chest,
will  be the best safeguards.  While treating
of this  subject, it should be mentioned that
persons are often needlessly much alarmed,
from thinking they are expectorating  blood,
while the fluid simply comes from the  throat
or gums, or, it may be, is the  consequence
of blood from  the  nose trickling down the
back of the throat.   It perhaps is scarcely
necessary to add, that the above details of
management are not meant to stand  in the
place of competent medical advice.   This
should never be dispensed with in so serious
a disorder as spitting of blood.
  In hemorrhage from the stomach, "hema-
temesis," the blood is vomited,  not coughed
up:  its causes and treatment, modified, of
course,  by the  difference  in the organ,  and
its site, are similar to those detailed  in he-
morrhage  from  the lungs.  Vomiting  of
blood in young females is  not  a very  un-
common accompaniment  of disorder  of the
menstrual  functions, and can  scarcely be
considered a dangerous affection.  The re-
storation  of the  proper excretion  is,  of
course,  the most effectual remedy.
  Vomiting of blood  may happen in con-
sequence of blood  which has been effused
from the nose  having been swallowed; in
this  case it is generally darkened by the di-
gestive action of the  stomach.   Blood from
the  lungs is generally much more frothy
than that  ejected  from  the stomach.   In
either case,  the  more  florid  the hue  the
more active or inflammatory the hemorrha-
gic tendency.  Profuse discharge of  blood
from the bowels often occurs in the course
of fever, or from diseases of the abdominal
organs, such as the liver, &c. Flow of blood
from the bladder ("hematuria") will be ad-
verted to under article  Urine.
  Refer to  Abortion—Artery—Child-birth—
Piles— Veins— Wounds, Sec.
  HEMP, or Indian Hemp—From which the
"haschisch" of  the Arab,  the bhang  and
gunjah  of  the East Indian is obtained, is
used by Asiatics on account of its intoxi-
cating properties, and is coming into  use in
medical practice in this country for its ano-
dyne powers, particularly in neuralgia.
  HENBANE — Hyoscyamus  Niger—Is  a
native of Britain, and of  Europe generally,
being found  on roadsides and uncultivated
ground, particularly in the vicinity of houses.
It is, however,  cultivated for medicinal use.
Henbane grows from one to three feet high;
its leaves are large,  the  edges  waved—si-
nuous—pale green, and viscid; the flowers
are  dingy-yellow, and   much  and darkly
veined; the whole plant smells disagreeably.
55               HER

 Henbane is one of the  narcotic substitutes
 for opium most generally employed.   It is
 given either in tincture or extract—the dosa
 of the former being from ten to thirty drops,
 and of the latter from five to ten grains.
   The action of henbane is  in many re-
 spects similar, but  much inferior in power
 to opium.  It possesses, however, one great
 advantage over that drug—it does not con-
 fine the bowels; it  is, therefore, a most ad-
 mirable  addition to medicines, particularly
 purgatives, which are apt to gripe. In many
 cases, the addition of one-third of the extract
 of henbane to the compound colocynth, and
 other aperient pills, is of much service.  It
 sometimes occasions (in  too large doses) a
 peculiar state of  delirious hallucination.  In
 a case of poisoning by henbane, treatment
 similar to that recommended under " Bella-
 donna" should be adopted.
   HEPATIC—Belonging to the Liver.
   HEPATITIS.—Inflammation of the Liver.
   HEREDITARY TENDENCY.—The trans-
 mission  of  a  tendency toward  certa'u
 forms of disease  from parents to children,
 and from  ancestry generally  to their  de-
 scendants, has been an  acknowledged fact
 from  remote ages; a  proof of  the unmis-
 takable  character and frequency of  the
 incident.   Some  portions of the body  are
 more liable to be affected by transmission
 than  others, " but  no  organ  or texture is
 exempt from  the chance of being the sub-
 ject of hereditary  disease;" and although
 some diseases are well  known  to be  much
 more generally  inherited than  others, we
 have  no  means of  determining how far the
 limitation  extends, or  whether  indeed  it
 does not include diseases generally, within
 its bounds.
   Although there  are  maladies,  such  as
 small-pox, which are so directly inherited
 that the offspring  is actually found  to  be
 affected  with  them when born,  this is not
 the common rule—the hereditary taint act-
 ing rather by giving the bias to the develop-
 ment of the disease; and it is  observed that
 those children which more nearly resemble the
 parents in physical conformation are more
 likely also to resemble  them in liability to
 certain forms of hereditary affections.   It is
 not necessary, however, for the transmission
 of hereditary  disease  that it should be de-
 veloped  in the parent, who,  although the
 connecting link between a grandparent and
 grandchild as regards the disease bias, may
 yet have been entirely free from the trans-
 mitted disorder.  In other words, an heredi-
 tary tendency to disease seems often to skip
 over one generation.
   Hereditary predisposition may be derived
21 
HER                286               H IP
fiom a  parent direct, nnd  from a  parent
only, in whom a certain  state of disorder
has been developed, independent of previous
hereditary influence.  Whatever debilitates
the system, whether  it  be advanced  life,
dissipated  habits, or the like, is  almost
certain to affect the children, and  may ori-
ginate  a tendency to  scrofula in a  family
previously free from it.    Even a transient
bodily condition seems frequently to influ-
ence the  offspring,  more particularly  as
regards the nervous system.  Drunkenness
in  the  parent produces  idiotic children.
Mental  excitement communicates its  own
tendency.
  Again, disease apparently hereditary may
be developed  in a family  without its being
traceable in the descent,  that is, the chil-
dren, (many, or all of them.) may be liable
to certain  forms of disease, toward which
neither the parents nor  ancestors generally
had displayed any marked tendency.  The
fact is one not uncommonly met with.
  Scrofula and consumption, gout and rheu-
matism, insanity and paralysis, asthma, epi-
lepsy, blindness, and a  good  many other
diseases are well  ascertained to be trans-
mitted by hereditary tendency.  It is not,
however, necessary that the tendency should
develop itself under  the exact form of the
disease of the parent; thus, scrofula, instead
of showing itself as consumption, may  take
the form of insanity,  or gout  may be  sub-
stituted for gravel.
  The practical importance  of a knowledge
of these hereditary tendencies  is self-evi-
dent.   There  are  perhaps few, if any, who
do  not inherit some  predisposition  to cer-
tain forms of bodily disorder.  It must, there-
fore, be not  only to  the  advantage, but it
must be the duty of every responsible per-
son to consider what  these predispositions
are in himself, and to endeavour, as far as
circumstances will permit,  to  avoid their
being excited.  Still more important is  it,
in  the contraction of  marriage, to consider
whether union  with  one  having  similar
hereditary  tendencies will  not  certainly
entail upon offspring  an irremedial  predis-
position to disease thus devolved upon them
from both parents.   This argument  derives
tenfold force  if the  parents happen to be
nearly related by blood; for even in  healthy
families, the  marriage and intermarriage
of  near  relatives almost  certainly leads
to the  production of  weakened and weakly
descendants.—Refer  to Marriage.
   HERNIA—Means the protrusion of a por-
tion of  any organ from the cavity in which
it is naturally contained ;  thus, there is her-
nia of the brain, or of the lungs.  The term
is, however, most generally applied to the
protrusion of part of the contents of the ab-
domen.—See Rupture.
  HERPES.—A disease of  the skin,  cha-
racterized by the eruption of aggregations
of small blisters.   Shingles  is a  form of
herpes.—See Skin.
  HERRING—Like the other oily fishes, is
apt to disagree  with weak stomachs.
  HICCUP—Is  a spasmodic affection of the
diaphragm.—See Diaphragm.   Generally a
trivial and transient  inconvenience, its oc-
currence in the last stages of acute disease
is  a  grave (often  fatal) symptom, indica-
tive  of giving way of  the nervous system
generally.
  Continued  and  obstinate  hiccup some-
times occurs in  the persons more especially
of young females of an hysterical tendency,
and may continue for weeks  without cessa-
tion, except  during  the hours of sleep, in
spite of all kinds of treatment.  The causes
of ordinary  hiccup  are generally  fasting,
or some  sudden stimulant  taken  into the
stomach, such as highly seasoned soup ; and
the affection  generally  subsides of its  own
accord.   When   inconvenient,  nothing is so
likely to remove it as  some  active emotion
of the  mind  suddenly  excited.  The  con-
tinued sipping and swallowing of cold water
is a frequent domestic remedy; or antispas-
modics,  such as sal-volatile, may be useful.
In the attacks  of continued  hiccup above-
mentioned, a medical man should  be  con-
sulted ;  but the disorder will  frequently run
its course in spite of his treatment.  Accu-
puncture  has been said to be a successful
mode of treatment.—Refer to Hysteria.
  HIP-JOINT.—The hip-joint is formed on
                Fig. lxxxv.
 
HIP                287               HON
 the one hand by the head of the thigh-bone,
 (fig. lxxxv.  1,) and  on  the other by  the
 deep cup or  cavity, (fig. lxxxv. 2.) which is
 excavated for its  reception in the bones of
 the pelvis, (3,)  or hips, thus  constituting a
 ball and socket-joint, which, although it may
 suffer dislocation, can only do  so from  ex-
 treme violence  in peculiar directions,  and
 in peculiar positions of the limbs.
   HIP-JOINT  DISEASE —Morbus Coxa-
 Rius — Is  a  disease  of the joint just  de-
 scribed, to which children of a scrofulous
 constitution  are more peculiarly liable.   It
 is of  the highest importance  as  regards
 ultimate  results that  this  affection should
 be placed under proper surgical  treatment
 in  the earliest stage in which it can  be
 detected ;  but its approaches are often so
 insidious that in  most  cases it has  made
 considerable advance before it is even sus-
 pected by parents that there is any thing
 wrong.  The following description, by Pro-
 fessor Syme, may, perhaps, put  some upon
 their guard:—
   "Hip disease prevails  in cold, moist  cli-
 mates, and attacks chiefly children between
 the  ages of  seven and  fourteen, though it
 is not unfrequently met with both before
 and  after this time of life.  The first symp-
 tom  complained of is  generally  pain  of
 the  knee,  which often exists for  months  be-
 fore  any indication can be perceived of  the
 true seat of the disease.  Sooner or  later
 the patient is observed to walk awkwardly
 and  less vigorously than usual;  and  when
 the circumstances on which this difference
 depends are  investigated,  it appears that
 the  affected  limb is  elongated  and emaci-
 ated— that the  convexity of the  hip is flat-
 tened  so  that  the furrow  between it and
 the thigh is less distinct and  more  oblique
 in its  direction—and that, in standing,  the
 foot  is advanced  a little  before  the  other
 one,  with  the toe  slightly everted, and that
 the  patient  does  not rest his weight  upon
 it.   Pain  is now felt in the hip-joint itself,
 and, though  aggravated by  motion,  often
 becomes  more  severe  from  time  to  time
 without  any such cause of irritation.   It
 is most apt to do  so during the night, par-
 ticularly  when  the  weather is  wet and
 changeable.  In this second  stage, the dis-
 ease  remains generally several months, and
 sometimes a  year or  two.   At length the
 symptoms  which  have  been  mentioned,
 either  disappear, and the limb recovers  its
 former condition, or they are succeeded  by
others  still more disagreeable.   In the lat-
ter case,  the limb  becomes considerably
shorter than  the  sound one ; its mobility
is  at  the  same time  much  impaired  or
 altogether destroyed, and  permanent rota-
 tion either inward  or outward is also appa-
 rent.  Collections of matter now generally
 make their appearance, most  frequently on
 the outer side of the thigh, but occasionally
 in the groin and hip. In some few instances,
 but very rarely, the fluid of these abscesses
 is absorbed, but the ordinary course which
 it follows is  to issue  externally through
 openings  formed,  either by ulceration, or
 artificially by the surgeon.  The patient
 then, after a tedious illness, becomes hectic
 and dies,  or recovers with  a stiff joint,  and
 a wasted, useless limb."
   HOME-SICKNESS, or Nostalgia—Is a
 peculiar affection of the mind to which  the
 natives of mountainous countries, especially
 the Highlanders of Scotland and the Swiss,
 are  liable when at a  distance from,  and
 during prolonged absence from their homes.
 They are  seized with a vehement desire to
 return, and if this  is not  gratified,  melan-
 choly, loss of sleep and appetite,  and finally,
 perhaps,  disease of the lungs,  supervene.
 The  emotion  is  liable to   be  excited   by
 whatever  recalls forcibly  to the mind  the
 beloved scenes:  national  music does  this
 most strongly ; so  much so, indeed, that it
 has been  found  requisite to prohibit for a
 time the performance of certain airs when
 troops have been stationed  abroad.
   HOMOEOPATHY—Is  the system of treat-
 ing disease founded by  Hahnemann, upon
 the principle that diseases  presenting cer-
 tain sets of symptoms are   cured by medi-
 cinal agents  which have the  power of  ex-
 citing  similar  symptoms in the  body of  a
 healthy person to whom they may be admi-
 nistered.  In  conjunction  with  this  prin-
 ciple, practical homoeopathy enjoins the  ad-
 ministration of the  above medicinal  agents
 in inconceivably minute doses.   In a work
 like the present it would be futile—in  the
 limited space which could be allotted to the
 subject—for the author to  attempt  to  lay
 before his readers  those reasons which, to
 his own  mind, would  render him  loth to
 trust either his own life or  the lives of his
 patients to homoeopathic treatment.
  HONEY—The well-known substance col-
lected by bees from flowers, consists almost
 entirely of sugar, partly crystallizable, and
partly not so  ;  the first being similar to
grape-sugar, and capable of undergoing at
once the vinous fermentation.  Honey varies
in degree  as regards  fragrance  and taste,
according to  the flowers from which it is
collected : and in some instances, it is even
of a poisonous nature,  in  consequence  of
being collected from poisonous plants.   As
an article of diet, honey is wholesome  for 
HOO
288
HOO
most persons, although with some it causes
acidity, and with others it gripes.  It is
slightly aperient.  For medicinal purposes,
especially domestically, honey is frequently
used, and answers well as a pleasant addi-
tion to cough-mixtures, &c.   Mixed with a
little vinegar  and lemon-juice, it  is useful
in cases of sore-throat and cough, with ad-
hesive expectoration.  Honey is frequently
used mixed with borax  in cases  of thrush
in children, and in  sore mouths generally.
The form is a bad one in all such cases, and
especially in the former disease.
   Refer to Borax.
   HOOPING-COUGH, or Chin Cough—May
be  described  as a spasmodic catarrh.  It
is one of those diseases of which one attack
confers immunity from all  future  liability
to the affection,  and  as  it is  generally
passed through in childhood, hooping-cough
is comparatively seldom met with in adults,
although they  are  by  no  means exempt
from it.
   The first symptoms of hooping-cough  are
those of common cold, which, having  con-
tinued unrelieved for ten days or a fort-
night,  gradually  assumes  the spasmodic
character of the disease, that  is, the cough
comes  on in prolonged  paroxysms, which
present the following symptoms :—After a
succession  of violent  expulsive coughs, a
long-drawn  inspiration  is  made,  accom-
panied  with  the  peculiar  crowing,   or
"hoop,"  which characterizes  the disease
and gives it its name ; this inspiratory effort
is again immediately followed by the same j
expulsive coughs, and the alternation  con-
tinues until the  child is relieved by the ex-
pectoration  simply of a quantity of glairy
phlegm, or by vomiting, which also expe-
dites the expectoration.  Very soon after
the paroxysm is over, the child resumes its
ordinary condition, whatever that  may  be;
and  if  the stomach  has been emptied  of
food, generally,  before long, complains of
hunger.
   While the expulsive cough is going on the
child seems on the point of suffocation; the
face becomes swelled and  livid, the veins
turgid,  the  eyes projecting; the whole
frame is so shaken, that the little  patient
seeks to  steady itself by laying  hold  of
some fixed object—its nurse, a table, a chair
—indeed, children who have suffered some
little time from hooping cough, instinctively
run to some means of support as  soon as
they feel a paroxysm coming  on.
   The  severity   of  hooping-cough varies
greatly ; sometimes it is  so mild a disease
that it is  scarcely possible to  pronounce
whether it  has existed or not, no more than
one or two " hoops" having been heard du-
ring its  course ;  at others, the paroxysms
of hooping and cough occur many times in
the twenty-four hours.  At first, the expec-
toration  is thin, and got up with difficulty;
as the disease advances,  especially  if fa-
vorably,  it becomes more consistent, and is
more readily parted with.
   When  hooping-cough  is on  the  decline,
the  paroxysms occur only at  more distant
intervals, and are  shorter, in  consequence
of the greater freedom of expectoration.
Bleeding at  the nose is not at  all an unfre-
quent consequence of a fit of coughing, and,
in stout  children, may be regarded  as a
relief.  The duration of hooping-cough may
be from  one month to six,  according to cir-
cumstances, such as season, summer  being
the most favorable.  When it exists alone,
it is  not  a serious disease ; but when, as it
too frequently does, it becomes complicated
with head affections, such as  convulsions,
&c. or  with  inflammation  of the lungs, it
is transformed into a most dangerous ma-
lady, and carries off numbers  of children,
particularly very young  children — under
two  or three years of age—to whom  it is
more fatal than to those at a more advanced
stage of  life, and who have passed the age
of teething.
  There  is no question as to the contagious
nature of hooping cough.
   In one  respect, hooping-cough is like
fever ;  it is a disease which, as far as our
present remedies are concerned, has a course
to  run,  and one we cannot  prevent; but
we  can  guide the  disease in  that course,
and  by watching symptoms,  and  meeting
them, should  they  assume a  conspicuous
or alarming character,  prevent, by  ap-
propriate treatment, those  complications
which  constitute  it  a disease  of danger.
In many  cases,  if the  attack  of hooping-
cough  is  tolerably  mild, parents  never re-
quire medical attendance ;  but in the event
of their  not doing  so, it is their duty to
watch  their children closely,  and on the
slightest  appearance, eitlier of inflammatory
affection  of the lungs, or  of a  tendency to
convulsion, to call in proper advice, using
in the interval—if there must be one—such
modes of management as are recommended
under these articles.  As regards the actual
treatment of the  disease  itself, it is ques-
tionable  whether any system of medicine is
of very  great  service,  but much depends
upon proper and judicious  management.
The diet  of  the child should be strictly at-
tended to, and ought to consist chiefly of
milk  and  farinaceous preparations;  in
short, a  mild, unheating  diet,  meat being 
HOO
289
HOO
 better avoided altogether, unless the child
 is very delicate, in which case tolerably good
 broth will  be the best  mode of giving ani-
 mal food.   The bowels ought to be kept in
 as regular a condition as possible by means
 of simple aperients, and the child protected
 from the influence of weather.—See Clothing.
 Indeed, if  hooping-cough occurs in winter,
 the safer plan is to confine the child entirely
 to the house, and especially during the pre-
 valence of  the east winds in spring.
   When expectoration is difficult, an emetic
 of ipecacuanha, given three or four times a
 week, will  be useful, and the simple  cough-
 mixture  containing ipecacuanha wine may
 be  used  regularly.   If the cough  is very
 troublesome, a couple of grains of Dover's
 powder, given to  a child of three years of
 age, at  bedtime,  will  moderate it; but  the
 most efficacious remedy within the author's
 experience, is the combination of laudanum
 and tartarized antimony, or tartar emetic,
 which, indeed, is sometimes used domestic-
 ally.  For  a child three years old, a single
 grain of tartar emetic is to be dissolved in an
 ounce  and  a half of  water, and  to this
 fifteen drops of laudanum are to be added:
 a teaspoonful may be given every five  or
 six  hours.   Dr. Golding Bird recommeuds
 alum, as in the following prescription:—
 Take of alum twenty-five grains, extract of
 henbane  twelve  grains,  syrup of poppies
 two drachms, dill-water  sufficient to  make
 a three-ounce mixture, of which  a des-
 sert spoonful  may  be  given  every  six
 hours.   Many other internal remedies  for
 hooping-cough are given and recommended,
 such as  alkalies,  cochineal, iron,  &c. &c.
 but these already mentioned are sufficient
 for  the management of the disease.  Ex-
 ternal remedies, such  as embrocations, are
 often  employed:   "Roche's Embrocation"
 has been in much favour for the purpose;  it
 is said to consist of olive-oil two parts, oil
 of amber and oil  of cloves each  one  part;
 it is, therefore, stimulating,  but probably
 any other stimulating embrocation, such as
 camphorated  or ammoniated oil,  would an-
 swer equally well.  If any thing can be said
 to cure  hooping-cough, it is change of air,
 which, in the latter stages of the affection,
 seems  to act like a  charm,  and  should
 always, when circumstances permit, be had
 recourse to.   When the disease has passed,
 or is passing away, if the child, as perhaps
 it  may be, is  much reduced, strengthening
 remedies, tincture of  steel, &c.  with  good
 diet, may be required.   For some time after
 an attack of hooping-cough, more than or-
dinary care  must be taken to guard against
cold, which is very apt to bring back—
      Z                                  1!
 in  degree—the  symptoms,  and  even the
 " hoop."
   It is  repeated, hooping-cough  is not in
 itself a disease of danger, and, especially if
 it occurs in  summer-time, may  be  safely
 and tolerably easily passed through, with
 judicious  and  simple  management;  but
 should it become complicated, as mentioned
 in the foregoing article, it may require  all
 the  care and skill of the physician to save life.
   Refer to Bronchitis—Catarrh—Convulsion
 —Expectorants, Sec.
   HOPS—The well-known bitter agent, are
 the  seed "catkins" of the Humulus lupulus,
 or hop-plant, which  is native  both to Eu-
 rope and the United  States,  and belongs
 to the nettle tribe.   The elegant twining
 hop is too  well known to require descrip-
 tion.  The hop is an  agreeable aromatic
 bitter; it is, therefore, a stomach tonic.  It
 possesses also narcotic properties,  though
 not  strongly marked  ones;  a pillow stuffed
 with hops  is frequently used to procure
 sleep, and hops heated in a flannel bag are
 a common remedy for toothache,  neuralgia,
 &c.   The use of hops  to impart  bitterness
 to beer was commenced in  this country in
 the  reign of Henry the  Eighth,  and there is
 no question that the addition is a perfectly
 wholesome  one when not in excess;  with
 this  view, the highly-hopped  bitter India
 beer, or  pale ale, may also be  regarded  as
 a medicinal tonic; but it must  also  be a
 matter of doubt  whether its continued use,
 in  cold  climates at  least,  is beneficial.
 Bitter tonics,  generally,  should  not  be
 taken  too long at a time, and  there seems
 no reason  why bitter  beer should  be an
 exception to the rule.   The practice, there-
 fore, of drinking it regularly cannot be re-
 commended—as far  at least  as  its tonic
 properties are concerned.  The infusion  of
 hop  is a  good tonic in weak and irritable
 states of the stomach, either taken alone or
 combined with an alkali;  it  is  made by
 infusing  an  ounce of  hops in two imperial
 pints of water: the dose a teacupful.  The
 young shoots of the hop-plant are, in some
 places, cooked and eaten like asparagus, for
 which they do not form a very bad substitute.
   HOREHOUND—White Horehound—bo-
 tanically  named  Marrubium  vulgare, is  a
 tolerably  common native  plant;  it is, too,
 much cultivated  in gardens in  the country
 for domestic use—horehound tea  being  in
 much request for coughs, &c.
  HORSE-RADISH—The well-known  con-
diment, is  the  root  of the  Cochlearia ar-
moracia, one of the scurvy-grass  tribe.  It
is powerfully  stimulant.  An infusion may
be made  in  the  proportion of an  ounce  of 
II 0 s
.00
H OS
the scraped root to a pint of boiling water,
and might be used in the absence of other
stimulants: or a poultice made of the scraped
root might be  used  instead of a mustard-
plaster.  The infusion made into a  syrup
with sugar, and frequently sipped, is said to
be useful in loss of voice from cold.
  HOSPITALS FOR THE SICK.—In large
towns  these benevolent institutions  are an
inestimable boon to the poor, more particu-
larly in the present defective condition of
sanitary arrangements.  In them, with the
exception  of privacy, they have all that the
wealthiest  in the land can command: skill,
cleanliness,  food,  medicines, and comforts
of every kind.  It is much  to be regretted
that the inhabitants of rural districts are, in
a great measure, deprived of the resources
of an hospital of some kind, especially in the
case of contagious disease  invading their
crowded cottages.
  Amid the poor,  many unfounded preju-
dices  and fears exist with respect to hos-
pitals and hospital  treatment. The following,
from a most interesting popular account of
St. George's Hospital in  London, published
in Dickens's Household Words, may perhaps
add force to the assurance that nothing but
the kindest and most considerate  care is
bestowed upon  the poor in these [as well as
in many other] most benevolent and  most
Christian establishments:—
  " A stranger's preconceived ideas of the
sufferings in an hospital are not at all borne
out  by the  appearance  of the patients
generally.   Many  of them are quietly read-
ing the better class  cheap literature of the
day; others are conversing round the ample
fire.   The little child with its leg  in a splint
is as merry as possible, with its bed covered
with playthings. Every thing that humanity
can dictate, or  to which art can minister, is
supplied.   The most eminent medical men
—whose attendance sometimes the rich can-
not purchase—watch the patient with all
due art and  skill;  while carefully-trained
nurses are at hand, day and night, to ease his
tired limb or to soothe his racking pain."
  Refer to Bedroom.
  HOUSES.—Nothing, perhaps, will  excite
greater surprise amid future  generations,
than the condition  of the houses or dwellings
in which the mass of the inhabitants of Eng-
land,  of the nineteenth century, were satis-
fied in some instances, compelled in others,
to spend the greater part of their lives.
  There  can  be  no question,  that to the
insalubrity  of  the dwellings of the poorer
classes especially, and often of the  rich,
much  disease is  owing.    This  is,  un-
doubtedly, in great measure due  to igno-
rance, for,  spite of the efforts of health of
towns' associations, nnd of the many chan-
nels through which sanitary information has
been attempted to be diffused of late years,
it is astonishing how little real or practical
information is retained by people generally.
With respect  to the various points connected
with the salubrity of houses, the reader is
referred  to  such  articles in  this  work
as "Bedroom," "Chimney,"  "Drainage,"
"Light," "Ventilation," " Water," &c.
  It is to be  regretted,  not  only for their
own sakes, but for  that of the  community
at large, that our poor are so generally, in a
measure, compelled  to inhabit the crowded
and unwholesome dwellings which they often
do, particularly in large towns.  When they
have the  power of the choice, the following
considerations should be kept in mind.   A
house should  not be chosen in a low, damp
locality;  it cannot  be well drained, and
fever,  rheumatism,  neuralgia,  &c.  often
prevail in such situations.  A dry, gravelly
soil is the  most to be preferred,  one  that
is well drained  naturally—a circumstance,
however, which should  not  prevent  strict
attention to artificial drainage   Good ven-
tilation, and  supply  of water, ought also to
be regarded as essentials;  neither is  situa-
tion as regards regular employment an  un-
important consideration.   If a man's work
is of a laborious, active character, he cannot,
perhaps, live  too near the scene of it;  but
if, on the contrary, he is engaged in confin-
ing and sedentary employment, it may make
all  the  difference between good  and bad
health, if his  dwelling be  at such distance
as shall compel  a regular moderate walk at
least twice in  the day.
  The author cannot  leave the  subject of
"houses" without adverting  to the idea,
that amid  the  numerous  schemes  pro-
pounded  for bettering the condition of our
humbler  classes, the facilities afforded by
the unlimited powers  of  railway transit,
have either been too much lost sight of, or
are not yet  sufficiently realized  to  men's%
minds.  The  necessities which in times past
forced  the population, first for the sake of
defence,  and  latterly for  the  purposes of
trade and commerce, to congregate in close-
packed towns, have  evidently passed away;
the one has been left behind in the march
of  civilization,  the  other has vanished in
the virtual annihilation of space  and time
by  railway power.   The  mechanic who—
under proper arrangements—may be con-
veyed in a quarter of an hour over six miles
of rail, may now, as regards time, be as near
his daily workshop  as he is living in the
crowded centre.    On this  fact the pro- 
HOU
291
HUN
position  is based, that, beyond three or four
miles from most of our large  towns, land,
for the  most part,  ceases  to  be of extra
value,  and  thus would permit  of decent
cottages  being erected for,  and gardens  let
to the  industrious mechanic, at an equally
small,  if not  smaller  rent than  he now
pays for his miserable room in the close,
unhealthy  street;  and at the  same time,
provided such habitations should be erected
near a line of railway, within reasonable
distance  of the town, and proper arrange-
ments  entered into, their occupancy might
be equally convenient  as regards  employ-
ment in  the  city  they suburbed,  as  the
present mode of living.   The advantages of
the humbler classes being  located in well-
regulated  moderate-sized  communities  in
the country, are in themselves  so manifest
and obvious, that it needs not here to dilate
upon them.   Health, comfort, decent habits,
new interests, such as  those  centred  in
the possession and  cultivation of a garden,
children  employed  in  salutary exercise  or
light employment, instead of wallowing in
the filth  and vice of  the town purlieus, may
be mentioned,  and with them  the facility
with which the suburban  railway  village
may be furnished with its school, its read-
ing and  lecture  room,  its   religious  pro-
vision,  and whatever may assist  in raising
the character and   moral standing  of  the
humbler  class; for without that elevation
there can be  no firm foundation  for a real,
efficient,  and lasting sanitary reformation,
such as  befits  a  civilized and  a Christian
people.
  HOUSEMAID'S  KNEE.—See Knee.
  HUMERUS.—The anatomical name  of
the arm-bone, (fig. lxxxvi.)   This bone  is,

                FT', lxxxvi.
at its upper end,  (1,) articulated or jointed
at the shoulder,  to the shoulder-blade, or
"scapula;" and at the elbow, by its  lower
end, (2,) to the two bones of the forearm.
   Refer to  Forearm.
   HUNGER.—The  desire for food is an in-
stinctive sensation, evidently connected with
the requirements  of the body generally, and
not solely with the condition of the stomach.
In a healthy state, the appetite  for food is
in proportion to the waste of the  body in ex-
ertion ;  in other words, if the motor change,
or transformation,  or using up  of tissues,
goes  on  more  quickly, as it  must  neces-
sarily do when  much exertion is made, the
tissue must be more abundantly  supplied
with nutriment, and vice versd,  if exertion
be less.  In any  case,  the  call  for  nutri-
ment is  made through  the medium of the
stomach, by the sensation of hunger.   The
direct*cause of that sensation is doubtful;
some have  referred  it to a distended  con-
dition of the vessels, &c. of the stomach;
but,  however that may be, it is  certain the
brain and nerves  participate largely in the
feeling.   Dr. Alison remarks,  " Whatever
be the conditions under which  the nerves
of the stomach become  the seat of  these
sensations,  it is certain that, in the healthy
state, they  are a true index, not  only to the
state of the stomach, but to the immediate
wants of the system  at  large."  To use a
simile, the  brain  may be likened to a  great
central telegraph-office, to which the  wires
—nerves—convey the information from all
parts of  the body that supplies are wanted,
and  this information is  transmitted to the
stomach  by its  own  special  means of com-
munication—or nerves—and causes hunger,
How and why this is, we cannot tell.   Al-
though, however, hunger is felt as a  sen-
sation in the  stomach,  in consequence  of
sympathy with the  system  at large, it is
appeased by the  introduction of food into
that organ, long before  the  digestion  of
that  food  can have  supplied  the  waste
which called for it.   To resume  our simile;
it would seem as if the" stomach telegraphed
back to the brain  the information that the
"order  had  been  received and complied
with"—that food  had  been  taken—and  so
the sensation ceases.  Moreover, the stomach
may give false information; for it is well
known that the sensation'of hunger  may,
for a time,  be  appeased  by the swallowing
of comparatively innutritious substances,
which occupy the  stomach, but which  can-
not be digested into nutriment for the sys-
tem;  and further, the sensation of hunger
may  be  allayed by  various medicinal  sub
stances, such as opium, tobacco, alcohol, &c, 
H U  X               292               II Y D
which dc not nourish.  Again, the informa-
tion respecting the  requirements  of the
Bystem, conveyed to  the stomach through
the brain, may, so to speak, be stopped in
transit;  this is seen in the case of acci-
dents ;  however hungry a man may be, if
he should happen to sprain a joint,  the ap-
petite will disappear at once.   Even mental
emotions will, by their effect upon the brain,
have the effect of destroying the  sensation
of hunger;  and Shakspeare adverts to this
observation, in the words addressed  to Wol-
sey by  King Henry the Eighth, along with
an unpleasant communication:—
                 Read o'er this:
    And after, this; and then to breakfast, with
    What appetite you may."
  Intense engagement of the mind in study,
or upon any subject which strongly excites
its interest, it is well known will often over-
power  completely the sensation of hunger.
This frequently happens to those who are
much absorbed  in scientific pursuits.   The
anecdote of the illustrious Newton is familiar
to most:—A friend  calling  to  see him was
shown into the room where Newton's dinner
—a chicken—was spread out;  being kept
waiting, he ate  the dinner and replaced the
covers.   The philosopher coming in  shortly
after, and finding  his  dinner gone, simply
remarked, "Dear me, I forgot I had  dined."
It is, perhaps, unnecessary to remark, that
Buch complete forget.fulness of the wants of
the body is scarcely consistent with con-
tinued  health, either of it or of the mind;
and, in consequence of this, even  Newton
paid the penalty.
  The influence exerted by mental emotion
over the sensation of hunger, may, however,
tell both ways;  for, if it destroy real, it may
excite  false hunger, and this it frequently
does. Very many are in the habit of eating
much more largely than the wants—the waste
—of the system require.  This may be the re-
sult of an unhealthy excitement of the nerves
of the  stomach, but much  more  generally
it arises  from epicurism, or love of  excess,
the mind being the cause of a false hunger,
or desire for tempting and unnecessary ar-
ticles of  food.  This is frequently the case
with people who live idle and indolent lives,
and who, having little else to occupy either
mind or body,  take  refuge in the indul-
gences of the table.  The effects of  this ex-
citement and indulgence of false hunger,
this habitual consumption of excess  of food
beyond what the wants of the system re-
quire, may, for a time, be compensated for
by  the  various  excretory  powers  of the
body, but sooner or later disease must be
the consequence.
  The proper and permanent appeasement
of hunger would seem, in some cases,  to
depend upon the fitness of the  food taken
for the circumstances  of the system gene-
rally ;  every one with healthy appetite feels
the desire  for different kinds  of food  in
winter and summer.   Sir John Richardson
mentions, with regard to his  arctic  experi-
ence,  that under exposure to intense cold,
bread and such articles were  not desired  as
food, which was always most acceptable when
of as fat and oily a character  as possible.
  Refer to Animal Heat—Appetite—Digestion
—Fasting—Food, Sfc.
  HYDATIDS—Are parasitic  beings belong-
ing to the animal kingdom, which are found
imbedded in the tissues, particularly the
glandular ones, of animal bodies.  The hy-
datid consists of a simple vesicle filled with
fluid,  and multiplies by the development of
young hydatids in its interior.
  HYDRAGOGUE—Is  a  term  applied  to
some purgative medicines which produce co-
pious watery evacuations from the bowels.
—See Purgatives.
  HYDRARGYRUM.—Mercury  or  quick-
silver.—See  Mercury.
  HYDRIODATE of POTASSA.—See Io-
dine,  Potash.
  HYDROCELE.—A dropsical swellingwith-
in the scrotum.  It requires proper surgical
treatment for  its cure, but a patient may
derive much  comfort  by wearing a  bag-
truss, or some similar  support, until he  is
relieved by operation.
  HYDROCEPHALUS.— " Water in  the
head."—See Brain.
  HYDROCYANIC ACID.—Prussic Acid.—
See Prussic Acid.
  HYDROGEN GAS—Is the lightest sub-
stance known, and,  when pure, has neither
colour,  taste,  nor smell;  the latter, how-
ever,  is very frequently present in conse-
quence of impurity.  Hydrogen gas  burna
with a pale yellow flame, the product of the
combustion is water, this fluid being a com-
pound of oxygen  and  hydrogen gases in
certain definite proportions.   The union of
hydrogen gas  with  sulphur constitutes the
very offensive  smelling  gas,  sulphuretted
hydrogen, which is  one of the products of
the decomposition of organized bodies,  and
also forms the characteristic feature of many
of the mineral waters, such as those of Har-
rowgate, [in England,  and of Virginia  and
New York, in the United States.]
  Refer to Carburetted Hydrogen.
  HYDROPATHY—Is the system of treating
disease by the use of water, both internally
and externally, in the modes  introduced by
Priessnitz. 
II YD               293               HYP
   Of the utility of water as an agent in the
 treatment of certain diseases, there cannot
 be a question, when its employment is judi-
 ciously regulated, and combined with other
 methods of cure; but it is equally certain
 that its indiscriminate and wholesale use, as
 it has been  practised in hydropathic esta-
 blishments, is too  often  a most dangerous
 quackery ;  a quackery, because  it  is put
 forth with pretensions to which it has no
 claim, and is used in an indiscriminate and
 ill-judged manner.   There are  many con-
 ditions of body—particularly that of the
 overfed and  the indolent—in which copious
 draughts of  pure cold water, regulated and
 simple diet, exercise  and promotion  of the
 functions of  the skin—all which are strictly
 enjoined  under the hydropathic treatment
 —must evidently be of the greatest service;
 nay, are  in themselves sufficient to restore
 health;  and  medical men have, perhaps,
 too much neglected such natural methods of
 cure, in their confidence in mere drugging.
 But it is no less certain, that an  indis-
 criminate and extravagant use of even these
 natural methods cannot fail to prove inju-
 rious in many states of the system; and so
 it has proved in many instances, and even
 death  has been the  result of  the  experi-
 ments.    Still, it  must be owned that the
 rise  of  hydropathy  has had   the  advan-
 tageous effect of directing more attention to
 the value of water in the treatment of dis-
 ease ;  and, if the  system itself has been
 mixed up with  much which must be con-
 sidered dangerous  error, that should be no
 reason  why  the  useful  suggestions  which
 may be gathered from it should not be taken
 advantage of.  Indeed, for medical men to
 refuse to do so, is to place themselves in the
 same position as the abettors of an  exclu-
 sive system, or the vendors of a "panacea."
 Medical science  can only retain its high
 place by liberal investigation  of those new
 phases  in  medical treatment,  which  must
 ever be arising  in  the progress of society,
 when these phases offer any tangible ground
 for such investigation—and this hydropathy
 certainly  does.   To refuse to investigate,
 or to refuse  to  adopt that which  is good,
 because  it has been found connected with
 some irregular system, is in itself quackery
 of the grossest kind, and is the most certain
 way  of strengthening the hands  of charla-
 tans or of fanatics.
   Refer to Water.
   HYDROPHOBIA—Literally, "Dread  of
water."—This  fearful and justly-dreaded
disease is especially of a nervous and spas-
modic character, and  is produced  by ino-
culation with  the saliva of an animal labour-
      z 2
ing under the malady.  Fortunately, it is of
so comparatively rare occurrence, that very
few medical men ever witness it at all.  For
the information in the following article,  the
author is indebted to the " Lectures" of  Dr.
Watson.
  After a person has been bitten by a rabid
dog, the wound  heals in the same  manner
as an ordinary wound from the same cause
would.  ♦' After an uncertain interval—which
lies for the most  part between six weeks and
eighteen months—the following symptoms
begin to be noticeable.   The patient expe-
riences pain, or some uneasy or unnatural
sensation, in the situation of»the bite. If it
has healed up, the scar  tingles,  or aches, or
feels cold,  or  stiff, or numb; sometimes it
becomes visibly red,  swelled, or livid.  The
pain or uneasiness extends from the sore or
scar toward the central parts of the body.
Very soon  after this renewal of local irri-
tation—within  a  few hours perhaps,  but
certainly within  a very few days,  during
which  the  patient feels ill and uncomfort-
able—the specific  constitutional symptoms
begin.   He is hurried and irritable ;  speaks
of pain  and stiffness,  perhaps, about  his
neck  and  throat;  unexpectedly,  he finds
himself unable to swallow fluids, and every
attempt to do so brings on  a paroxysm of
choking and sobbing, of a very distressful
kind to behold; and this continues for two or
three days, till the patient dies  exhausted."
Hydrophobia has  never been  cured when
once the  decided symptoms have  shown
themselves.
  " Generally, the disease, when it has once
set in,  and shown the peculiar hydrophobic
symptoms,  runs  a short and fierce course.
The nervous irritability becomes extreme.
The peculiar paroxysms of choking,  spasm,
and  sobbing are  excited, not only  by  at-
tempts to swallow liquids, but by the Very
sight or sound of them.   Even  the passage
of a gust of wind across  his face, the waving
of a polished surface, as of a mirror, before
his eyes, the crawling of an insect over  his
skin, is often sufficient to excite  great irrita-
tion, and the peculiar strangling about the
fauces  in  an hydrophobic  patient.  Death
occasionally takes place within  twenty-four
hours after the commencement of the specific
symptoms.   Most commonly of all, it hap-
pens on the second or third day;"  but may
be postponed even  to the seventh or eighth.
In some instances the symptoms alter  be-
fore death,  and the patient is able to swal-
low liquids.
  With respect to the infection of  hydro-
phobia, Dr. Watson  says—" We are sure
that the  disease, by the  inoculation  of 
II Y D               294               II V D
 which  hydrophobia  may be  produced  in
 man, is common in the dog,  and that  it has
 been communicated by the fox, the wolf, the
 jackal,  and the cat.   Mr. Youatt says that
 the saliva of the badger, the horse, the  hu-
 man being, have undoubtedly produced  hy-
 drophobia; and some affirm that it has been
 propagated  even  by the hen and the duck.
 All animals, even fowls, are susceptible of
 the disorder, when bitten by a rabid dog.
   The late Mr. Youatt, who had seen more
 of the  disease, probably, both in man and
 in other animals,  than any other person in
 this country, did not  think  that the  saliva
 of a rabid  animal  could  communicate  the
 disorder through  the  unbroken  cuticle:  he
 believed that there must be some abrasions,
 or breach of  surface.  He  held, however,
 that it  might  be communicated  by mere
 contact  with the mucous membranes.
   Of its harmlessness on the sound integu-
 ment, he offered this presumption—that his
 own hands  had  many  times  with perfect
 impunity been covered  with the saliva  of
 the mad dog.  He records some singular in-
 stances in which the disease was transmitted
 by  contact of the saliva with  the  mucous
 membranes.  " A man endeavoured to untie
 with bis teeth a knot  that had been firmly
 drawn in a cord.  Eight weeks afterward he
 perished undeniably  rabid.   It was then
 recollected that with  this cord a mad dog
 had been confined.  A woman  was attacked
 by a rabid dog, and escaped with the lacera-
 tion of her gown.  In  the act of mending it,
 she thoughtlessly pressed down the  seam
 with her teeth.   She  died.  If these  cases
 be  authentic,  they  are conclusive  of this
 question;  unless, indeed, the lips  of  those
 who perished happened to have been chapped,
 or abraded.   But Mr. Youatt's own opinion
 was, that the virus could not be received on
 a mucous surface without imminent danger.
   The disease is said  to have been caused
 by  the scratch of a cat.  But as we  know
 that cats as well as dogs frequently  apply
 their paws to their mouths, especially when
 the latter part is uneasy, (as it clearly is in
.mad dogs,)  this fact,  of the production  of
 the disease by a scratch, if thoroughly made
 out, would not prove that the disease can be
 introduced  into the system  in any  other
 way than by means  of the saliva.
   "It is still more interesting  to  inquire
 whether the saliva of a human being labour-
 ing under hydrophobia be capable of ino-
 culating another human being with the same
 complaint ?   Mr.  Youatt says, yes, that the
 disease  has undoubtedly been so produced.
 If this be so, the  fact  will teach us—not to
 neglect  or desert these unhappy patients—
' but to minister to their wants with ccrtnii
 precautions, so as not to suffer their saliva tc
 come  in  contact with any sore or abraded
 surface;  nor with any mucous surface.  On
 the other hand, all carefulness of thnt kind
 will be unnecessary, if the disease cannot be
 propagated by the human saliva.  Certainly,
 many  experimenters have tried  in vain to
 inoculate dogs with the spittle of hydrophobic
I man ;  but there is one authentic experiment
 on record, which makes it too probable that
 the disease, though it may not be communi-
 cated often, or easily, is yet communicable;"
 enough to enforce nil necessary caution upon
 those engaged  in attending upon an hydro-
 phobic patient.
   " Is  a  man who  has  been  bitten by a mad
 dog, and  in  whose  case no precautions  have
 been taken, a doomed man?  Will  he be sure
 to  have the disease, and therefore die of
 it?  By no means.   But few, upon the whole,
 of  those who are so bitten,  become affected with
 hydrophobia.  This frequent immunity from
 the disease in persons who have been bitten
 has tended to confer reputation upon many
 vaunted methods  of prevention.   Ignorant
 persons and knavish persons have not failed
 to take advantage of this.   They announce
 that they are in possession  of some  secret
 remedy which  will prevent  the virus from
 operating:  they persuade  the  friends of
 those  who  die  that the remedy  was not
 rightly employed, or not resorted to  suffi-
 ciently early: and they persuade those who
 escape, that they escape by virtue of the
 preventive remedy.  If  the plunder  they
 reap from  the foolish  and  the  frightened
 were all, this would be of less consequence ;
 but unfortunately the hope of security  with-
 out undergoing a  painful  operation  leads
 many to neglect  the only sure mode of ob-
 taining safety.
   *    *    "A still more anxious inquiry
 next arises.   Whoever  has  been bitten by
 a rabid or suspected animal must be con-
 sidered, and  will generally consider  him-
 self, as being in more  or  less  danger of
 hydrophobia.   This dread  is  not  entirely
 removed,  even by the adoption of  the  best
 means of  prevention.  Now, how long does
 this state of hazard  continue?   When is
 the peril  fairly over?   After  what period
 may the person who has received the injury
 lay aside  all apprehension of  the  disease?
 To  this inquiry,  no satisfactory reply can
 be  given.   In a vast majority of instances,
 indeed, the disorder  has broken out within
 two months from  the infliction of the bite.
 But the  exceptions  to  this rule  are toe
 numerous to permit us to put  firm trust in
 the unanimity afforded by that interval. 
H YD
295
H YD
   *   *    "Mr. Youatt describes cases in
 which there had been no symptoms of rabies
 observed  in the dog at the time the injury
 was  inflicted,  though soon  afterward the
 animal became decidedly rabid.   It is much
 to be regretted  that the dog is so often de-
 stroyed.    When a person has been bitten
 by a  dog or cat suspected to be rabid, the
 beast ought by no means  to be  killed, but
 to be secured and kept under surveillance,
 and suffered,  if it should  so happen, to die
 of  the disease.   If he do  not die, in other
 words, if he be really not rabid, that will
 soon  appear,  and the mind of  the  patient
 will then be relieved  from a very  painful
 state of  suspense and uncertainty, which
 might otherwise  have  haunted him for
 months or years.  Should the dog die mad,
 the injured person will be no worse off than
 if the animal had been killed  in the first
 instance;  nay, in one respect  He  will  be
 better off, inasmuch as  certainty of evil is
 preferable to perpetual and uneasy doubt.
   "There are gross errors prevalent with
 regard to the signs of madness  in the dog.
 If a dog be seen in a fit in the street, some
 person charitably offers a conjecture that
 perhaps he may be mad;  the next person
 has no doubt of it, and  then wo  to that
 dog.  But Mr. Youatt assures us that the
 rabid dog  never has fits;  that the  existence
 of  epilepsy is  a clear proof that there is
 no  rabies.   Again, it  is  a very common
 belief that a rabid dog, like an hydrophobic
 m \n,  will  shun water; and if  he  take to
 a  river,  that is thought  to be  conclusive
 evidence  that  he is not  mad.   But the
 truth is,  that  the disease in the quadruped
 cannot be called  hydrophobia; there is  no
 dread of water, but an unquenchable thirst;
 no  spasm  attending the effort to swallow,
 but sometimes  in dogs an inability to swal-
 low from paralysis of the muscles about the
 jaws  and throat.  They will stand lap, lap-
 ping without getting any of the liquid down.
 They fly  eagerly  to the  water;  and Mr.
 Youatt  states  that  all  other quadrupeds,
 with perhaps an occasional exception in the
 horse, drink with  ease, and with increased
 avidity.
  "There  is another superstitious  opinion
 not at all uncommon, viz. that healthy dogs
 recognise  one that is  mad, and fear him,
 and run away from his presence, in obedi-
 ence  to  some  mysterious  and  wonderful
instinct warning them of danger.   This is
quite  unfounded.   Equally mistaken are
the notions that  the  mad dog  exhales  a
peculiar  and offensive smell,  and that he
may be known by  his  running  with his
tail between his legs ; except when,  as Mr.
Youatt says, weary and exhausted he seeks
his home."
   It will not be out of place to state what
are the symptoms of rabies as observed  in
the dog, and as described by Mr. Youatt.
   " The earliest symptoms of madness  in
the dog." he says,  " are  sullenness, fidgeti-
ness, continual shifting of posture, a stead-
fast gaze expressive of suspicion, an earnest
licking of some  part, on which a scar may
generally be found.  If the ear be the  af-
fected part, the dog is incessantly and vio-
lently scratching it.  If it be  the foot, he
gnaws it till the  integuments are destroyed.
   "Occasionally, vomiting and a depraved
appetite are very early noticeable.  The dog
will pick up and swallow bits of thread or
silk from the carpet, hair, straw, even dung,
and frequently he  will  lap his own urine,
and devour his own excrement.  Then the
animal becomes irascible,  flies fiercely  at
strangers, is impatient of correction, seizes
the  whip  or  stick, quarrels  with  his own
companions, eagerly hunts and worries cats,
demolishes his bed, and,  if  chained up,
makes violent efforts to escape, tearing his
kennel to  pieces with his  teeth.   If he be
at large, he usually attacks only those dogs
that come in  his way ; but if he be natu-
rally ferocious, he will diligently and perse-
veringly seek his enemy."
   According to  Mr. Youatt,  the disease  is
principally propagated by  the fighting dog
in towns,  and the  cur,  or lurcher, in the
country; by  those dogs, therefore, which
minister to the vices of the lower classes  in
town and  country  respectively.   He main-
tains that if a well-enforced quarantine
could be established, and every dog in the
kingdom  confined  separately for  seven
months, the disease might be extirpated.
   " Very early in the disease, as it appears
in the dog, the expression of the countenance
is remarkably changed; the  eyes  glisten,
and there is slight squinting.  Twitchings
of the face come on. About the second day
a  considerable discharge  of  saliva  com-
mences ; but  this  does  not continue  more
than ten or twelve  hours, and is succeeded
by insatiable thirst; the  dog is incessantly
drinking or attempting to drink ; he plunges
his muzzle into the water.   When  the flow
of saliva has ceased, he  appears to be an-
noyed by some viscid matter  in his fauces ;
and  in the most eager  and extraordinary
manner he works with his paws at the cor-
ners of his mouth to  get  rid of  it;  and
while thus employed, he frequently loses his
balance, and rolls over.
   "A loss of  power  over  the voluntary
muscles is next  observed.   It  begins with 
II YD
296
II Y D
the lower jaw, which hangs down, and  the
mouth is partially open; but by a sudden
effort the dog can sometimes close it, though
occasionally the paralysis is complete.  The
tongue is affected in a less degree.  The dog
is  able to use it  in the act of lapping; but
the mouth is not sufficiently closed to retain
the water.   Therefore, while he  hangs over
the fluid, eagerly lapping  for  several mi-
nutes, it is  very little or not at all  dimi-
nished.   The paralysis often attacks the
loins  and extremities  also.   The  animal
staggers about and  frequently falls.  Pre-
viously to this,  he is in almost incessant
action."   Mr. Youatt fancies that the dog is
subject to what he  calls spectral illusions.
He says "he starts up, and gazes eagerly at
some  real or imaginary object.  He appears
to  be  tracing the path of something floating
around him, or he fixes his eye intently upon
some  spot in the wall, and suddenly plunges
at it; then his eyes close, and his head droops.
   " Frequently, with his head erect, the dog
utters a  short and very peculiar howl;  or,
if  he  barks, it is in a hoarse, inward sound,
altogether dissimilar from  his usual  tone,
and  generally terminating with this cha-
racteristic  howl.   Respiration  is  always
affected; often the  breathing is very labo-
rious  ; and the inspiration is attended with
a very singular grating, choking  noise.  On
the fourth, fifth,  or sixth day of the disease
he dies,  occasionally in slight convulsions,
but oftener without a struggle.
   "Most people  think that the disease is
generated, de novo, in the dog at least; and
causes have been assigned for it which cer-
tainly are not the true or  the sole causes.
Thus, hydrophobia in the dog has been as-
cribed to extreme  heat  in  the weather.
It  is  thought by many to be particularly
likely to occur in the dog-days;  and to  be,
as Mr. Mayo observes, 'a sort of dog-lu-
nacy, having the same relation to  Sirius
that insanity has  to the moon; which, in-
deed, in  another sense, is  probably  true.'
Many cautions are annually put forth  about
that period for  muzzling dogs, and  bo  on.
Very  good and proper advice ; but if  those
who have noticed the  statistics of the dis-
ease may be depended upon, it would be as
appropriate at one period of the year as at
another.  Rabies occurs nearly as often in
the spring,  in the  autumn, and  even  in
winter, as it does in summer.   M. Trolliet,
who has  written an interesting essay  on
rabies,  states that  January, which  is  the
coldest,  and August, which is  the hottest
month in  the  year, are the very  months
which furnish the  fewest  examples of the
disease.   The disorder has often been as-
1 cribed to want of water in hot weather, nnd
 sometimes  to want  of  food.   But MM.
 Dupuytren,  Breschet,  and Magendie have
 caused both dogs  and cats to perish with
 hunger  and  thirst without producing  the
 smallest approach to a state of rabies.  At
 the veterinary school  at  Alfort, three doga
 were subjected to  some very cruel, but de-
 cisive experiments.  It was during the heat
 of summer,  and  they were all  chained in
 the full blaze of the sun.  To  one, salted
 meat was given, to the second water only, and
 to the third neither food nor drink.  They
 all died, but none of them became rabid."
   When an  individual has been bitten by
 an  animal  respecting  which  the  slightest
 suspicion of hydrophobia exists,  the  one
 remedy cannot be  too quickly  resorted to—
 complete excision  of the  bitten part.   Some
 persons  have possessed  sufficient nerve to
 do this for themselves—few perhaps could—
 but it has been  effected  by unprofessional
 persons for others  : indeed, there might be
 more  danger in  waiting  many hours  for a
 surgeon  than in  submitting  to unprofes-
 sional operation.  The method  of excision
 most  to be  trusted, is the insertion of a
 Bkewer of wood,  made to fit into the wound
 caused by the tooth, and carrying the  in-
 cision so  far round, that the  entire hollow
 or cone of flesh  is cut out along with the
 piece  of  wood.    This might  be done with
 safety in the thick part of  the calves of the
 legs, or  on  the  back  part of  the thighs or
 buttocks.   Where  excision is  not resorted
 to, the free  application of lunar caustic or
 of aquafortis, whichever may  be most rea-
 dily procured, would be advisable;  or in
 lieu of these, a piece of  iron, heated to
 whiteness, may be inserted into the wound,
 bo  as thoroughly   to destroy the  surface
 which may have  been poisoned.  These may
 seem  severe measures, but they are light
 compared with  the unceasing  anxiety of
 mind  which must haunt a person who, after
 having been bitten, feels that due  precau-
 tion has not been  taken; and light  indeed
 compared with liability to the disease itself.
 In the event of none of the above measures
 being submitted to, or available, the wound
 may be thoroughly washed for  hours, by
 means of a stream of warm  water poured
 upon it from a height; a cupping-glass being
 applied at intervals. These measures are of
 course only provisional,  until the  attend-
 ance of a surgeon can be procured.
    As  might be  imagined, the preventive
 medicines for hydrophobia are very nume-
 rous; some have been thought highly of by
 medical  men, but for the most part they
 are secret  quack  remedies, and perfectly 
H YD
297
H YS
 worthless.   It is  absolute folly to trust to
 them, to the  exclusion of the  only certain
 preventive—excision  or  destruction of the
 wounded tissues.
   When, from the  peculiar symptoms,  and
 taken in connection with the circumstances
 altogether they can scarcely be overlooked,
 an individual is thought to be attacked with
 hydrophobia, if  the  hope  of saving life is
 small, much may  be done to  alleviate so
 terrible an affliction by proper medical care,
 which should be sought for at once.  In the
 mean time, while all those sights and sounds
 alluded to  in  the first part of this article
 are carefully avoided, as a fearful aggrava-
 tion of the  necessary suffering,  laudanum
 may be given in thirty-drop doses, and re-
 peated  as  circumstances seem to  dictate.
 If ice can be taken, it is said to  afford relief
 put into the mouth in small morsels ; it has
 also been found of  service applied  to  the
 back of the neck.  If, on the  arrival of a
 medical man, he likes to try any of the va-
 rious remedies which have been proposed in
 this disease, he of course can do so, but the
 above-mentioned will be  sufficient for  lay
 interference.
   The general interest and anxiety, and  the
 very erroneous ideas on the subject of hy-
 drophobia which are entertained by people
 generally, have rendered the length of this
 article necessary, and  in  taking it almost
 entirely from the valuable writings of Dr.
 Watson, the author has endeavoured to draw
 from the best possible source,  information
 which, fortunately, few medical men have an
 opportunity of acquiring  personally.
   HYDROTHORAX.—Water in the chest.
 —See Dropsy.
   HYDROSTATIC BED.—See Bed.
   HYGIENE.—The science of  the preser-
 vation of health.
   Refer to various  sanitary articles,  such
 as Air—Bedroom — Climate—Food—Heat—
 Ventilation—Drainage, Sec.
   HYOSCYAMUS.—See Henbane.
   HYPOCHONDRIA.—See Abdomen.
   HYPOCHONDRIASIS.—See  Indiges-
 tion.
   HYPOGRASTRIUM.—See Abdomen.
   HYSTERIA—Is  a disease more  particu-
 larly manifested through  the nervous sys-
 tem, and is,  almost without exception, pe-
 culiar to females  between the age of puberty
 and  the fiftieth year of life.  The affection
is, but very rarely so, developed  in the male
sex.
   Hysteria in the female is unquestionably
closely  connected in  sympathy with  the
womb and its functions, and few cases, per-
haps, occur, in whi'h there cannot be traced
 some disorder of this important  organ a»
 the exciting cause.
   Hysteria may manifest itself particularly
 in three different modes.  First, either as a
 pure nervous  and spasmodic affection;  se-
 cond, as a simulator of other and more di-
 rectly definable disease;  and third, as a mo-
 difier of other diseases really existing.  The
 varied  forms of hysteria, and the way in
 which it modifies and masks, or closely si-
 mulates other more  important affections, is
 apt to  render' it at times one of the most
 puzzling disorders with which the physician
 has to deal; it is one, moreover, especially
 liable to mislead the young and inexperi-
 enced practitioner.
   A fit  of  hysteria  may assume different
 forms, but, generally, the female becomes
 apparently, of  a sudden, partially insensible,
 it may be,  falls down,  but  more generally
 has sufficient  warning to  seat herself on  a
 chair.  The eyes are closed, the lids tremu-
 lous, the limbs are stretched out, and spas-
 modically and suddenly contracted at inter-
 vals, or there  is violent struggling, the chest
 heaves, the heart and  vessels of the neck
 beat violently, and the  face  is more or  less
 flushed.  Frequently the patient puts  the
 hand to the throat and neck, as if to  dispel
 some uneasiness, and not uncommonly gives
 utterance to  incoherent or disconnected
 sentences,  generally in a peevish or  dis-
 tressed  tone of voice.  In  most cases  the
 power of supporting the body when seated,
 remains, unless  it is worked off the  chair
 in the struggles.   At  length, the attack,
 having lasted  for a longer or shorter  pe-
 riod, from  a  few minutes to some hours,
 terminates,  probably with a fit of sobbing
 and crying, the patient recovers conscious-
 ness, but is  left  exhausted  and fatigued
 with the efforts and struggles, and, perhaps,
 falls into disturbed or heavy-snoring  sleep.
 When the fit has terminated, or even during
 its progress, if continued, the kidneys  act
 very freely, and  large  quantities of  urine,
 almost resembling pure water, are voided.
   Such are  the leading features of a "fit"
 of hysteria, but they may be greatly varied.
 The struggles, especially, being  so violent
 as to require  the assistance of two or three
 strong men  to restrain a comparatively  fee-
 ble female, and to prevent her injuring her.
 self, and sometimes, though not commonly,
 those around her.
   Such are  the outward manifestations of a
fit of hysteria ; but before it comes on, many
patients complain of a sense  of general  op-
pression  or uneasiness, with  coldness or
numbness of the limbs.   Just previous to
the  accession, the characteristic hysteria 
H YS
298
HYS
" globus."  or ball in  the  throat, is  pro-
bably felt.   It  seems  as if a  ball  com-
menced rolling upward in the bowels, gene-
rally from  the lower  left side, and ns if it
kept gradually ascending toward the throat,
which it seems entirely to  fill up, causing
those sensations which induce hysteric pa-
tients  so  often to carry  the hand to,  and
pull at the  forepart of the neck or throat.
  It would  serve no good purpose  here, to
follow the history of hysteria  into  the  mi-
nutire of its  various phases.  It might be
said, that  there  is scarcely  a  disease to
which  the  human body is  liable  which it
may  not simulate  so closely as  to  call for
all the  tact and discrimination of  the phy-
sician  to detect the difference between  the
two.   Continued,  incessant, hard  cough,  loss
of voice, delirium of  various  kinds,  para-
lysis,  contractions of the limbs, obstinate
vomiting or  constipation, nay,  even preg-
nancy, may be enumerated amid  the various
simulated conditions.  Neither would it be
profitable,  in the present  work,  to enter
into  an investigation of the way in which
the hysteric  tendency will  modify the  va-
rious  diseases to which the body  is liable.
This can  only be conducted by  the  me-
dical practitioner, but it is a matter of  im-
portance,  that not only  parents,  but  the
individuals  themselves,  should  be aware
of those habits, &c. which tend  to develop
the hysteric  tendency;  and,  further, that
the best mode of managing an hysterical
individual  during the fit, and  in  the  ab-
sence of a  medical man,  should be under-
stood.
  During the continuance of a fit of hys-
teria, little either  need  or should be done,
beyond preventing the patient hurting her-
self  during  the  struggling.   Cold  water
dashed  upon the  face may be useful, or it
may be poured in a stream upon  the head
for a few  minutes at a  time :  a  mustard-
plaster  on  the lower part of the back may
be applied.  If there is much flatulence, a
teaspoonful or  two of sal-volatile  in water
will give it relief.  It must be remembered,
that in most  cases of hysteria, the  patient is
sensible of what is  going on around,  and
may, in the excited state of the nervous
system, be painfully alive to any unguarded
or unfavourable  opinions uttered  by those
in attendance.  For this reason, it is not to
be recommended  that, as sometimes is done,
severe  and violent remedies should be  pro-
posed  within hearing of the patient  with
the  view of  frightening her out of the fit.
Such a course has had  the opposite effect,
causing an  aggravation  of the symptoms
This is a different thing from  threatening
severe remedies while the patients are com-
paratively well.  Such a plan of treatment,
it  is well known, has  often  succeeded in
putting  a stop to the  spread of  hysteria
(by imitation) through schools, or such like
collections of young  females.
  The exciting causes  of hysteria arc, re-
motely,  whatever tends to exalt the influ-
ence of  the  nervous system.   Among the
moderately-fed and  hard-working popula-
tion in  the country, hysteria  is compara-
tively rare, but it is  not unfrequent  in  ser-
vants who remove from the poor  living of
their own homes to the stimulating diet of a
rich man's house.  Most generally, hysteria,
although in some degree the result of con-
stitutional  tendency, is connected with de-
bility, and irregularity of  the usual con-
ditions  of  female health—all  these being
aggravated by emotions of the mind, par-
ticularly those which  are  connected with
the affections ; these,  too,  when  in direct
excitement, as well  as  inordinate  physical
exertion, which produces exhaustion of the
nervous  system,  must be  ranked  as  amid
the most general directly originating causes
of  the  hysterical fit  itself.   If,  however,
mental  influences, either of excitement or
of depression, connected with the affections,
are apt  to  occasion hysteria—excitement
of another kind  has been found  to be one
of  the  best counter-agents  of the  morbid
tendency.   It has  been  remarked,  that
amid  states of great public agitation, such
as revolutions, &c. &c. hysterical affections
have decreased in frequency; and instances
often occur of women  subject  to  frequent
attacks   of  hysteria  as long  as easy  cir-
cumstances permitted self-indulgent habits,
losing the tendency when reverse of fortune
or some other cause has  forced them  into
active exertion. Under these circumstances,
it is not to be wondered  at, if marriage,  with
its new cares, and duties,  and  interests,
often cures hysteria.
   The  prevention of a  disease, or of the
tendency to it, must ever be the most im-
portant consideration connected with it, par-
ticularly when, as in the case of hysteria,
prevention  is very  possible.   Experience
testifies to  the much greater frequency of
hysteria amid those classes whose mode of
life is comparatively indolent and luxurious,
being, in fact, that best calculated to develop
those hysterical tendencies,  of which the
foundation is too often laid in the absurd
education  of the girl.  This subject has been
sufficiently entered  into, under the  head of
education, and requires not further ampli-
fication here.  Suffice  it to say, thit those
who would not have their  daughters grow 
                  ICE                21

 up subject to the miseries of "nervousness,"
 should use the rational means of developing
 their physical health, and give them  those
 habits of healthful  exertion, both of body
 and mind, which, carried  up into woman-
 hood, will be  the best  preventives of hys-
 teria,  with its long train  of exaggerated
 ideas and exaggerated ailments, which are
 too apt to render single life useless and a
 burden,  and,  if long continued, to  make
 weak mothers  and  nurses,  if marriage  is
 entered into.
   As regards  the treatment of the hysterical
 tendency, it is needed to say but little in a
 work like this, beyond the enforcement of
 those general means of health  which are
 laid down in  the various  articles.   As re-
 gards medicinal treatment, it requires to be
 so varied according  to each particular case,
 that it can only be rightly conducted under
 the  care of a medical man; and in a dis-
 ease  like hysteria, long  continued, and
 also a concomitant of artificial life, medical
 assistance always can  and  should  be pro-
 cured.
   Lastly,  although  hysteria may  be de-
 pendent on physical derangements, it  must
 be considered as a disease  to a considerable
 extent under  the control  of the will, and
 this fact should be strongly urged upon the
 subjects of it,  even when they are sufficiently
 sensible, as they most generally are, during
 the existence  of a fit of the disease.   Hys-
 teria is a disease which lives and grows on
 superabundant  sympathy and  attention;
 and while all kindness and consideration
 is shown, it  is wonderful  how  much  good
 may be derived from a little wholesome neg-
 lect.   While recommending  that the medi-
 cal  treatment of  the   hysteric  tendency
 should be committed to the medical man,  it
 is right to caution, that  there  is  always
 much  tendency to  a confined,  and, conse-
 quently, loaded state of the  bowels, which
 it is  highly necessary should be obviated.
 The compound colocynth or compound rhu-
 barb pills, compound decoction of aloes, in-
 fusion of senna, or  clysters, will  be found
 the best  adapted aperient remedies.

   ICE.—Water solidified or crystallized by
 the action of cold, or, more correctly, by the
 abstraction of heat,  is often an agent of the
 greatest value in the treatment of disease—
 one, indeed, for which  there  is at times no
 substitute.   As  an  external  application,
 when cold is  desirable for the  purpose of
 reducing  the  heat of any particular  part,
 (such as  the head,) ice manifestly offers the
most efficient means. It may either be per-
mitted to  dissolve  in the water in which
                  ICE

the cloths are dipped, or,  better, it may
be  pounded  and  placed  on the  part  in
bladders, or  in elastic water-cushions.   As
an  internal remedy, in inflammatory affec-
tions  of the stomach,  in  obstinate vomit-
ings, and in hysteria, small fragments of  ice
swallowed frequently, or allowed to dissolve
in the  mouth,  are, often, not only  of  the
most  essential  service, but the remedy is
one of the most agreeable to the feelings of
the patient.   Under the article " Hydropho-
bia,"  it was stated that ice used in this way
had afforded comfort, at least, to a sufferer.
Of late, the action of the extreme cold pro-
duced by the admixture of pounded ice and
salt, has been introduced as an  external
remedial application in neuralgic and other
similar  affections.   The treatment  consists
in partially freezing the affected part, and
is said  to be successful.   It is, of course,
not adapted for unprofessional use.  In  in-
flammatory affections of the throat and up-
per part of the windpipe, either the result
of cold, or of accident, such as that which
so often occurs to children  in consequence
of their swallowing boiling water  from the
spout of  a kettle, ice  given in small fre-
quently repeated morsels, will be found  at
once one of the safest, best, and most agree-
able remedies.  It has been found useful in
loss of  voice.
  Refer to Cold.
  ICES, or  Iced  Drinks—As  articles  of
luxury,  if taken moderately, cautiously, and
slowly,  and when the stomach is not full  of
food,  are not injurious to  healthy persons.
It was  found, however, in  Dr. Beaumont's
experiments,  that  cold  fluids and the like
produced a reduction in the temperature  of
the stomach  to the  amount of  20° or 36°
Fahr., and that the organ did  not recover.
its  proper heat for  some time.   As, how-
ever, the natural temperature of the stomach
—about 100° Fahr.—is necessary for healthy
digestion, it is  evident  that the custom  of
eating  ice after dinner, or after any full
meal,  must materially interfere with the dis-
posal of that meal.
  Refer to Indigestion.
  ICELAND  MOSS—Which belongs to the
class  of lichens,  in  some degree  resembles
the lichen which grows upon  the  trunks
and  branches  of  trees;  it is, however,
more  of  an  olive-green  colour.   Iceland
moss  is  found  abundantly in the  country
whence  it derives  its  name, but  also  in
Northern Europe generally,  and  in  Britain.
It has long been noted as a nutritive remedy
in cases of debility, and, when prepared
for food, is frequently first soaked in water,
to deprive it of its bitter principle ; it is a
2! 
ICH
300
ID  I
question, however, whether this proceeding !
does not materially interfere with the tonic
properties of the remedy. Iceland moss may
be prepared in a similar way  to Carrageen
moss.—See Cookery.   It has been estimated
that a ton of Iceland moss  contains about
as much nutritive matter as half  a ton of
wheat.   The Saxon government published
a report upon this subject a few years ago,
in which we are informed that six pounds
eleven ounces of lichen meal, boiled  with
fourteen times  its quantity of water, and
baked in this  state  with  39$  pounds of
flour, produced 111 J pounds of good house-
hold  bread.   Without  this  addition,  the
flour  would  not have produced more  than
78$ pounds of bread: consequently the addi-
tion of six pounds  eleven ounces of lichen
meal occasioned an increase of above thirty-
two pounds of good bread.  This increase,
however, being owing, of course,  to addi-
tional water.
  ICHOR—Is a thin, acrid, often brown or
bloody-looking  discharge from wounds or
ulcers.
  ICHTHYOSIS.—A disease in which  the
skin becomes covered with thick hard scales,
which make it, in some degree, resemble the
Bkin of a fish.—See Skin.
  IDIOCY and  IMBECILITY—May be re-
garded as degrees of deficient mental mani-
festation, consequent upon a similar disor-
dered or defective state of the brain.  Some
have  defined the  difference, that idiocy is
congenital,  and imbecility acquired;  but,
generally, imbecility is regarded as  a minor
degree of idiocy.
  An idiot has been defined as one "who
knows nothing, wishes nothing, and can do
nothing," whose  instincts  scarce  prompt
him to seek food  under the  pressure of
hunger;  from this  lowest condition of all,
up  to the weak mind or judgment,  every
shade of idiocy,  weak intellect, imbecility
or silliness, is met with, and all perhaps are,
more or less, capable of improvement, by
means of attention to the physical health,
and by education of the  faculties.
  Till within the last few years, the general
idea has been that  idiocy was  incurable;
the unfortunate beings, whether in the fami-
lies of the rich or of the poor, were allowed
to grow up, their physical wants attended to
in accordance  with the circumstances  in
which they happened to be placed, but their
mental condition left without attempt at cul-
tivation.  Fortunately,  the  error has  been
exposed, and institutions, both in this king-
dom and on the continent, are now in suc-
cessful operation, for the end  of elevating
these unfortunate beings from their debased
position.   The  fact that idiocy has  beea
regarded too much as a thing of the mind
alone,  independent of physical  influences,
has tended in some degree to interfere with
the efforts for its amelioration: attention tn
the physical health is a matter of paramount
necessity.  In the  case of the cretins of
Switzerland, this fact is peculiarly manifest.
Enough has been said  to give hope to those
who number amid their families  an idiot,
that something may be done to ameliorate
the calamity, and  to  induce  them, as  soon
as the condition of an idiot  child becomes
manifest, to place it, or, if possible, to get
it  placed under judicious management at
an  early age.   In a  paper  lately read by
Dr.  Forbes Winslow,  before the  Medical
Society of London, he remarks with regard
to the causes of idiocy—" The great mass
of idiots were said to spring from  an  un-
healthy stock,  and have either been  the
children of idiotic  parents, or of those of
vitiated organizations, of scrofulous diathe-
sis, or of intemperate habits.  Three  hun-
dred idiots were ascertained to have  been
the children of drunkards."  Dr. Winslow
referred to the effects of intermarriages of
near relatives, and to the influence of the
mind of the mother, ns well  as  that of the
father, upon the condition of their offspring.
  Refer to Brain—Cretin,  Sec.
  IDIOPATHIC —Is   a term  applied  to
primary diseases,   in  contradistinction to
"symptomatic," applied to such disorders
as are evidently connected with, or originat-
ing from diseases previously existing.
  IDIOSYNCRASY—Is  a  peculiar  state,
either  mental or  physical, which  renders
an individual more than usually susceptible
to certain  influences, which  do  not affect
the  generality  of  persons.   Thus, some
cannot  take the smallest dose of any  mer-
curial  without  suffering from it  constitu-
tionally,—that  is,  being salivated,—owing,
as it is expressed, to their peculiar idiosyn-
crasy :  another cannot eat the pip of an
apple,  a bit of almond, or indeed any of the
seeds belonging to the same family—which
contain  prussic  acid—without  suffering
from  cutaneous eruption.  These, and nu-
merous others  which  might  be  cited, are
instances of peculiar  idiosyncrasy,  and,
probably, every one is subject to such influ-
ences,  in some  way  or other;  every  one,
probably,  has   his  idiosyncrasy,  whether
he  is aware of  it  or not.  Mental idiosyn-
crasies  are not  less common than physical,
and for neither one or other  is it possible
to fix on any assignable cause.  It is, how-
ever, a matter  of  considerable importance,
when  any peculiar  idiosyncrasy  exists, 
I L1                 301                IND
 more  especially with regard to medicines,
 that whenever a medical man is consulted
 for the first time, he  should  be informed of
 it.   As there is no traceable cause for idio-
 syncrasy, it cannot become known to a medi-
 cal adviser, except by experience respecting
 his patient's constitution, or by information
 given  him.  The latter should  always be
 done at a first visit.  It is a very annoying
 circumstance for an  invalid  to find he has
 unwittingly taken a medicine which invari-
 ably disagrees; and equally annoying is it for
 a practitioner, having every reason to expect
 benefit as the  result of his prescription, to
 find that his  patient has, perhaps, to say the
 least,  been  unrelieved,  simply because he
 was not warned that calomel  invariably
 caused vomiting,  that colchicum produced
 distressing nervous depression, or that senna
 griped most unmercifully.
  Refer to Diathesis.
  ILIAC PASSION.—See Colic.
  IMITATION.—The tendency to imitate,
 by which all, perhaps, but especially children,
 are more or less influenced, is, of course, an
 important consideration in the education of
 the latter, particularly with  respect  to the
 imitation of involuntary movements or pecu-
 liarities, such as stammering, squinting, &c.
 &c. which  young persons  are very  apt to
 acquire, if much associated with those who
 are the subjects of them.  The power of the
 tendency to imitate in causing the diffusion
 of disease  of the nervous system, such as
 hysteria, epilepsy, &c is well known.  Per-
 sons of a susceptible nervous system, by ex-
 posure to the influence, that is, by witnessing
 the occurrence of the disease in another, may
 themselves become, involuntarily, imitators;
 in some cases, doubtless, quite involuntarily,
 without  power  of control,  but in  others
 only partially so.  That  in many cases the
 power of the will may prevent the manifest-
 ation or development of disease from imita-
 tion, has often been  proved.   The anecdote
 related  of Boerhaave is known to most.
 This  celebrated  physician  was  consulted
 respecting  the girls of a school, who, daily,
 one after the other, became  the subjects of
 fits   of  hysteria,  simply  from  imitation.
 Boerhaave  had it made known that  his
 mode of treatment must be to apply  actual
cautery, that is a red-hot iron, to the  spine:
not  another case of hysteria occurred.
  Refer to Hysteria.
  IMPERIAL—Is a drink made by pouring
upon an  ounce of cream of tartar a quart or
three  pints of boiling water, flavouring it
with a few slices of lemon, and sweetening.
When  the water cools,  a crystalline sedi-
ment, which does not, however, possess  the
     2A
acidity of the cream  of tartar,  remains at
the bottom of the jug, and  is not available
for further use.  Imperial forms a cooling
drink  in feverish conditions of the system ;
sometimes, however,  it produces irritation
of the  kidneys and pain in the back.
  IMPETIGO.—A  pustular skin disease.
—See  Skin.
  INCONTINENCE of URINE.—See Urine.
  INCUBUS—Night-Mare.—See Sleep.
  INDIGESTION,  or Dyspepsia.—Under
the article Digestion, to which the reader is
referred, those conditions which are  requi-
site  for  the  healthy performance of this
important function were pointed  out.   It
was  shown that the due  mastication of the
food by the teeth, and its admixture, par-
ticularly when of a farinaceous character,
with the saliva, were essential to its perfect
digestion in the  stomach  by means  of the
gastric juice,  and in  the  alimentary  canal
generally, by means  of the various secre-
tions which become mingled with the food
mass during its progress through that tube.
It was further pointed out, that  not only is
a healthy condition of the organs of diges-
tion themselves requisite for  the proper per-
formance of  their functions,  but  that  the
food must, in some measure at  least, bear
a relation to the natural constitution and
intention of these organs.  And,  lastly, that
the state of the  system at large influences
considerably the  exertion and progress of
the digestive powers;  that is, to insure the
vigorous putting forth of  those powers, the
system must stand in  need of the supply of
nutriment which the stomach is called upon
to elaborate;  and, partially at least, and for
a longer or shorter period, its efforts  must
be devoted, in efficient co-operation  with
those of the stomach,  to the preparation of
the nutriment  for its own  requirements—
plastic material  for its tissues, and respira-
tory  elements for its animal  heat.
  When it is  considered how much the sto-
mach is under man's regulation and control
—how  dependent its  management is  upon
his  external  relations, his habits, and ca-
prices, whether  these  affect it  directly or
indirectly—it can scarce  be a matter of
surprise, that in the present condition of
mankind,  indigestion  is one of, if not the
commonest of  disorders.   The savage, with
his long periods of fasting, terminated by a
gluttonous meal of perhaps  indigestible, or
(if cooked at  all) badly cooked food, suf-
fers from it.   The pampered, the luxurious,
and the indolent suffer from it; the over-
wrought  in body, and  the  over-taxed in
mind are all  liable to dyspepsia in one ot
other of  its  varied forms.  It is, in fact, 
I  X  I)
302
IN  D
one of those maladies most closely and evi-
dently connected with  man  in a state  of
disorder, or of vice; or of ignorant  or wil-
ful disregard of all the conditions of health,
either by the individual sufferer himself, or
by those from whom he is descended.
  Many varieties of indigestion are enume-
rated.   In the present work,  it will serve
every practical purpose to consider  the dis-
order, in the first place, as dependent  upon
causes directly connected with the digestive
organs themselves; and in the second,  as
indirectly  dependent upon causes  which,
although manifested  through the digestive
organs, are  traceable to certain disordered
conditions  of the system in general, or  of
some of its organs  not specially devoted to
the preparation of food.
  It  is  unquestionable  that  there exists a
great difference  in  the  natural digestive
power of  different  individuals.   Even  in
childhood this is evident; and when weak-
ness  is evinced  thus early, it must  be con-
sidered  as  a tendency congenital in, or na-
tural to  the constitution, which will pro-
bably continue with it during life.   Persons
thus constituted, even  as children, cannot
eat the food—either of the same quality, or
in the same quantity—that their stronger
companions do ;  and  if  they  occasionally
do so, or, as too often happens, are forced to
do so, sickness  and vomiting frequently
follow.  These individuals, their whole life
through, are liable to dyspepsia.  With  all
their care  they cannot  always escape  its
visitations, even under the most favourable
circumstances; and if placed  in such  posi-
tions as  confined  workshops,  counting-
houses,  and the like, they are perfect  mar-
tyrs  to the disorder—are never happy ex-
cept when  their  stomachs are  empty, and
not  always then.  It  is very  common to
hear such  persons say,   "If  I could live
without eating, I should be perfectly well."
They are always conscious of sensations in
the  stomach : it is  generally most comfort-
able when  free  from food, but even in  its
state of rest is  apt to be the  seat  of  pain,
or of craving or gnawing uneasiness.   After
a meal has been taken, instead of the satis-
fied  feeling  of  health,  the stomach  and
btwels  generally  feel  distended;  perhaps
there is tolerably acute pain ;  windy, and
acid, (very acid,) eructations quickly follow ;
there is heartburn, perhaps headache, some-
times, though not often, vomiting, and these
symptoms continue, with more or less seve-
rity, till the food has passed off the stomach
in some condition or other.  After this there
is a state  of comparative comfort.   Along
with these periodical  dyspeptic symptoms,
the tongue is at all times more or less furred,
especially at the back part.  On first waking
in the morning this furring is  notably in-
creased, and the mouth is ulmost invariably
dry ;  the bowels are costive, the  hands and
feet are almost always cold, and the face is
very liable to be the seat of pimply erup-
tions. Notwithstanding all these symptoms,
the appetite often remains good, too good in
fact for the  digestive powers.
  With such persons, the slightest indiscre-
tion or  excess  in  diet is liable to bring on
protracted  fits of aggravated dyspepsia—a
little  additional  anxiety of mind, a  little
extra fatigue, being almost sure  to put them
wrong.   But  yet this species  of  indiges-
tion, which  belongs  to the  atonic  or weak
form of disorder, seldoms tends  materially
to shorten  existence.  Many pass  on from
year to year, throughout a tolerably long
life, without being  a single day quite  free
from its visitations.  It may be that the care
they are compelled to take saves them from
many of the  sources  of disease  to  which
those who do not know they have stomachs,
and  who can  take any liberty  with  them,
wilfully expose  themselves; but  so it is.
Medicine, that is  drugs, does but little good
in this  form  of indigestion, except in  its
occasional aggravations;  and aperient reme-
dies, habitually and  frequently taken, mate-
rially increase the natural weakness of the
digestive powers.   The  best remedies are
strict attention to the laws which  regulate
health, and to the means of invigorating the
constitution.  When a young person shows
this tendency, the fact ought to influence the
choice of the employment for life.   If pos-
sible, all such as involve  close  confinement
at desks, or work which calls for much wear
and tear of brain, should be avoided.   Agri-
cultural  and such-like pursuits, which  re-
quire regular  exertion  in the open  air,
should be chosen.   A man had  better earn
his daily bread by the literal sweat of his
brow—earn, as Abernethy used  to  say, a
shilling a day, and live upon it—than be a
miserable hypochondriac, dyspeptic, valetu-
dinarian,  in the  more  dignified Study or
office.   In  the form  of indigestion  we are
considering, particular regulation of the diet
is worse than useless ;  and especially  the
confinement, once so fashionable, to  two or
three articles of food—to wit, mutton-chops,
brown bread, &c.—which  were considered
more than usually wholesome. The healthy,
strong  stomach  craves  for and  requires
change; still  more  the  weak   one.  There
are, it is true, certain general rules of  diet,
to be observed ; such as the avoidance of
pastry, cheese, and such-like  well-known 
IND
303
IND
 indigestible articles,  but this is different!
 from the  minute considering, nay,  almost
 weighing and measuring of food.  Nothing
 is so liable to aggravate and  perpetuate a
 tendency to dyspepsia,  as the constant  at-
 tention to the actions  and capabilities of the
 digestive organs, which  minute  dietetic  re-
 gulation involves.   It is a well-known fact,
 that organs, such as  the heart, not usually
 under  the influence  of the  will, may  in
 the course of  time  come  to be affected
 thereby, if the  attention be  frequently  di-
 rected  to  the  organ, which, as  a conse-
 quence, becomes disordered in action.  This
 is well exemplified  in the act  of breathing.
 This function, though generally performed
 involuntarily, may nevertheless be sensibly
 affected by the will, and if any one tries to
 regulate  his  breathing by his own  will, it
 quickly becomes most fatiguing and neces-
 sarily embarrassed;  so  it is  with the sto-
 mach, there is no surer way of disordering
 its functions than by keeping the mind con-
 tinually attending  to their  operation.  A
 dyspeptic  is  more  likely to get rid of his
 complaint by  casting aside restraints of diet,
 if he at the same time untrammels his mind,
 than by the constant minute dieting, and re-
 ference to tables of the digestibility of what-
 ever he eats: within  certain  limits, a lati-
 tude and  variety is  absolutely  necessary.
 The dyspeptic who, instead of trusting to at-
 tention to the general  laws of  health, trusts
 to  limiting his food to such  things as  he
 finds, or thinks he finds, his stomach capable
 of  digesting  comfortably, will shortly get
 himself driven into  a corner by the enemy.
 Water-gruel and sago-pudding will succeed
 the mutton-chop and bread ; and at last, the
 stomach, so long allowed its choice of work,
 refuses it altogether,  and reduces its  pos-
 sessor to despair.   The  author has  known
 such cases, and the  very despair has worked
 its own cure;  the  dyspeptic  has made a
 rush at  some  long-dreaded  or  forbidden
 viands ;  a beef-steak and a tumbler of por-
 ter are perhaps taken, with some floating
 idea of its  being a  suicidal  act, and, much
 to the surprise of the despairing invalid, they
 seem to take up their quarters, and  to  be
 most comfortably received by his stomach,
 which had nothing but acidity for the  milk
 and farinacea.  In  fact,  the  stomach  only
 wanted  stimulus,  and no sooner  does it get
 it, than it rouses  to the proper exercise  of
 its powers.  It may be that it will not con-
 tinue thus after a few repetitions to respond
 to the stimulus so vigorously; but if reason-
able judgment and moderation  are exercised
as regards food—if the person trusting to this
 unexpected power does not run into excess,
| (the reverse of his former abstemiousness,)
 and if he attends to the general health and
 strength, especially,  if  possible, by means
 of change of air and scene, he may to a
 great degree get the better of his former
 miserable condition.   The above case is put
 to demonstrate that ultra-dietetic regulation
 is not only useless, but worse than useless,
 in cases of atonic dyspepsia generally ; and a
 large  proportion of the cases of the disorder
 met with in medical practice are of this class
 —not, it is true, of hereditary or congenital
 origin, or of life-long continuance, but still,
 long-continued cases, the effects of the vari-
 ous debilitating and  depressing influences
 which affect the citizens of large towns.  The
 deficient  supply of fresh air, and the con-
 tamination of this vital  element by noxious
 emanations, the contamination of water, the
 close  confinement and anxiety  of business,
 and the hurried meal, all tend to produce the
 form of atonic dyspepsia.   Such cases may
 perhaps be relieved temporarily by medicine
 and regulation, but they have but little hope
 of cure without removal  from the causes
 which originated them ;  they are the cases
 which confer celebrity upon watering-places,
 and would confer celebrity  on any place
 which happened  to  become  their  resort,
 provided it offered plenty of fresh, pure air,
 and relaxation  from care  and anxiety.   It
 matters  but little—water-cure, in modera-
 tion, grape-cure, sulphurous  or chalybeate
 springs, sea-bathing or shampooing, even
 homoeopathy  will suffice—the  atonic dys-
 peptic will get well under the  influence of
 the natural stimuli of fresh air and  cheer-
 ful exercise.
   Persons who  suffer from the above form
 of dyspepsia, if they have been accustomed
 to the use of alcoholic stimuli, cannot leave
 them off,  at least when  following out their
 usual  mode of life, without  risk of having
 their ailments much aggravated, and suffer-
 ing  much both from  mental and physical
 depression.  They must,  moreover, carefully
 avoid whatever tends to  exhaust the powers
 of the system:  long  fasting, long fatiguing
 walks,  especially before breakfast,  active
 exertion or severe study soon after a meal,
 are  all injurious to them.  Their digestive
 organs are so comparatively feeble, that for
 the first stages of their  operation they call
 upon the whole nervous  energies of the sys-
 tem for assistance; and,  if these energies
 are called off for other purposes, the function
 of digestion necessarily  suffers.  It matters
 little whether the nervous  exhaustion or
 derivation takes place  immediately before
 or after the meal, the  effect  is the same.
 Persons who suffer from this form  of dys- 
IX D
304
IN D
pepsia,  almost invariably  experience  lan-
guor after a full meal, in consequence  of
the nervous power going to the stomach in-
stead of to the muscular system.
  The  next form of indigestion to be  con-
sidered partakes  more  of strength  than
weakness; it occurs iu persons of naturally
good constitutional powers and  digestion.
It may be  brought on  by indolence  and
close  confinement,  but is  more  generally
induced by excess in eating and drinking,
and is, in most cases,  connected with more
or less  biliary disorder.   The appetite fails,
the tongue is much furred, there is often
sickness and vomiting of bile, the  bowels
are  rather  irregular  than  confined,  the
urine is high-coloured and deposits red or
pink sediments,  there  is  heartburn  and
acidity, and generally headache, often  pain
between the  shoulders  extending  to  the
back of the  head; the  condition,  in  fact,
is in a  great  degree similar to that which
precedes  an attack of  British or  bilious
cholera,  and  often  does end  in a  "sick-
headache,"  or "bilious  attack."   In  this
form of dyspepsia, abstinence  and exercise
may effect a cure, but it  is much facilitated
by proper medicine.   It is  in such cases
that the  calomel,  or  blue  pill and black
draught method are most useful, if properly
employed;  the system at large,  and  the
whole of the digestive organs are oppressed
and  overloaded, and one or more doses of
the above  medicines  clear them in a way
that nothing else will,  bringing away large
quantities  of  acrid, dark bile, with imme-
diate relief.   After  this remedy has  been
repeated,  the bowels ought to be  kept lax
by means of  the blue pill  and compound
rhubarb, or blue pill .and  compound  colo-
cynth pill, at bedtime.   If the tongue re-
mains  furred, and the  appetite deficient,
two or three doses during the  day of effer-
vescing mixture,  with  the  addition  of a
teaspoonful of tincture of columbo, or of
tincture of gentian, to each, will be  of ser-
vice ; or a mixture composed  of  a drachm
of carbonate of potassa, half an  ounce of
nitrous aether, and twelve ounces of  infu-
sion of  columbo or  of gentian may be used,
a wineglassful being  taken twice  a  day.
In this form of dyspepsia also, the infusion
of dandelion, either alone or combined with
one of the bitters, is very serviceable.  This
form of dyspepsia does not call for change
of air and scene, as the first mentioned  does,
although  unquestionably—especially if the
attack his been a severe one—these remedies
are  of  service, if taken  advantage of  after
the organs have been relieved  and the  func-
tions regulated by medical treatment.
  A very necessary caution is requisite wit!
respect to the management  of this form of
indigestion.   The  immediate  and  striking
relief which  follows  the  clearance of the
liver and digestive  organs, by  the use of
the mercurial  and  purgative, is very apt
to induce people to  trust to this means of
cure, or  rather of relief,  and to disregard
all  those methods of self-management  and
self-restraint which  would keep them well.
There  is, perhaps,  no  substitute,  nothing
which will so completely, at the outset of the
treatment of a case of this form of dyspep-
sia, clear away the causes of its symptoms,
and leave a  good foundation for after treat-
ment and management.  But to trust to this
mode of relief alone,  and, front time to time,
to persevere in  those habits of  self-indul-
gence  and of  excess  in which the  disorder
originates, is  most  dangerous,  and  must,
sooner or later, lay  the foundation of dis-
ease, or, at least, substitute for the dyspep-
sia of a strong stomach  that of a weak one,
and with it of a weak system generally.
  The  form of dyspepsia of which  we now
treat is, in so great a majority of instances,
the result of excess  in eating or drinking,
and of inattention to proper  exercise, &c.
rather than  of any real weakness of  diges-
tive function, that there are few  who suffer
from it, who might not  enjoy,  under proper
restriction, the best  possible health.
  The  two forms of indigestion above treat-
ed of, that which results from weakness and
that which does not, may be  taken as the
types of dyspeptic ailments generally, which
all  incline, more or  less, to one or  other of
these   divisions.  To  enter  into  the  varied
phases which  cases  of  indigestion  assume,
and to detail  the varied symptoms they
present,  would demand a volume of itself.
Although, therefore, in this article less is
said than in most others respecting  appli-
cation to a  medical  man, it is not because
it is not highly desirable in all cases of con-
tinued or aggravated indigestion ; there are
often  so many  anomalous  symptoms,  and
the disorder is  frequently dependent upon
so many causes  which skill and  experience
only can detect, that  it is the safer and
wiser plan to take advantage of these  guides
whenever procurable.
   One of the most general features of dys-
peptic disorder is the mental  depression,
often amounting to  " Hypochondriasis," or
even " Monomania," which accompanies it.
In  sufferers from  the atonic and continued
condition, this is more apt to take the form
of  constant  dwelling upon symptoms and
feelings, and magnifying their importance;
in  fact, such persons' whole time and atteu- 
IND
305
IND
 tion seems to be occupied in registering the
 various sensations  they experience  in  the
 course of the day;  and, if attended by a
 medical man, they do not fail—if allowed—
 to trace  the  turning  and winding of every
 pain and ache, how  much and what they ate
 for the last week, and so on.  In the form
 of indigestion less connected with constitu-
 tion, the  spirits are  apt to be more regularly
 depressed, and more  decidedly hypochon-
 driacal, or even, in  some, suicidal emotions
 are felt.
   Headache,  which is  so frequent  an  ac-
 companiment  of indigestion,  arises from
 very various and very opposite causes.  The
 most general headache is a dull  persistent
 pain over the eyes, which comes on from
 half an hour to two  hours after food, and
 seems to be  connected,  so to speak, with
 a negative or inactive condition  of the sto-
 mach, on which the food lies with but little
 change.  This kind of dyspeptic headache
 is accompanied with dulness of the mental
 powers and incapability of  their exertion.
 It  is best relieved  by whatever stimulates
 the stomach: a  cup of  hot tea,  a glass of
 wine, an  effervescing  draught, and often a
 spoonful  of vinegar  will relieve it, the acid
 seeming to alter the  sensation of the nerves,
 whatever that may be, on which  the  symp-
 tom depends  even  acid generated in  the
 stomach  itself will cause its disappearance,
 and persons who suffer from this  headache
 are often aware that it  will probably sub-
 side as soon as the heartburn begins.   The
 same description  of headache may be pro-
 duced in  persons of weak  stomach by a
 dose of soda or magnesia, or by any article
 of food which  does not stimulate sufficiently
 the stomach and  its nerves.   A  headache,
 exactly the  reverse  of the  foregoing, is
 caused by the presence of superabundant
 acid, and is, of course,  relieved by the al-
 kaline  remedies—carbonate  of  ammonia,
 soda, or potassa—which neutralizes the acid.
 Persons liable  to indigestion often  suffer
 also from various forms of  nervous  head-
 ache, from giddiness,  dimness of sight, &c.
 The chest comes in for its share of disorder
 when indigestion  exists.  A peculiar irri-
 table " stomach" cough is  not  unusual;
 palpitation of the heart is almost a constant
 attendant upon the condition; and shortness
 of breathing often results from the pressure
 jxerted upon the chest by the stomach dis-
tended with gas.  Indeed, there is scarcely
a symptom which may  not,  some time or
other,  be  met  with,  traceable to disorder
of the  digestive powers.  The sympathetic
connections of the stomach, and its office as
preparer of the nutriment which is to sup-
      2a  2                              2(
 ply the body, necessarily makes its derelic-
 tions felt throughout the system ; and gout,
 gravel, rheumatism, cutaneous  affections,
 scrofula,  and indeed most other disorders,
 may, at times, be distinctly traced back to
 faulty digestion.   Moreover, the abundant
 sympathetic connections of  the  stomach
 make it liable to  be affected by the state of,
 as well as to affect, distant organs; and it
 not   unfrequently  happens,  that obstinate
 cases of indigestion turn out to be not so
 much the consequence of disorder in the sto-
 mach itself, as of its sympathy with disease
 going on  elsewhere—in the heart,  the kid-
 neys, or womb.   When,  therefore,  indiges-
 tion, spite of all proper regulation  and
 treatment, continues to harass  a patient,
 something of a  deeper-seated and graver
 character must, at least, be watched for.
   Nervous pain at the  stomach, also  called
 gastrodynia, is   one of  the  most painful
 forms of indigestion, sometimes coming on
 when the stomach is empty, sometimes after
 eating.   The disorder ought  to be treated
 by a medical man.  If there is  much ten-
 derness, a few leeches, followed by blister
 or mustard-plaster, may be applied to the
 pit of the stomach.  Bismuth, in five-grain
 doses, twice or thrice a day, will sometimes
 relieve.  The author has found the oxyde of
 silver, in one-third of a grain doses,  as re-
 commended by Sir James Eyre, of consider-
 able  service in some cases.   In this  affec-
 tion  of the stomach, as  well as in  other
 forms of dyspepsia, the  rhubarb and mag-
 nesia mixture, with or without the addition
 of sal-volatile, is often very useful.  When
 the pain is present, and very acute, a cup
 of hot water, swallowed as hot as possible,
 is often of service, 'with the  addition, if
 there is acid on  the stomach, of fifteen or
 twenty  grains of  carbonate of soda, or, as a
 possible addition, four or five  drops of lau-
 danum.  When the pain amounts to spasm,
 it must be dealt  with as  recommended  in
 the article on the subject.
   The principal features connected with in-
 digestion  have now been  enumerated; a
 short general recapitulation of the subject
 will  probably make  it  more clear to  the
 mind of the unprofessional  reader.   The
 first  form  of indigestion noticed, was that
 dependent  on weakness: in this it  maybe
 taken as an axiom,  that it is better to bring
 the stomach up to its reasonable work, than
 to reduce  the work to  suit  the  enfeebled
 powers of the stomach. In doing the former,
 the whole system must be attended to and
 strengthened, and the stomach made to par-
 ticipate in and to give its proper  aid to  the
strengthening process.  In attempting to  do 
                 I  X  F                 :>(

tl e latter, not only do the powers of the
Btomach become less aud less—shrink away,
at it were, from their work—but the whole
system partakes of  the debility.
  In  the  second form of indigestion  ad-
verted to, that accompanied by strength, or
at least not dependent on weakness, it was
shown that medicines and abstemiousness
offered the proper means of relief.  Lastly,
the varied forms, symptoms, and  connec-
tions of dyspepsia were pointed out, to show
how often there must be difficulty in deter-
mining  the treatment and  true nature of
the case, and to impress the unprofessional
reader, that  when suffering from any thing
more  than   transient  indigestion — unless
indeed his be one of the  cases of constitu-
tionally feeble digestion — the safest,  best,
and perhaps most  economical plan will be
to put himself under proper medical care.
Above all  things, those who suffer from the
form  of indigestion dependent on weakness
must  beware  of purgatives;  nothing  so
completely debilitates  whatever digestive
powers they may possess.   The bowels per-
haps,  probably, may be  regularly costive,
but. they must be, as a rule,  regulated by
the clyster.
  Refer to  Alimentary Canal—Digestion—
Drinks — Food — Exercise — Meals —Dinner,

  Note.—The reader is requested to refer to the above*
and other articles bearing upon the subject of digestion
and indigestion generally, as it  has been thought su-
perfluous to repeat information once given.

  INFANTS.—See Children.
  INFECTION. — See  Contagion — Disin-
fectants, &c.
  INFLAMMATION —Is  that  process  or
action occurring or   " set  up"  in the living
animal body, which  is characterized by red-
ness and swelling of the part  affected, and
by heat and  pain.  When these phenomena
take place, in a decided manner, on a visible
part of the body, such as the eye, or the
skin, they are generally recognisable by all:
when  they (that is, inflammation) occur in
in internal parts, its presence is judged of
by certain concomitant   symptoms.   Few
diseases to which the human body is liable
are unaccompanied by inflammation  to  a
greater or less degree, in some part of their
course, and  many seem to owe  their  cha-
racters and influence chiefly to its presence.
At the same time, inflammation must not be
regarded as entirely a diseased action ; its
occurrence is often  a necessity;  without it,
the wound could not unite, the broken  bone
could  not  be  repaired; that  is to say, in-
flammation must precede the  reparative
processes, or in other words,  the means of
i;                 I  N  !■'

reparation are the consequence  of inflam-
mation—one of its terminations.
  These " terminations," as they  are called,
of inflammation,  are very important  consi-
derations,  and require brief  notice.  The
nature of the process  of inflammation has
long been a subject  of investigation to me-
dical men, and within  the  last  few  years
much light has been thrown upon it; it is
sufficient to mention here, that when a part
is inflamed, its minute vessels are enlarged
and  much more crowded with blood globules
(see  Blood) than  in their  ordinary condi-
tion; that in  one portion  of  the inflamed
part, the  flow of  blood through  these ves-
sels  may be impeded, while in others it is
quickened;  there is determination of  blood
to the part.   These facts are sufficient  to
explain  the redness, the swelling, the pain
—consequent  upon  the pressure  of the
swelling upon the  nerves—and  the  heat;
they also  explain  the throbbing around an
inflamed spot, caused  by the  efforts of the
vessels to  overcome the obstruction in these
parts, which  are  crowded  or blocked  up
with blood globules.
  When a portion of  the living  body has
been for some time in  the  condition above
described, it may, either in  consequence of
the temporary exciting cause of the inflam-
mation being withdrawn, or from some other
reason, resume its healthy condition,  with-
out any  trace of the previous  action  being
left.   This is the  termination  by "resolu-
tion," and it is the most desirable termina-
tion  in many diseases, such as inflammation
of the lungs, in which it is  important that
an organ should be left intact as regards its
structure  and functions ; and  it is to  bring
about this termination that the  efforts  of
the physician, his bleedings, and fomentings,
and medicines, are directed, to prevent the
inflammation running on to  one of its  other
terminations, which almost inevitably da-
mage the structure and after-working of the
affected  organ, and perhaps  lay the founda-
tion of, or form the nucleus for  after disease.
  Should inflammation not terminate in the
most  desirable mode by  "resolution,"  it
may  give rise to effusion of serum or of the
watery part of the blood.  This effect of in-
flammation is familiar to all, as it  takes
place in blisters, from  any  cause, whether
Spanish  fly, scalds, or  friction, as  on the
foot  in walking; it also occurs in pleurisy,
forming "water in the chest," or in  other
cavities  of the body.  This effect  of inflam-
mation undoubtedly,in many instances, leads
to bad consequences, as for instance,  when
it compresses a lung so that air cannot pe-
netrate it; but the same action may be alst 
INF
307
INF
 viewed as beneficial, when, as in the case
 of a blister, it interposes the elastic fluid
 between the inflamed and sensitive surface
 of the true skin and  the irritating cause.
   A third and most important effect of  in-
 flammation is the  effusion of what is called
 ''lymph,"  that is,  an adhesive—at first
 liquid, afterward  solid—matter,  which be-
 comes a permanent medium  of  connection
 between two parts, which, when undergoing
 the "adhesive" form of inflammation, are
 placed  together,  or   in  apposition.  The
 edges of a cut are the most familiar ex-
 ample of the  above.  A few hours after the
 infliction of the wound they inflame; as a
 consequence of the inflammation, the adhe-
 sive  "lymph" is exuded, which glues them
 together.   As, however, this exudation of
 adhesive  matter takes place as a necessary
 consequence of inflammation in many cases,
 irrespective of circumstances, it  must hap-
 pen that  it is sometimes as much a source
 of injury, as it is at others of benefit.  Thus
 in the case  of inflammation within the ab-
 domen, it may glue the bowels together; in
 the chest it may fix  the  lungs to the side,
 or the heart  to its containing bag.   Even
 internally, however,  it is  often beneficial;
 it may seal parts  together in such  a way
 as to prevent  escape  of matters,  as for
 instance into  the cavity of the  abdomen,
 which must otherwise have proved fatal.
   It ought to  be mentioned that this effused
 " lymph" always shows a disposition to as-
 sume the characters  of  the tissue  with
 which it  is connected; the  lymph which
 connects a divided  tendon will become tough
 and  fibrous—that  around  bone, bony  or
 osseous :  this approximation to the natural
 healthy tissue  becoming more complete as
 time goes on.   In this  we recognise a most
 beneficent provision of the Creator  for the
 reparation of those diseases and  injuries to
 which man and animals are subject;  and if
 the agent, which at one time saves life, may,
 at another and under different circumstances,
 destroy it. we can  but see in this  the unerr-
 ing, certain operation of his laws which regu-
 late our physical  being—feeling  sure that
 though the  action  of  the agent may at one
 time  be for good,  and at another for appa-
 rent evil, all  is equally  under  his  wise
 control.
   But inflammation may terminate in  none
 of the ways above mentioned ; it may  go
 on to the formation of pus, or matter.   This
 effect is too familiar  to all to require de-
 scription ; suffice it, that it too may be either
 beneficial or the reverse, according  to cir-
 cumstances.   The  matter formed around a
foreign body lodged in any of the tissues
may be  the means of its discharge, and
may cure or save the patient;  the  abscess
may burst and prove fatal, or the long dis-
charge of matter may wear out the powers
of life.
  Again: ulceration maybe  another effed
of inflammation,  which breaks  down and
casts off the component tissues of  surface
parts ; and lastly, mortification, or " slough-
ing," or "gangrene"—all  names  for the
same effect—may take place in an inflamed
part: that is, the vitality being completely
destroyed,  the  tissues dissolve  or break
down into one putrefying mass.
  These various  effects or terminations of
inflammation are, in some degree, doubtless,
dependent upon the violence  and extent of
the action in  the first  instance ; but they
are also much modified by the nature of the
affected tissue.  Thus,  a serous membrane,
such  as lines  the cavity of  the chest,  is
most  liable to  " adhesive"  inflammation,
with effusion of serum, and a mucous mem-
brane,  such  as that which lines the  bowels,
to the form  which terminates in the forma-
tion of matter, or of ulceration.
  What has now been said respecting the
nature of this most important  process will
sufficiently  indicate to the unprofessional
reader how  closely it is connected with the
whole science  and practice of medicine, and
how a great  part of medical treatment must
be conducted with reference to it; how, when
it occurs, as a process of disease, either in a
vital organ,  or indeed in any organ,  the first
effort must  be to procure its termination  in
"resolution,"  if  possible,  and when  that
cannot be done, in the method best adapted
to secure the ultimate well-being both of the
affected part and of the patient.
  The  means  used to procure resolution of
inflammation are, bleeding, either  general
from the arm,  or local by means of leeches,
cupping, &c. which relieve the overloaded
and  obstructed vessels;  further, fomenta-
tions and  poultices, that is, heat and moist-
ure, which relax the parts, and also relieve
by producing perspiration; also by medicines,
such as diuretics, diaphoretics, purgatives,
&c. which, by increasing the discharge from
kidneys, skin,  or bowels, necessarily deter-
mine the blood to  these organs,  and thus
also relieve  the inflamed part.  In addition
to these  means,  the  physician employs
medicines which experience has taught us
have a  peculiar  power  in  arresting  and
subduing inflammation  in certain parts—as
tartar emetic subdues inflammation in the
lungs.  In some cases, when inflammation  is
seated directly on the surface, it is  treated
successfully  by  the direct application  of 
                 INF                 3

astringents  to  the  part.  Inflammation  of
the eye, or rather of its outward covering,
the conjunctiva, is  cured  by the astringent
wash;  inflammation  of  the membrane  of
the throat, by the astringent gargle; some
treat external inflammation of the skin,  by
the astringent action of cold.
  Along  with these more directly  medical
means, the  diet  in most cases,  of active
inflammation at  least, is reduced  both  in
quantity  and quality; all stimulants, either
alcoholic, or in  the form of  animal food,
being forbidden,  and bland, unstimulating
diluents  freely administered.  The  dietetic
treatment  of  inflammation,  however,  is
generally regulated as much by the natural
appetites as by the physician—the  articles
mentioned above as suitable  being  instinc-
tively desired, and  the others  rejected.   In
the employment of  the means, however, for
the  reduction of active  inflammation, the
physician must be careful that in arresting
the disease he does not unnecessarily weaken
his patient;  he must look beyond the actual
existing  process  going on at one time,  to
what may succeed  it, and remember  that
power will be required for the termination
stage, whatever that may be; and that what
it  will be may depend upon the condition
of the  patient, as to strength or weakness,
when that termination arrives.   Neither,
even during  the  most active inflammation,
must the tendency  to get well—to self-cure
—existing  in the  animal constitution,  be
forgot, nor its powers mistrusted.
  In addition to the  above  considerations,
there are the constitutional effects of in-
flammation,  which more or less accompany
the process, unless in its most trivial forms.
These effects are inflammatory, hectic, or ty-
phoid fever, according to the nature  and ex-
tent of the inflammation, the part involved,
or  the constitution of the  patient.   The
first occurring generally in the active stage
of inflammation,  the second should matter
be  formed,  the  third if mortification  or
sloughing takes  place.    When inflamma-
tion to any extent  is going  on within the
body, particularly some forms of inflamma-
tion, the blood  acquires the peculiar  pro-
perty of  becoming  " buffed," after it has
been drawn from a vein;  that is,  instead
of red or dark  red, when it is coagulating,
a bluish tinge is perceptible on its surface,
and as the process of coagulation  is com-
pleted, a tough yellow coat of greater  or
less thickness forms on the surface of the
clot.   Redness,  swelling, heat,  and pain
have been  mentioned  as characteristic  of
the presence of inflammation when  in com-
bination : separately they may occur without
)8                I X  F

 any inflammation being present.   Thus tin
 redness  of blushing is no inflammation;
 swelling may be caused by pressure or by
 air, heat by exercise, pain by spasm.
   The redness  of  inflammation  is by  no
 means always of a bright  tint;  it may be-
 come bluish or yellow-looking, according to
 the congestion of the blood, the nature of
 the part affected, &c.   The swelling is also
 similarly modified,  and  the pain etill  more
 so; this latter symptom  is  not  by  any
 means of  severity  commensurate with the
 importance of the part affected, but seems to
 be  regulated chiefly by the texture.  Thus,
 in loose spongy tissues, such as the substance
 of the liver, pain is comparatively trifling, or
 absent; in dense, unyielding tissues it is most
 severe or agonizing, as  in  the  ear-passage.
 Moreover,  parts,   such  as  bone,  which
 in  their healthy state possess  but slight
 sensation,  become,  when  inflamed,  most
 acutely sensitive. Further, in some respects,
 pain in  inflammation is a deceitful guide;
 sometimes  it  is altogether absent when its
 presence might have fully been anticipated,
 and at others, if felt, it is not at the affected
 part, but at  a distance from it.  In other
 points of view, however, pain in inflamma-
 tion is a valuable guide. As a general rule,
 inflammatory  pain is increased by pressure,
 and is in  this way  distinguished from the
 pain of spasm [or neuralgia.]
  One other important  phase of inflamma-
 tion requires  notice: it is that known by
 the name  of  "metastasis,"  that  is,  the
 transference   of  the inflammatory action
 from one part of the body to another.*  This
 occurs in various ways, but probably rheu-
 matism affords  the most marked  example
 of  it; in  this disease, on  one day a par-
 ticular joint is exquisitely painful, it is hot,
 swollen,  red; the  day  following, all these
 symptoms  have perhaps vanished  from it,
 and left not a trace behind, but have trans-
 ferred themselves to some other joint, or, it
 may be, have attacked the heart.   Or again,
 inflammation  of an  internal organ may be
 relieved  by an eruption on  the skin, or by
 the formation of an abscess in some distant
 part.  Thus, this tendency  of inflammation
 to  shift  its quarters, may, like  its other
 characteristics, be  exerted  either for  good
 or evil.  Its good the physician endeavours
 to  imitate, when,  by  blisters and other
 means of  counter-irritation,  (see  Counter-
 Irritation,) he endeavours  to  produce in-
 flammation and its  consequences upon the
 skin, with  the view of  drawing it off from
 Borne more directly vital and less accessible
 organ.
   The  causes of  inflammation  are  very 
INF
309
INF
numerous;  whatever irritates locally, as
familiarly  exampled by  dust  in the  eye,
will cause it;  but it may also originate from
causes  affecting the constitution, such as
cold; or it  may arise in  the course of  con-
stitutional diseases, such  as fever.
   Such are the principal general points con-
nected  with the  subject of inflammation,
with which it  is expedient  unprofessional
readers should  be acquainted.   A clear un-
derstanding of  them will tend  greatly to
assist the formation of rational and common
sense ideas respecting  the nature and  pro-
gress of disease, and throw light upon some,
at  least, of the whys and wherefores of its
rational treatment.
   The inflammations, or  inflammatory dis-
eases, which affect the body may be classed
as external and internal.
   The external inflammatory affections, pro-
perly so called, are the various skin diseases,
particularly erysipelas,  which is essentially
inflammation of the skin; inflammation of
the  eye, ear, throat, &c.   The internal in-
flammatory affections are those of the brain,
of the chest and lungs,  including laryngitis
and croup, which  affect the windpipe;  and
bronchitis, which is seated in the air-tubes;
also pneumonia and pleurisy, and carditis,
or inflammation of the heart.
  Of the abdomen  the inflammations  are
those of the stomach and bowels generally,
and of  the  other viscera, such as the liver
and kidneys, and womb.    In  addition to
the  above,  there are inflammation of the
blood-vessels, especially  of  the veins, in-
flammation  affecting the  bones, joints, &c.
All these are entered into sufficiently under
their separate  articles, with exception of
inflammation of the bowels, or alimentary
canal.
  Inflammation  of the  bowels,  or  aliment-
ary canal, may affect any portion of it—the
stomach, the large  and small  bowels, &c.;
it may  attack  its covering membrane, the
"peritoneum,"  or  its lining mucous mem-
brane.   Inflammation  of  the  peritoneal
covering  of the  bowels  (peritonitis — see
Alimentary Canal)  is one of the most  for-
midable and often  one  of the most painful
of the acute diseases: it may be confined to a
small portion of the abdomen, (see Abdomen,)
or  be spread  over,  not  only  the  perito-
neum, which covers  the  alimentary canal,
but that which covers the other contents of
the cavity, such as the liver; hence medical
men distinguish  general  and partial peri-
tonitis, the latter being  named according to
the part affected.
  The accession of peritonitis, or inflamma-
tion of the covering membrane of the bowels, |
like that of other inflammatory diseases, is
attended with the usual symptoms of fever,
languor, depression, shivering,  and  is  fol-
lowed  by  heat,  thirst,  and  quick pulse.
Either simultaneous with these symptoms, or
shortly after, there is usually intense cutting
or  burning pain in the abdomen, general,
or  confined to one spot, according  to  cir-
cumstances.   This pain is much increased by
pressure, so much so,  indeed, that even the
weight of the bed-clothes  cannot be borne,
and the patient  lies  on the back with the
knees  drawn  up—an  attitude very charac-
teristic of this disease—in order to keep off
the weight of the clothes.   At  this time.
the pulse,  which is very quick,  is usually
of  a  peculiar hard,  wiry  character.   The
symptoms of peritoneal inflammation of the
bowels are usually so well  marked as to be
distinguishable  even  by an unprofessional
person.  When  they  do  occur, especially
under  circumstances  to be  hereafter point-
ed  out, as  likely to occasion them, it  need
scarcely be said here that  a  medical  man
should be called with  the shortest possible
delay.   The disease is most serious and dan-
gerous, often  very rapid in  its course,  and
cannot too soon be submitted to the active
treatment which skill and experience alone
can venture upon.  In the mean while, the
provisional remedies to be adopted must be,
in some degree, regulated by circumstances.
If many hours must  elapse before medical
assistance  can  be obtained,  and  if  the
affected person is of strong, full habit, bleed-
ing from the arm, if  there is  any one com-
petent to perform  it,  (see Blood,) ought to
be  resorted to,  to  the extent of sixteen or
twenty ounces, and, either with this or with-
out it, leeches may be freely applied  over
the seat of the pain;  a warm bath for half
an hour will be useful, and  hot fomentation
assiduously used for  a long time will  give
much  relief, being substituted for  the hot
bran, the weight of which,  probably, could
not be borne, unless  made  very light—and
then fomentation is as good.  If the  bowels
are confined, they should be gently relaxed
by  means of castor-oil, or by Epsom salts, a
teaspoonful in half a pint  of warm water
or gruel every two hours, till the effect is
produced.  Warm clysters, repeated from
time to time, not only keep the  bowels
clear, but act as an  internal  fomentation;
they should not be large, and if the pain is
severe, may contain twenty to thirty drops
of laudanum.  The best medicine wi'l be
calomel, combined  with opium,  six  grains
of the former combined with one—or, if the
pain is very violent, two—of the latter ; this
being  given,  made into a  pill,  every six 
I X  F                310                 1  X F
hours, until  the  doctor  arrives.   The diet
must of Course !>e reduced, and nothing but
diluents, such  as thin  gruel, barley  and
toast water, allowed.   In following out the
above directions,  an  unprofessional person,
at a distance from medical  aid, would be
doing the most possible to keep the disease
in check;  the means  may, of course, require
varying in  some degree,  but  in  this, as,
indeed, in all such matters, something must
be left  to  the judgment of  an intelligent
person.
  Whenever, with the symptoms enumerated
as characteristic of peritoneal inflammation,
there is tenderness on pressure, inflamma-
tion  may be  strongly suspected, sufficiently
bo, at least, should  more active measures
not be adopted, to forbid all administration
of stimulants, such as is had recourse to in
colic  and  spasmodic pain.  Indeed,  should
the attack  turn out to be the latter, all the
remedies recommended for peritonitis, ex-
cept  the blood-letting, would be serviceable,
especially the warm-bath and fomentation.
The  causes of  inflammation  of  the  bowels
are chiefly cold, the  abuse of stimuli, or of
strong purgative medicines, constipation, a
loaded state of the  alimentary  canal,  and
child-birth.  The most  severe  and rapidly
fatal case of inflammation of the peritoneal
covering of the bowels the author ever wit-
nessed, was traceable  solely to  the  indivi-
dual  rising from a warm  bed and  standing
for some  time on a stone floor barefoot.
For  information  respecting  inflammation
after child-birth, the reader  is referred to
the article  on that subject.  It is, however,
right in this  place to warn him that, under
this circumstance, a spurious or imitative in-
flammation is apt to occur, in which bleed-
ing will do the greatest  possible mischief;
in such  cases,  therefore, its  employment
will be most  prudently left to the judgment
of the medical man.   Inflammation of the
lining or mucous membrane of the bowels,
is generally  associated with  diarrhoea or
dysenteric  affections, and to  these  articles
the reader  is referred.
  Refer to Abdomen—Alimentary  Canal—
Liver.
  INFLUENZ V. — This disease was cited
under the article Epidemic, as the best speci-
men  of an epidemic disease.  It is a peculiar
feverish attack, accompanied with catarrhal
affection of the air-tubes  of the lungs,  and
great prostration of strength.  It  is  not
uncommon to call various forms of cold  and
catarrh, influenza; but the true influenza is
a very distinct disease, and seldom  occurs
but as an epidemic, attacking large numbers
at once.
   The  symptoms of influenza are those of
 general fever; coming on suddenly, there is
 shivering, loss of appetite,  perhaps vomit-
 ing,  heat, and  thirst, with  cough,  frontal
 headache, and  generally great depression
 and languor.  The  feverish symptoms may
 last  from one day to ten, but their general
 duration is from three to five, or even seven
 days, the cough usually remaining a variable
 time, after  the  acute symptoms are gone,
 according to exposure  and circumstances,
 such as a predisposition to cough, &c.
   To the strong and  healthy, influenza is
 but  a  trifling disease.   It  certainly pros-
 trates even them for a few  days, and leaves
 them weak ; but it is  in almost all cases
 perfectly  devoid of danger—ivith ordinary
 care—and requires little or no medicine.  A
 few  days in bed, according to the severity
 of the case,  with low diet, a gentle aperient,
 and diluents, the feet in hot water, being all
 that  is required.   If the catarrhal symp-
 toms are  severe, treatment similar to what
 is recommended for catarrh or cold may be
 had recourse to.
   To the weakly and the aged,  influenza is,
 on the  other hand, a  comparatively fatal
 disease:  and, from  the almost universal na-
 ture  of its attack, carries off more, perhaps,
 of these classes than many  more apparently
 severe  and  more dreaded  disorders.  The
 attack  of influenza in the description of per-
 sons  above mentioned should be the signal
 for medical  attendance.  Lowering means,
 especially, must not be resorted to;  con-
 finement to bed, nnd the use of diaphoretic
 remedies, as recommended  under  articles
 Cold and  Catarrh, will be required; broth,
 strong  or weak,  must be allowed, according
 to circumstances ; if the strength is deficient
 wine may be requisite,  and stimulant ex-
 pectorant medicines, especially in the aged,
 if the expectoration is abundant, viscid,  and
 difficult to be got up.  In such cases,  the
 following will be found useful:—Take of car-
 bonate of ammonia, thirty to forty grains;
 tincture of squill, one drachm;  wine of ipe-
 cacuanha, forty drops;  water or  camphoi
 julep,  sufficient  to make an  eight-ounce
 mixture, of which  two  tablespoonfuls,  or
 one-eighth, may be  given every few hours.
 If the cough is very irritating and trouble-
 some,  two drachms  of  paregoric  may be
 added  to  the above, but the opium  rather
 tends to check the free expectoration which
 is so  desirable.   Demulcent drinks, such as
 barley-water, should not be neglected, and a
 mustard-plaster or blister to  the chest will
| do good.  In severe  forms of  the disease,
 with  difficult breathing, if the strength va
; much reduced  and  the  appetite bad,  two 
INF
311
INH
 doses  of  decoction of  bark may be given
 during the day.
   Persons who generally  suffer from deli-
 cate chests should beware of allowing the ef-
 fects of influenza to hang about them; as the
 debility and cough are very apt, if predis-
 position exists, to lay the foundation of con-
 sumption. The strong and healthy may trust
 to  the  domestic  management of influenza;
 but the weak and aged ought to have proper
 medical advice, if it is  within reaoh.
   The history of the various epidemics of
 influenza which, at intervals,  have visited
 Europe, and, indeed, the world, is a subject
 of  much  interest.  It  has been remarked,
 that the  invasion of the epidemic has been
 preceded  by dense, dark, and in some places,
 it is said, offensive fogs.
   During the  last epidemic of influenza, it
 was remarked  that the  barometer waS much
 and unusually affected.
   Refer to Cold—Catarrh—Diaphoretics, Sfc.
   INFUSION—Is the  submission of sub-
 stances to the action of water, hot or cold, for
 the purpose of extracting from  them certain
 portions which are soluble in the fluid.   The
 most familiar instance of an infusion is com-
 mon tea.  For the purpose of infusion, a jug
 with both cover and spout.and with a strainer,
 is the best; but, of course, a common jug, with
 a saucer or plate placed on the top of it, or
 an  earthenware  teapot, will make  a  good
 substitute.  The object of an infusion is to
 extract volatile and other substances, which
 would either  be dissipated or injured  by
 exposure  to higher heat, such as  decoction
 or  boiling; indeed, some  infusions,  such
 as  that  from  senna,  &c.—as noticed in
 their articles—are better made without heat
 at all.
   The commonest method  of forming a hot
 infusion is to  pour boiling water  upon the
 substance, cover it, and  allow  the whole
 to stand near  the fire for some time, before
 it is permitted to become cold.   If the sub-
 stance to  be infused is thick or tenacious, it
 ought, of  course, either  to  be cut up or
 well bruised before  being submitted to the
 action of water.   The  chief inconvenience
 connected with infusions is their great ten-
 dency to spoil; some, such as columbo and
 dandelion, becoming unfit for use in twenty-
 four hours in summer.   It is said that if the
 infusion be poured boiling hot into a bottle,
 filled  up to the top, and the bottle imme-
 diately well corked, it will keep a good long
 time.
  Concentrated infusions are now made by
chemists,  but  many of them  contain  so
much spirit that  they are almost tinctures,
and in some cases, therefore, are  inadmis-
 sible ; otherwise they  are good  prepara-
 tions.   The most useful infusions are—
          Infusion of Bark.
             "      Broom.
             "      Columbo.
             "      Chamomile.
             "      Dandelion.
             "      Hop.
             "      Gentian.
             ••      Linseed.
             "      Rhubarb.
             "      Rose-leaves.
             "      Senna.
   INHALATION—Is the " inspiration," or
 drawing in, of vapour—sometimes of pow-
 der—into the lungs, as a form of medical
 treatment for the cure of disease.  Inhala-
 tion was  much more regarded some  years
 ago than it is at present; perhaps, like most
 other things, the reaction from extravagant
 praise has gone too far the other way.   At
 present,  inhalation  is chiefly  heard  of  in
 connection with aether and chloroform.  In-
 dependent of these, the  agents which have
 been  chiefly administered by inhalation are
 vapour from water,  either simple  or  medi-
 cated, chlorine  gas, iodine  fumes, fumes
 from mercurials, &c.
   The steam from water may often be used
 as a safe domestic inhalation, in cases which
 require the  local  application of heat and
 moisture; indeed, in sore-throat,  steaming
 is very commonly had recourse to.  It may
 also be employed with  advantage in cases
 where the breathing is difficult, with tena-
 cious expectoration, especially in old people.
 In  chest  affections, such as consumption
 with spasmodic  cough, the vapour of boil-
 ing water, into which has been put a few
 drops of sulphuric or chloric  aether, or ten
 or  a  dozen  drops  of laudanum,  will fre-
 quently afford much temporary relief.  Me-
 dicated inhalations, such as  those  from
 chlorine,  if  used at all,  must be so under
 direct  medical superintendence.  It is pro-
 bable  that  the  slow,  imperceptible, but
 continual  breathing  of an atmosphere im-
 pregnated with  such medicinal agents  as
 chlorine, iodine, &c. &c. is more likely to be
 of service than their temporary use in more
 powerful  doses.   It has  been  observed  in
 manufactories in which  a chlorine atmo-
 sphere prevails, in consequence of  the ope-
 rations, such as bleaching, carried on within
 them, that men who have entered the works
 with weak chests or consumptive tendencies,
 have,  in the course  of time,  become much
 improved in health.   It is, also, not impro-
 bable, that part of the benefit, at least, de-
rived  from sea-side  residence, may be due
to the constant  imperceptible  iuhalatior 
IN J
312
I XS
of chlorine salts, and other vaporized  sub-
stances.  If, however, the constant inhala-
tion of some agents be beneficial, it is still
more certain that the presence of others in
the atmosphere  breathed is  most inimical
to health.  This subject, however, is suffi-
ciently entered into  in other articles,  such
as Air, Atmosphere, Ventilation, Sec.
  Various  methods of inhaling steam are
employed :  simply holding the mouth  over
a jug of hot water will  answer, but if the
throat be the part affected, the vapour is
most directly conducted to it by means of a
tube of some kind.   A  filtering-funnel, or
tundish, inverted over the vessel from which
the steam issues, will do very well.   Where
vapour is wished to be 'inhaled by persons
confined  to bed, or very weak, a good me-
thod is to  place a quantity of hot bran in
a suitable  vessel, pour  some boiling water
upon  it,  and place it under a light cloth,
which  also covers the face of the  patient.
If desired, various forms of inhalers can be
procured at the  instrument-makers.
  Refer to  Chloroform—JEther, Sec.
  INJECTION.—See Clyster.
  INOCULATION—Is the introduction of
a  poison into  the  system  by means of a
wound.  Any poison which  will thus affect
the part in which it is placed, or the system
generally, may be said to be introduced by
inoculation.   The  term is  most generally
used with  reference to the poison of small-
pox, to the article on which the reader is
referred.
   Refer to Poisons.
   INQUEST.—The inquiry into  the cause
of death from violence, or in an unusual, or
in an unexpected  manner, ought to be one
of those safeguards to  human life in this
country, which every  one  should  uphold
and promote, instead  of, as  is too  often
done, throwing  impediments in the way of
the operation of the law.  For this purpose,
in cases of unexpected death (see  Persons
found Dead) those who chance  first  to be
at the scene should note carefully whatever
may  be  of service  in  the  inquiry of the
coroner and jury.  Probably, never at any
time  was the authority and surveillance of
the coroner's court more required than it is
at present, when the crime of secret poison-
ing seems  so fearfully on the increase.   It
is a  very common  opinion, that  inquests
are only called  for when there is  a strong
suspicion of crime.   1 f  they are to be con-
fined to  such cases, they might almost be
superseded entirely.  Their great  use is to
investigate unexpected death, whether sus-
picion exists or nit.   In this way only can
they be an effectual and dreaded check upon
crime.  Moreover, the full efficiency of the
coroner's  office  is  very  greatly  impaired
by the anomalous proceeding of  generally
placing what ought to be  a medical inquiry
in the hands of a legal functionary.   The
law of inquest is, or  ought to be, in some
degree, at least, a fixed principle or rule of
action.  The medical  questions which  are
involved in the majority of inquests are so
varied, that they cannot  possibly be fully
judged of by a non-medical inquirer.   Me-
dical  men alone  are,  or ought to be, com-
petent to seize hold of and follow up many
clues of inquiry  that must and  do fail to
attract the notice of those whose knowledge
(if possessed at  all) is necessarily limited
on subjects of medical science.
  Refer to  Death — Drowning—Hanging —
Poisons.
  INSANITY — Lunacy—Unsoundness  op
Mind—Are all terms for a disorder, of which
it has  puzzled  the  most acute  to give an
accurate, and, at the same time, sufficiently
comprehensive definition,  although all are
aware  of the general  sense  of  the  terma
used  to indicate the disorder.  It is suffi-
cient for our purpose here, to mention  that
the most general division of the  subject ia
into  mania,  that is insanity,  along  with
more or less violence in demeanour and ac-
tion;  monomania, in which either the  un-
derstanding or the will is perverted on one
particular point; and dementia, or inco-
herent  thought,  verging  to   imbecility.
Amentia, or idiocy,  has  been already ad-
verted to.
   The main character of insanity, in a legal
point of view, is said to be the existence of
a delusion; that is, that a person should be-
lieve something to exist that does not exist,
and that  he  should  act  upon  this belief.
 Many persons may labour  under harmless
delusions, and still be fitted for their social
duties ; but  should  these delusions be such
as  lead  them  to   injure themselves or
others in person or property,  then the  case
is considered to require legal interference;
otherwise not.*
   The approaches of insanity are variously
characterized.   Sometimes, to all appearance,
it comes on without warning,  a  sudden  out-
break of  violent mania being the first in-
 timation  of  the disease.  Even  in these
cases, however, investigation  will generally
 discover that there  has  been some amount
of preceding  disorder, some  sleeplessness,
 some unusual irritability or mental excite-
 ment,  perhaps  concealed or controlled by
 the individual.   In  other cases, the mental
* Taylors Medical Jurisprudence. 
INS
313
INS
  oddities, irritabilities, fluctuations of spirits,
  &c.  have been evident, but  too slight to
  excite apprehension.  At the last, the acute
  attack may be induced by some severe or
  prolonged mental emotion, or by some phy-
  sical depression.  The  onset  of the attack
  Itself,, is frequently preceded  by, or accom-
  panied with feverish symptoms, which par-
  ticularly affect the head.   In  this case, the
  insanity is probably, at its first onset, ac-
  companied with acute affection of the brain
  or its membranes, and partakes of the cha-
  racter of delirium, properly so called. Where
  the circumstances, such as hereditary pre-
  disposition,  or previous warning symptoms,
  give' rise to  the suspicion  of impending in-
  sanity,  medical advice must at once  be
  sought, preparatory to the one essential and
  most merciful step—removal of the patient
  to an asylum.  In the mean while, the most
  perfect  quiet, both of body and  mind, and
  the treatment recommended under the head
  of "Delirium," will  be the most advisable
  mode of proceeding.
   Insanity is a disease which, when  once
  developed, ought never to be kept under do-
  mestic management,  or  rather mismanage-
  ment.  The  only reasonable hope rests with
  speedy removal to  proper  care and  to a
  state of external  circumstances specially
  adapted to promote recovery.   Asylums for
  the insane are not what they were,  and the
  most attached and affectionate relative need
  not fear to place the afflicted under the pro-
  tection of a well-managed establishment.
   The following extracts from the interest-
  ing " Reports" of Dr. Brown,  the energetic
  superintendent  of  the  Crichton Asylum,
  near Dumfries, will best explain the bearing
  and connection of the insane  on and with
  society at large, and  will show how  much
 comfort,  and it may be said happiness, may
 be enjoyed by the afflicted  under kind and
 intelligent management.  In the Report for
 1845, it is remarked—"  Prompt treatment is
 of most  importance,  and   obstacles  which
 make it difficult of access, afford a pretext
 and palliation for that repugnance to resort
 to isolation,  which still exists in the minds
 of friends and guardians, but which is fading
 and falling, and must ultimately fall before
 the   influence of a  system  of  discipline
 founded upon humanity, and which  is open
 to investigation. The procrastination which
 occurs when  an individual is attacked with
 insanity, in adopting the only  course which
 can  insure the  enforcement  of judicious
.means of care and cure,  is the result of
 various causes. .  .   .  Frequently it may
 be traced to ignorance, that  the extrava-
 gance and  incoherence which  inflicts so
       2B
I much pain, and creates so much confusion,
 are symptoms of diseased organization; and
 to skepticism that these originate, increase,
 disappear, or are removed, according to the
 same principles,  and  nearly in  the  same
 manner that gout  and jaundice  are  miti-
 gated  or removed.   If the opinion  were
 generally prevalent,  that  insanity in  all
 cases, whether its development is determined
 by disappointment or by a blow on the head,
 whether signalized by great constitutional
 disturbance or apparent robustness of frame,
 depends upon bodily disorder, and can only
 be reached, whether curable or not, through
 the body, and  by agents  which act in  ac-
 cordance with the known laws of the  eco-
 nomy.   Advice should be sought at once, or
 as speedily as in other maladies: the powers
 or efficacy of medicine would  be  put to a
 fair test, and it is admissible to anticipate
 that the mortality and evils of an intracta-
 ble class  of diseases would be materially
 diminished.   Even now, when  months  are
 allowed to elapse before  assistance is  ob-
 tained, a very large proportion of the more
 transient  and  trivial  cases of mania  are
 found to recover under judicious  manage-
 ment ; while one-third, at least, of the more
 desperate and  chronic  and hopeless cases,
 which are sent to public institutions because
 they have set all conciliatory and  temporiz-
 ing expedients  at defiance, and resisted  the
 treatment pursued, are ultimately restored
 to such a degree of intelligence as to capa-
 citate them for the resumption of former
 pursuits and responsibilities, and for the per-
t formance of the duties of  active life."
   But even within the walls of an asylum,
 active duties and  enjoyments may be  en-
 gaged in,  if properly arranged.    In   the
 Report for 1851, Dr. Brown remarks—"The
 character of the moral management is acti-
 vity without excitement, progress, the com-
 bination of self-government with appeals to
 the intellect and sentiments. There is always
 something to expect to prepare for; some
 anticipation or some  retrospect.  Patients
-are participators  in   every  arrangement.
 They are identified with the recreation ns
 well as the labours, of the community.  They
 are led to understand  that each progressive
 step is not merely for  them, but  by theni;
 They are  their own  gardeners, labourers,
 players,  precentors, (Anglice, clerks,) libra-
 rians, and, under certain restrictions, their
 own police.   Each day has its appropriate
 relaxation, as well  as its duties; but mono-
 tony, which engenders torpidity rather than
 tranquillity, even the monotony of continued
 recreation,  is obviated  by useful pursuits
 and physical  exertion.   Sub-matrons have 
TNT
314
I X T
been  thrice  selected from  the patients;
they delighted  in  the badge of office,  and
proved worthy  of the trust.   The library
is now intrusted to a patient  whose mind
seems  specially  constituted  for  such  an
avocation.   He  has  prepared  and  nearly
arranged  the  catalogue,  which is  to  be
printed at  the  institution  press."    The
drama has been used and found useful, both
to "interest and elevate many classes of the
insane," both as performers and spectators.
Further, in  the same  interesting report, it
is said—"The  number of  cultivated  minds
which  still  retain  former  predilections,
though  shorn  of  former  power, may be
learned from  the  solicitude displayed in
adding to the  collection of books,  in mul-
tiplying literary pursuits, and  in  extend-
ing the range of intellectual impressions."
After describing the occupations of many of
the inmates of the institution,  the Report
continues—" The act of composition, from
whatever  motive it may proceed, is bene-
ficial  and invigorating.   It could  only be
by the sudden withdrawal of this liberty of
thought, and of these intellectual luxuries,
that their full  efficacy could  be tested in
establishing tranquillity, and in suggesting
a deportment which closely resembles, if it
do not entirely realize, that of sanity  and
serenity.   Worship is  regularly performed
according to the forms of the  established
churches.   Members  of other  communions
visit their churches  in  Dumfries,  accom-
panied by  officers, or are visited by their own
clergyman.  The timidity  which formerly
excluded the insane from  such ordinances,
or concealed their  presence by a vail, has
passed away;  the error  that  they  were
incapable  of comprehending or joining in
worship has been  demonstrated;  and in
these  assemblies children  and maniacs are
seen to bend the spirit and the knee side by
side;  in them it is impossible to distinguish
the sane from the insane, the guardian from
his charge; and all ideas are banished from
the mind  of a spectator  except  those of
universal brotherhood, and that peace which
passeth understanding.   It  may be that
there is a  sense of supplication where there
is no power of precise and articulate prayer:
and it may  be, that independently of.  and
even in opposition to, external manifestations,
there  is an "inner life hidden wit't  God ;'
but it is certain that  reverence and  atten-
tion prevail; that the tranquillity is greater than
under other circumstances; that the acknow-
ledged effects are contentment and calm."
  Did space permit, there is much of interest
and information  which the  author  would
wish to have extracted from the  able reports
 of this splendid and well-manngco. institu-
 tion ;  but enough, periiaps, has been given
j to convey some idea of the interior arrange-
 ments of  a well-conducted lunatic asylum
j of the present day.  [Many such are in the
 United  States.]   None,  perhaps, are  so
 ignorant as to believe that the chains and
 other barbarisms, nay, even the lash, arc the
 lot of the inmates of these hospitals—fur
 such  they may truly bo  called —but  the
 generally diffused ideas, either of the treat-
 ment or of the capabilities of the insane, are
 very undefined or erroneous.
    A very erroneous idea exists, particularly
 among  the  ignorant, that  if  a person  be
 insane, he cannot act or look like a rational
 being at all, but must be  constantly doing
 things in an insane manner.  Consequently,
 if the individual be simply  lunatic or mono-
 maniac, without being  actually under the
 influence  of maniacal excitement,  or  even
 should he have a "lucid interval," that is,
 a temporary cessation of mania, and  tem-
 porary return, either wholly or partly, of
 his rational condition, those  around are
 apt to be lulled into a false security, the
 vigilance  or attendance is  relaxed, and a
 momentary  return of the  delusion is  at-
 tended,  perhaps, with the most serious con-
 sequences, rendering nugatory hours and
 days of  anxious care.
   In addition  to the various  causes predis-
 posing to, and directly exciting  insanity,
 such  as  hereditary  tendency,  political or
 commercial excitement, grief and disappoint-
 ment, false  or erroneous  religious excite-
 ment, &c.  no fact is more clearly ascertained
 than the vast amount of insanity caused by
 drunkenness.  The  temporary  insanity of
 intoxication cannot  be indulged   in  with
 impunity;  it may be frequently repeated,
 but at length  the mind permanently gives
 way, and the individual becomes a confirmed
 lunatic.    On this  point  Dr. Robinson, of
 Newcastle, in an interesting paper upon the
 Mutual  Relations  existing between  Intemper-
 ance and Insanity, remarks—"Intemperance
 and  insanity,  the two greatest  curses of*
 civilization,  are in their very nature so inti-
 mately connected, that any examination of
 the one  would be  necessarily  incomplete
 without  the other; for both  exhibit, as their
 essential phenomena, perversion or disorder
 of those  mental  powers which impart  to
 man  his  vast  superiority  over the rest of
 the creation.  Since, then, a single dose of
 intoxicating substance possesses the power
 of temporarily disordering the intellect, per-
 verting  the moral  sentiments,  and  even
 wholly suppressing the operations  of  the
 mind, it is  not wonderful that  the  con- 
                 INS                 31

tinued use of such agents should frequently
induce  permanent  mental derangement."
In  a table drawn  up for the  returns  of
twenty-five asylums in England an 1 Wales,
it is found that  one-fourth of the cases of
insanity admitted are referred to intemper-
ance alone, and  to  it,  in  conjunction with
vice and sensuality,  nearly one-third.
   Refer to  Delirium—Delirium  Tremens—
Dipso-Mania—Monomania, Sec.
   INSPIRATION.—The act of drawing air
into the lungs, and  the opposite of expira-
tion, which consists of its expulsion;  the
two together constituting respiration.
   INSTRUMENTS.—But few of these me-
chanical agents used by the surgeon in the
treatment  of  disease  can ever  be of  legi-
timate  use to unprofessional persons living
within  reach  of  a medical  man, and those
who are likely to  be  placed in circumstances
where such assistance is not available, who
may wish  to be  prepared  for emergencies,
should get themselves practically instructed
in  the  use of the few they may venture to
take in band.   The instruments required in
such operations as bleeding, cupping, tooth-
drawing, &c. are sufficiently described under
the  articles devoted to the subjects.    In
addition to them, the dweller—such as  a
clergyman—in a remote parish, even in this
country, might find the following useful:—
   A Lancet.   A silver probe.
   A gum  scarificator.—See Children.
   A pair of plain forceps. "I See Forceps and
   A pair of spring forceps. /   Dressing.
   A vaccinating lancet.—See Cow  Pox
   A pair of scissors  with blunt points.
   A caustic holder.
   A two-ounce syringe.—See Syringe.
   A clyster instrument, or rather two ; one
being a syringe, and one  the elastic bag.—
See Clyster.
   To these the emigrant  might add  with
advantage—
   A tenaculum.—See Tenaculum.
   A tourniquet.—See Tourniquet.
   A shut-up bistoury, or knife.
   It is perhaps superfluous to add, that these
should be  got at some respectable surgical
cutler's; and  it is well to add, that all who
provide themselves with them should endea-
vour, if possible,  to get a little practical in-
struction in their employment.
  INTEMPERANCE.—See Stimulants.
  INTER-MARRIAGE.—See Marriage.
  INTERMENT.—See Burial—Death, &c.
  INTERMITTENT.—A term applied  to
diseases which,  like ague  and neuralgia,
come on in paroxysms, between which there
is an interval of comparative freedom from
the symptoms of  the disease.  The term is
.5                INT

 also applied to the pulse, when some of its
 beats are as it were omitted.
   INTOXICATION—Means literally what
 it really is, a condition of poisoning,  either
 by alcohol or by other narcotic agents:  the
 former however being the most  frequent
 cause  in this country.  Intoxication from
 the use  of opium, Indian hemp, &c. is  ad-
 verted to in the articles upon  these agents.
 The phenomena of alcoholic intoxication are
 thus described by an esteemed writer:—
 "The effects which follow the introduction of
 a large quantity of moderately diluted alcohol
 into the  stomach, are, first, the local excite-
 ment of this organ indicated by the sensation
 of heat  in it."  "This impression is next
 conveyed to the brain, spinal marrow,  and
 entire nervous system; ideas  of unusual
 brilliancy pass through the mind.   As  the
 power of the stimulus  increases, all control
 of the  will is suspended ; the ideas are then
 irregular, and instead  of being combined in
 such a manner as to produce even agreeable
 conceptions, they  arise in  the most incon-
 gruous order.  The extent of the excitement
 becomes apparent in the unusual vivacity of
 the eye, the swelling of the veins  of  the
 neck, and the beating  of the  arteries;  but
 new symptoms quickly follow, namely, pain
 in the  frontal region, the head drops on the
 chest,  the eyes  lose their expression  and
 are half-closed, the physiognomy is altered
 and vacant, the voluntary muscles cease to
 act, the  arms are pendent or their  move-
 ments  are  irregular,   the legs cross  one
 another  in  the  effort  to  walk, giddiness
 supervenes,  and delirium follows.  The ex-
 hausting influence of such a state is  too
 great to  continue ;  in a short time collapse,
 and sleep, resembling that  of apoplexy,  fol-
 low "   Probably,  the influence of alcohol
 upon the brain, in the  first place at least, is
 partly effected through the  nerves  of  the
 stomach, but  it is  very quickly  absorbed
 into the blood, and speedily reaches and acts
 directly upon the brain itself.   This has been
 proved by experiment and examination after
 alcohol had been  swallowed, and there  has
 been found in the brain a considerable quan-
 tity of  fluid  distinctly impregnated with
 spirit,  to such an extent, even, as to burn.
   The cases of sudden death—too frequently
 recorded in the newspapers—from the rapid
 drinking of a large quantity of spirit, may
 be quite  accounted for by the  shock com-
 municated directly  by application, of  the
 spirit to the brain  itself, or indirectly by  a
 shock  given to the stomach and its nervous
 connections, with an effect similar to that
 which  ensues from drinking largely of very
 cold water when  the  body i:  heated  and
3: 
I X T                316                I P E
exhausted, or from a blow on the stomach.
Death in the latter stages of intense intoxi-
cation is similar to that from some forms of
apoplexy.  Some  indication  of the amount
of danger to life, existing in a person in a
Btate of intense intoxication, may be gather-
ed from the condition of the  iris.—See Eye.
If this retain its power  of contraction, the
person will generally recover;  if, on  the
contrary, it  remain in a state of extreme
dilatation  and  immobility when  a  strong
light is directed upon it, only a feeble hope
of recovery can be entertained.  The ordi-
nary duration of fatal cases of intoxication
is said to be from twelve to eighteen hours,
but on this head there is considerable varia-
tion.  When  death is threatened from  the
absorption of alcoholic fluid into the system,
the individual, after the  usual symptoms of
intoxication,  becomes  insensible; the face
is flushed and  the vessels of the head dis-
tended ;  the  pupils contracted and the skin
hot; or,  contrasting with violent throbbing
action of the heart and arteries,  the face is
deadly pale,  lips blue, pupils dilated, sur-
face cold and covered with clammy sweat;
the natural  contraction  of the muscles is
suspended so that the jaw drops.   In short,
there is  every appearance of death,  which,
indeed, may speedily take place: neverthe-
less,  a  patient may be roused  by  appro-
priate measures,  even from this apparently
hopeless state.
  The first proceeding which naturally pre-
sents itself in the treatment of such cases,
is to procure  the evacuation of any alcoholic
fluid which  may remain  on the  stomach.
If a medical man is at  hand,  he will pro-
bably effect this  by the  stomach-pump;  if
not,  sickness may be excited  by the first
procurable emetic—except antimony—or by
a feather in the throat.   After the stomach
has been emptied by vomiting, a little sal-
volatile in water, or hartshorn  in water,  or
vinegar and  water should be  given;  cold
water should be used freely to the head; it
is most effectual if poured  upon it in a
regular continued stream for some minutes.
If the extremities are cold, heat should be
applied  to them.   The author  has found a
stimulating injection of an ounce of turpen-
tine in half a pint of gruel, of much service
in rousing the depressed system.  Mustard-
plasters may be  applied  to the pit  of the
stomach, between the shoulders, &c. It ought
to be remembered, however, that  sensibility
may be restored and the most serious symp-
toms dispelled,  and yet, if the stomach has
not  been entirely emptied, they may again
return and prove fatal, unless the patient is
"losely watched.—Refer to Stimulants
   INVERSION.—The turning inside out of
an organ, such as the womb.  It is a serious
accident, which sometimes occurs under pe-
culiar circumstances, as after labour.  The
assistance.of a medical man is always im-
peratively called for.
   INUNCTION.—The rubbing of an  oint-
ment upon the skin, for the purpose  of
promoting  the absorption into the  system
of any  medicinal substance  contained  in
the  ointment.   Ointments  which  contain
mercury or iodine are principally used with
this  intent.
   IODINE—Is a substance at present consi-
dered as elementary. It is principally obtain-
ed from sea-water,or sea-products, but is also
found in some mineral waters, and in some
plants, such as common watercress.   Iodine
exists in the form of dark, metallic-looking
scales;  it possesses a strong pungent odour,
and  stains whatever it may come in contact
with of a  deep yellow or brown colour.
When heated in a flask, iodine rises in the
form of a beautiful violet-coloured  vapour,
and  condenses unchanged on the side of the
glass. Iodine and its preparations are much
used by medical men, but can scarcely fall
within  the sphere  of domestic remedies;
the ointment of the combination of iodine
with potash is used in bronchocele, or swell-
ed neck.—See Bronchocele.  When combined
with iron, iodine is a remedy of much value
in debility, and in scrofulous disease; it is,
however, a medicine  that should never be
taken without medical sanction.
  IPECACUANHA—At once one of the most
valuable medicines of the practitioner, and
one  of  the safest remedies which can be
used domestically—is the root of a pretty
little South American plant.   It is brought
to this country in pieces about the thickness
of a  goose-quill, and about six  inches long,
brown, wrinkled, and knotty.  But its most
characteristic feature, and that which serves
to distinguish it from spurious roots often
attempted to be substituted for it, is its
ringed appearance;  it seems as if made upv
of a  number  of separate  pieces, or rings,
strung, as it were, upon one central  stem.
  Ipecacuanha is best known as an emetic,
and  it is perhaps the most certain, safest,
and best of the class we possess.  No family
medicine-chest in  the  country should be
without it.  It is also a valuable expecto-
rant  and diaphoretic remedy, and facilitates
greatly the action of aperients.  The powder
and the wine of ipecacuanha are the most
general  forms in which it is  used; as an
emetic, it should always be given in powder
if possible; a great error is often committee1
in giving children the wine to act emetic 
                  IR I

ally, for frequently it  fails  in action alto-
gether, or requires so much  as to make the
amount  of  wine given, a  consideration, in
cases  of febrile disease especially.   As an
emetic, the  dose of ipecacuanha in  powder
from twenty to thirty grains for an adult,
is half that  to a child of ten years old.  For
young children, especially when,  as in chest
affections, the  constitutional and expecto-
rant influence  of ipecacuanha is as  much
wanted as its emetic effect, the  author pre-
fers giving  it in smaller divided doses ; for
this purpose, from twelve grains to a scruple
of ipecacuanha powder may be  rubbed up
with an ounce and a half of sugar and water,
[or  the  syrup may be  obtained from the
apothecaries,]  and of this a  teaspoonful
given  at intervals,  according to the  effect
desired or produced.   Quarter-grain  doses
of ipecacuanha, combined with  any of the
common aperient  pills, seem  to facilitate
their action, and  to leave the bowels with
a better tendency to relaxation than before.
   When ipecacuanha fails in exerting  its
emetic influence, and, indeed,  sometimes
when  it does cause vomiting, it acts upon
the bowels, producing diarrhoea.  Its emetic
action is slower than  that  of sulphate of
zinc, and the latter is therefore more  gene-
rally used in cases of poisoning, provided it
is at hand.   Ipecacuanha  enters into the
composition of Dover's powder.—See Opium.
Ipecacuanha may be kept in the form of
powder; but, perhaps, for those  who may
not be able to renew their stock frequently,
it will be preferable to have it  in the form
of the entire root,  as it will thus  longer
preserve its activity.  Moreover, the pur-
chaser may then assure himself that he gets
the genuine  article, which  it is  impossible
for him  to  do  when he buys the drug in
powder.   The  labour of powdering is not
very great, and the wine may be made by
steeping half an ounce of the well-bruised
root in  half a pint of sherry  for two or
three weeks, and then filtering.
   Refer to Emetics.
   IRIS.—See Eye.
   IRON—The well-known metal, is and has
been used as a medicinal  agent in a great
variety of preparations: it  also forms one
of the most common  ingredients of mineral
springs.   The tonic and strengthening pro-
perties of iron are well known,  even popu-
larly, and, probably, we have no remedy of
the kind so generally useful  and applicable
in cases of debility; at the same time, it is
not so much adapted for  domestic use as
many  medicines  of less value.   The  cases
in which preparations of iron are most em-
ployed are not emergencies, they are  usually
       2b2
.7                I RO

 constitutional affections of some standing,
 in which medical  advice is not only requi-
 site for the general treatment, but  also as
 a guide for the  administration of the  iron
 which, improperly given, may do much mis-
 chief.  Persons  who are habitually costive,
 who suffer from  piles, or from determination
 of blood to the head, require to be especially
 careful with respect to the use of medicines
 containing iron,  and should never take them
 without  medical  advice.   The  weak, the
 pallid, the delicate may, for the most part,
 use them with greater  safety, and very ge-
 nerally with benefit.
   The tincture of the muriate of iron, or, as
 it is called popularly, " tincture of steel," is
 one of the most generally used and useful
 preparations,  in doses of from ten to fifteen
 drops  twice a day, in water,  for an adult.
 It is not disagreeable, and children take it
 readily;  the dose  is four or five drops for a
 child of six years of age.   This preparation
 is powerfully astringent, and is  extremely
 useful in  relaxation of the throat, applied
 by means of a camel's-hair brush.  The
 common  sulphate  of iron,  or  green vitriol,
 is a very cheap and good preparation, in
 doses of from half a grain to a grain dis-
 solved in  water,  or  made into pill  with
 crumb of bread.  The ammonia-tartrate of
 iron, the citrate, and the citrate of quinine
 and iron, are all recent introductions; the
 former is very soluble in water—dose, one,
 two, or three grains.—See  Citrates.
   When iron is  really required by the con-
 stitution,  it cannot, probably, be taken in
 any more  beneficial  form  than  that  of  a
 mineral water.  At the same time, these
 natural sources of the  medicine are  open
 to  the same objections  and  causes as its
 artificial  preparations, and  many persons
 injure themselves  by inconsiderately,  and
 without advice,  drinking these waters regu-
 larly,  merely because  they happen to be
 close  to  them  for the  time being.   In
 mineral waters, iron is found  in  a  state
 of  great dilution, and  the striking benefit
 which follows its use in this state in proper
 cases,  justifies  the  fact that, when given
 artificially, it is found  to be  most  service-
 able in small  doses in, a considerable quan-
 tity of water.
   Persons who  are taking preparations of
 iron, should pay  extra attention  to  their
 teeth during the time, to prevent discolor-
 ation.   The evacuations from  the bowels
 always assume  a  dark or  black   colour,
 during a  course  of  iron, and  particular
 attention  is always required  to keep  them
 in a perfectly open state during the continu
 ance of the remedy.
3 
                  1RR

   IRRITABILITY—Cannot perhaps have a
 better  definition  than that  of Abernethy,
 "excited  debility."   It  is a  symptom of
 many diseases, trying both to patients and
 to their attendants, but one for which every
 allowance and  consideration  ought  to be
 made.  Those who have never suffered from
 the weakness of disease,  especially such as
 affects  or has affected the nervous system,
 cannot  imagine in how  many ways, which
 appear not only trifling, but  absurd,  to a
 person  in health, the irritability  of the
 invalid  may be jarred upon.
   The term irritability is also used to ex-
 press that property of muscular fibre to
 which it owes its powers of contraction.
   IRRITATION—May be defined as diseased
 excitement, not amounting to inflammation.
 Many of the  diseases of children partake
 more of irritation  than inflammation.  What
 is called  irritation of an organ  may  take
 place at  a distance  from the source of the
 irritation; thus, worms and other matters
 in the intestines may cause convulsive and
 other affections consequent upon  irritation
 of the brain; or the  irritation  of  the gums
 in teething may also cause  convulsion, or
 spasmodic croup.  The irritant action being
 in these cases in the first place felt by the
 brain, and thence reflected so as to affect
 the muscles which are thrown into spasm.
   Refer to Convulsion.
   ISINGLASS.—See Gelatine.
   ISSUE.—An issue  is an  artificial  sore,
 from  which a discharge  of matter is  kept
 up by artificial means; it may,  therefore,
 be formed in various ways, such as burning
 with  a  red-hot iron, by caustics, &c.; but
 the most general,  and indeed common form
 in popular use, is the pea issue.  This is
 made by  pinching up a  fold  of  the  skin,
 and  making  an incision into it, which will
 admit the insertion  of two  or three peas,
 which are to be  secured in the wound by
 adhesive  plasters.  In the course of a few
 days  the  irritation occasioned by the  peas
 causes discharge of  matter.  The peas are
 generally changed every day, or two days, as
 long as the issue is desired to be kept open.
   A very good issue may be formed by  blis-
 tering the skin by means of one of the  blis-
 tering tissues, and applying daily  a piece of
 the same tissue to the sore, to keep up the
 irritation.
   The seton is  only another form of issue,
 made by passing a skein of  silk through a
 fold in the skin, by means of a seton-needle
 prepared for the purpose.
   The  principle  on  which issues,  setons,
-and other means  of counter-irritation are
 «stablished, is that of producing derivative
8                 I TO

action,  nnd to the article on that subject
the reader is  referred;  also  to "Counter-
Irritation," "Blister," &o.   The strictest
cleanliness must always be observed about
an issue or seton, or any other discharging
sore.  It is perhaps superfluous to add, that
an issue should  never be made on a portion
of the skin which is liable to be visible.
  ITCH.—This dreaded  skin  affection con-
sists of the eruption  of small pointed vesi-
cles, which show themselves chiefly upon
the wrists and between the fingers, but also
at the bends of both the upper and  lower
extremities—in  children,  upon the breech
—and  is attended with  excessive itching,
when the person affected  gets warmer than
usual, either in  bed or after taking stimu-
lating food or exercise.   The itch attacks
persons of all ages,  or of either  sex, and
may be  spread by contagion through  those
of any  rank of  life.  It is, however, more
likely to*become established and  to be pro-
pagated wherever cleanliness  is neglected;
and  among the  poor, especially in those of
bad  constitution, and who are also  badly
nourished and clothed, it is apt to  be mixed
up with other eruptions, indicative of the
impaired constitutional power.
  Coincident with  the  eruption  of itch,
there is often discoverable a minute insect
of the  mite kind, which burrows in and
deposits its eggs in the skin.   By some, the
origin of the disease is ascribed to this in-
sect ;  by others this is denied.
  Fortunately the cure of this disagreeable
affection is in almost  all  cases certain and
quick, sulphur,  in  the  form  of ointment,
made by rubbing up one part of the common
flowers  of sulphur with two parts of lard,
being the agent generally employed. Before
this  application  is  used,  the entire skin
should  be  thoroughly washed  with  soap
and water; the ointment must then be well
rubbed  in  all over the body, and washed
off again  next morning—the person sleep-
ing in a flannel dress, or between  blankets.
This process may be repeated two or three
times if requisite.  In persons of full habit
of body, it is advisable for them to take  an
active purgative  the  day before using  the
sulphur ointment.
  A much quicker method of cure is said to
be employed in the Hospital of St. Louis, in
Paris.   It is thus reported in the Lancet for
December liO, 1851 :—"The  patient is put
into a warm bath, and rubbed for an hour
with yellow  soap; he then  passes  into a
clean bath, where be continues to cleanse
his  skin  for another hour.   After leaving
this bath  he is  taken to a particular room
fitted for this purpose, and, with the aid of
3] 
J A L
319
JOI
 one of his fellow-sufferers, he is rubbed all
 oyer for half  an hour with the following
 ointment:—Lard eight parts, flower of sul-
 phur  two parts,  carbonate of potash one
 part."  After  this  friction the patient  is
 generally cured.
   In a disease of so contagious a nature as
 itch,  the utmost care is  requisite  in the
 avoidance,  not  only of  contact with the
 person  suffering, but  with any article  of
 dress,  or otherwise,  which  he may have
 made use of; and when the person who has
 suffered  is cured, it is  requisite for him
 to exert equal care with respect to these
 things himself, until they  have been puri-
 fied, either by washing,  or by  fumigation
 with  sulphur—bearing in  mind the  effect
 of the latter agent in changing or discharg-
 ing the colour of articles of furniture  or
 dress.   By some it is said that itch can be
 cured by the rubbing  in of simple lard,  or
 of olive or any of  the fixed oils  into the
 Bkin—the  application  being  used   twice
 daily, for two  or three days in succession.
 The author has  no  experience of the  prac-
 tice, but it is worthy of trial, if it will
 supersede the  somewhat  filthy,  and cer-
 tainly not very odorous application of sul-
 phur.   Mr. Erasmus Wilson states that he
 has found camphor  dissolved in olive-oil,
 one part to eight, perfectly efficacious as an
 application in  the  cure  of  itch.  When
 sulphur is used for the cure of itch, it may
 occasion  some  amount of irritation of the
 skin, which, being mistaken for the uncured
 disease, sometimes causes persons to go on
 rubbing long after the  itch is cured,  there-
 by keeping up unnecessary irritation and
 causing needless trouble and uneasiness.

   JALAP—So  well  known as a purgative,
 is the root of a species of plant resembling
 the convolvulus, a native of South America,
 its name being derived from Jalapa, a town
 in Mexico, in  the neighbourhood of  which
 the drug is produced.  Jalap is  an  active
 purgative, in doses  of from ten to  thirty
 grains,  but  with some persons it  causes
 great nausea, and other it  gripes severely.
 The best form for its administration  is the
 compound powder,  composed  of jalap  in
 powder  three ounces, cream  of tartar six
 ounces, and ginger two drachms, well rubbed
 up together; the dose  half a drachm to  a
 drachm.  There  are  purgatives  more con-
 venient for domestic use than  jalap.
  JAMES'S POWDER.—See Antimony.
  JAUNDICE—Is one of the secondary dis-
 eases, the result of  a  primary one;  that
is, some cause, in the first place, stops the
flow  of bile  from  the  liver; and jaundice,
 which  consists in the absorption of that
 bile into the blood, is the effect.
   This impediment to the flow of the bile.
 may arise from  whatever  blocks up  the
 canal of the gall-duct.— See Gall-Bladder.
 Probably, gall-stones, or  thickened  bile,
 are  the  most common  obstructions;  but
 tumours which press upon the duct, or spasm,
 may also stop the bile and induce  jaundice.
 Jaundice  has sometimes  succeeded to vio-
 lent  mental  emotions.   The presence  of
 bile in  the blood  is quickly manifested  by
 the color of  the  skin, and  also more par-
 ticularly of   the  white of  the  eye;  the
 shade of colour varying from the  slightest
 perceptible tinge,  to deep golden yellow, or
 even brown.   At the  same  time, the  stools
 become white and chalky-looking, and the
 urine — sometimes  the  perspiration — is
 deeply tinged with bile; the  constitutional
 symptoms are generally those of disorder-
 ed digestion, headache, and  languor.  For
 many reasons, jaundice is a  disease which
 ought, when  possible, to be  under proper
 medical  treatment, not so much  from  the
 danger of the affection itself, as from  its
 being symptomatic of disorder elsewhere.
 Should gall-stone or spasm be the cause of
 jaundice, the case is generally plain, (see
 Gall-Stone;)  but should the  presence of a
 tumour, or disease of the liver be the origin,
 it requires medical examination for its elu-
 cidation.
   The treatment of jaundice, which unpro-
 fessional persons may adopt  in the absence
 of a medical man, is very simple:  from five
 to eight grains of  "gray powder"  being
 given at bedtime, either alone, or, if there
 is pain, made into pill with  extract of hen-
 bane, and  followed by a dose of castor-oil
 or senna in  the morning.   When  there is
 much acidity of the stomach, carbonate  of
 soda  may be  given.   The  diet should  be
 simple,  devoid of milk,  fat, or  saccharine
 articles while the jaundice exists, and all
 alcoholic  stimulant  avoided.   Of course,
 when violent  spasmodic pain indicates gall-
 stones, the measures  recommended under
 the article on the subject must be adopted.
   Refer to Bile—Gall-Bladder—Liver, &c.
   JAWS.—See Skull.
   JEJUNUM.—A  portion of the small in-
 testines.
   JELLY.—See Cookery—Gelatine.
   JESUIT'S  BARK.—See Bark.
   JOINTS.—Also called articulations.  The
joints, generally, from their  mobility and
 exposed situation, are very  liable  both  to
 accident and  disease ;  in either case, much
 care  on  the  part of  the attendants,  and
 much patience on that of the patient,  ig 
JOY
820
KI D
called for, as it need scarcely be remarked, '
that the most  perfect rest is, in most cases
of disease affecting the joints, the essential,
for which  no other remedial  measures will
compensate.  Incurable disease of the bones
of a joint does not now, under the improve-
ments of  modern  surgery, necessitate the
loss of the limb:  the joint, such as the elbow
— and even the knee—may be cut out, and,
in  the course of  time, a  tolerably useful
member remain, a kind of new joint being
formed.
  Refer to  various  joints—Ankle—Hip—
Knee, Sec.  Refer also to articles Dislocation
—Skeleton, Sec.
  JOY.—This powerful and  instantaneous
mental emotion may  act upon the body, be-
neficially or the reverse.   There are so many
recorded instances, either of overturned rea-
Bon or of death resulting from excessive and
sudden j y, that too great caution cannot be
exerted in arousing it in persons of a nervous
temperament, or in those who are debilitated
by disease.  Epilepsy has resulted from  sud-
den joy.
  JUGULAR VEINS—Are the large veins
which convey the blood from the head and
face back to the  heart.   They are both in-
ternal and external.
  Refer to Neck— Veins, §c,
  JULEP—An old name for what are now
called Camphor Mixture—Mint- Water, Sec
  JUNIPER.—Two species are used in me-
dicine ; the common, well-known juniper,
which grows in  England, [and also in the
United States,] and the juniper which yields
the savine.  The former  of these, the com-
mon juniper, is a diuretic, a property it owes
to its essential oil, and cannot be employed in
any better form  than  that of Hollands  gin,
which was originally introduced as a medi-
cine.—Seet?m.   The savine is notorious from
having been frequently employed for crimi-
nal purposes, and  when so 3mployed, from
its fatally irritant properties being frequent-
ly manifested.   Savine has been used  as  a
remedy for  destroying worms  in children,
but cannot be regarded as safe.

  KALI—Potash.—See Potash.
  KIDNEY.—The kidneys, or glands whose
office is the  secretion of the urine from the
blood,  are situated  on  either side of the
Bpine,  (fig. lxxxvii. 1, 1,) just in what  is
usually called the "small of  the back,"
where they lie imbedded in fat.  Each kid-
ney is supplied with blood, by vessels,  (2 2)
which proceed from the aorta or main blood-
vessel.— See Aorta.    From   each kidney
issues  a  duct,  (fig. lxxxvii.  3, 3,) the
ureter,  which conveys  the urine into the
Fig. lxxxvii.
Fig. lxxxviii.
bladder, (fig. lxxxvii. 4.)  When cut open,
(fig. lxxxviii.,) the kidney presents, even to
the naked eye, two very different structural
arrangements;  an  outer  one,  granular
looking,  the  " cortical" substance,  (fig.
lxxxviii. 2, 2,) and  an inner or "tubular"
structure, (fig. lxxxviii. 3, 3, 3,) the latter
being, as represented, arranged in pyramids
or  cones, with  their bases  situated upon
the cortical  substance, and  their points or 
•
KID
321
KNE
 apices, which are free,  pointing inward,
 and  opening into a  central  cavity,  (fig.
 lxxxviii. 4,) the "pelvis" or  basin of the
 kidney, which may be regarded as an ex-
 pansion of  the upper portion of the ureter,
 (6, 7.)  The entire kidney is enveloped by a
 sufficiently  strong membrane or "capsule,"
 and is lined by a smooth  " mucous" mem-
 brane,  continued  into  its  cavity, by the
 ureter, from  the  bladder.   Those who are
 curious  on the  subject  may  easily make
 out these  particulars, by examining the
 kidneys of the sheep.   When the minute
 structure of the kidneys  is microscopically
 examined,  it is  found to  present a very
 beautiful arrangement.   The  tubular  por-
 tion (fig.  lxxxviii. 3) is seen to consist of
 numbers of minute tubes about the diameter
 of a hair, and minute blood-vessels, placed
 side  by side; these tubes, as  they proceed
 toward the  bases  of  the cones, or toward
 the cortical structure, (fig. lxxxviii. 2,) be-
 come forked and twisted,  and at last end  in
 a minute  globular  expansion, on which the
 " capillary" of  hair-like   branches of the
 artery of the kidney are spread  out  in a
 kind  of tuft.  It is these  globular expan-
 sions, each  about the one-hundredth of an
 inch in diameter, which give this portion of
 the kidney its granular appearance.   The
 minute blood-vessels which had been spread
 out in a tuft are again collected  into one
 vein—and these minute veins are distributed
 amid  the  tubular  structure,  previous  to
 being collected into larger trunks for the
 conveyance of the blood out of the kidney.
 The  object of  all this elaborate  arrange-
 ment is this:  the urine is secreted from the
 blood, which is conveyed into the kidney by
 its own proper artery, the watery portion
 of the fluid  being  strained  off, as it were,
 from  the minute tufted vessels, described as
 being expanded  over  the globular expan-
 sions, and the other  constituents being se-
 parated by secreting  cells from tbe blood,
 after it  has been recollected  from these
 tufts, and as it passes among the tubular
 structure.   The mingled  watery and other
 constituents of the urine  (see  Urine) being
 thus separated from the blood, and united,
 pass down the straight tubes in the form of
 urine, which  is discharged front the points
 of the cones, (fig. lxxxviii. 3,) into the cen-
 tral cavity  or pelvis, (4,)  whence  it is con-
 tinually being drained off by the ureter (7)
 into the  bladder.   The   ureter  is  about
 the. diameter  of  a goose-quill,  is  about
 eighteen  inches  long,  passes   behind  the
bladder as represented by the 'dotted lines,
 vfig. lxxxvii.J  and enters that  organ at its
lower part.
                                         21
  The diseases of the kidneys could not b«
profitably entered into with unprofessional
persons, and when suspected, should,  with-
out delay, be submitted to proper medical
care.   In the mean while, should there be
much pain in the back, the application of
hot moist bran, or of  heat and  moisture in
some  way, (see Heat,) will be of service ; a
gentle aperient, such  as  castor-oil, should
be given, and  also warm demulcent drinks,
and warm clysters used.   Should there be
shivering  and signs  of  fever,  with  much
tenderness over the kidneys, and no medical
advice at hand, blood  may be taken away by
leeches  or cupping,  and a dose of  opium
given.  Gravel—either in  one  piece,  or in
grains—sometimes  collects in  the  cavity,
(fig. lxxxviii. 4,) and causes pain in the back
while it remains ; when, however, it passes
into the ureter,  (7,)  it causes extremely
violent spasmodic pain, constituting what is
usually  called " a fit of the gravel."—See
Urine.
  KING'S EVIL. —A name for scrofula,
which originated  in  the superstition  that
the disease  was  cured by the  touch  of a
king.   The practice  is  said to have ori-
ginated with Edward the Confessor ;  it is,
perhaps, needless to add that it has become
obsolete.
  KING'S  YELLOW —Is  a compound of
arsenic with sulphur.—See Arsenic.
  KINO—Is  the  concrete juice of a tree,
and is brought chiefly from the East Indies;
it is  an  astringent closely resembling ca-
techu, and is used for the same purpose.—
See Catechu.
  KNEE.—The knee  is, perhaps, the most
important joint in the body, and is certainly
the most  serious  to  be affected either by
disease or injury.   It is formed of  three
bones, (fig.  lxxxix.,)  the extremity  of the
thigh-bone, (1,1,) the upper extremity of the
larger leg-bone, (2,) and the knee-cap, or
"patella," which lies on the forepart of the
joint, but which is supposed to  be removed
in the figure.    The small bone of the leg
(3)  does not enter into the construction of
the joint.   The rounded ends of the thigh-
bone  rest in shallow excavations in the ex-
panded broad  head of the bone of the leg:
the knee-cap protects the joint in front, and
enables the muscles of the thigh to act with
more  advantage and greater leverage in the
movements  of the leg;  the  entire  joint
being fitted  and  bound together by means
of  cartilages  and ligaments, (5, 6.)—See
ligaments.
  The knee-joint is  liable to  become the
seat of inflammation, either acute or chronic,
caused either  by violence or wounds,  or as 
KNE
Fig. lxxxix.
the result of constitutional causes.  In any
case, the disease is of so serious a nature,
that it should as soon as possible  be put
under  proper medical care.   If  the knee-
joint  has  been  opened by  a wound,  the
only course for an unprofessional person to
pursue,in  the  absence of a  surgeon, is to
close it as quickly and effectually as possible,
(see Wounds,) to put the joint in a state of
the most perfect rest, to keep it cool with
cold water applications, the  sufferer being
put on lpw diet, and the bowels attended to.
When inflammation of the knee-joint arises,
either as the consequence of a wound or from
any other  cause, very free leeching is re-
quisite, along with fomentations  and poul-
tices,  and  the  constitutional  treatment of
inflammation  generally.  Blisters near the
joint should never be used in an early stage.
   " White-swelling"  of the knee, so dreaded
popularly, consists of increased effusion of
fluid into  the  joint,  consequent upon dis-
ease of  some portion of its structures.  This,
however, and other chronic diseases of the
knee, require so much educated  skill and
care, that  they must  be treated by the me-
2               K O U

dical man.  Till his aid is procured, the most
perfect rest of the limb, the suppression of
extra heat  by  cooling   applications,  the
soothing of pain by warm fomentations or
poultices, attention  to the  state  of  the
bowels,  and to the diet, is all that should
be attempted.  White-swelling is often con-
nected with a weakened and scrofulous state
of the constitution; consequently, all debili-
tating measures are, generally, to be avoided.
The  knee is sometimes the seat of  a very
unpleasant affection, termed "loose carti-
lage," which  consists of a rounded gristle-
like  body lying  loose within the joint,  and
which,  being  apt in  the motions  to be
squeezed between the surfaces of  the bones,
causes severe sickening pain, and may oc-
casion the person to  fall.   The "surgeon
must be  applied to.
  The knee-cap, from  its exposed situation
in front of the joint, is liable to various ac-
cidents, to fracture, (see  Patella,) also to
dislocation, being  pushed  to one side.  It
may be  replaced,  either by the  knee being
bent by a second  individual, or by straight-
ening the knee, and bending the thigh upon
the body, so as to relax the muscles on the
forepart of the thigh, within the  tendons of
which the knee-cap is situated.  On the fore-
part of the knee-cap, between it and the skin,
is placed a small "bursa," (see Bursa,) which
is liable to become inflamed in persons who
have to  kneel much on  hard  substances.
The affection is called "housemaid's  knee,"
from its frequent occurrence in  that class
of servants, who kneel a good deal:  it also
occurs in thatchers, who press  the knee
upon the ladder when  at work.   Matter is
liable to form  in consequence of the  inflam-
mation,  and in  this case  the treatment of
abscesses generally is requisite.   If the  dis-
ease be  taken early,  the knee  should  be
rested, and the inflammation subdued by a
few leeches and fomentations, &c  : a blister
will  frequently  remove the swelling, or it
may be  painted over with tincture of iodine
once daily, for some time.  Occasionally i*
remains  in  spite  of treatment,  and ulti-
mately disappears of itself.
   Refer  to Leg—Patella.
   KOUSSO—The  new  remedy  for  tape-
worm,  is the  product of a  plant brought
from  Abyssinia,  and  it certainly appears
to be  a most efficient  cure for  the  above
most   troublesome  and   intractable  dis-
order.   In two cases — which had resisted
all previous treatment—the author  found
the kousso  perfectly  successful.    At  the
same time, it is not improbable, if the  root
of the male fern, found  so  abundantly in
this country, was employed with the same 
                 K RE               31

precaution  as the  far-fetched African  re-
medy, that  it  would prove equally effica-
cious.  The following are the  directions is-
sued  by  Mr. Hooper, of Pall Mall, with
each  dose of kousso :—"The kousso should
be taken in the morning, fasting.   The only
preparation  necessary is that  all solid food
should be abstained from for twenty-four
hours before taking it; and a dose of castor-
oil, or a saline purgative, administered  the
previous evening.   The powder is to be tho-
roughly mixed with about half  a pint of
lukewarm water, (for an  adult,)  and  al-
lowed to  infuse for a quarter of an hour,
being occasionally stirred.   The whole is to
be taken, liquid and powder, at one, two, or
three  draughts,  at short  intervals, being
washed down by cold water and lemon-juice,
or any agreeable fluid.    To   promote  the
operation, tea (without sugar  or milk) may
be taken, but nothing  else.   In three or
four hours,  if the remedy has  not operated,
a dose  of castor-oil, or a saline purgative,
should be administered."
  [The fresh bruised seeds of the common
pumpkin have  also  proved efficient in doses
of two ounces every hour for four hours, and
then one ounce the  next morning.]
  Refer to Fern— Worms, Sec.
  KREASOTE.—See Creasote.

  LABOUR.—See Child-birth.
  LABURNUM.—The seeds,  and  also  the*
bark, of the common laburnum are highly
poisonous, and  a few cases have occurred in
which children have been severely affected
in consequence of their  eating the former.
Vomiting, with delirium  and stupor,  are
said  to  be the consequences.  Treatment
similar to that recommended under "Bella-
donna" should be resorted to, and medical
assistance procured without delay.
  LACERATION.—See Wounds.
  LACTATION.—The secretion of milk.
  LACTEAL —See Absorbents — Diges-
tion.
  LACTUCA.—See Lettuce.
  LAMB—Like other "young meats," is
not so desirable for invalids as mutton.
  LAMENESS.—See Ankle. Deformity,&c.
  LANCET.—See Blood-letting.
  LANGUOR—Is a very general  symptom
of disease, and is—both  true and false lan-
guor—sufficiently treated of under the head
of " Debility."
  LARYNX.—The  organ of voice situated
at the top of the windpipe.—See Lungs.
  LAUDANUM—Tincture ok Opium.—See
Opium.
  LAUGHTER—Which arisen  from  an  ex-
sited condition of the nervous system, though
13               .LEA

proverbial as a promoter of health,  may,
nevertheless,  if excessive  and  prolonged,
give rise to  serious consequences;  the fit
of laughter might pass into one of  convul-
sions in  a predisposed constitution, or in a
child.  The practice of tickling children, and
thus keeping them in a state of laughter for
some time, is strongly to be condemned, and
may be attended with some mischief.
   Refer to Convulsion.
   LAUREL.—The common laurel, more par-
ticularly its young shoots and leaves, con-
tains a considerable proportion  of  prussic
acid, and a few cases of poisoning have oc-
curred by their distilled water.  [Partridges,
or quails, which sometimes feed on the ber-
ries, have also proved  poisonous as  articles
of food in the United States.]  The practice
of using laurel-leaves  in confectionary  for
the sake of the flavour is not to be recom-
mended.
   LAVEMENT.—A clyster.—See Clyster.
   LAXATIVE.—See Purgative.
   LEAD.—This metal is of importance in a
medical point of view, both on account of its
medicinal and of its poisonous properties.
   Of its various medicinal  preparations, it
will be sufficient here to notice three:  the
acetate,  or "sugar of lead;" the solution
of an acetate of lead, or Goulard's extract;
and the  lead-plaster.  The acetate  of lead
is used both externally and internally.  In
the former case, in the proportion of from
one to five or six grains to the ounce of dis-
tilled, or rain water, it  forms one of  the
best cooling  lotions; it  may also be used
slightly warm, either  simply, or with  the
addition  of one or two drachms of laudanum
to the half-pint.   The weaker solutions of
sugar of lead, one or two grains to the ounce,
are often used as an eye-wash, but  are  not
so  generally  useful as zinc.   Internally,
sugar of lead acts  powerfully as an astrin-
gent, and may be given in doses of from two
to four grains, once in eight hours, in cases
of emergency, by the unprofessional.   It is
generally  made into  pill  with  crumb of
bread ; often a quarter of a grain of opium
is combined with it, and it is advisable to
wash the dose down with a draught of weak
vinegar and water.   The few cases,  such as
abortion, in which,  in the absence  of all medi-
cal assistance,  sugar of lead may be  given
domestically,  are  particularly noted  when
treated of in  this work.
   The solution of lead (liquor plumbi) is used
in the proportion of about one  drachm to
the half-pint lotion.  It ought to be  known,
that symptoms of lead-poisoning have been
developed  in consequence of the continued
use of lead lotions to ulcerated surfaces.
3! 
                 LEA                3-

  Lead-plaster is the most unirritating form
of plaster we  possess, and is preferable to
diachylon on irritable  skins;  it is also the
best in  abrasions  and  bed-sores.   Lead,
when conveyed into the system in minute
doses  for any length   of  time,  occasions
serious constitutional effects,  the  most re-
markable being  palsy,  and obstinate con-
stipation, with colic.—See Colic.   Persons,
such  as  painters,  type-founders,  &c. (see
Artisan,) who work with lead, or its prepa-
rations,  are  peculiarly  liable  to  be  thus
affected by it.   The subject is sufficiently
entered into in the articles above mentioned.
Another  very fertile source,  however,  of
the introduction of lead into the system in
individual minute  doses, but ultimately by
the  accumulation  of these, in poisonous
quantity, is  from the pipes in which  water
is  conveyed  for household  purposes.—See
 Water.
  The common  use of  lead or its prepa-
rations in the arts, either legitimately or
fraudulently, is not an unfrequent  cause of
disagreeable, sometimes of fatal attacks, in
consequence of the  metal finding its way
into the body.   The use of lead as a glazing
to earthenware vessels  may prove  a source
of great  injury,  being liable to be  dissolved
off, (especially when the vessels are  new,)
either by fatty or acid  matters.—See  Drip-
ping.  Confectionary is sometimes  coloured
with the yellow chromate of  lead, or with
Turner's  yellow  or chloride  of   lead;  or
whitened  by  the most   poisonous  prepara-
tion of all,  the  carbonate of  lead.   Wine,
when sour, has been sweetened by the  use
of litharge, or oxide of  lead, and,  in conse-
quence of this fraud, a fatal epidemic colic
at one time prevailed in Paris.  Wine is also
sometimes accidentally  impregnated  with
lead, in  consequence of shot, which had
been used to clean bottles, having  been  left
in them.   Poisoning has occurred  from this
cause.  New rum and  cider are  both  apt
to become impregnated with lead in  the
manufacture.  Symptoms of colic have been
brought on in persons living much in a room
newly painted with lead colours.  The white
glazed cards are made so by means of lead,
and might injure  children, who are apt to
suck them at times if  they come in their
way.  Many of the  hair-dyes contain lead,
and have caused injury.
  When  the  causes of  lead poisoning act
slowly, from  the smallness  of the  quantity
taken  in  at once, the symptoms are  gene-
rally those described under Colic;  but when
the dose  is large, it quickly brings on pain-
ful colic, vomiting,  and  extreme depression.
In  such  cases,  the best  measure  to  be
24                L E K

 pursued  until  medical assistance  can  be
 procured, would  be the  administration  of
 vinegar in the first place, and  in six  or
 eight minutes  after, an  emetic  of half a
 drachm to a drachm of sulphate of zinc, 01
 some other sulphate, such as Epsom salts or
 Glauber  salts, in quantity proportionate to
 the  lead  swallowed.   The vinegar  in  the
 first place converts the  lead  into  one  of
 its least poisonous  salts, and  the one most
 easily decomposed by the sulphates.
   The  accumulation of lead poison in  the
 system  is, in  many cases,  denoted by the
 existence of a bluish line along the margin
 of the gums,  at their junction with  the
 teeth, and is a sign  which should always be
 looked for when any suspicion exists.
   Refer to Artisan—Colic—Constipation—Li-
 tharge— Palsy—Water, Sec.
   LEECH.—The  general appearance of the
 leech it is unnecessary to describe, the soft,
 ringed body being common to all  the tribe.
 Two species only, however, are recognised
 in  this country as fit for medical  purposes,
 these are each distinguished by six greenish
 yellow chain-like stripes disposed down the
 length  of the animal on the back and sides,
 the  belly being,  in the one  dirty yellow
 spotted with  black, in the  other greenish
 olive and unspotted.   The former of these
 species of leech is  found sparingly in this
 country, but occurs  throughout northern and
 central Europe.
   Leeches fit for medical purposes are said,
 by Dr. Royle, to abound in India: many of
 those now used in this country are  brought
 from Hamburg,  where they are collected
 by the  merchants from  different parts of the
 Continent.  The  former of the two- species
 mentioned, that with  the  spotted  belly, is
 often known  as  the  "brown  leech;"  the
 other, unspotted,  as the "green leech."
   The  narrowest  extremity of the leech (fig.
 xc. 1)  is the sucking-mouth;  the broader,
                    Fig. xc.
is  simply provided with  a sucker,  (2,) by
means of which the animal attaches itself
to  any substance.   The mouth is furnished
with  three  " mandibles," (fig. xc. 3.)  the 
LEE
325
LEE
 edges of which are set with minute  teeth,
 by means of which  the animal perforates
 the skin, by a sawing  action  after it has
 been sucked up;  the mandibles  also, pro-
 bably, keeD the edges of the wound asunder,
 and form a sort of tube through which the
 blood passes.  The invaluable properties of
 the leech as a local abstracter of blood are
 sufficiently well known; at the same time
 these  are often, in a measure, neutralized
 by unskilful  and ignorant  management in
 application.   When leeches are required, it
 is  always better to be provided with more
 than the number thought requisite, in case,
 as often occurs, some cannot be  made to
 fasten.  When persons can choose their own
 leeches, the  readiest  mode of selection is to
 take a number up in the hand and  gently
 to  close  it upon them—the strongest and
 most vigorous of the animals will contract
 themselves into a  tolerably firm ball:  the
 same may be done  just previous to applica-
 tion.  Some persons recommend leeches to
 to  be removed from the water in which they
 are kept about an  hour before  they  are
 wanted, being in the  meanwhile laid upon a
 a towel.   The part to which leeches are to
 be  applied must previously be thoroughly
 cleansed  with  warm water; and when they
 are put on by the  order of a medical  man,
 it is, in many cases, better to have  the space
 within which  they are  to be fixed, marked out
 with ink.  Many methods of applying leeches
 are recommended,  but  none, perhaps, is so
 generally applicable as confining them within
 the proper space, by means of an  inverted
 wineglass; in situations where this cannot
 be  done, they may be put on individually by
 hand,  holding each one by  the larger end,
 till it  has fastened, by means of a piece of
 cloth.   In some situations,  such as the in-
 terior of  the mouth, a leech-glass, or  tube,
 made to  enclose a single leech, is conve-
 nient.   When  leeches have fastened  they
 should be allowed  to suck  perfectly undis-
 turbed, resting on the smooth skin, or some
 smooth surface ; if they hang  down  upon
 hair, or any rough  material, they are apt to
 get fidgety, and to drop off too soon.  After
 leeches have come  off, it  is, in most cases,
 desirable to encourage further flow of blood;
 and for this purpose,  hot poultices  of bread
 or bran are most useful: in situations and
 circumstances  where the moisture is ob-
 jectionable, pieces  of soft linen or calico,
made quite hot, will  answer very well, ap-
plied folded  two or three times upon the
place.   In children and some persons who
bleed freely but little encouragement is re-
quired, the difficulty often being to  stop the
flow of blood.
      2C
   The possibility of this occurrence should
 always be kept in mind when leeches are
 applied to such persons,  and, as a rule, they
 ought always to be placed over a bone against
 which pressure can be made, and never, unless
 for some very cogent reason, upon such places
 as the neck or abdomen; most of the cases
 of fatal bleeding from leech-bites in chil-
 dren, have probably occurred from  want of
 attention to the above precautions.
   When bleeding from leech-bites continues
 longer than is  thought  necessary,  it  may
 generally  be stopped by placing a small pad
 of folded  lint over  the wound,  and keeping
 up pressure with the finger for some time,
 provided  there is the  bone underneath to
 press against.   When the bleeding seems to
 be arrested, the little pad may be kept in its
 place by one or two strips of adhesive plaster.
 If the simple pad appears insufficient, it
 may be soaked  in a strong hot solution of
 alum.  Even should there be no  bone under-
 neath against which pressure can be made,
 the above  plan may succeed—but it may not.
 In such cases, it is  often recommended to
 pass  a pointed  piece  of caustic into the
 wound ; but this is not a  very efficient plan,
 and  the pain it causes,  by making  a child
cry,  increases  the tendency to the  flow of
blood.   In an extreme case, a sewing-needle
passed through the wound from side to side,
and wrapped about with a thread, (fig. xci.,)
                 Fig. xci.
will stop further loss of blood. At the same
time,  the  author must  add,  that he never
found a case resist pressure well  and care-
fully used.  Such cases ought, of course, to
be attended to by a medical man, if possible;
but at a distance in the country, it would be
better for a mother even to use the remedies
stated than to let her child  bleed to death.
Any other  astringent  remedies may, of
course, be tried, if  they are procurable.—
See Astringents  and Styptics.   A wire or
skewer, heated to a white  heat, has been
employed for the purpose, being thrust into
the wound.
  It ought further  to be remembered  that
even after leech-bites have ceased to bleed
in children, they may,  especially under  the
influence of warmth, burst out again:  and
fatal consequences have ensued  from chil-
dren being placed in bed after leeching, and
not being looked at  during the night—they
have become completely drained of blood.
On this account it is always desirable, when 
L E E
326
LEE
 it can be done, that leeches should be put
 upon children  in the fore part of the day, and
 also, that examination should be made from
 time to time after the  operation is over, to
 see that all is right—if it is night, a light
 should  be burned in the room.   It is not
 only the immediate consequence  of exces-
 sive  bleeding which is to be dreaded, but
 the unnecessary loss  may make all the dif-
 ference between a child struggling through
 an illness or  not.—See Blood and  Hemor-
 rhage
   In a  few individuals, the  application of
 leeches  is apt to be followed by  inflamma-
 tory swelling  of the  skin, resembling ery-
 sipelas.   Of course this  is  an obstacle to
 their use on slight occasions.  The swelling
 may be subdued by the lead lotion,  cold or
 warm, as most agreeable to  the  feeling of
 the patient.
   There is often  considerable difficulty in
 getting leeches to fix where  and when they
 are wanted.   This may arise from various
 causes;  the leeches may be sickly, or torpid
 from cold,  or may have  been recently used,
 or, as they are rather sensitive, the skin may
 be unclean, either from its own perspiration,
 &c. or from applications,  such as  embroca-
 tions, &c. which have been used to it.  It is
 vain to attempt to apply leeches if this is the
 case.  The skin, therefore,  must  be made
 thoroughly clean, and if there is hair on the
 spot, it must be shaved off clean and smooth;
 as  a further  inducement, a little  cream,
 sugar and water, or blood,  may be  put on
 the skin. If cold is thought to have rendered
 the leeches inactive, their immersion for  a
 quarter of an hour in water (temperature
 70°) will be the best remedy.  The addition
 of a  couple of tablespoonfuls of porter to
 the half-pint of water will not unfrequently
 make them more lively.
   If it is wished to detach a  leech before it
 has finished sucking, it  must not be pulled
 off—a few grains of common salt sprinkled
 on its head, will cause it to drop off  very
 quickly.   When leeches come off, it is the
 common  practice to put them upon a plate
 of salt,  which  makes  them  disgorge .the
 blood they have sucked.  This is better done,
 by putting them  into a little not very strong
 salt  water, which is equally effectual, but
 does not injure them, as the salt in substance
is  apt to do.  After the greater amount of
blood has  been  thrown up under the influ-
ence of  the salt, the leech should then be
 "stripped," that is, its tail end being  held
firmly between the thumb  and finger of the
left hand, the animal is to be drawn between
the thumb and finger of  the right, nearly up
to  the head.  By this means it is freed from
 the blood, tud is sooner fit for use.  Blood
 which has  been drawn by leeches, afford*
 no guide to a  medical  man like that taken
 by the lancet;  it therefore need not, as is
 often done, be kept for bis inspection. After
 the leeches have been  stripped, they should
 be put into some fresh water, which will re-
 quire changing twice a day for the  first two
 or three days;  afterward, only every four
 or five days.
   The great  expense of leeches renders it
 important that the best means of preserving
 them,  and of rendering  them, if possible,
 again  quickly ready  for use, should  be
 known.
   They arc best  kept in  good-sized wide-
 mouthed  jars or bottles, half filled with
 rain or pure  spring water, covered at top
 with  gauze,  or  some  such  material,  and
 having at the  bottom a little clean  sand or
 gravel on which the creatures can rub them-
 selves, and  so clear the  skin  of the slime
 which  naturally  covers it, but which they
 cannot get quit of in a vessel  with smooth
 surfaces.   The temperature of  the water in
 which  leeches  are kept should never  get
 below  50° Fahr.    The  water should  be
 changed every ten days. The place in  which
 they are kept must  be airy and free from
 strong odours.  Of  course, dead or  sickly
 leeches should be removed at once from the
 healthy ones.
   It has  been  stated  that  leeches  which
 have been used  may be rendered in  a few
 days as active and  useful as  ever, by dis-
 solving a little  white  sugar  in the water,
 and renewing  this solution twice, at  inter-
 vals  of twelve hours,  and twice afterward
 at intervals of a day.   Dr. Christison says,
 " I have tried this plan, and found  that the
 same leeches  drew  blood three times  at
 intervals of three days, with scarcely any
 diminution of  activity, and without a  death
 among  them."   Another method  recom-
 mended is,  after  stripping, " to put  them
 into a vessel with  half au inch of sand  at
 the bottom, and containing water, with two
 teaspoonfuls  per  quart,  of  French  white
 wine, and to change  the liquid daily  till
 the fourth day, when  pure water  is  to be
 substituted."  With  respect to  the choosing
 of leeches, the  following  remarks  of Dr.
Christison  are important:—"The  gorging
of leeches is a more common fraud than the
substitution of spurious species.  They are
known by being less velvety  in their coat,
less flat when  pressed,  and by presenting a
little tumour  when  squeezed  between the
fingers from the head to the tail.   Leeches
 which have been used are often sold for un-
used, or 'virgin'  leeches.   These are best 
LEE
327
LEM
  known  by puaing them  on  a white cloth,
  and dusting the  fore-part with finely pow-
  dered salt.   In thirty seconds a little blood
  will be emitted,  but not a particle  if the
  leech be quite fresh.
    The  greatest   inconvenience  connected
  with  leeching, even  when well managed,
  is the uncertainty of the amount of blood
  taken ;  but generally it may  be calculated,
  that  the  application  of  each  good leech
  should, on the average, including what the
  animal  itself draws,  and what flows after-
  ward, amount to  about half an ounce.
    The great expense of leeches, and other
  considerations, have  given  rise  to  many
  attempts  to  make an  artificial substitute,
  but none have as yet been fully successful.
  Kidston's artificial leech is the most recent
  invention,  and is  said to be efficient;  it
  might be worth  the  attention of the emi-
  grant and others, [were its utility certain.]
    Leeches applied to such places as the nos-
  tril, mouth, or ears, occasionally get beyond
  reach, and find their way into the stomach
  or bowel.   The best remedy, and one which
  should  be used  without  delay,  is  strong
  Bait water, either  swallowed or injected into
 the bowels—this quickly kills  the animal.
   LEEK—As an  article of diet, does not
 generally agree with persons of weak diges-
 tion.   It is most  wholesome when blanched
 like celery, and stewed.
   The  vapour  from boiling  water poured
 over leeks is something used  as a popular
 remedy in piles.   The leeks are cut up, and
 put in the pan of a  night-chair, or  in a
 chamber utensil, on which a person sits.
   LEG.—Swelled-leg, or white-leg, as it  is
 sometimes named, is one of the most trou-
 blesome of the disorders  which are  apt to
 follow child-birth.   It  is inflammation of the
 veins  connected with  the  lower extremity.
 The  symptoms of  swelled leg may com-
 mence  within the first two or three days
 after delivery, or notJfor some weeks.  There
 is more or less fever, and the parts about the
 groin and  thigh feel hot, stiff, and painful,
 swelling commences, and  extends over the
 whole  limb,  which,  however,  does  not
 change colour, being perhaps paler or whiter
 than  usual;  at this time  the  pain is often
 very severe.   After a time, these symptoms
 are  ameliorated;  but  the limb remains for
 long  swollen,  painful,  and comparatively
 useless.
   The above, it  need scarcely be remarked,
 fs a disease which requires proper medical
 assistance  as soon  as  possible.  In  the
mean time, leeches,  fomentations and poul-
tices to  the parts  about  the groin  and
thigh will  be  at  once  the best and the
most soothing treatment;  the bowels being
regulated either by mild aperients  or clys-
ters, and  opium given, if the pain becomes
severe.   For this  purpose,  ten grains of
Dover's powder, with two of calomel,  may
be given at bedtime.  Blisters are often used,
but  as troublesome  ulcerations are some-
times apt to form, their application should
be left to medical judgment.  Continued fric-
tion with simple oil is of much service.  Du-
ring convalescence, bandaging,  friction, the
salt-water douche, together with strengthen-
ing remedies and diet, will be requisite ; but
these must  be left to the regulation of the
medical attendant.
  THE LEG—The portion of  the inferior
extremity between the knee and the ankle
—is formed of two bones, (fig. xcii.)   The
                 Fig. xcii.
larger or main of the leg (1) is named the
tibia; the smaller, or  "splint" bone,  (2,)
the fibula.   The upper broad portion of the
tibia (3) forms part of  the  knee-joint, (see
Knee,) but the fibula does not;  at the lower
end  of the leg, however, both  bones  are
required in the formation of the ankle-joint.
—See Ankle.  These bones  may be broken
together or separately ;  fracture more gene-
rally occurs below their middle than above.
  Refer to Fracture.
  LEMON.—This  well-known  fruit  and
sick-room  luxury  is  cultivated chiefly  in
Southern France, in Italy, Sicily, Spain, &c.
The  best lemons are smooth on the skin, and
have a thin rind ; if packed in newly slaked-
lime in closed vessels, lemons may be pre-
served good for a considerable time.   The
rind  of the lemon, and the agreeable essen-
tial oil derived from it, are chiefly used in
cookery and  confectionary.  The  juice  of
the  fruit, which  owes its acidity  to  citric 
L E N                328                 L I F
aci 1, is  used ns the most agreeable medium
for the formation of effervescing draughts ;
the proportionate quantity required  to  be
used with alkaline carbonates will  be found
under  article Effervescing.  Its use  in the
formation of lemonade is familiar  to all.
— See  Cookery.    Until  lately, the  chief,
direct medicinal use of lemon-juice was in
the treatment of scurvy,  (see Scurvy,) but
recently  it  has  been  introduced by  Dr.
Owen Rees as a remedy in rheumatic fever,
and there are many testimonies to its value
in this painful, and often  tedious  affection.
The author has reason, from his own expe-
rience, to speak favourably of  its remedial
power in the above painful disease. Lemon-
juice is  not  only a curative  medicine  in
scurvy,  but  it is  also a preventive;  and it
should,  therefore, form part of the " sea-
store" of all who are going  a long sea-voyage.
The juice may be procured at a  moderate
price from  confectioners  in large  towns.
The best method of preparing it for keeping,
is to add about one-tenth  of spirits of wine,
to  separate, by  straining,  the   jelly-like
matter  which coagulates in consequence,
and  then bottle for use.   "Salt of lemon,"
which is sold for removing the stains of ink
or iron, is no preparation of lemon  at all,
but is a salt of oxalic acid: the name might
lead to serious mistakes.
   LENITIVE ELECTUARY.—See Senna-
Confection.
   LENS.—Crystal lens.—See Eye.
   LENTILS—Belong to the pea tribe, and
are  used as food.  The Egyptian  lentil,
known,  when in  the form of meal,  as the
revalenta. or Ervalenta Arabica, is not only
nutritious, but possesses aperient properties,
which render it,  in  some cases, a valuable
auxiliary to treatment, if  it agrees with the
stomach.
   LEPROSY.—See Skin,  Diseases or.
   LETHARGY—An unnatural  tendency to
sleep, is closely connected, as to cause, with
languor  and  debility, and approaches apo-
plexy in character.  It  may arise from the
opposite causes of over fulness of  blood, or
from deficiency of circulation  in  the brain,
from nervous exhaustion  of that  organ, or
from actual disease in it, such as tumour or
abscess.   The lethargic state may  also arise
from an impure or poisoned state of the cir-
culating fluid, such as precedes an attack of
British or bilious cholera, or diarrhoea, or is
a  consequence  of suppression of urine.   It
may also, of  course, be the consequence of
the action of narcotic drugs, or of alcoholic
intoxication.    These  latter  contingencies
should be  kept in  mind in the  event of
lethargy coming  on suddenly: in  such a
case the treatment, with  precautions, re-
commended under  article Apoplexy, Bhould
be  adopted—modified,  of course, in some
degree,  on  account  of the milder character
of  the disorder.    In the aged, especially,
lethargy is always to be regarded with sus-
picion ;  but in any case, the cause should be
investigated by a medical  man as  soon as
may be.
  Refer to  Apoplexy—Biliary Disorder—De-
bility—Languor—Palsy,  Sec.
  LETTUCE.—Two kinds  of  lettuce  are
used, the common garden or edible lettuce,
and the stronger or medicinal lettuce.  The
botanical name of lettuce, " Lactuca," from
lac, milk, is given on account of the milky
juice which  exudes from  the plant when
cut: this milky juice turns brown, and dries
on exposure to the air, and is then called
lactucarium, or "lettuce opium," from its
narcotic  properties,  in some degree  re-
sembling those of opium.  The milkiness of
the juice of  the  lettuce,  and  its narcotio
properties, are not fully developed until the
period of flowering  approaches; the plant,
however, possesses them more or less at all
stages of growth.
  As  an article of diet, lettuce is  in very
general  use, and with most persons agrees
well, though  some  find  it,  in common with
uncooked vegetables generally, disorder di-
gestion ;  others find its narcotic properties
—even in  its mildest  condition—inconve-
nient.  Lettuce eaten at night has been had
recourse to successfully,  amid others, by
the celebrated anatomist Galen, as an anti-
dote to sleeplessness.  ._
  Extract of lettuce, orMactucariura, or let-
tuce-opium, might be used in doses of from
ten to fifteen grains,  as a substitute  for
opium, with this advantage, that it does not
confine  the bowels: it  is not,  however, by
any means so powerful  or certain in its ac-
tion.
  LEUCORRH^A.—See Whites.
  LICE.—See Acari.
  LICHEN.—See Skin, Diseases of.
  LIFE.—The word,  here,  is simply taken
in  its one  sense  of man's  actual material
existence in  this  world:   that existence
which, however it may  be regarded as  but
the prelude  of  another and more peifect
state, all persons of healthy mind have an
instinctive desire  to preserve—instinctive,
truly, it may be called  at the present day,
for the feeling with a large—a very large—
class, seems to rise no higher.  It seems
to  protect from immediate, urgent,  threat-
ened  danger,  but beyond  that it  appears
not to  go;  and  life  is   yearly, daily,
hourly extinguished in  England, by causen 
»
                  LIE                 3

 which are perfectly under man's own con-
 trol  to  prevent—by  causes  which  it is
 utterly unworthy of intelligent and respon-
 sible beings should continue, or be allowed
 to  continue, in operation among them.  It
 is confirmation enough to reiterate the fact,
 that fever carries off  yearly in England a
 larger  number of victims than  fell in the
 ranks of the allied armies at Waterloo;  and
 that one-third of the children  die before
 they reach the age of five years.  As these
 tiny victims have been well called in  a late
 number of a popular periodical, " drooping
 buds;" they languish  and die in  the un-
 wholesome   dwellings  of city, town,  and
 village.   And  this need not be ; for, fearful
 as  the  loss  of life now  is, it is  less, con-
 siderably, than it was a hundred, fifty, even
 twenty years ago; and might be much les-
 sened still.   It is enough  to refer the reader
 to  the case of  the Dublin lying-in hospital,
 mentioned  under  the  article Children, to
 demonstrate how quickly—how remarkably
 —the value of life  may be increased  by
 a few well-directed and comparatively sim-
 ple measures.   The whole science of  medi-
 cine, surgery,  the efforts of  hygiene  or
 sanitary precaution, even the object of such
 a work as the present, is the preservation
 and prolongation of human life; and that it
 is not preserved nor prolonged to  a  much
 greater extent than it now is,  cannot  be
 for  want  of knowledge,  at least amid  the
 higher classes.  Parliamentary commissions,
 and "blue  books," and  sanitary publica-
 tions of all  kinds, have, or ought to  have,
 diffused information respecting those sources
 from which  the curtailment of life  arises;
 but  indifference,  self-interest,  prejudice,
 interferes, and the small  band of those who
 would  push forward  the  good  work  can
 scarcely  make head  " against  the  wind,
 against the tide" of opposition—can hardly
 stir the huge mass of inertness that  will not
 move.  At the same  time, it is not the part
 of  the people  to wait  till these  things  are
 wholly done  for them; it may be, that the
 principles of a true political  economy ren-
 der the preservation  of every man's life in
 the state  a duty, and a direct advantage to
 the community; but each man must in  the
 matter act for  himself  as far  as  lies in his
 power.  The preservation and  prolongation
 of  life  can  never be simply a selfish  con-
 sideration ;  man does  not  live for himself
 alone.  But if none  can doubt that  the
 duration and value of life  might be extended
far  beyond  what  it  now  is, it is  equally
certain  that  it is  much greater than it was
formerly.   A glance  at  the  past  in  this
respeot may give hints for the future.   One J
      2 c 2
29                LIF

 great cause for the short duration of human
 life  among a barbarous  or semi-civilized
 people, is the little value set upon it; hence
 it is  sacrificed for the most trivial reasons—
 and  from the destruction of the weakly or
 unwished-for infant, so common, not only
 amid a savage people, but even  among  the
 comparatively  civilized  Chinese—to   the
 abandonment  of  the aged  parent  on  the
 prairie, by the North American Indian, or
 the destruction of adults in  public war or
 private quarrel amid these nations generally,
 all tend  to shorten human  life.  True,  the
 wars and revolutions of civilized  nations,
 even in Europe, do cost many useful lives,
 but their occasional  action  is not  marked
 like the regular systematic cutting short of
 life in all its stages, which unceasingly goes
 on in uncivilized communities.
   As a nation rises  in civilization, there-
 fore, the lives of its members  are  in part
 prolonged,  simply because  they are   not
 violently  curtailed—other  causes  at   the
 same time  coming into action.  Increased
 comfort of dwellings,  and  more effectual
 shelter from  the  weather,  both by these
 and by clothing,  more regular supplies of
 wholesome  and  better-prepared food—all
 reduce the chances  of disease  and death.
 Improvements in  the practice of medicine
 and  surgery  more quickly and  effectually
 alleviate  the  former when  it does occur,
 and diminish  the probability of the  latter;
 and,  lastly, for it comes last, increased—
 though  far from  sufficient—attention  to
 hygienic  and sanitary  precaution counter-
 balances  in some degree those unhealthy
 influences  and combinations of  circum-
 stances which inevitably arise during,  and
 advance with, the progress of civilized com-
 munities.   Hitherto, the  increase  of  the
 comforts  of  civilization,  though   in  one
 mode it  has tended to  prolong life,  has
 nevertheless, in some degree, balanced  this
 advantage,  by giving rise  to other  sources
 of  disease.   The wandering savages, or na-
 tives of thinly peopled countries, if liable
 to suffer from privations and exposure,  are
 nevertheless, in a  great measure, free from
 the  fever-generating  drain, and  closely
 crowded  street or habitation ; and  in  this
 and  other  similar ways it happens, that
 although  the value or duration of life in a
 community ought  to  be a test of its civil-
 ization, the fact has not as  yet assumed its
 full preponderance in the history  of national
 progress.   Ignorance of the  laws of health
 in  the first instance, and obstacles to  the
 carrying out of those  laws in the  next, have
 hitherto kept  the average of life,  in  this
 kingdom  at least, far below the  average it 
                 LIF                Si

ought to hold.  Probably too, indifference as
to the means of prolonging human life has
partly  arisen from  the very common  error
which  supposes  that  the evil of premature
deaths  has  some compensating advantage
in removing  a  portion of surplus popula-
tion ;  whereas, in  the general  case, it  is
not the surplus,  but  the  valuable portion
of life  that  is  thus  lost.  If a boy dies
at some period  between  ten  and sixteen,
his existence has been an absolute cost to
the community,  and  he was  but just ap-
proaching the period  when  he might have
become a  productive  member  of it.   If a
husband dies in the early years of his mar-
ried life, he  leaves as burdens  on the world
a  widow  or children,  for  whom,  in the
general case, if  he  had  lived, he  would
have worked: " bearing out  the fact,  that a
parish  or  country where life is  precarious
pays more poor-rates—has to support more
unproductive members — than  its  neigh-
bours."
  Connected  with  these  remarks  is the
statement of Dr. Southwood  Smith,  made
before  the Parliamentary Commission, on
the "State   of Large Towns,"  "that the
period  of  human existence, during  which
fever can  alone be said  to be  prevalent, is
from the age of twenty to forty; that is,
the period of maturity—the most precious
portion of  the  term of  existence—that
during which the individual is  best  fitted
for all  the duties and enjoyments of life—
during which he is most capable of pro-
moting  the happiness of others, and  of se-
curing and of appreciating  his own;" and
fever is the fatal scourge of  the  ablest and
most useful  working  members of the com-
munity.
  The  effect  of the  adjuncts of civilization
in prolonging life will best  be  illustrated
by the following extracts  from the Messrs.
Chambers's most useful publication on " Sa-
nitary  Economy," by which is shown how
greatly the   duration of  life  is extended
under favourable circumstances, how  much
it is diminished under the  reverse.
  Dr. Duncan, Officer of Health  for  Liver-
pool, says in  his paper on the high rate of
mortality  in that  town—" Not  the  least
striking result  of the investigation  is  the
very high  rate  of mortality  which we have
found going on in the various districts;  for
while  in Rodney Street,  and  Abercromby
Wards, with upward of 30,000 inhabitants,
the mortality is below that of Birmingham
—the most favoured in this respect of the
large towns of England—in Vauxhall Ward,
with a nearly equal amount of population,
the mortality exceeds that  which prevails.
10                LIF

 in tropical regions.   In Rodney Street  and
 Abercromby  Wards,  1U0  persons  die  an-
 nually out of 4102; in Vauxhall Ward 23o()
 persons are sufficient to furnish the same
 number of deaths, leaving an excess of 1812
 persons engaged  in  furnishing  additional
 deaths at this high rate of mortality.   In
 other words,  177  persons  die  annually in
 Vauxhall  Ward, for every 100 dying out of
 an equal  amount of population  in Rodney
 Street and Abercromby Wards."
  In one of the Registrar-General's Reports,
 two districts are compared with  each other,
 one of twenty-five towns, another of seven
 counties.  " The number of deaths in  the
 former, from all causes whatever, was 51,492,
 while in the country districts it was 3:!,0:59.
 Vet out of this smaller number, the deaths
 from old  age amounted to 4699; while  out
 of the much larger amount of deaths in  the
 town  districts, the number that had sur-
 vived causes of premature disease, to die of
 old age, was only 3525.   In round numbers,
 a seventh part of the country  population
 has thus  been allowed to  run the natural
 course of their  days, while only a twelfth
 of the town population have had the same
 good fortune  to avoid the snares which dis-
 ease and accident  have laid for them.  The
 following  tables from a Sanitary Report of
 Mr. Chadwick's, show the different value of
 life in the different classes  of people in  the
 same districts:—
          Whitechapel Union.
 No. of                           Average Age
 Deaths.                          of Deceased.
  37 Gentlemen and  persons en-
       gaged  in the professions,
       and their families........... 45 years.
  387 Tradesmen and their families 27  "
 1762 Mechanics, servants, and la-
       bourers, and their families 22  "
              Strand Union.
  86 Gentry and persons engaged
       in professions, an'd their
       families........................ 43  "
  221 Tradesmen and their families 33  "
  674 Mechanics, servants, and la-
       bourers, and families.......24  "
              Kendal Union.
  52 Gentlemen and persons en-
       gaged in professions, and
       their families.................45  "
  128  Tradesmen and their families 39  "
  413  Operatives, servants, labour-
       ers, and families............. 34  "
  We  here find that in some communities
 —such as Whitechapel  Union—there  will
 be differences so great between the average
 duration of life in the different classes, that
 those  born in the large house of the pro-
3J 
LIF                 331               LIG
 fessional  man or  independent gentleman,
 live rather more than twice as long as those
 born in the crowded houses of the  small
 alleys  which  ramify hither  and  thither
 round it.  It is a melancholy  truth, rest-
 ing on  evidence  only too  strongly  over-
 whelming, that  the  lives of  the  poorer
 classes,  who  inhabit the crowded  districts
 of  large towns, are liable  to be shortened
 by a variety of causes."
   And yet these things need not be; there
 is  no  possible reason why the  duration of
 life in a district in which it is  low should
 not be greatly raised, the amount  in  some
 degree of course depending upon the nature
 of  the district.  Neither is there  a reason
 why the standard should  not be elevated in
 every district.   That such will  be  the case
 at some future day there can be little doubt,
 nor is it  unreasonable to suppose, that
 there is yet a "good time coming," in which
 the value and duration  of  life  will'be ex-
 tended greatly beyond what it is at present
 —greatly  beyond,  perhaps,  what  we  at
 present  can  imagine — when
 Bcience  and benevolent  exer-
 tion have  corrected the errors
 and retained the  good of an
 advanced  civilization,   when
 sources of disease from without
 are removed,and when man has
 learned that  health  is  better
 than great riches, and ceased to
 offer the former, either his own,
 or  that of  work-people,  worn
 down,  at the shrine of mam-
 mon.
  LIFE ASSURANCE.—The se-
 curity of a sum of money to the
 family or to the survivors, of an
 individual whose death involves
 loss or diminution of income to
 those survivors, may become an
 important  consideration,  when
 the chances of death or recovery
 in severe illness  are nearly balanced—when
 the tranquillity or disturbance of the  mind
 may make that balance incline to the one or to
 the other side.   The racking thought of a
 wife and family left without provision, may
 drive away the  sleep  that would  precede
 amendment—may  give the last jar to the
 sinking nervous system.   In this remedial
point of view only, can this important sub-
 ject be alluded to here.
  LIFTING CHILDREN—Is  a subject on
which  a few  words are  highly requisite.
It is really surprising to see in what  a cruel
and  dangerous manner children are often
lifted about,  not  only by  their nurses, but
by their mothers ;  and the  evil  results are i
very commonly brought before medica men,
in the shape of sprains, separations of "epi
physes," (see Epiphysis,)  dislocations, ano
even  fractures.   When  a heavy  child  is
perhaps  seized by  the hand  or arm, and
swung over a gutter, or the like, the won-
der is, not that  injury results, but that it
does  not always result from the practice.
Among boys, and even by  those  who are
old enough to know better, there is a trick
of  lifting children  or  boys, by the  hands
placed under the chin and at the back of
the head.  This is a most dangerous practice
—dislocation of  the neck and instant death
has been the result.
  LIGAMENTS—Are white glistening bands
of inelastic fibrous tissue,  which retain the
different bones in contact at their points of
junction.   There is also  a  yellow  fibrous
tissue, which in some places is called a liga-
ment, but which is extremely elastic.
  It would answer no good purpose here to
enter  into a detailed account  of the liga-
ments. The example (fig. xciii.) which repre-
          Fig. xciii.
Fig. xciv.
 
LI G                 332                LIG
sents the ligaments (1) which bind the collar-
bones  (4, 4) nnd upper ribs,(2, 2) to the
breast-bone, (3,) and the example (fig. xci*.)
which  exhibits  the  " capsular  ligament"
(1) which envelops and connects the bones
at the  shoulder-joint, will sufficiently illus-
trate the use and position of these connect-
ing media.
  In their ordinary condition, the ligaments
are not very sensitive;  but when, in conse-
quence of a strain of the joint, or " sprain,"
they are overstretched, they become acutely
BO.
  LIGHT.—" The  prime work  of God."
We know that the  great  source of light is
the sun, and that we have sources of arti-
ficial light.   We know that it is light  by
which  we are enabled  to take cognisance
of the  colour, size, shape, and position  of
various bodies; we know  that this  light is
subject to laws which it is in our power to
trace;  but we cannot frame a definition  of
the agent itself.   To enter into  a considera-
tion of the optical properties of light would
be out  of place here ; its effects as a stimu-
lant on animal life and  development are
extremely important.  The stimulant action
of light not  being of such obvious universal
necessity to vital action  as that of heat;
nor its effects and influence bo  prominently
marked, its  full power as  an excitant upon
animal and vegetable life has not been until
lately sufficiently  well recognised, although
every day it is becoming more so.   The ef-
fect of tha deprivation  of the  stimulus  of
light in producing  blanching, or etiolation,
in  vegetables,  has  long  been practically
applied;  and the effect of the absence  or
diminution of the stimulus  on animal de-
velopment  and  health, though  compara-
tively little  is certainly known respecting
it, is being more attended to in consequence
of  the  present  sanitary  movement.   Dr.
Edwards, whose experiments upon  the in-
fluence  of light are  well known, has  re-
marked, that persons who live in  abodes
excluded from the free  access of light, are
apt to produce  deformed children.   It has
been stated  on the  best authority, that the
cases of disease on  the  dark side of an ex-
tensive barracks  at  St. Petersburg  have
been uniformly, for  many years, in the pro-
portion of three to one to those on the side
exposed  to  strong  light.    Humboldt has
attributed the  absence  of deformity amid
the Caribs,  Mexicans,  Peruvians,  &c.  to
constant exposure of the  body at large  to
strong  light.   It is now, therefore,  a re-
ceived  fact,  that  a free supply of  light is
almost as necessary to health as fresh air or
pure water.   It is, too, a fact which  should
not be lost sight of with respect to the laying
out of dwellings.   The powerful stimulant
action of light upon  the  eye is evinced by
the fact  that strangers in the arctic regions
are liable to suffer from inflammation of that
organ produced by  the  glare of reflected
light  from the snow, and that, from the same
cause, the natives  of those regions suffer
from  snow blindness.   Light, however, ex-
erts different effects according to its colour:
as well known, bright white, yellow, or red
lights are much  more apt to injure  the eye
than  those of a  blue or green tinge.  When,
therefore,  persons find  exposure  to the
former coloured lights injure the sight, it is
usual to  protect the eye by the use of glasses
of a bluish shade.
  Refer  to Amaurosis—Blindness—Eye, Sec.
  LIGHTNING.—Injury  or  death  from
lightning appears to be principally  inflicted
through  affections of  the nervous system;
although, at the same time,  severe and ex-
tensive wounds  are not unfrequently pro-
duced.   Burning, on the other  hand, is not
occasioned by  the electric   fluid itself, so
much as  by the clothing, which is generally
set  on fire.  Persons who  are stunned, but
not killed, by lightning, generally remain in
a state of insensibility for  some time, the
breathing being slow and deep, the muscular
system relaxed.  In  such cases it  will be
proper to  use  means  for  preserving the
animal warmth, which has  a  tendency to
become depressed, to  keep up artificial re-
spiration,  as recommended  under  article
Drowning, to  use mustard-plasters  to  the
spine  and pit of the stomach, to administer,
from  time to  time,  a little  sal-volatile in
water, if the patient can swallow—if not, to
give a warm clyster containing half an ounce
of turpentine—or to use  such other means
as  are  recommendod  under  the  articles
Drowning and Carbonic Acid,which may seem
adapted to the case.  It is a common idea,
that persons who have been  killed by light-
ning  do  not  stiffen, and  that the blood re-
mains fluid, but this is erroneous.  It would,
considering how often the  fact is reiterated,
seem  almost superfluous  to point  out the
ordinary  precautions   which  those  who
chance to be exposed  to a storm of thunder
and  lightning ought  to adopt: but not a
summer passes without lives  being lost from
sheer ignorance.   Harvest  labourers  and
others will persist in sheltering under trees;
people will continue  to put up even  iron
umbrellas in the midst of a thunder-storm,
and mowers walk unconcernedly home with
their  scythes over  their  shoulders.   If ne
individual is overtaken by a thunder-storm
in a place  where trees abound, he  should 
LIM
333
LIN
avoid them as much as possible. A thorough
soaking  win  De rather a protection  than
otherwise.  If, on the contrary, the position
is on a moor or wide  plain, where the body
is the highest  object,  lying  down is the
safest procedure.  In  any  case,  metallic
objects, such  as sickles, scythes, &c. being
laid aside at considerable distance.  Under
shelter, the most hazardous position appears
to be in a draught or  current of air, such
as between a door and window, this seeming
to exert  considerable  influence  upon the
course of the electric fluid.
   LIME — Is one  of  the  alkaline  earths,
formed by  the union of oxygen  gas with
the metal or metallic base calcium.  In its
various forms of carbonate, such as marble,
chalk, limestone-rock, &c. it  is very widely
distributed  over the globe.   Quicklime is
formed by expelling the carbonic acid from
one of these carbonates, by means of  heat.
Its appearance, when freshly burned,  is fa-
miliar to all.   It,  however, quickly changes
if freely exposed to air and  moisture, at-
tracting both  carbonic  acid  (for which it
has a strong affinity) and water,  and  being
again converted into a carbonate of lime.
   Lime is used in medicine in its pure form.
It is used  as  a carbonate in the  form of
chalk, (see Chalk,) and as chloride of lime.—
See Chlorine, &c.  Pure lime is given in the
form of lime-water. This is made by putting
some freshly-burned and newly-slaked lime
into a bottle, and filling it to the top with
water, agitating it slightly.   Wrhen  the lime
subsides, it leaves  the water above perfectly
transparent,  and holding a certain amount
of lime in solution.  When any of the  lime-
water thus formed is  withdrawn for use, all
that is necessary is to fill up quite to the
top  again  with fresh  water, giving the
bottle a shake, and  to cork  tightly.   This
may  be  repeated for a considerable  time
before the lime requires  renewal.   Lime-
water is used as an  antacid  by some indi-
viduals,  even  habitually.   It is  taken in
doses of from half an ounce to three ounces,
generally in, or along  with  milk, which it
renders lighter, and  more  likely to agree
with the stomach,  while the milk covers the
somewhat acrid taste of the lime.   If lime-
water is exposed to the atmosphere, a pel-
licle forms on  its surface, and  it quickly
becomes turbid, from  attracting  carbonic
acid—the carbonic thus formed being less
soluble  than  the  lime  itself.  The  same
thing will be  seen  to  take  place   more
quickly if an individual  propels the breath
through  some  lime-water in  a  glass,  by
means of a quill—the water at once becomes
turbid,  demonstrating,  at the same  time,
the presence of carbonic acid in the breath.
If,  however,  the breath  be kept  passing
through the lime-water for  some time, it
again becomes transparent, in consequence
of the additional amount of carbonic acid
redissolving  the carbonate  of  lime,  and
making it  a  bicarbonate.  In many hard
waters lime exists in solution, in this form
of  bicarbonate of lime.—See Water.  The
property possessed by quicklime  of absorb-
ing carbonic  acid,  renders  it valuable  in
cases where, such as in old wells, this nox-
ious gas exists and requires  removal.—See
Carbonic Acid—Bedroom.   Burns  from lime
are not uncommon.   In such  cases, the best
application is vinegar and water, or some
other acid, if vinegar is  not at  hand,  [or
sweet oil,]  freely applied ; the acid in  this
case converting the caustic lime into a harm-
less substance.  The  same  treatment is to
be pursued in the event of lime getting into
the eye, the vinegar or acid being, of course,
more largely  diluted  than  when used  to
other parts; [but the oil is better.]   In any
of these cases, the after consequences, such
as ulceration  of  the  skin or inflammation
of the eye, must be treated as recommended
in burns generally.—See also Eye.
  LINCTUS.—Medicine made into a thick
syrupy consistence.  The  form of linctus is
not often prescribed at the present day.
  LINIMENT.—An embrocation.—See Em-
brocation.
  LINSEED,  or Lint-Seed, [or Flaxseed]
—The seed of the Linum usitatissimum,  or
common flax, contains a fixed  oil, well known
by its name of linseed-oil, which is procured
from the seeds by pressure.   The seeds also
yield,  when_  boiled,  or infused  in boiling
water, a thick, almost tasteless,  mucilage.
Linseed-oil was formerly more employed in
medicine than it is at present, its chief use
now being  in the formation  of the carron-
oil, used by some in the treatment of burns.
This is made by agitating  together equal
parts of lime-water  and linseed-oil.—See
Burns. The infusion of linseed, or " linseed-
tea," [flaxseed-tea,] may be made  in  the
proportion of half an ounce of the seed to a
pint of boiling water.—See Infusion.  It is
a cheap and very good demulcent remedy in
coughs, and  in  irritation of the  urinary
organs.  The  meal of linseed is made by
grinding the seeds after the oil has been ex-
pressed from them.   It is chiefly used  for
poultices.—See Poultice.
  LINT—Which was formerly old linen cloth
scraped to give it a soft woolly  surface, is now
manufactured on purpose, of new material,
and of good width and length, instead of the
bits and scraps in which it used to be sold 
                 LIP                 Si

Professedly,  lint is  made  of flax or linen
thread alone, but microscopic examination
will often detect a considerable admixture
of cotton  fibre.—See  Dressing.   Taylor's
new patent linen is thicker and more spongy
than the  other sorts, and  therefore more
suited for the  same  purposes ;  it does  not
tear well, which is a disadvantage.
  LIP.—The lips owe their colour to their
extreme vascularity, and to the  thinness of
the skin   by  which  they are covered, and
their  sensitiveness  to  a more  than  usual
Bupply of nerves.
  The colour of the lips is closely connected
with that of the blood, and also depends
upon the vigour of  its  circulation.   When
the blood is poor and deficient in red glo-
bules  (see Anaemia)  the  lips become pale.
When, again, from failure of the heart's ac-
tion, as in fainting,  the  blood is  not circu-
lated properly, the  lips also  become  pale;
when,  from  disease, the  blood does  not
undergo  its proper  changes, the colour of
the lips, instead of being red, inclines more
or less  to purple.   The lips (particularly
the lower) are  apt  to  become  the seat  of
cancer in old age,  especially,  it is  said,
in those  who  have  smoked  much  from a
short pipe. A continued sore upon the lip
that will  not heal, in an old person, should
be examined by a medical man.  If it is
such as to require removal, this cannot be
done too  soon.
  Refer to Hare-lip—Lip-sore.—See Skin.
  LIQUORS.—See Alcohol—Stimulants,
&c.
  LIQUORICE  and  Liquorice  Root. —
Liquorice root,  which is long and creeping,
is produced from a plant belonging  to  the
leguminous, or  pod-bearing tribe, a native,
chiefly, of Spain, and of Southern Europe,
but cultivated in England.   The  extract of
the root,  known as hard "extract of liquo-
rice," or  "blacksugar," or "Spanish juice,"
is used chiefly as  a demulcent remedy in
coughs and irritation of the throat, in irri-
tation of the stomach and bowels, and  of
the urinary organs.  Many persons take it
largely,  and find it useful, in  heartburn.
It does not disorder the stomach, or  cause
thirst, like common  sugar,  even when used
in considerable quantity.   The  extract is
also employed to cover the taste of nauseous
drugs,  such as aloes,  &c.  and  is added to
demulcent drinks generally.  It  also forms
the basis for various kinds  of lozenge.
   A  soft extract of liquorice  is used  by
druggists in  the composition of pills,  and
the powder of the root is used for the same
purpose.
   L:THARGE—Is an  oxide of lead, which
54                LI V

occurs in the form of reddish-white scales.
It is sometimes used to adulterate wine.—
See Lead.
   LITHONTRIPTIC—An old term applied
to medicines which were supposed to possess
the power  of dissolving  or disintegrating
urinary calculi.
   Refer  to  Urine.
   LITHOTOMY.—The operation of cutting
for the stone.
   LIVER.—The liver  is  the largest  organ
in the body, weighing,  on  the  average, in
man, about four pounds.  It  occupies  the
upper part of the  abdomen, (see Abdomen,)
just  beneath the  diaphragm or  midriff, to
which it is attached, or, as it were, slung,
by what  are called the  ligaments  of the
liver.  By  anatomists  the liver  is divided
into  various "lobes," but here it is suffi-
cient to  point out the general division into
a  larger, or right lobe, (fig. xcv. 1,) and a
                  Fig. xcv.
                   3
smaller or left lobe,  (2,) the former occupj
ing the right  "hypochondrium," the lattei
extending  far  into  the  left.   The  gall-
bladder  (fig. xcv. 3) is  seen  occupying the
forepart of the  under side of the right lobe
of the liver, in which aspect it is represented
in the cut.  The liver is made up of  a num-
bers of minute  lobules, about the size of a
millet-seed, which  are  composed  of the
smallest  or  "capillary"   branches  of the
blood-vessels; of  the cells which seem  to
separate the bile from the blood; and of the
ducts  which convey the  secreted bile into
the larger common ducts. These converge
to the one main duct of  the liver through
which the bile  flows, either into  the gall-
bladder, or directly into the digestive canal
The  bile  (see  Bile) is  formed  from the
blood  which  has  circulated  through the
organs  within  the  abdomen,  and  which
passes through  the liver on its way back to
the heart.  In this passage, the bile is sepa-
rated from it, thereby  purifying the blood,
and affording a secretion  which performs an
I important part  in the processes of digestion,
3: 
                 LI V

and probably in the body at large.  This
intimate connection, however, of the liver,
by means  of the blood, with the other  or-
gans within  the abdomen, and particularly
with the stomach, renders it  extremely lia-
ble  to  be disordered;  and,  indeed, there
are few cases of disorder of the stomach or
bowels, in which the liver is not  in  some
degree  implicated,  either primarily or  se-
condarily.   Probably, in no way is the con-
nection between the stomach and liver more
strongly manifested than by the manner in
which the latter is affected by  the inordinate
use  of alcoholic  liquors.   In  this case,  the
spirit being  absorbed directly from  the sto-
mach by the veins, and  conveyed directly to
the liver, acts very powerfully upon it, par-
ticularly if the  form in which the alcohol is
taken be that of pure  spirit, such as gin or
brandy.  In this instance, if the use of  the
spirit be persevered in,  a low form of inflam-
mation is  excited  in the  substance of  the
gland, which ends in the formation of  what
has  got the  name of the "gin-drinker's
liver"—a disease, indeed, of which the only
traceable cause  is the excessive use of spiri-
tuous  liquors, and  which proves  fatal to
many in this kingdom annually.  Its symp-
toms and treatment could  not  profitably be
laid before unprofessional persons, but its
cause should  be impressed on all.  In its
advanced stages, it  generally causes drop-
sical swelling of the lower extremities and
of the abdomen.
   Inflammation  of the liver is atteuded by
the usual feverish symptoms  which accom-
pany inflammation of internal organs gene-
rally, and must be managed on the  same
principles  (see  Inflammation)  until  proper
advice can  be obtained.   The pain varies
considerably in  this affection,  being  usually
very acute when  the surface of the liver,
with its covering membrane, is implicated;
but  less so, or of a duller character, when
the  substance of the gland is the part  in-
volved.   As  is  the  case in liver affections
generally,  pain  is  often  felt  somewhere
about the shoulder-blades, most  frequently
in the right, but sometimes in the  left, or
between them, extending even to the  back
of the head.  Inflammation of the  liver is
much more frequent in warm  climates than
it  is in this country; and, in  the former, is
very apt to end in the formation of abscess.
The  disease,  of course, requires the  most
active treatment of  a medical  man; but it
should be known to those going to a hot
climate, (see  Climate,) that this,  like other
liver diseases, is much more likely to attack
the free-living  than the  temperate man.
For  further  information  respecting liver-
!5                LOC

 disorder, the reader is referred to articles
 Biliary Disorder—Climate—Gall-stone—Jaun-
 dice, Sec.
   LOBELIA, or " Lobelia Inflata"—Is a
 plant  native to, and very commonly found,
 in North America.  It was one of the medi-
 cines of the Indians.   It has been used by
 medical  men in England  as a remedy in
 asthma, and, in some  instances, proves of
 service;  but this is generally the case when
 its emetic action has been exhibited.   It is
 not a  remedy, however, for unprofessional
 hands, for it may prove a powerful irritant
 poison.  Lobelia has, within the  last  few
 years, acquired notoriety in consequence of
 its being the medicine  of a set of quacks, in
 whose hands it has, in more than one in-
 stance, produced fatal effects and been the
 means of subjecting them to legal proceed-
 ings and punishment.
   LOBSTER—Like most shell-fish, is unfit
 for persons  of weak digestion.
   Refer to Fish.
   LOCHIA.—The "cleansings"  after de-
 livery.
   LOCK-JAW—Is  the  popular name for
 the first and partial symptom of  a fearful
 spasmodic disease, known to medical men
 as  tetanus, in which, not only the muscles
 of the jaws, but the  muscles  of  the  body
 throughout  are, more or less,  extensively
 thrown into violent spasm, so strong indeed,
 that the teeth or bones may be broken by it.
 The set of muscles most generally affected,
 after those  of  the jaws, are those of the
 back;  the  patient,  by the  spasm, is bent
 like an arch, so that the back of  the  head
 and the  heels alone touch  the bed; occa-
 sionally  the body  is  bent  forward.  The
 disease most frequently commences with a
 sensation of stiffness  and soreness of the
 muscles of  the  neck and jaws; .the latter
 become fixed, and the  spasm extends  more
 or less over the body.  It is  needless to add,
 that this  extensive cramp is attended with
 the most severe pain, which is also, in most
 cases,  experienced severely about the pit of
 the stomach, being dependent, doubtless, on
 spasm of the diaphragm.
   The most usual exciting  causes of lock-
 jaw or tetanus are wounds, especially of a
 punctured character,  but in some persons
 the very slightest injury is sufficient  to de-
 velop the disease.   In  England, however, it
 is fortunately comparatively rare;  in warm
 climates  it  is common.  It  is also liable to
 prevail among the wounded after battles,
 if exposed to much vicissitude of  weather;
 indeed, cold will occasionally  give  rise to
 lock-jaw independent, of injury.  When lock-
 jaw arises from  a wound, it shows itself in
31 
L 0 N               836                LOW
from four days to three weeks after the in-
jury.   It is a very fatal disease, the greater
proportion  of those affected by  it  dying;
some, however, recover.  Of course, as soon
as  practicable,  a  medical man  should be
called to a case exhibiting even the slightest
tendency to lock-jaw after an injury ; in the
mean time, large, very large doses of opium,
in the liquid forms of laudanum or of seda-
tive solution, may be administered,  even by
unprofessional  persons;  they may mitigate
the sufferings of this dreadful disease. Com-
mencing with from  thirty to sixty drops of
laudanum, the  same doses, if they can pos-
sibly be swallowed,  may  be repeated at in-
tervals of from half an hour to an hour, as
long as the system remains unaffected by
the drug; if the medicine cannot be given
by the mouth, it must  be by a clyster.  In
addition to the  above, the affusion with cold
water may relieve.   The patient having been
taken  out  of bed,  and  a quantity of cold
water dashed over  the body and  down  the
spine, is immediately to  be rubbed dry and
replaced in  bed—quiet sleep may possibly
follow.  While  the  jaws  are firmly  closed,
nourishment cannot, of course, be given in
the usual way ;  a medical man will probably
administer it by means  of a tube passed into
the stomach, either by the nose or  by  mouth,
passing it  behind  the  teeth;  until his ar-
rival,  should that be delayed,  the adminis-
tration of small clysters of meat-broth will
assist in maintaining strength.
  Refer to Convulsions—Wounds, Sec.
  LONGEVITY —Prolonged  Life—It is
well known popularly, is, in some respects,
hereditary, the  ages at which different mem-
bers of  a family usually die bearing a very
near average to one another,  even  despite
the influence of occupation, habits, and con-
dition of life, although these,  undoubtedly,
exert  considerable influence in determining
the period  at which the  component  tissues
of one or more of the organs begin to give
way.   Many tables and calculations have
been made at different  times, with a view of
determining the extent to which  the dura-
tion of life is affected by the circumstances
in which individuals may be placed.  The
following table from Casper of Berlin, if it
may not  exactly  apply to this  country,
shows, at all events, how greatly the ave-
rage duration of life may vary in different
classes:—
Of 100 theologians, there have attained
          the age of 70  and upwards 42
      Agriculturists and foresters..... 40
      Superintendents.................... 35
       Commercial  and  industrious
           men.............................. 35
 Of lOOmilitary men........................ 82
       Subalterns........................... 82
       Advocates............................ 29
       Artists................................ 28
       Teachers and professors.......... 27
       Physicians........................... 24
   Another  table,  by a  different  observer,
 exhibits the difference of locality as follows:
 the observations were taken from a French
 department:—
                            Inhabitants to ont
                             death annually.
   Mountain parishes.................... 38-3
   Seaside................................... 26-6
   Corn districts........................... 24-6
   Stagnant and marsh districts...... 208
   Refer to Age, Old—Life, Sec.
   LOINS. — See Lumbar.
   LONGING—Is  the  term  applied to the
 almost morbid craving for certain articles
 of diet, with which some females indulge
 themselves  during  pregnancy;  it is pro-
 bably a phase  of  hysteria.   Under the cir-
 cumstances, it is only right and humane to
 yield  to  those  fancies in some measure;
 but when  there  is any real or adequate
 reason for their being debarred, it may be
 insisted upon without the risk of the conse-
 quences popularly supposed to follow.
   LOSS of  BLOOD.—See  Hemorrhage.
   LOTIONS—Are liquid applications, prin-
 cipally composed  of water,  used either to
 the skin or  to the mucous surfaces, such as
 the inside of the mouth or of the nostrils.
 The variety of lotions,  from  plain water—
 which is often a most  excellent one—up-
 ward, is very great.  Lotions may be classed
 as—1. Cooling; 2. Stimulating; 3. Astrin-
 gent; 4. Soothing; and,  5.  Sedative.   Of
 the first,  water is an example, either alone,
 combined with spirit, from half an ounce to
 an ounce to the half-pint,  or combined with
 vinegar.  The lead lotion (see Lead) is an-
 other example of  the cooling lotion, but in
 this case it is  astringent at the same time.
 Water, with one-third or one-half spirit of
 wine, applied to the skin by means of lint,
 which is covered to prevent evaporation, is
 a good  example  of a  stimulating lotion.
 Very  cold water,  the lotion  of  sulphate of
 zinc  or  of  white-vitriol, in  the  proportion
 of from one to ten grains to the ounce of
 water, and  other astringents in solution,
 (see Astringents,) form the astringent lotions.
 The various preparations  of  opium, decoc-
 tion  of poppies, decoction of hemlock, &c.
 are soothing lotions: the prussic acid lotion
 a sedative one.
   The reader is referred to  the various ar-
 ticles, such as " Lead,"  "Zinc," &c.
I   LOW DIET—Must necessarily be a com- 
LOZ
337
L  UN
 parative  term, influenced by  the  previous
 habits of the patieut, but generally it means
 the absence of all  stimulants  and  animal
 food from the allowances—generally of eggs
 also—and a  diminished amount of bread
 nourishment.   Weak  tea,  bread,  diluted
 milk,  cocoa,  gruel,  arrow-root, sago, and
 such-like preparations,  generally constitute
 the staple of  low diet in this  country;  to
 these, however, the cooling  fruits  may fre-
 quently be added.   Half diet includes the
 above with the addition of puddings of milk
 and eggs, of broth, and it may be of a small
 allowance of meat.—See Abstinence—Fasting
 -—Hunger, Sec.
   LOZENGE.—A hard compound of sugar
 and gum, which  contains either simple fla-
 vouring or  some  medicinal  agent.   The
 system of giving medicine  in  the  lozenge
 form has fallen into comparative disuse;  it
 is, however,  a  useful and agreeable  method
 in some cases, particularly in affections of
 the throat, such  as relaxation,  when it  is
 desirable to apply the medicinal agent gra-
 dually.  In children, the lozenge  form of
 medicine is useful,  either for  the adminis-
 tration of ipecacuanha, domestically, or of
 morphia, under  medical sanction.   Such
 lozenges, however,  ought to be carefully
 made, so as to contain  a certain definite
 dose—in the case of morphia, the  twenty-
 fourth of a grain—and  the  amount  of the
 dose should be stamped  upon the  lozenge.
 The manufacture of lozenges is now almost
 entirely transferred  from the apothecary to
 the  confectioner.  Lozenges  are sometimes
 adulterated with what is called "mineral
 white," in other  words,  plaster of Paris:
 it cannot  be  regarded  as a harmless ad-
 dition.
   LUMBAGO—Ts rheumatism of the large
 muscles  of the back, and, like  rheumatic
 affections generally, is often extremely pain-
 ful,  the  pain  being  increased by stooping,
 and again when the  person attempts to rise.
 This peculiar  aggravation of  the  pain by
 these movements  is generally stated to be
 the  distinction between  this  disease and
 painful affections of the kidney.   In lum-
 bago, nothing affords more, if so much, re-
 lief  as hot moist  applications  to the back,
 (see Heat,) continued from twelve to twenty-
 four hours at  a time, and followed by the
 soap liniment combined with  one-sixth part
 of turpentine,  rubbed  well  into the back
 and  loins  Ten grains of Dover's powder,
 with a couple of grains of calomel, given at
bedtime,  and followed in the morning by  a
dose of castor-oil or infusion  of senna, will
expedite the cure.  While  the  person is con-
fined to bed under the influence of  the hot I
      2D                                2:
 applications to the back, it will be advisaMe
 to give warm diluent drinks tolerably freely.
 In  a severe or  obstinate case of lumbago,
 the " thermal hammer" of Dr. Corrigan (see
 figure, Counter-Irritation) might be  used  as
 directed; in such cases, however, the safest
 plan is to have medical attendance, if pos-
 sible. Should the urine be scanty  or high-
 coloured, ten grains of carbonate of  potassa,
 with a teaspoonful of sweet nitre, may be
 taken in a wineglassful of water  twice a
 day  with   advantage.   Persons liable  to
 attacks  of lumbago  should wear a  flannel-
 belt  round  the loins.  [The  application  of
 six cups to  the small of  the back will often
 expedite  the  cure of lumbago, especially
 when the attack is recent and severe.]
   Refer  to Rheumatism.
  LUMBAR.—Belonging to the loins.  The
 term is  frequently used  in connection with
 abscess.   In children  of weak and scrofu-
 lous constitution, an  abscess in the loins, or
 "lumbar abscess," is apt to occur, and is
 often  connected  with disease of the ver-
 tebrae, or bones  of  the  spine.   Continued
 complaint of  pain in  the back, with any
 awkwardness  in  walking, particularly  if
 accompanied  with failure of  the  general
 health, should awaken suspicion, and give
 occasion for the child being  examined  by
 a surgeon.  Lumbar abscess may occur in
 adults.
  LUMBRICUS.—A worm.  Applied to the
 large round worms which occur in the in-
 testines.—See Worms.
  LUNACY—See Insanity.
  LUNAR CAUSTIC—Nitrate  of  Silver.
 —See Silver.
  LUNCHEON. —A  kind  of  intermediate
 meal, and therefore  sometimes an unneces-
 sary  one.   The  English  labourer  has  his
 "lunch" between breakfast and dinner, and
 again between the latter meal  and  supper.
 The English of the higher classes, particu-
 larly if their time is not well occupied, are
 apt to make luncheon a  kind  of dinner—a
 meal of animal food and stimulants, which,
 if superadded  to dinner, is certainly unne-
 cessary,  and therefore productive of disor-
 der.  Either the luncheon  should be  made
 a bona-fide dinner  at an early hour, [as  is
 the   practice of  very many in the  United
 States,]  or  it  should  be a  meal  without
 animal food—provided, of course, that an
 additional amount of animal nutriment  is
not  considered necessary by a medical man,
as a remedial measure.  Fruit is generally
more  wholesome  at  luncheon  than in any
other part of the day.
  LUNGS.—The organs of respiration.  Tne
lungs are two,  each occupying  its own side 
L II N
338
hV N
of the chest, (fig.  xcvi. 1, 1,) the left being
rather the smallest, on account of the greater
space taken up by the heart on the left side.
The  latter organ  is situated in the  space
(fig.  xcvi. 4) between the two lungs, which

                 Fig. xcvi.
are separated from one another by a middle
partition.   Air passes  into  the  lungs by
means of the  windpipe,  or trachea, (fig.
xcvi.  2,) to  the top  of which is fixed the
larynx,  or organ of the voice; at its lower
extremity,  the  trachea divides  into two
branches,  or bronchi, of unequal length,
one for each lung; these bronchi on enter-
ing the  lung subdivide into  branches, and
these  again  into still smaller tubes,  until,
after  continued division  and  subdivision,
they end in the air-cells.   These  air-cells
are minute  membraneous cavities, on the
membraneous walls of which  the  blood cir-
culates  in a network of  veins, in such  a
manner  as to be brought into intimate con-
tact with the  air  which is drawn  into the
lungs  at each inspiration.  Nothing, indeed,
intervening between  the blood in the veins
and the  air in the  air-cells but a membrane
so thin  that it allows the transpiration  of
the gases and vapour, which  takes  place as
the blood becomes  purified by  means  of
this air contact.   In consequence  of  their
structure  being  adapted  for  the  admis-
sion of  air  into numberless minute cells,
the lungs feel  spongy when pressed be-
tween the fingers.   Those who are curious
on  the  point  will  learn more  from five
minutes' examination of the lungs and wind-
pipe  of a  sheep  or calf, in  a butcher's
*hop,  than from any  description.   In these,
nowever, the mode  of death, by bleeding,
gives  the lungs a much paler  colour than
iheir natural one.  The tubes, the air-cells,
 the blood-vessels, &c. of the lungs  are helQ
 together by "cellular" tissue, and the entire
 organ  is  enveloped by a membrane—the
 "pleura"—which covers  its surface,  and  is
 thence "reflected" to cover the inner sur-
 face  of the ribs of the chest; in this way
 forming a  shut pouch, or sac, the inner sur-
 faces  of which are  in contact, and  these
 being in the healthy state perfectly smooth
 and moistened with a lubricating fluid, they
 glide  over each  other in  every motion of
 the chest.   The trachea and the bronchi, at
 first, are  composed of incomplete  "rings'
 of cartilage, connected together by  an elas
 tic tissue; the former tube—the windpipe—
 as generally known, occupying  the forepart
 of the neck and lying in front of the gullet.
 —See Neck.
   The  larynx, or  organ of voice, which is
 placed on  the  top of the windpipe,  extends
 to the  base  of the  tongue;  its situation is
 often  strongly marked in thin men, espe-
 cially if somewhat advanced  in life, when
 it  forms  the prominence  popularly called
 "Adam's apple."  This prominence is caused
 by a cartilage which forms a main  portion
 of the  body, or  box, of the larynx.   Into
 tho -composition  of this wonderful instru-
 ment of articulate and vocal sound,  various
 other   cartilages,  ligaments,  muscles, &c.
 enter, and the whole is lined by a continua-
 tion of the mucous membrane of the mouth,
 which, after passing  through  the  larynx,
 lines the trachea,  or windpipe, and follows
 the branchings of the bronchi.   The cavity
 of the larynx is divided  by a constriction
 of a  triangular  form—the  glottis—and is
 protected  from  injury by a  heart-shaped
 cartilage—the  epiglottis—which, especially
 in the act of swallowing, when the larynx ia
 drawn  upward, completely closes the  open-
 ing.— See  Throat.
   From the above slight sketch, the general
 reader may derive some idea of the  import-
 ant organs of respiration.  To recapitulate:
 situated at the base of the tongue, and pro-
 tected  from injury by the cartilage of the.
 epiglottis,  is the larynx, constricted in the
 centre  and ending  in  the  trachea, or  wind-
 pipe, which, descending in front of the neck
 into  the chest, divides into the right and
 left bronchi; these, entering their respective
 lungs,  divide and subdivide, till the minute
 branches enterthe air-cells, on the thin walls
 of which the blood circulates in a network
 of veins, and undergoes purification by ab-
 sorption of the oxygen of the  atmosphere,
 while it frees itself from carbonic acid and
I watery vapour.
   The  act of respiration is  partly involun-
I tary—that is, goes on (as  during sleep) 
                  L  U N

independent of nny exercise of the will: it
is, however, as all know, capable of being,
to a certain extent,  controlled by the will;
this being, doubtless, a necessary adjunct to
the power of the utterance of sound.  The
process of respiration is essentially effected
by means which enlarge the capacity of the
chest.   These means  are the various muscles
attached to the ribs, and which, by elevating
them,  increase  the  diameter  of the  chest
from before backward, (see Chest,) and also
the diaphragm and muscles of the abdomen,
which, by their downward and outward mo-
tions, increase the capacity of the chest from
below.   The enlargement of  the chest by
these  agencies, either in combined or sepa-
rate action, has the effect of causing the air
to rush in, or to be sucked into the chest as
it is into a pair of  bellows.    If the  cavity
was empty  it would rush into it; as  it is, it
rushes into the spongy distensible lungs and
distends them—it  may be, assisted in some
degree by  the  action of the lungs  them-
selves.  The air having  been thus  drawn
into the  chest by an active  movement, is
immediately thereafter expelled  by  a com-
paratively passive one: the active muscular
movement  ceasing,  the ribs descend, and
regain their position by their own weight
and elasticity.  The movements, however,
both of inspiration and  expiration, may be
increased—"forced"—by the will; and, in
in this case, other muscles are called into
action, and those usually employed  in  the
process  are more strongly exerted.   It is
the necessity for these forced efforts  in the
asthmatic, which, after frequent repetition,
gives the peculiar curve  of the shoulders so
often observable.  The average  number of
respirations in a minute varies from  fifteen
to twenty-two  in  different individuals, and
even in  the same at different times.  The
end  of the  process of respiration—that is,
the change  undergone by the blood, in con-
sequence of its exposure to atmospheric air
in the lungs—has been  sufficiently entered
into in the articles Aeration—Blood—Circula-
tion, Sfc.; it is therefore unnecessary to re-
peat it here.
  The passage of the air into and through
the  lungs  gives  rise  to certain definite
sounds perceptible to the attentive ear,  ap-
plied closely to  the  outside  of  the  chest.
These  sounds vary but slightly in healthy
individuals; consequently,  any deviation
from them is indicative of disease, experi-
ence furnishing the link which enables  the
physician to pronounce upon  the nature of
the disorder, from the nature  of the sound,
or from its entire absence, which latter con-
dition  occurs, either when the lung  is ren-
19                L U N

 dered so solid  by diseased  action, that air
 cannot penetrate its tissue, or when it is
 condensed, or pressed together by the pre-
 sence of fluid within  the chest.   Moreover,
 it is evident that organs  like  the  lungs,
 which,  in their natural healthy  state, are
 distended with air, must, when the side of the
 cavity within which  they are contained is
 struck, give  out a somewhat hollow sound  ;
 but  that, should the  lung become solid, or
 the cavity be more or less filled with water,
 the sound, instead of being hollow, will  be
 dull or flat.  It is further evident that the
 power of conducting sound must be changed
 by the various alterations in  the structure
 of the lungs, and that the voice must sound
 differently to the ear  applied to the chest, ac-
 cording to these alterations.   These brief
 observations will, perhaps, convey to the
 general reader  some idea of the means of
 judgment, and of the principles  on  which
 they  depend, which  the physician  avails
 himself of, when  he  goes through the—to
 the unprofessional—somewhat mysterious-
 looking process of physical  examination of,
 or "sounding" the chest.
   The  narrowness of the triangular  chink
 in the larynx, through which the  air passes,
 always  renders  disease of this organ  a
 matter of anxiety and of danger, for that
 small opening cannot be  obstructed for
 three or four minutes,  without  death en-
 suing.
   The  larynx  is liable to be  obstructed
 from swelling of its lining membrane, either
 from  inflammation  or  other  cause,  from
 spasmodic contraction of its muscles, or by
 foreign bodies accidentally  introduced into
 it. It is also liable to ulceration.  Inflam-
 mation of the larynx, or laryngitis, though
 comparatively an infrequent  disease, is a
 very  fatal one when it does occur ; it is re-
 markable! from  having  been  the cause  of
 death to General Washington.  Laryngitis is
 usually the result of  cold ;  in Washington's
 case  it was  caused  by the  snow, during a
 storm, lodging about  the neck. In one case
 under the author's care, it arose from a la-
 bourer   having  incautiously thrown  aside
 his  neckerchief  while  warm with  work,
 but  at  the same time exposed to a March
 east wind.  The symptoms of laryngitis are
 those of general feverishness, with pain in
 the  organ affected,  pain   on swallowing,
 hoarseness, and hoarse, dry, ringing cough;
 it is, in fact,  a disease in the adult, in many
 respects similar to croup in the  child, and
 even  more dangerous.  It is,  too, an affec-
 tion  which  calls f,or the  exercise of the
 most  energetic and   best-directed  medical
 treatment as soon as it caD  be  procured.
3 
L  U N
310
M A D
But for the same reason, it is of the highest
importance that no time should be lost, even
while waiting  for that aid,  and that some
properly directed means should be at once
resorted  to.   First, from half a  dozen  to
two  dozen of leeches,  according  to the
strength  of the patient, should be applied
to the throat and upper part of the chest;
or, if leeches are  not available, from six to
twelve ounces of  blood  are to  be  taken
from the back of the neck by cupping. Tar-
trate  of  antimony,  in eighth  of a  grain
doses, is  to be repeated at intervals of from
one to two hours,  at first,  and calomel given
in four grain  doses every four  hours, with
a quarter of a grain of opium  in every,  or
every second  dose, should  purging ensue.
Hot bran-poultices are to be  kept constantly
to the throat, the feet put in hot water, and
advantage  may be derived  from  breathing
the steam of hot  water, the  patient,  of
course, being  kept  perfectly quiet  in bed.
These measures will do all that  can be done
Until the arrival of  a surgeon;   he may  do
more, and possibly, if the case  becomes ex-
treme, may think it requisite to open the
windpipe.
   Closure of the  larynx,  or rather  of its
narrow  portion,  the glottis, may be the
result of swelling, extending to it from the
throat.   Partial chronic swelling,  causing
permanent, or at least continued,  loss  of
voice, is not  an unfrequent  and not a dan-
gerous affection ;  and ulceration within the
larynx, also causing loss of voice,  is met
with in consumption.
   Of the spasmodic affections of the larynx,
that mentioned under the spasmodic croup
of childhood  is perhaps the most charac-
teristic, but the researches of Dr.  Marshall
Hall  make  it evident, that in  the nervous
convulsive diseases, such as epilepsy, spas-
modic closure of  the  larynx takes  place,
and  that in aggravated  cases, relief—by
proper hands—may be given by the opera-
tion of opening the windpipe.  [This point
is by no means  settled,  and there is con-
siderable evidence to prove  that it does not
afford relief except temporarily.]   When
death does occur from any of the causes
mentioned,  it is  by suffocation,  or " as-
phyxia," just as  if the  person had been
drowned or hanged.  It may also take place
in consequence  of  foreign bodies,  either
getting wedged in  the larynx  itself, or in
the gullet behind it; when,  if of large size,
they act by their mechanical bulk  and com-
pression.  Foreign bodies are usually drawn
into the larynx itself, in consequence of tb"e
person,  often a child, laughing or crying
while the substance or fluid  is in the mouth.
As  all  know, even the smallest crumb or
drop of fluid getting into the larynx, or as it
is popularly called, " going the wrong way,"
immediately, inconsequence of the irritation
of the extremely sensitive lining membrane
of the organ, causes violent cough, and per-
haps choking spasm.  If the foreign body is
large, those symptoms are severe in a corre-
sponding degree, and may, by their severity,
prove the patient's safety, by expelling the
offending substance.   Should this not  be
effected,  and  if  it is  too  large to  pass
through  the  larynx, death must inevitably
and quickly ensue ; sometimes, however, the
body  passes through  the larynx into the
bronchi,  as happened in the well-known in-
stance of the half-sovereign in Mr. Brunei's
case.   When this occurs, the more severe
suffocative symptoms subside, but irritating
cough continues, with  the  constant risk of
driving the  foreign body back  into  the
larynx.  In such cases, unprofessional per-
sons  can do little or  nothing,  and unless
proper surgical assistance is quickly pro-
curable, there is much chance of a fatal ter-
mination.  It would  always be  right, how-
ever,  for some person to pass the forefinger
as far back in the throat as possible, under
the chance that the obstruction might  be
within reach ;  and also to adopt the reme-
dies for  choking laid  down  under article
Gullet.
  The various inflammatory affections  of
the air-tubes,  such  as Croup,  Bronchitis,
Catarrh,  Influenza, &c. &c. are treated  of
under their  separate heads ; inflammation
of the lungs  falls under article Inflamma-
tion ;  and other diseases of the  respiratory
organs, such as Consumption, Asthma, &c.
&c. are  assigned to  distinct articles in the
Dictionary.
  Refer  also to Aeration—Blood—Chest-
Circulation, Sec. Sec.
  LUXATION.—A dislocation.—See Dislo-
cation.
  LYMPH.—The fluid contained within the
lymphatic or absorbent vessels.—See Ab-t
sorbents.   The term is also applied to limpid
exudations from the body, such as vaccine
lymph, adhesive lymph, &c.

  MACE—The outer covering, or, in bota-
nical language, the " arillus,"  of the  nut-
meg, and one of our pleasantest and  most
generally used spices,  may, when taken too
largely,  produce  determination of blood to
the head, and intellectual disturbance.  The
characteristic  properties  of  mace  depend
upon an essential oil.—Refer to Nutmeg.
   MADEIRA.—Of  this  much  frequented
! and most important resort for invalids,  Sir 
M A D
341
M AL
James Clark thus  speaks: — Madeira has
been  long held in high estimation for the
mildness  and equability of its climate;  in
which respect  it will well bear comparison
with the most favoured situations on the con-
tinent of Europe."
   Compared with the best of these, it  is
warmer during the winter, and cooler during
the summer;   there is also less difference
between the temperature of the day and that
of the night,  between one season and an-
other, and between  successive days.   It is
almost  exempt from keen, cold  winds, and
enjoys a  general steadiness of weather to
which the continental climates are stran-
gers.  During  the summer, the almost con-
stant prevalence of north-easterly winds,
especially on the north, and the regular sea
and land breezes on the south  side of the
island, maintain  the atmosphere in a tem-
perate state.   The sirocco, which occurs
two or  three  times, at  most,  during the
season, and then  continues only for  a few
days, (seldom more  than three,) sometimes
raises the atmosphere in the  shade to 90°.
With this exception, the  summer tempera-
ture  is   remarkably  uniform — the  ther-
mometer  rarely rising above 80°.  In con-
sequence  of the regular sea-breezes, the
heat  is  not so oppressive as that of the
summer in England often is.   Close, sultry
days are little known in Madeira, and there
is neither smoke nor dust to impair the pu-
rity of the atmosphere.   Such, indeed,  is
the mildness of the summer  at Madeira,
that  a  physician, himself an invalid, who
resided for some time on the island on ac-
count of his health, doubted whether the
season was not more favourable to pulmonary
invalids than the winter.
   *  *  *  " The spring at Madeira, as at
every other place, is the most trying season
for the  invalid, and will require even  there
a  corresponding degree  of  caution on his
part.   In March, winds  are frequent; and
April and  May are  showery;"  but Sir
James adds—" On the whole continent  of
Europe there  is no  place with which I am
acquainted  where  the pulmonary invalid
could reside with so much advantage during
the entire year as in Madeira."
  MADEIRA WINE—Is one of the strong
dry  wines,  and  contains from  twenty  to
twenty-two  per cent,  of spirit.   It  gene-
rally contains more acid than either port or
sherry.
  MADNESS.—See Insanity.
  MAGNESIA—One of the alkaline earths,
is largely used in medicine, in the form of the
pure or calcined magnesia; also in the form
of the carbonate, and of bicarbonate, which
      2 d 2
latter,  being soluble, constitutes the fluid
magnesia  of the shops.    In  combination
with sulphuric acid, it forms sulphate of
magnesia, or Epsom salts.—See Epsom Salts.
  The  principal use of magnesia is  as an
antacid in acidity of the stomach and bowels;
it at the same time—provided it meets with
acid—acts as a gentle aperient;  it is often
combined  with rhubarb,  Epsom  salts,  &c.
The effectual  manner  in  which magnesia
neutralizes acid in the stomach, and thereby
relieves heartburn  and other uneasy  sensa-
tions, has probably been  the reason  for its
extensive  use, and  certainly for its  abuse
among dyspeptics generally, whereby much
evil has resulted ;  for there is no question,
that the  continued use  of magnesia  as
an  antacid  greatly  impairs the digestive
powers.  Moreover, if  used  in the form of
calcined magnesia, or of carbonate, should
it not  encounter sufficient acid in  the ali-
mentary canal to convert  it into a soluble
aperient  salt, it is apt to  accumulate, and,
if taken  regularly  and largely,  to collect
into and form  concretions in  the bowels.
On  this  account,  persons  who  will take
magnesia  habitually, ought to be careful to
clear out the bowels thoroughly, at intervals,
by means  of a dose of castor-oil; the same
rule being observed with regard to children,
if magnesia  is  given  regularly to  them.
These  remarks do not apply to the com-
paratively pleasant and efficient preparation
of the bicarbonate, or fluid magnesia, which
has greatly, and with advantage, supplanted
the  other preparations.
  Fluid magnesia, in doses of from half an
ounce  to two ounces, may be taken  either
alone,  or  in milk—the latter  mode  being
convenient for children; or it may be given
as  an  effervescing  draught, with lemon-
juice.  It has been  already observed, that
magnesia only acts  as  an  aperient when it
meets  with acid; the  author has  found a
dose of magnesia, taken  after the garden
rhubarb used as food, act  very well as a
gentle  aperient.
  Of  the  solid  preparations,  Henry's  [or
Husband's of  Philadelphia] calcined mag-
nesia is the best.  Some kinds of magnesia,
when kept for a time mixed with water,  are
apt to form a solid mass.
  Refer to Children—Indigestion—Piles, Sec.
  MAGNETISM, ANIMAL.—See Mesmer-
ism.
  MALARIA.—See Ague.
  MALE FERN.—See  Fern.
  MALIC ACID.—The peculiar acid  of  the
apple.
  MALIGNANT.—A term  applied medically
to various diseases when they assume a fa- 
M A L
342
M AS
tally severe, or intractible form, such as ma-
lignant sore-throat, &c.
  MALT LIQUOR.—See Ale and Beer and
POKTEK.
  MAMMA.— The  female  breast — See
Breast.
  MANNA—Ig the  saccharine  exudation
from a species of ash-tree, and  is  chiefly
brought  from Sicily  and  Southern Italy.
Flake manna  is  the variety used  in  this
country,  but it is not  employed  by  any
means  to the same extent as formerly.   It
is gently aperient, but  as  two ounces are
requisite for a dose, it is likely to disorder
the stomach.   There are many  good substi-
tutes.
  MARASMUS — Wastinq — Atrophy. —
See Atrophy.
  MARMALADE.—The well-known pre-
serve, made from  the Seville orange, is by
some regarded as a stomachic.
  MARRIAGE.—The religious and lawful
union of  the sexes.   Various observations
go to confirm  the fact  that  the married
state is  conducive both to health  and  to
prolongation of life; thus it has been ascer-
tained, that married women at the age of
twenty-five have,  on  an average, thirty-six
years of  life before them, while unmarried
women of the same  age have  not, on the
average,  m°re than  between  thirty  and
thirty-pne years ;  that in men, the mortality
between  the  ages of thirty and forty-five
amouuts,  on  the  average,  to eighteen per
cent, in  the married, but  to twenty-seven
per cent.,  or  one-third  more,  in the un-
married ;  and,  further,  that at the  age of
seventy, while there remain alive  but eleven
bachelors out of  every hundred,  twenty-
seven married men out of the same number
may be  expected  to reach the threescore
and ten-
  It has also  been shown  from  statistical
returns,  that  suicide is very  much more
frequent among  the  unmarried than the
reverse.   On the  score,  therefore, of phy-
sical and mental health,  independent of
other considerations, marriage is advisable;
of course its advisability, in individual cases,
must  rest on  the relative  position  of the
parties.   Certainly,  however   favourable
other matters may be, it is a great evil for
parties to enter into the married state too
early in  life;  the  female especially, if she
commences  child-bearing  early, that  is,
before  the age of  two or three  and twenty,
cannot fail to suffer in her own constitution,
and almost necessarily entails the acquired
debility upon her offspring.   In the case  of
Miose who have a  family when advanced in
life, the  trial  is less to their own constitu-
 tions,  but should  the  father be aged, the
 children are not likely to be strong.   The
 reader is further referred  to articles Disease,
 Hereditary,  Sec.  for  information  respecting
 the influence whioh the health and constitu-
 tion of the parent exerts upon that of the
 offspring.
   As regards physical and mental develop-
 ment,  it  is  an undoubted  fact, that the
 mixture of races, or at  least of families
 totally unconnected with  each other, tends
 greatly to  elevate the standard of both.
 It has been  remarked by  Humboldt  and
 others, that in South America, the progeny
 of the negro  and of the  native Indian are
 greatly superior to the progenitors on either
 side;  the superiority of the Caribs to other
 American  Indians  has  been  ascribed to
 their  latitude in  intermarriage  with the
 surrounding tribes;  and  it is well known
 that the Anglo-Saxon  attributes the  posi-
 tion of his race in  the vanguard of progress,
 to the mixture  of blood  which  has taken
 place, as a  necessary consequence of the
 successive occupations of  Great Britain by
 different races.
   MARROW—Is  the fatty matter  which
 fills  up the centre of the  shaft of the long
 bones.  As an article of  diet, it possesses
 the  same  nutrient  properties as the  fats
 generally.
   MARSH-MALLOW —Is  found  on  the
 continent,  and  frequently in  England, in
 marshes near the  sea; it  bears pale bluish-
 red  flowers on the upright stem ; the leaves
 are heart-shaped, cut at the edges, and, like
 the stem, are covered with soft, hairy down.
 The whole plant  is mucilaginous,  but the
 root is the part chiefly used; four ounces
 may be put into six pints of water with two
 ounces of raisins, and the whole reduced
 one-third  by  boiling;   the mucilaginous
 decoction thus  obtained  is  to be strained
 through calico before use.
   Marsh-mallow  is  much  more used in
 France and Spain than it is in  this country,
 not  only in decoction, but also as lozenge,
 and syrup; it is, undoubtedly, a good de-
 mulcent, but probably not superior to linseed
 or pearl barley.
   The leaves of the common roadside mallow
 are often used in England  by the poor, under
 the  name of marsh-mallow, as an  addition
 to, fomentations; it is, perhaps, needless to
 add, it is a very useless one.
   MASTICATION.—The   act by which the
 food  is, or  ought to be,  reduced to a soft
 mass  before  swallowing,  by the action of
 the teeth, and by  admixture with the saliva.
| The importance of the proper performance
 of this act has been pointed oui in article 
M AT
343
M E A
 " Indigestion."   It has even been suggested,
 that the average of life  at the present time
 exceeding that of former periods is  partly
 due to the improvements in dentistry, ena-
 bling the aged to masticate their food more
 perfectly.
   Refer to Digestion—Indigestion.
   MATERIA  MEDICA, (Medical  Mate-
 rials.)—Refer to Medicines.
   MATICO—Is the  term  applied  to the
 leaves of one of the  pepper tribe, a  native
 of  South America;  the  drug has recently
 been introduced as a powerful astringent in
 cases of  bleeding;  the  leaves,  especially,
 being lauded as a certain remedy in obstinate
 bleeding from leech-bites.   The author has
 not found,  in his own  trials  of  it, that
 matico  possesses any advantage  over  other
 astringents, and  that which he  used  came
 direct from the importers; [and  such is the
 experience of others.]
   MAW-WORM.—See Worms.
   MEALS.—See Breakfast, Dinner, &c.
   MEASLES—Is one of the eruptive fevers,
 which most persons  go  through once in a
 lifetime, and  generally  during   childhood;
 the disease usually occurs as an epidemic,
 and is contagious.   The first symptoms of
 measles  are those of  a feverish cold ;  there
 is shivering, headache, loss of appetite, and
 perhaps vomiting;  the eyes  look red, and,
 as well as the nose, furnish increased watery
 discharge; there is hoarseness  and cough.
 On the fourth day of the disease, or in from
 seventy to eighty-four hours after the first
 symptoms of sickness have shown themselves,
 the peculiar  eruption of measles begins to
 appear, generally about  the  forehead, then
 on the neck and arms, and thence extends to
 the trunk and extremities; at first the erup-
 tion shows  only in red  points,  not unlike
 flea-bites, but these soon enlarge into rather
 broad,  slightly  purplish, crescent-shaped
 spots,  which  are just perceptibly elevated
 above the skin.   At this period, the skin is
 hot, there is a good  deal of general  fever,
 with thirst, and much hoarse  cough, with
 quickened breathing.  After remaining out
 about  four  days,  the  eruption—first,  of
 course,  on the face—begins to decline, and
 by the seventh day it has generally  disap-
 peared, leaving the skin  slightly roughened,
 followed by  separation  of  the  cuticle in
 small scales.
  Measles, however, does not always  follow
 the same regular course;  there may exist
 the constitutional symptoms without erup-
tion ;  but a  more  common variety is the
characteristic eruption without  any  consti-
tutional affection.  This, however, affords no
protection from future attacks of the disease.
Again, measles may prevail, either as a very
mild disease, scarcely requiring treatment,
or it may be as a most malignant and fatal
epidemic.  The principal danger in ordinary
measles arises from the affection of the chest,
especially in very young children, many of
whom  die from this cause, particularly if
the epidemic happens to  occur during the
prevalence of cold winds  in spring, and if
the children, as often happens among the
poor, are insufficiently attended to.  When
measles  occurs in its malignant, or putrid
form, it  becomes a fearfully fatal malady,
carrying off numbers of children, in  spite of
the best-directed treatment.
  In any case of measles, the safest  plan is,
of course, to have medical attendance; very
many  parents, however,  in  the humbler
classes,  when  the prevailing  epidemic is
mild in character, take the matter in their
own hands,  and do little more than keep
their children in bed for a day or two, if
they do  even that.   There is  no question
that a  mild  attack of measles will get well
without  any treatment; but  in  even  the
mildest, ordinary care to guard against cold
should be observed,  this being, of  course,
requisite in  proportion to the season of the
year.   If the attack be a smart one, the per-
son should be  kept in bed and moderately
warm,  allowed to  drink freely of diluent,
and  especially of demulcent  drinks, such
as barley-water.   The  diet should  consist
of milk  and farinaceous  matters;  cooling
fruits and  such-like  may  be  allowed,  the
bowels at the same time being  attended to,
but not purged.   Should  the  eruption  of
measles seem tardy in coming out, or come
out small or insufficiently, or, after having
shown  itself,  should  it  disappear again
suddenly, and before the time of its  regular
decline, danger must  be apprehended;  the
warm-bath is  at once the safest and  the
best remedy;  the child being  kept in  the
water—temperature 98°—from ten to twenty
minutes,  according to age.  In addition tc
this, to a child  five years  old, a drachm or
teaspoonful  of  spirit  of mindererus  should
be given in a little sweetened water every
two or three hours, and warm drinks freely
administered at the same time.  A very per-
nicious practice prevails, especially in  the
country,  among the poor, of giving children
stimulants,  "to bring  out the eruption,'1
and also in the course of the disease;  in Scot-
land, whiskey is given ;  in England,  cowslip
wine is the most generally employed stimu-
lant ;  [and  in  the United States,  saffron,
tansy,  and catnip teas are often resorted
to,  with  nearly  always   evil  results,  as
they increase the fever. Warm gruel is much 
M K  A
344
M E A
safer.]  It is perhaps scarcely necessary to
add, that  none but the most ignorant and
prejudiced could be guilty of so dangerous
a practice.  In  England there  seems to be
a popular prejudice in favour of the virtues
of the cowslip in measles, and when the wine
is not used, it is very common to find  the
infusion, or tea of the "cowslip  pips"  or
flowers, given; this, of course,  is  perfectly
innocent, and  may be permitted.  When the
feverish symptoms in measles run high, it is
commonly in connection with the chest-affec-
tion ;  in such cases, from four to six grains
of ipecacuanha powder and half a drachm
of carbonate of potassa are to be made into
a mixture with  three ounces of water, and
of this, a dessertspoonful given to a child
of five years of age every four or five hours;
in milder cases, ten or fifteen drops of ipeca-
cuanha wine are to be given in  the same
way.   Should  symptoms  of inflammation
within the chest show themselves, as often
happens  if  the child has been  permitted
to take cold,  (see Inflammation,) they must
be treated as  directed in  the article on the
subject; but in all such cases a medical man
should be called.  It must always be borne
in  mind,  that measles do not bear  much
lowering treatment, and that blisters are apt
to prove dangerous—a bran-poultice  being
always a  preferable  application.  An idea
prevails, that  persons affected with measles
cannot be kept  too  hot; this is often a
source of much mischief.   Cold certainly is
to be avoided; but  free ventilation, with
a moderate temperature, (see Bedroom,) is
always the most advantageous.   When mea-
sles  assumes  a malignant or putrid form,
the case must be considered as  eminently
dangerous.   In this form the eruption is
dusky and purple, or rather, livid, the patient
extremely depressed, and the tongue dry and
black looking.  Medical assistance as soon
as possible is, of course, indispensable, and
even then the hope  of saving life  is  but
small.   Nourishing  meat-broth,  wine, or
 warm wine whey must be given frequently,
 and  those measures resorted to which  are
 recommended under typhoid fever.
   The convalescence from measles requires
 much care, if the weather is at all cold, for
 the disease leaves a susceptibility to inflam-
 matory  chest-affection for some  time.   In
 children of weak constitution,  measles,  like
 the other eruptive fevers, is  apt to leave
 a tendency to discharges from the ears, to
 weakness and redness of the eyes, kc.
    Refer to Inflammation—Catarrh, Sec.
measure, (fig. xcvii.,) and the ounce  inea
sure, (fig. xcviii.)

                 Fig. xcvii.
                 Fig. xcviii.

  The  drop measure  is,  or ought  to  be.
cylindrical, as represented.  It is graduated
or marked with divisions equal  to  five or
ten minims each,  and may  be made  for
sixty minims or one fluid drachm only, or
for one hundred and  twenty minims or  two
fluid drachms, or for a greater quantity.
A minim  measure  for sixty drops will be
sufficient  for domestic purposes.  A minim
by measure contains  a larger quantity of
fluid than a drop;  the latter,  too, is liable
to vary in bulk according to the nature of
the fluid,  and of the lip of the phial or vessel
from  which it falls;  on these accounts, it
would be desirable that the measured minim
only should  be  used, but  as  the measure
glass itself must necessarily  be frequently
wanting,  the  drop  is  a more generally ap-
plicable mode of division.   When the doses
                                          of drops, of any medicine, are measured in a
  MEASURES.—Two kinds of measures are  minim glass, one-fourth ought to be allowed
used by the apothecary for smaller quanti-  for the greater bulk of the minim ; that is,
ties of fluid; these are the drop or minim I if the close is twenty drops of laudanum by 
MEA
345
MED
 drop, by minim measure it should be  only
 fifteen.
   The fluid ounce measure-glass [called " a
 graduate" by the apothecaries] is graduated
 as represented, (fig. xcviii.,) on the'right side
 of the perpendicular line into  fluid drachms,
 and on the left side into fluid ounces.  It may,
 of course, be made of any size, from one
 ounce upward.
   The other fluid measures used by the apo-
 thecary in England and Scotland are the pint,
 which contains twenty fluid ounces, and the
 gallon, which contains eight pints: in Ireland
 the  pint is only reckoned at sixteen ounces ;
 [and the same is the practice of apothecaries
 in the United States.]  The following table
 of the  apothecaries'  fluid measures,  also
 shows the initial  letters, by which, for the
 sake of  brevity, these  measures  are  distin-
 guished in prescription:—
       Fluid.          Symbol.
   One gallon............. C = 8 pints.
   One pint................ 0 = 20 ounces.
   One ounce.............. ^ = 8 drachms.
   One drachm............ 3 = 60 minims.
   One minim............. m
   Besides  these regular measures, there are
 a variety of less accurate modes of measure-
 ment for medicine, used on account of their
 convenience ; these are, the teaspoon, equal
 to about one fluid drachm; the dessertspoon
 to double,  and the tablespoon to four times
 that quantity,  or  to  half an ounce.    The
 wineglass  generally holds about two fluid
 ounces, the teacup about one ounce  more ;
 the  breakfastcup  and  tumbler  about half
 a pint each.  These  irregular  modes of
 measurement, however, are not only incon-
 venient, but they may,  at  times,  be of
 serious moment.   Spoons and glasses must
 vary greatly in size; what the poor  call a
 " meat-spoon" and consider  a  tablespoon,
 barely equals an  ordinary dessertspoon in
 calibre: again, one person will fill a spoon
 till it runs over, another scarcely more than
 half, so that in one  way or  another, it  is
 a great chance whether the patient  gets
 the  quantity the medical man orders.   To
 remedy these evils, glasses marked in table-
 spoonfuls, and porcelain measures (fig. xcix.)
 made only to hold a certain quantity, have
 been manufactured,  and  are  certainly con-
 venient  when at  hand.   But  by far  the
 most certain  method  of apportioning  the
 doses of fluid medicine, is by means  of the
 moulded  graduated  bottles  now largely
 used; these being marked in fourths, sixths,
 eighths,  &c.  and  the  medicine being pre-
 scribed in  these proportions, there  is  no
further trouble;  no  spoon is required—a
great saving to  silver,  which is  apt to be
Fig. xcix.
stained—and the medicine is poured directly
into the cup from whence it is drunk. These
graduated bottles are now beautifully made
by the York Glass Co., [England,] and are
not higher in price than plain ones.  A few
of them would be found convenient in most
houses.
  MEAT.—See  Beef—Flesh—Muscle—Mut-
ton, Sec.
  MECONIUM. —The  dark,  olive-green
discharge from the bowels of  a newly-born
infant.
  MEDICINES.—Under  this  head will be
included  all that would  come  under the
more correct designation of Materia Medica.
This  term,  which literally means medical
materials—that is, the various agents used
in the practice  of medicine—may appear
somewhat technical in a popular work, but
it is the most conveniently comprehensive
under which to include the enumeration of
all  those  agents, whether  medical or sur-
gical, which may be used  domestically.   It
is unnecessary here to give more  than an
enumeration, the agents themselves being
sufficiently treated of in the  various arti-
cles  devoted to them, either  classified or
individually.   The following list is meant to
include whatever, either in the way of me-
dical  or  surgical materials, an  intelligent
emigrant, in a remote district, might, with
reasonable  care   and  ordinary  common
sense,  safely employ; thus constituting a
domestic  materia  medica,  in its widest
sense.  At the same  time it must be  evi-
dent that, however  desirable  this latitude
may be for the circumstances supposed, it
is by no means requisite  for those who are
placed with greater facilities for procuring
proper professional  assistance; neither it 
M ED
346
MED
 it  recommended that they should take ad-
 vantage  of it  as  a whole, but  that  each
 should select whatever may  appear  most
 suited  to  their  own circumstances.    The
 articles in  the list to which the asterisk  is
 prefixed  are  such  as may most  readily be
 dispensed  with   in most  instances.    Of
 course, the list includes but a portion of the
 medicinal remedies  mentioned  throughout
 the work at large; neither does it include
 other  agents  used in  medical treatment,
 Buch as heat, cold, &c.
   A list of the most generally useful domestic
 medicines: —

 ♦/K.tiier—Either chloric or sulphuric.  To be kept  in
    a stoppered bottle, tied over with bladder, or with
    sheet gutta-percha.—Chloric aether, see Appendix.
 Aloes—In the form of the simple drug.
 Alum—Burnt, in powder.
 *Ammo.ma—The carbonate of ammonia, to be kept  in
    a wide-mouthed, stoppered, or well-secured bottle.
 Ammonia—The compound spirit of ammonia, or sal-
    volatile, to be kept in a stoppered bottle.
 Ammonia—The acetate  of ammonia, or spirit of min-
    dererus.
 Antimony—The tartrate of antimony, or tartar emetic.
 Antimony—In the form of James's Powder, [or Tartar
    Emetic]
 ♦Arnica—The tincture.
 ♦Bismuth—Nitrate of, in powder.
 ♦Borax—In powder.
 ♦Columbo—Root, and powder of root.
 *Camphor—In bottle.
 Cantharides—Or Spanish blistering fly.  In the form
    of the common blister plaster, or in the form of
    blister tissue, or of blistering fluid.
 Castor-oil.
 ♦Catechu—The simple drug.
 Ch ALKrr-Prepared.
 ♦Chamomile Flowers,
 Chlorink—Disinfecting  powder, Collins'g; or solution
    of chloride of lime, Beaufoy's.
 Cinchona Bark.—The simple  drug, or in the form of
    quinine.
 ♦Confection—Aromatic, in powder.
 Cotton Wadding—In sheets.
 Cream of Tartar,
 Creasote—In stoppered bottle, about two drachms.
 Copper—Sulphate of—blue vitriol.
 Diachylon Plaster—Adhesive plaster; but not spread
    if going to a warm climate. [That made in the
    United States, and put up  in  rolls in a tin case,
    will keep in any latitude.]
 Dill-water—For infants.
 Extract of  Henbane.
 ♦Galls—'Whole, or jn powder,
 Gentian Root.
 Ginger.
 *Gcm Arabic—In mass and in powder.
 Ipecacuanha—In whole root, and in powder.
 ♦Iron—Sulphate of—green vitriol.            ,
 Iron—Tincture of muriate of, "tincture of steel."
 ♦Jalap—Powder.
 Lead—Acetate, sugar of.
 ♦Lemon-juice—Bottled, if for a sea voyage.
 ♦Linseed Meal.
 Magnesia—Calcined or fluid.
 Magnesia—Sulphate of—Epsom salts.
 Mercury—Chloride—Calomel.'
 Mercury—With chalk—gray powder.
♦Mercury—Red precipitate.
♦Muriatic Acid—Spirit of salt, in stoppered bottle.
 Mustard—In powder, in close canister.
♦M^irh—Tincture of.
*N'r»uc Acin—Aqua-fortis, in stoppered bottle.
*OlL—Camphorated.
Opium—Tn powder.
Opium—Compound tincture, with camphor— Parcgnrio.
♦Opium—In the form of Pauley's solution, a small
    quantity, or in tlio form of muriate of morphia.
Opium—In the form of laudanum.
Pills—Eithe? in powder, rendy mixed for making up,
    or made up with a small addition of glycerine to
    keep them soft,  and kept in stoppered bottles.—
    Blue pill in the mass, in a well-covered pot.
Pills —Compound colocynth pill.
       Compound colocynth pill, with calomel.
       Compound colocynth pill, with blue pill.
       Compound rhubarb  pill.
       Compound expectorant pill.—See Pills,
Potash—Bicarbonate, in  powder.
Potash—Nitrate of—saltpetre, in  powder.
♦Potash—Solution of—"  liquor potassse," in stoppered
    bottle.
Powders—Compound.
         Compound chalk,  with opium.
         Compound  powder of  ipecacuanha  and
           opium—Dover's powder.
Rhubarb—In root, aud powder of root.
Rhubarb—Tincture of.
Scammony—In powder.
♦Squill—In tincture.
Senna—Leaves.
Silver—Nitrate of, or lunar caustic in stick mould, in
    a bottle, or with gutta-percha holder.
Soda—Bicarbonate, in powder.
♦Spirit of Wine.
Spirit of Sweet Nitre.
Sulphuric  Acid—Oil  of  vitriol, diluted to medicinal
    strength, and kept in stoppered bottle.
♦Tartaric Acid.
♦Turpentine—Spirit of.
Zinc—Sulphate of, white  vitriol.
   [Before  purchasing   any of, these, the
reader would do well to consult an intelli-
gent druggist,  or  a physician.]
   To the above medicines, or such  of them
as are selected, it will be requisite to add a
set  of  scales with apothecary's weights; a
couple, at least, of "graduated" glass-mea-
sures ;  a Dutch tile;  a bone spatula, and one
or two  iron spatulas or palette knives; a fil-
tering funnel  or tun-dish, and a moderate-
sized mortar and pestle  of VVedgewood ware.
The above  may be said to be the necessary
articles of  the  domestic  laboratory, and  it
is  advisable that they and  the  medicines
should  be  included  in a chest or box pro-
perly constructed for the purpose.   Where
expense is not too great  an  object, strong,
glass-stoppered bottles will be found the
best receptacles  for the various medicines,
wider   mouthed  ones  being  used  for the
pills and powders,  and narrow ones for
fluids.   In addition  to the above requisites,
the following will be found convenient addi-
tions for all, but especially in the case of emi-
grants : —A measure graduated for doses; a
few bottles of various sizes, from half a pint
downward, graduated, that  is,  marked into
parts,  such as fourths, sixths,  &c.;  phial-
corks ;  filtering or blotting paper; a few cut
papers for powders ;  a glass rod for stirring.
   The  above-mentioned  articles may and
ought  to  be  included in  a  thoroughly fur-
nished   medicine-chest;  and   thore who 
MED
347
M E D
would be completely equipped, should also
provide  the  surgical materials  mentioned
below.   All  these, however, add to the ex-
pense;  and as  there  are  many  persons,
whether emigrants or  others,  who  either
cannot or do not wish to incur the cost of
providing so amply, but yet who would de-
sire to  keep beside them  a stock of the
most  efficient  medicines,  and  those  most
likely  to be required on  emergencies,  an
emigrant's medicine-chest has been manu-
factured by Mr. Hooper, of Pall Mall, London,
[and by all others in all large cities,] which
is calculated to  contain, in the most com-
pact form,  a stock of  selected  medicines,
with the means of dispensing them, such as
scales, measures, &c.  Mr.  Hooper's chest is
entirely constructed of japanned tin, this ma-
terial  being better calculated to resist the
effects of climate, and the attacks of insects,
than wood, and at the same time occupying
much  less space; indeed,  the  entire chest
measures barely eight inches in length, and
five in width, and the same in depth, and is
to be sold stocked, at  a  cost of 30*., which
will place it in the power of most.
   A complete  medicine-chest, in  the full
sense  of the word, cannot  certainly be pro-
vided when the object is to  furnish one fitted
with selected medicines, of the best quality
—more  essential than  quantity or great
variety—at such a  moderate price as will
make it generally accessible ; but, of course,
those who  can afford it, and may  desire a
more  amply furnished store, can  have  it
constructed  on the same  principle as the
smaller and cheaper article.
   In the  case  of emigrants especially, the
author would advise those  who are provid-
ing a  medicine-chest, to make themselves
well  acquainted, previous  to purchasing,
with the probable  requirements of the cli-
mate and  situation to which they are  re-
moving, or which  they  are likely to pass
through; thus, for instance, quinine would
be a much more indispensable article for the
settler in some parts of the United States,
where ague prevails, than for the Australian
emigrant; or sulphate of zinc, for eye-wash,
would be an omission not to  be supplied in the
medicine-store of the voyager upon  the Nile;
or, as another example, persons going to hot
climates must not take their adhesive plas-
ters ready spread, [unless in canisters.]  By
reference to the articles on the individual me-
dicines mentioned in this work, the  requisite
information on these points will be gained:
it is unnecessary,  therefore, to detail it here.
  To  the surgical department belong—lint
and old linen;  oiled silk or oiled calico, or
thin sheet gutta-percha;  bandages; scis-
sors;  pins;  goldbeater's leaf, &c.  Instru
ments, properly so called, (see Instruments,)
must  entirely depend upon the contingent
circumstances, present  and probable, an \
upon  the  inclination  of  the  individual
Indeed, so  much  depends upon these, that
it  is  impossible  to lay down any uniform
system of domestic materia medica ; but it
is  trusted  that the foregoing enumeration
will be some guide in  the selection.   At the
same  time,  the author would strongly advise
parties,  either  resident  in  England, or
going  abroad,  to avail themselves,  when
possible, of the aid of a medical friend, or
adviser, when furnishing the domestic labo-
ratory.   They will thus be put in the best
way of getting what they want, good  of its
kind ; this  is  essential, for the money had
better be kept in the pocket than wasted
upon  cheap and worthless  drugs:   they
will, too, have some guarantee that when  a
good  price  has been  given, a  good  article
has been procured.—See Drugs.   Further,
although there are certain general remedies
which none can err in providing, there may
be others more especially adapted, either to
the constitutional tendencies of the  indi-
vidual, or family, or,  in the  case of  emi-
grants, to the nature of the climate,  and of
its  peculiar diseases,  to  which they are
about to remove.  These are points on which
a medical man only can give proper advice;
and few are so friendless as not to be able
to get it;  indeed, the  author knows well
that none need want advice on these points;
the members of the medical profession will
always give, and  give it freely, under such
circumstances.   This  article is little more
than an enumeration of our domestic reme-
dies,  the plan  of  the  work  rendering it
necessary that the information  connected
with each should be given under the  indi-
vidual heads, and  to these the reader is
referred in particular,  as well as to  such
articles  as  Bedroom—Dressing—Drugs, Sec.
Indeed, the reference  may be said to extend
to the work at large.
   In  accordance with  the plan laid down
at  the  commencement, whenever doses of
medicine are  given, they are, unless  it is
otherwise specified, such as are suitable for
an  adult;  the following table is generally
considered  a sufficient guide in the  appor-
tionment of the doses to the different ages:
  For an adult—
Suppose the dose to be 1, or 1 drachm....3 I
Under
 1 year the dose will be -fa =  5 grains...gr. v
 2          "          i=  8 grains gr. viii
 3          "          £ =10grains...gr. x
 4          "          | =16grains..gr.x\ 
MED
:J4*
i\1E D
Under
 7 years the dose will be J =  1 scruple...9 i
14         "         |==  Jdrachm...3fs
20         "         |=  2 scruples..^ii
21 to 60 years...... ..............1 drachm...3 i
  Above sixty—that  is,  in  old  age—the
dose gradually diminishes.
  Although the above table is, and may be,
accepted as  an  average rule, it must not,
by any means, be adopted  as an invariable
me  in  practice, without  reference  to the
i-onstitution,  state  of health, &c. of  the in-
dividual.   A  strong child at  three years of
age may require, and  may tolerate  better,
a  much stronger  dose than a weaker  or
weakly one two  years older.   Moreover, in
the case of many aged persons, purgative
medicines especially will  often  require  to
be used as actively as in the young.  Again,
in such a medicine as opium,  the propor-
tions given in the  table would give  rather
large doses  for  children,  while,  on  the
other hand, in the  administration of mercu-
rials, such  as calomel or gray powder, they
would reduce them too greatly.  These ob-
servations  are  made,  as  qualifications  to
what some  might regard, from its being in
the tabular form, as a complete guide in  all
cases.   The  variations are  of  less  conse-
quence, as  sufficient information respecting
dose is  always given in the place or  article
in which it is directly  requisite.
  As a general rule, women require smaller
doses of medicine  than men;  and  at the
same time, it is  always requisite to keep in
view the peculiarities, periodical and other-
wise, of their constitutions; and in the case
of matrons, the possibility of pregnancy.  It
is better to avoid the use of strong  purga-
tives, and of astringents, during the healthy
menstrual  period.  In some cases,  all re-
laxing remedies, such as warm  bathing  of
the  feet,  and diaphoretic  medicines, are
inadmissible  during the same event.   Tem-
perament, in all cases, requires to be con-
sidered in  the administration of medicine.
See  Temperament—Diathesis, Sec.
  There is some  art—and  a  good deal
depends upon  it—in  administering medi-
cines properly, not only to children, but to
adults.    It  is  a very common  popular
saying, that " doctors do  not give  sugar-
plums," and verily, unless it  be the homoeo-
paths, they do  not.   At  the  same  time,
much may be done to  lessen the nauseous-
ness  of many  drugs;  the  methods are
generally pointed  out when the medicines
themselves are  treated ;   the following do
not  occur  under  any regular  head.   The
aromatic waters, such as  peppermint, cin-
namon, &c. are  as much disliked by some
as they are liked by others ;  their  addition
to medicines  may,  therefore, generally—
unless they are  given  as carminatives—be
left to choice; as a rule, they do not render
the medicine  more  palatable.   The same
observation  generally applies to sugar  and
syrups; in cough-medicines  and  the like,
sweetness may be agreeable,  and an advan-
tage, but in the case of a nauseous medicine,
sweetening it only renders it more  sickly
to most patients. From his own experience,
the author can  testify that the fewer addi-
tions made to  the essential medicine—what
physicians call  the  " basis"—the  better.
In the case of children,  bulk is always an
objection to be  guarded against, as much
as consistent  with  utility.    The fact is
perhaps not sufficiently realized practically,
that one  most efficient method of avoiding
the taste of nauseous medicine is to blunt
for a time the acuteness of  the  nerves of
taste:  nothing does this so well and agree-
ably as the essential oil of orange or lemon
peel.   A small piece of the  rind of  either
of the above fruits chewed, just before  and
immediately  after swallowing the dose, is
very efficacious.
  The nature of the  medicine, and its form,
should, in  some degree, bear  a connection
with the periods of the twenty-four hours.
Tonic remedies  generally, are better  taken
before evening;  the time for taking purga-
tives  should, in  some degree, depend upon
their nature.   Unless for some special pur-
pose, liquid purgatives, such  as castor-oil,
senna, salts, &c. which, like  liquid medi-
cines generally, exhibit their action  quickly,
should not be taken late in the evening,
when  their action will probably disturb the
night's rest.  Pills  and  powders,  on  the
other  hand, which are slower in their  ac-
tion, may be, and generally are, taken at
night.   Although medical men order some
medicines to be  taken upon a full stomach,
for special  purposes,  the  generality  are
better taken when the stomach ia empty, or
nearly so ; tonics, purgatives, astringents,
&c, particularly.   In the first place, they
are not so likely to  interfere with the pro-
cess of digestion, and in the second, their
proper action is  more readily and effectually
manifested.
   In  conclusion, it might be thought by
some,  that more of what medical men  call
prescriptions, and the public, recipes, might
have been given in this article, or through-
out this work generally.  But the author
trusts that before this, the principle of his
system of  " safe domestic  medicine"  has
been  manifested;  that it is not to furnish a
set of nostrums, one "good  for" this com- 
MED
349
MED
 plaint, and another "good for" some other,
 to  be used  without reason why  or where-
 fore.   Such a  system  of  blind  popular
 quackery  is truly mischievous, and very far
 apart from the intelligent management  of
 disease, modified more or less, according to
 circumstances, and which is based upon a
 true, even though a popular, knowledge of
 the functions and requirements of the human
 body as well as of the constitution, disorders,
 and  accidents  to which both are  liable.
 Under such  a system, no series of nostrums
 and mixed recipes is requisite ;  its safety
 and its efficiency rest, in the first place,
 upon the correctness and  intelligent under-
 standing of the  anatomical  and physiolo-
 gical knowledge, as far as it goes; upon the
 clear appreciation of the causes and nature
 of disease and accident,  as far as they can
 be popularly explained; and lastly, upon the
 simplicity of the means of alleviation or of
 cure, which can be legitimately pointed out.
  The  term " medicine"  is usually given to
 the substance  in its  prepared state; in its
 crude condition  it is more generally called
 a drug.—See Drugs.
  The prepared forms of medicines are—
  Cataplasm, or poultice.  Mixture.
  Cerate.                  Ointment.
  Confection.             Pill.
  Decoction.              Plaster.
  Distilled water.         Powder.
  Enema, or Clyster       Spirit.
  Extract.                 Syrup.
  Infusion.               Tincture.
  Liniment.               Wine.
  Metallic salts.
  Medicines are also divided according  to
 their actions, as follows:—
  Antispasmodics.        Errhines.
  Astringents.             Escharotics.
  Antacids.                Excitants.
  Demulcents.              Expectorants.
  Diaphoretics.           Narcotics.
  Diluents.                Purgatives.
  Disinfectants.           Refrigerants.
  Diuretics,               Sedatives.
  Emetics.                 Sialagogues.
  Emmenagogues.          Tonics.
  Epispastics.
  For explanation, refer to the articles on
 the above subjects.
  Refer  to articles on  medicines  individu-
 ally and classified—Measures—Filter—Scales,
 $c.
  MEDICINE.—The science  and practice
 of medicine is, in its highest  and worthiest
 sense,  the  practical application  of many
 sciences to the investigation of the number-
less diseases and disorders to  which the hu-
man frame is liable, and to  their removal,
      2E
as a result  of that investigation, either by
the direct action of medicine, properly so
called, by medicine as an assistant simply to
the natural  tendency toward  health, or b?
other means which exercise a beneficial in
fluence  over the health of the body.  To
exercise well and truly this  noble art is,
perhaps, the most difficult task in  which a
man can engage;  but  it would  seem also
to be  the  easiest channel through which
the ignorant knave can gull his fellow-men.
That it  is so, however, cannot be laid to the
charge  of the  science  of medicine, but is
the consequence of the  thorough  ignorance
respecting the nature  and requirements of
their own bodies and constitutions in which
people,  hitherto, have been for the most part
content to rest;  an ignorance which, strange
to say, has been too often favoured by mem-
bers of  the medical profession, who  seem to
have laboured  under a morbid dread  lest
a patient should have the least rational idea
of the  nature of his own malady, or of the
means—medical and otherwise—requisite for
its removal.   The effect of this mystery has
been, in the  eyes of the ignorant, to place
the educated physician in many instances
on the  same level as the charlatan—more
particularly  in  cases  requiring  long and
slow treatment.  In  a case  admitting  of
rapid and successful cure, by the  well-di-
rected  efforts of scientific treatment,  even
the most ignorant can see and, in some de-
gree, appreciate the educated skill which has
afforded the striking  result.   But  should
the case prove to  be a necessarily tedious
one—its progress slow, perhaps uucertain,
ebbing  and  flowing—the  patient and  the
patient's friends, unconscious of the nature
of the   case,  and of the  difficulties to be
overcome, see nothing, perhaps,  but mys-
tery in  the   treatment;  looking  upon  the
curative powers of medicine  as  exerted in
some  undefined curative effect  upon  the
disease.  On seeing first one medicine pre-
scribed, and then another, they probably
attribute the changes to the endeavours of
the physician to "hit the complaint," while
he is only making those changes requisite
in every case of continued  disease,  to meet
the varying  and varied symptoms which
arise ; and when, by the exercise of patient
skill, the disease is cured, the last medicine
reaps the credit of  the whole; and if the
patient  has  been whimsical, very probably
the last doctor gets  the full credit  for that
which was really effected  by a predecessor
in attendance.
  Now,  while it is evident that the entire
treatment of such cases may have been con-
ducted on the most scientific,  rational, and 
MED
350
M E  M
lon^cie&tiuus principles, to an  ignorant or
prejudiced patient—and  there  are  many
Buch—or  to  one  kept  in  ignorance,  the
whole is unintelligible, quite  as much so as
the quack nostrum, as far as the method of
cure goes.   And, perhaps, if the  physician
be a conscientious man, holding out far less
brilliant prospects of speedy cure, the quack's
promises and lies carry the day against  the
physician's  well-considered,  and,  perhaps,
s;uarded opinion;  for the  simple reason
that the patient is without any true rational
idea of  the structure  of his  own frame—of
the requirements of his own  constitution—
of the nature and tendencies of his malady,
and, lastly, of the objects  and intentions
which  regulate the  necessary  treatment,
and direct its aim.
  Quackery and deception,  in  connection
with the  treatment  of disease, never will
and  never  can be  extinguished  by legal
enactment—they flourish on ignorance alone.
It may  be said that  the higher and edu-
cated classes in this  country are the chief
supporters of quackery, legal  and illegal,
patent  and secret, and undoubtedly they
are—because they are ignorant—ignorant
of the  simplest  laws which regulate  the
working of that frame, so fearfully and won-
derfully made,  in which God  has  placed
them to dwell on earth.
  It is  a reproach  often brought  against
medical science and practice, that  it is "so
uncertain,"  so  full of  doubt, so liable  to
error:  if persons would  but reflect for a
moment, it would be apparent that this un-
certainty  must in some degree be insepa-
rable from a science which is not one of order,
but of disorder; unlike chemistry, astronomy,
and the other exact sciences, medicine has
to deal with that which is regulated by  no
fixed laws, but  varies with the constitution,
the habits, circumstances, and numberless
other contingencies connected with the indi-
vidual whose constitution, on the other hand,
has its  own peculiar susceptibilities to  the
action of  remedies.   These  considerations
will  show why medicine  must be to some
amount  uncertain ; but with this admission,
it  is contended, that  its skilful practice is
capable of conferring  the most extended be-
nefit on  suffering humanity.   If medicine is
yet uncertain, it is far less  so  than it has
been, and every day is making it more exact.
  The practice of medicine or treatment of
disease  may be  classed under the two divi-
sions  of  Empirical   and Rational.   The
former is  rather the result  of experience
and experiment than  of reasoning,  and  ad-
ministers medicine which is known to remove
certain  symptoms, or sets of .symptoms—
constituting a disease—without any rational
ground for the  administration of the cura-
tive  agent  beyond  the  fact  of its  being
known from experience  to  act  beneficially
in such cases.   Rational medicine,  on the
other hand, looks less at the symptoms than
at the  causes, and endeavours to ground  its
treatment upon the observations after death,
and upon microscopical, chemical, and other
examination. The most efficient practitioner
will  probably be he who neglects  neither
method.
  Refer to Diagnosis—Disease, Sec.
  MKGRIM—Is a species of nervous  head-
ache affecting  only  one  side of, or one de-
fined spot on the head, and  is generally the
result  of  debility.   The immediate  attack
of megrim  headache may  be relieved  by
the application  of flannel or sponge, soaked
in hot water.   The tendency is to be re-
moved by the improvement of the  general
health and  strength, by  good  diet, air, and
exercise, and by the use of bark, iron, and
other tonics.
  MELON.—The well-known  pleasant 'but
indigestible  fruit.
  MEMBRANE—In its  purest  form, is a
thin expanded substance or pellicle, in which
no trace of structure can be detected under
the highest powers  of the  microscope;  in
this state it  is now known as " primary" or
'• basement" membrane.   Membrane, how-
ever, may be constituted also, either of flat
cells or of interlaced  fibres.  The surfaces of
the serous or mucous membranes are spread
over with  a  layer of minute  cells, which are
concerned in, and adapted to  the functions
of the particular membrane  they cover; this
layer is called  the epithelium of the mem-
brane, and resembles, in situation and pur-
pose, the epidermis or cuticle which is spread
over the skin.
  Refer to Skin.
  MEMORY—The mind's record of the past,
is, we  have  every reason to believe,  impe-
rishable.  The  power  to recall what has
been  imprinted on  its,  to  us,  mysterious
tablets, may not be always at command, but
all know that it is more so at one time than
another; and medical men not unfrequently
meet with cases of disease, in which the me-
mory of long-forgotten knowledge is  again
opened up ;  the scenes,  the thoughts, i.nd
the language and words of the  first  child-
hood  pass again through the mind jf the
second ; the thoughts and feelings  uf later
times  are  unremembered,  and  the  Greek
exercise or Latin poem of the school-room
are once more gone over correctly, by those
to whom they have been  unknown  tongues
for  years.   This resuscitation,  as it were, 
MEN                351                M E N
 of memory, as the effect of disease, is not
 less remarkable than its loss; in many in-
 stances, under the same influence, one man
 will remember numerals but forget  letters,
 another the reverse; one can only recall the
 last syllables of words,  a second stops short
 after repeating the first. Still more remark-
 able are the cases of double memory or con-
 sciousness, several of which  are  on  record.
 In  these,  either  in  consequence of some
 acute disease, or mental shock, all memory
 seems to be swept away; the mind is left a
 perfect blank, and education, even in adults,
 has to be commenced  anew.  In such cases,
 the individual has gone on  for some time
 acquiring the simplest  rudiments of know-
 ledge, when, all  at  once,  the old memory
 has returned,  and with it all its  mental
 stores, blotting out,  apparently,  the new;
 and this alternation  of these two singular
 states of mind has occurred again and again.
 Loss of memory, exhibited either with re-
 spect to things that have hitherto been well
 remembered, or in unwonted difficulty in
 the acquisition of new  ideas, must, unless
 well accounted for by advanced age, be re-
 garded suspiciously, as the possible result
 of incipient cerebral disorder—it may be, of
 a tendency to insanity.
   MKNORRHAGIA.— See Menstruation.
   MENSTRUATION.—The  monthly peri-
 odical discharge,  the  "catamenia,"  is  one
 of, if not  the most important of the facts
 connected with female health.
   Commencing, usually, in  this country, be-
 tween the  ages of thirteen and fifteen, its
 recurrence in health—except during preg-
 nancy and nursing—is  generally extended
 for a period of thirty years.  It needs not to
 dwell  upon the necessity  for  the mainte-
 nance of the regular and sufficient develop-
 ment of this function during those thirty
 years of life.  Females  are generally suffi-
 ciently aware of it, although sometimes, in
 carelessness or wilfulness, they neglect  the
 temporary self-restraint it imposes.
   It is  a foolish error, or neglect, not un-
 common with mothers, to omit all mention
 of  the  occurrence of this  event to their
 daughters:  the consequence is,  that  the
 symptoms  which  usually  precede  it  are
 ignorantly unattended to, and, it may hap-
 pen, the  development of  the  function  is
 checked  by imprudences which a little  in-
 formation  might  have  prevented.   More-
 over,  the  unexpected  appearance  of the
 period is apt to excite much alarm, and the
 mental  agitation, or  other  causes, may at
 once check a natural and healthy proceed-
ing; it need  scarcely be  said, with how
great probable  injury to health.  Mothers
  or female guardians should always forewarr-
  those  committed to their charge,  and puT
  them on their guard against those exposures
  to cold and fatigue, to mental  excitement,
  or abuse of purgative medicines, which may
  interfere with the natural relief.  There is,
  of course, considerable variation as regards
  the amount of the menstrual discharge, and
  also in the period of its  continuance.   The
  one  is in  this  country  from  four to  five
  ounces,  and  the other from three to  five
  days on the average.
    Climate, temperament, habits, &c. all ex-
  ert much influence  over the function in dif-
  ferent individuals,  or  even  over the same
  individual  at different  times;  but these
  variations  may all  fall within the  limits of
  health, and  do  not require interference;
  and, althtfugh in the majority of instances
  the function  is established before  the  six-
  teenth year, it  may, coincidently with per-
  fect  health, be  delayed two or  three years
  longer.  Generally, however, the delay, or
  non-development of the menstrual function,
  if not  owing  to structural  deficiency, or to
  mechanical  obstruction,  is  owing  to  some
  deep-seated constitutional defect,  such as
  is usually  distinguished  as " chlorosis" or
  " anaemia."—See Anaemia.   In any case,
  medical advice  is  requisite  to  give  those
  proper directions for  the  improvement of
  the  general  health and  strength, which
  are  necessary,  or to investigate the cause,
  whatever that  may be,  of so important a
  deficiency.
    After the first appearance of menstrua-
  tion, it is not uncommon  for the second to
  be delayed for  a  considerable period, with-
  out the health in the least suffering: after
  its full establishment  this can  scarcely be
  the case.  During  the  menstrual  period,
  there is almost always some amount of irri-
  tation  of the  system, at least of  an in-
  creased susceptibility  to  external  impres-
  sions, and very often of increased tendency
  to hysterical affections.  These facts always
  require to be kept in mind in the treatment
  of disease, and care taken that this does not
  interfere with the natural discharge, which,
  often in itself, proves no slight relief; indeed,
  there exists so strong a prejudice  on this
  point among females themselves, that they
  will  voluntarily  stop a course of medicine
  at the time of their period. As well known,
  menstruation is  generally  absent  during
 suckling.  Its occurrence and  recurrence,
 while this is going on, should be a signal for
 weaning, for not  only  is  the double  drain
 most hurtful to the maternal constitution,
 but the milk undergoes alteration, becomes
j more serous and less nutritious. 
M E N
35^
M E N
  Menstruation  may be interfered with by
causes from  without, which check its  de-
velopment, and  throw it, as it  were, back
upon  the system ; or by causes from within,
generally incipient disease, such as  con-
sumption or general debility. In the former
case,  the stoppage  is of the active, in  the
latter, of the passive character.   In either
case, the term " amenorrhcea" is applied to
the condition by medical men.
  When  menstruation in  a  healthy female
is checked by external causes, such as cold,
the whole system exhibits symptoms of  op-
pression.  There is probably fever, much
headache, torpor* pain  iu the  back, loins,
&c. ;  these  symptoms  being aggravated,
and perhaps mixed  up with hysteria, on the
return of each menstrual  period.  In such
cases, relief is  best afforded by those  mea-
sures  which  tend to relieve the overloaded
system.  Free  purgation  by some of  the
more  active  pills, such  as compound colo-
cynth, or compound rhubarb, with or with-
out calomel or blue pill,  senna, jalap,  &c.
will   be  found  of service.  Effervescing
draughts of carbonate  of potassa  and tar-
taric acid may be tolerably freely taken.  If
there  is much complaint of headache,  or of
pain in the  lower  bowels,  leeches in  the
groins,  or cupping at the  bottom of  the
back will do good.  But these must be used
in  the interval, not just  at the return  of
the period, at which time, immersion of the
feet  and legs in hot mustard  and water
and hot hip-baths will be  most serviceable,
the latter at the full heat  of 98°, and re-
peated nighty for a few times, the patient
remaining in for  twenty minutes.   Until
the restoration  of the   function  the  diet
should  be  reduced, especially  as regards
animal  food  and  stimulants, and walking
exercise  regularly taken for a considerable
time every day.
  In Amenorrhcea, or suppressed menstrua-
tion from constitutional  causes,  the reverse
of all  these measures recommended above
will probably be requisite.  In  such cases,
the secretion is  not thrown back upon  the
constitution,  but   the  constitution,  from
some  cause, has not power  to bring it for-
ward.  It is evident, then, that  remedial
measures  must not be so  much  directed to
the inducement  of  the function, as to  the
amendment  of the  debilitated constitution
and  improvement  of the general health.
For these purposes, the plan recommended
under  article " Anaemia"  will be generally
applicable, and  to  that the reader  is  re-
ferred.
  In  any case of suppressed menstruation,
medical  attendance  should be procured if
possible,  but  especially   so  in  the  last-
mentioned form,  when the secretion ceases
without any appreciable cause, and the con-
stitutional powers seem to bo impaired.  In
such cases, the threatening of some disease
of debility is to be dreaded, which may, if
detected early, be nipped  in the  bud.   It ia
repeated, in such  cases a  medical  examina-
tion cannot be too soon submitted to. More-
over,  the  distinction  between  suppressed
menstruation  with  overfulness, and  that
dependent upon   debility,  is   not always
clearly  defined.   Such cases call for  the
most careful exercise of educated judgment.
In  cases  of  suppressed menstruation,  the
chance  of pregnancy  is,  of course, to be
kept in  view.  Many  mistakes  have been
made on this point.—See  Pregnancy.  The
time of life is, of course,  to be  considered,
and the possibility of the secretion disap-
pearing at an earlier age  than common.
  In some cases of suppressed menstruation,
what  is called a vicarious or compensating
discharge is sometimes established from the
nose, the ears,  the lungs,  the stomach, &c.,
sometimes from an open ulcer.
  Painful menstruation, " dysmenorrhcea,"
is very common  both  among  married and
single, chiefly those  of an irritable consti-
tution,  and of indolent habits.   It causes
much suffering: the subjects of  it  are less
likely  to  become  mothers, and  often  mis-
carry.   As regards the cure of this painful
disorder, it is not a matter for  the unpro-
fessional, it is generally  tedious  and dif-
ficult, or it may be unattainable,  even in the
best hands. For the relief of the paroxysms'
of pain, much may be effected.   Dr. Asbwell
says,  " Let the patient, on the first premo-
nition  of pain, commence the  use of  the
hot bath at 90° or 98°, and  ordinarily  re-
main  in it for a half  or  three-quarters of
an hour, repeating it three or four  times in
the twenty-four  hours, and always guard-
ing against the effects of cold,  by keeping
in a hot bed, so  long  at  least as to  allow
the skin to resume its  natural temperature.
When the pain is  very  severe, the bath may
be  continued  until  faintness  is  induced;
and if it be inadequate  for this  purpose
then half a grain of ipecacuanha or fifteen
drops of antimonial  wine  may be exhibited
every  hour."   Opiates  give  relief;  five
grains  of  Dover's powder may  be  given
twice  or three times in the  twenty four
hours, or ten drops  of laudanum, or  .seven
or  eight of Battley's solution at  the dame
intervals.  Anodyne suppositories  (sec Sup-
pository) are often of much service, or small 
MEN                353                ME N
 warm clysters,  containing  ten or  fifteen
 drops of laudanum ;  castor-oil being used
 if an aperient is requisite.
   In the slighter cases of difficult and pain-
 ful menstruation, the hot bran poultice may
 be substituted for the hip-bath.
   Profuse menstruation,  or menorrhagia,
 like  internal hemorrhages,  may  be either
 of an active or passive character.  Many
 varieties of the affection are recognised,  but
 it will be sufficient here to consider it under
 the above two general heads.  Those  ad-
 vanced in life are,  as a general rule, most
 subject to the disorder.  Constitutional ten-
 dency and  the influence  of climate both
 exert so much influence upon  the freedom
 of the menstrual discharge, that they must
 not be lost sight of in the consideration of
 cases of menorrhagia.   What in one person
 would be excessive,  may be only natural in
 another, and the usual amount in a warm
 climate  would  be accounted  profuse in a
 cold one. Profuse menstruation of an active
 character is most apt to occur in  persons
 of full habit of body; and  in  such cases,
 within  certain limits, may  be considered,
 and allowed to go  on, as a salutary relief.
 When, however, it  becomes  so free as to
 tell distinctly  upon the  strength,  medical
 assistance  should be procured, and in  the
 event of the case  being a severe one, blood
 and clots being passed away in quantity,
 treatment  similar  to that  recommended
 under the head of  " Abortion" should  be
 resorted to till proper aid  can be obtained.
 Females liable  to these attacks of profuse
 menstruation, if of full habit of body, ought
 in  the interval  to  submit  themselves to
 medical  treatment.   Animal  food  must be
 taken sparingly, stimulants avoided, early
 rising practised, and  active  exercise taken
 during the day, the  bowels being attended
 to by cooling saline  aperients.  A teaspoon-
 ful of Epsom  salts, with fifteen drops of
 dilute sulphuric acid, taken  every  morning
 in  half a pint of water, will form  a most
 suitable dose. Continued and repeated active
 menorrhagia may end in the passive form.
   Passive menorrhagia is most general in
 persons of debilitated constitution, in whom
 every drop of blood  is of consequence, and
 in whom the continued weakness resulting
 from  the disorder  is  very apt to  lay  the
foundation of  consumption,  and other dis-
 eases of debility.  Such persons ought always
to be under the care of a medical man.  In
the event of a sudden attack, means very
similar to those employed in the active form
 are to be at  once resorted to, the strength
being supported by strong animal  broths,
and, if there is much exhaustion, by stimu-
      2 e 2                               2
lants.   In  such cases, the oxide of silver,
as  recommended  by Sir  James  Eyre, in
one-third and half-grain doses, is extreme-
ly useful, but must be given under  medical
sanction.   In the interval, these cases will
require  a  strengthening   tonic treatment,
animal  food and  broths  freely,  wine or
malt  liquor, bark and  mineral  acids, or
"tincture  of steel,"  in fifteen-drop doses.
twice a day.  It  is  repeated,  there are so
many modifications and varieties,  both of
cause and effect,  in  cases of menorrhagia,
that medical advice cannot be safely dis-
pensed  with, and  should be  resorted  to as
soon as practicable.
   The decline  of  menstruation usually oc-
curs, as already noticed, about thirty years
after its first establishment.  The period is
(and always is) regarded by females them-
selves, as a critical era in their  lives.   With
the cessation of menstruation the capability
of  conception  also  ceases.  Such  an im-
portant change cannot  take place without
causing  some  constitutional  disturbance;
indeed,  women themselves seem to  think it
a matter of necessity that they must  have
illness at this period.  This is probably going
too far; many do get over the change with
comparatively  trifling  indisposition,   and
much of the disorder that does occur may
be traced to luxurious and artificial modes
of life ;  perhaps, also, to privation and  over-
work.   However,  disorder at the  "change
of life" is  sufficiently common  to make it a
matter of expediency in all cases, of neces-
sity in  many,  that the health should be
carefully  watched, and  any symptoms of
disease  at  once  attended to.   As might be
expected, irritations of the nervous system,
hysterical, hypochondriacal,  and even ap-
proaching  insanity,  are  apt  to occur;  still
more  frequently,  disorder,  indicative  of
plethora,  or overfulness of blood,  such as
headaches, or apoplexy, spitting of blood,
piles, &c.;  or the individual becomes corpu-
lent.  Lastly, cancerous diseases not unfre-
quently show themselves for the first time at
the cessation of the  menstruation.  Mode-
ration  in diet,  particularly in the  use ol
animal  food and  stimulants,  regular and
sufficient  exercise, strict  attention  to the
state of the  bowels  by  means  of the  com-
pound  colocynth pill alone, or with  blue
pill, or  by senna, castor-oil, or saline pui ■
gatives, are  means which may safely and
with benefit  be  carried out; on the occur-
rence of actual disorder or disease,  medical
aid should be sought at once—any sudden
attack  being attended to  according to its
nature,  and under the directions given for
its management in the proper place. 
M E  R
"t-1
M E  R
  Refer to Abortion—Hemorrhage—Pregnan-
cy, Jre.
  M ERCURY — Quicksilver — The  well-
known metal,  fluid at ordinary  tempera-
tures, furnishes some of the most important
agents used in medical practice.  Of these,
it will be sufficient to notice its preparations
in the form of blue pill and of gray powder,
of calomel, and of " red  precipitate," and
of blue  ointment.   Corrosive  sublimate,
although a preparation of mercury used by
medical  men as  a medicine, will  only  be
noticed here with  reference to its^ioisonous
properties.
  Quicksilver itself has been used in medi-
cal  practice  not as a medicinal,  but  as a
mechanical agent, in obstruction of  the
bowels;  as  much as  a  pound being  ad-
ministered at once, under the idea  that  its
mere weight in passing through the bowels
would  overcome the stoppage.   The  prac-
tice has been almost abandoned.
  In  the forms of blue  pill  and  of  gray
powder, mercury,  according to some, exists
merely in a state  of minute division, but is
most generally thought to be in a state of
low oxidation.   The former of these  pre-
parations is  made by rubbing «p  metallic
mercury in certain definite proportions, with
conserve of roses and liquorice-root powder,
until  the mercury disappears, or, as  it is
often   expressed,  is  "killed,"  the entire
mass assuming the well-known grayish-blue
colour.   Gray powder is  similarly  made
by rubbing the mercury with chalk. These
two  forms are  mild,  but effective  and
most useful preparations; the blue pill for
adults, the gray  powder  for  children, or
where  very gentle action only is required,
it being  milder than blue pill.   It should
be remembered in giving gray powder, that
if  given in  preserve or  treacle, the acid,
meeting  with the  chalk, gives rise to effer-
vescence.
  Calomel  is a compound of mercury  and
chlorine, and is a  much more powerful pre-
paration than either of the above.  It occurs
in lumps,  but  is  generally met with and
sold in the form  of a heavy white powder
with a slight tinge  of yellow.  It is often
adulterated.
  Red precipitate is an oxide of mercury,
and should be in the form of brilliant red,
somewhat  glistening scales.   It  is  often
adulterated with red lead, which has a much
duller  appearance.
  Corrosive sublimate, like  calomel, is also
a compound of mercury with chlorine, but
with a larger proportion of the latter; hence,
in chemical language, calomel  is known as
the chloride of mercury, and corrosive sub-
limate as the bichloride.   Calomel has also
been called the submuriate, and  corrosive
sublimate  the  muriate.   These terms  are
apt to create confusion, and might occasion
dangerous  mistakes, as the corrosive subli-
mate, except in minute doses, is a virulent
poison.  It is better, for medicinal purposes,
to adhere regularly to the old and perfectly
distinctive  names of calomel and  corrosive
sublimate.
  The medicinal uses of mercurial prepara-
tions  are,  perhaps, more  numerous than
those of any other single  agent in the mate-
ria medica; for while, in itself, a mercurial
acts as an alterative, as  a purgative, as  a
stimulant,  or as  a  powerful constitutional
remedy, according to the  mode in which it ia
given, it appears, when conjoiued with other
remedies,  to  merge  its  action in  theirs,
quickening and strengthening  that of  the
drug to which it is adjoined. With the diu-
retic it tends to the kidneys, with the dia-
phoretic it  increases the determination to the
skin, while to the  purgative it  gives more
energetic action.  Not the least remarkable
and valuable property of  mercury  is its
power of controlling or of subduing inflam-
mation.  In many cases, it is often all that
the practitioner can trust to; hour after hour
he  pushes  on the mercurial, in the assur-
ance that  if he can get the constitution,
however  slightly, under its influence,  the
disease will succumb. This effect of mer-
cury is more particularly manifest in inflam-
mations affecting the eye, such as iritis, in
which, as through a glass, the whole process
is to  be witnessed; and  it  is such a cura-
tive effect,  as he in  this case witnesses, that
gives the physician  confidence that, in cases
where he cannot see, similar desirable re-
sults follow the action of the drug upon the
constitution of his patient.
   The administration of mercury in various
diseases  being noticed when the diseases
themselves are treated of, the reader is re-
ferred to the proper articles.
   The constitutional affection, by  means of
mercury,  known  also as mercurialism,  or
ptyalism, or  " salivation," is not a state to
be  lightly  induced, and  without good rea-
son, by a medical man; never by an unpro-
fessional person, except in  an extreme and
acute  case.   The  first  symptoms  of  the
constitution being affected  by mercury,  or
of approaching salivation,  is a sen^e of ful-
ness and tenderness of the gums;  the teeth
feel, as it  were, elongated,  and the person
cannot bite any firm  substance, such as a
crust,  as  well  as  usual;  coincident with
these  symptoms,  the breath   acquires  a
peculiar  fetor, which, once smelled, cannot 
                  M E R                3f

be  forgotten,  and the  gums, if examined,
are seen to be slightly swollen, and of rather
a  purple  hue.   If  the  medicine be  now
Btopped, or given only in very small quan-
tity,  the  constitutional indications  do  not
become more developed,  nor, indeed,  does
it serve any good purpose that they should
be so; but if the medicine be gone  on  with
as  usual,  the gums  become  much  more
swollen and  tender, the tongue and glands
around the  jaws inflame  and swell,  and
there is continued flow of fetid  saliva from
the  mouth.   At the same  time,  there is
much  constitutional irritation — mercurial
fever, as it is called—and,  altogether, the
individual under the action  is in  a  most
miserable  condition.   It is  by no  means
requisite for the good effects of  a mercurial
course  to  be  developed, that the influence
of the medicine should  be pushed thus far,
neither is  it desirable; all that is requisite
is, that the gums should  give indication of
the  constitution  being  affected.    At  the
same time, in some  individuals, any consti-
tutional affection by mercury  appears  to
involve  this  violence  of  action.   Indeed,
there are some constitutions  so susceptible
of  the  action of  the  medicine,  that  the
smallest dose cannot be  taken  without its
producing free, or even violent  salivation.
Such cases are among the most  vexatious
which it falls to the  lot of a medical men to
encounter.   He  orders,  perhaps,  a  mild,
ordinary dose of some mercurial,  and finds
it  has  produced  salivation, injuring  the
patient,  and  probably  entailing days—it
may be weeks—of  discomfort.   It  is  only
experience of the fact which can  point out
the individuals to whom this accident  may
happen;  but, having once  occurred,  it
ought always to be  kept  in mind, and any
person  thus  liable,  having  occasion  to
change their medical  attendant, the  fact
should  be communicated  at  the very  first
interview.    Unfortunately,  but little  can
be  done  to  cut  short,  or  even alleviate
greatly,  a course of mercurial salivation:
cold,  of course, is to be avoided, the alum-
wash for the  mouth, or tincture of myrrh,
or camphorated spirit in water, used  to rinse
the  mouth, afford  some  relief.  A lotion
made with two drachms of chloric ether, to
eight ounces of water, is  also serviceable,
and diminishes the fetor;  a solution of chlo-
ride of soda, in the same proportions, will
^ave the same effect. A few leeches  may be
ipplied under the jaw, and saline aperients,
such as Seidlitz  powders, or Epsom salts,
largely diluted, may also  be given with ad-
vantage, if the patient can swallow them,
and is not in a very reduced state.   The |
>5               M ER

 excitation of mercurial action must always.
 as much as possible, be avoided in scrofulous
 constitutions;  in  such,  mercury  seldom
 acts as beneficially as  in others.  Mercurial
 action is not unfrequently induced by persons
 continuing to take, inadvertently,  aperient
 pills,  which  contain  small doses  of the
 medicine.  When these are prescribed by a
 medical man for a temporary occasion, warn-
 ing should always accompany the prescrip-
 tion.
   When mercurial preparations are given
 in small doses, they exert an inappreciable,
 or what  is called  "alterative"  action,  in
 improving the quantity and quality of vari-
 ous secretions.   For this  purpose  a grain
 of blue pill, or a couple of grains of gray
 powder, may be given  twice in the twenty-
 four  hours.   Of all the organs on  which
 mercurials exert their effects, the liver  is
 most  obviously  affected;  small alterative
 doses stimulate gently the flow of bile, and
 improve  its quality  if impaired;  larger
 doses  stimulate more  actively, bringing
 down  the  bile  freely, and  carrying   it
 through the bowels with a  purgative action.
 This  is more  obviously  the case when the
 liver has been in an overloaded  condition:
 then, a dose of mercurial, even a small one,
 opens, as it were, the flood-gates,  and the
 rapid descent of bile, often in an acrid con-
 dition, causes diarrhoea with severe griping.
 When mercurials are  given with other me-
 dicines not purgatives, it is  generally in
 doses which will not purge, for should that
 occur, the desired action is interfered with.
 When mercurials are given in frequent and
 not very small doses, either in inflammatory
 cases, or for  the purpose  of affecting the
 constitution, it is  usual  to combine with
 them small quantities of  opium, a quarter
 of a grain in each  dose, to check the pur-
 gative effect^ or, as it is expressed, to pre-
 vent the  mercury from running  off by the
 bowels.
   As an alterative, the doses of mercurials
 are, of blue pill one grain,  gray powder two
 grains, calomel half a grain;  as a purga-
 tive, blue pill from five to eight grains, gray
 powder six to ten grains,  calomel three to
 five grains.  When  mercury is  given to act
 specially upon the  liver, it is  better given
 according to  the Abernethy plan—that  is,
 uncombined- at night, and followed  by a
 dose of  liquid purgative,  [citrate  of mag-
 nesia,] black-draught,  castor-oil, or the like,
 in the morning.  In this way the mercury
 is able to exert its full  effect upon the liver,
 whereas,  if combined  with a purgative at
 first, it is  hurried  through the bowels to_
 quickly to do  this.
31 
m j: r
350
M  [ C
   In  some persons, mercurials produce  a
Btate  of great nervous irritation; in others
they  cause deadly  sickness and faintness.
Children  generally  bear mercurial  medi-
cines  well, in  doses  which are  large when
compared with those of adults.   It is almost
impossible to salivate a child—indeed, in
most  cases it is quite so.  The  stools occa-
sioned by the purgative action of mercurials,
especially in children, are  generally of  a
dark  olive-green.
   Poisouing may be  occasioned by any of
the preparations of mercury, but corrosive
sublimate is the most frequent agent of the
class  by which  it is  produced.   This sub-
stance occurs  in the form of a heavy crys-
talline powder, and  has a strong metallic
taste.  Three grains would be a dangerous,
if not a  fatal dose.   Corrosive sublimate
can   scarcely  be  swallowed  without  the
Btrong taste being quickly perceived ; very
shortly, violent  pain  in  the  bowels, suc-
ceeded  by  vomiting  of stringy  phlegm
mixed with blood,  comes  on,  the  bowels
act violently, and if  the  patient is  not re-
lieved, collapse  or  sinking  is  followed by
death.  Of course, in  such  a case  medical
assistance should be  got with all speed;  but
fortunately the most effectual antidotes are
generally within easy reach.  These are the
white of eggs given  mingled with  a little
water, or if this cannot be had at once,
thick  flour and water, or milk;  free vomit-
ing being  at the same time  encouraged by
ipecacuanha, if at hand, or  by  a feather in
the throat.  The white of egg  must not be
given  too freely;  for, if in excess, the good
effects of  a sufficient  smaller quantity  are
neutralized.  If the quantity of the  poison
given  be known, the white of one egg may
be given for every three grains.  Accidental
poisoning, even by the mildest of the mer-
curials,  may arise in consequence of violent
constitutional  affection,  owing to peculiar
susceptibility.   Such cases are most fre-
quent in children, and are  usually accom-
panied with severe affection of the mouth,
and mortification of the cheeks, gums, &c.;
they generally occur in weak constitutions,
and  the  best antidotes  are wine,  strong
animal broths,  bark, or  quinine, with two-
drop  doses  of  muriatic  acid  every six or
eight  hours.  Such cases must be put under
medical superintendence.
   Slow poisoning by mercury is  apt to occur
in  those who are  much in contact with
the metal in  their daily  occupations—
Buch  as looking-glass silverers,  &c.  Tb.ey
become liable to a peculiar shaking or mer-
curial palsy, which  compels  them to aban-
don their occupations; the same symptoms
 occur  in those  employed in  quicksilver
 mines.
   Mercurial, or blue ointment, is prepared
 in a somewhat similar way to  blue  pill  or
 gray powder.—See  Ointments.
   A sulphuret  of mercury constitutes the
 well-known pigment, vermilion.
   Powders containing gray powder, calomel,
 &c. and  indeed, heavy  powders generally,
 should  either  be   simply  placed on the
 tongue, or  given in  some thick  vehicle;
 but  a teaspoonful  of milk  answers very
 well for the  administration of gray powder
 to children.   Calomel in a thin  liquid, such
 as tea, &c.  sinks at once  to  the bottom,
 and  probably is not swallowed.—Refer  to
 Plummer's Pill.
   MESENTERY—Is a  broad  fold of the
 "peritoneum," or  covering membrane of
 the bowels, by which  the  small  intestines
 are connected with the posterior part of the
 abdomen and retained in their  place.  The
 mesentery  contains the  mesenteric lym-
 phatic glands, &c.—See Digestion.
   METASTASIS.—The shifting of diseased
 action from one part of the  body to another,
 the portion deserted  being left free from
 disease.   This occurs in  rheumatism, in
 gout, in mumps, &c. &c.
   MEZEREON. — The  root-bark of  the
 Daphne mezereon,  a  shrubby  plant found
 in shady woods, which flowers in February.
 It is rarely used as a purgative  and diapho-
 retic.  The berries are poisonous.
   MIASMA. [Miasm]—See Ague.
   MICROSCOPE.—This well-known instru-
 ment, which enables us to  examine  struc-
 tures far too minute to be even visible to
 our unassisted vision,  has done, and ia
 doing much every day, to render the prac-
 tical applications of medicines more  exact.
 Many of the conditions  of the urine are
 appreciable only by the aid of this invalu-
 able  instrument.  The  nature  of  tumours,
 often  a matter of  serious import,  when
 their removal  by surgical operation  is the
 question, is determined by it, in many cases,
 in a way that no other means of discrimina-
 tion could admit of.   Many other instances
 might be cited; in  fact, a  medical practi-
 tioner  cannot now  be  considered  to  avail
 himself of every resource of his calling un-
 less he  uses the microscope.   In medico-
 legal investigation it proves of the highest
 service; stains  which,  without  the use  of
 the microscope, could only be  doubtfully
 distinguished, are by  it so exactly discri-
 minated as to  afford foundation for  sworn
 evidence.  As  a rational  and highly in-
 structive means of amusement, every  familj
J should possess a microscope. 
MID                357                  MIL
   MIDRIFF.—The diaphragm.—See  Dia-
 phragm.
   MILIARY.—An  eruption, consisting  of
 numerous  very  minute vesicles,  which is
 apt to appear intermixed with other erup-
 tive  diseases, but particularly in  cases
 where persons have  been perspiring very
 much, or kept too  hot  in illness.   Miliary
 eruption on the skin  used to be very com-
 mon  in women  after childbirth,  in  times
 when it was the custom to keep them much
 too hot, and to stimulate.—See Skin.
   MILK—The nutrient fluid  secreted by
 mammiferous  animals  for the  sustenance
 of their  young, through the  agency of the
 peculiar  " mammary" glands provided for
 the purpose, is the only material  through-
 out the range of organization prepared by
 nature expressly and solely for food.  More-
 over  it contains  within itself  all  that is
 requisite in food to maintain  in  health and
 to build  up the frame of a living  animal.
 The  milk of animals generally is  charac-
 terized by certain  general properties and
 constituents, although  it varies much  in
 the proportions of the latter it contains. In
 this article, attention must be  confined  to
 the peculiar nature of the milk of the hu-
 man female, and to that of the cow: "ass's
 milk"  has been  already noticed.   When
 milk is examined  under  the microscope  it
 is found  to consist of numberless  minute
 spherical globules, which are suspended or
 float in a  serous  fluid.  From  these glo-
 bules, which are of various sizes, milk de-
 rives  its  opaque whiteness ;  consequently,
 when  it is diluted  with water, and the fluid
 increased in proportion  to the globules, the
 rich  whiteness of  pure new milk is de-
 stroyed, and the liquid  assumes a  more or
 less  bluish  or  semi-transparent  appear-
 ance.   These  globules  consist principally
 of the oleaginous, fatty, or creamy portion
 of the milk, but they  also contain  curd or
 caseine.  This constituent, however, chiefly
 exists in  a state of  solution, in  the serous
 or fluid portion of the liquid,  along with
 the sugar and salts,  chiefly phosphates of
 lime  and  magnesia,  with potash, and  a
 small  proportion of iron.
   Thus, we have milk consisting of—
   Cream, its  oily or  fatty constituent, in
 the form of globules, which are suspended in
   Water, which holds  in solution,
   Curd or caseine, in combination with salts,
   Phosphate of lime, and of magnesia, with
 potash and iron, and also,
  Sugar of milk.
  The latter ingredient is not present in the
milk of carnivorous animals as long as they
are fed on flesh solely, but appears if  they
 are made to eat a portion of vegetable food.
 In the milk of the cow, the proportions of
 curd, of cream, and of sugar,  that is, of the
 caseous, oleaginous, and  saccharine ingre-
 dients are about equal.   In  human milk,
 the saccharine and oleaginous constituents
 are  proportionally  greater than the curd.
 This milk is less opaque and thinner in ap-
 pearance  than cow's  milk,  and  is most
 nearly approached  in  composition by that
 of the mare and ass.
   Fresh milk is alkaline, has an  average
 specific gravity  of 1 -030, and when good, is
 at first perfectly homogeneous.  After stand-
 ing,  the light oily  particles separate  and
 float in greater or less proportion at the top
 of the  fluid, in the well-known form of
 cream.   If the  milk be  kept some time,
 (more  quickly in a warm  situation,) lactic
 acid is formed by a process of fermentation,
 and the curd separates, souring or curdling
 taking place.   Various  modes  and  instru-
 ments  have been employed for testing the
 quality of milk  as   to  richness, &c.  The
 addition of a  small  quantity  of carbonate
 of soda  to milk retards  its  souring and
 curdling, if it be requisite to keep it longer
 than usual.
  The very general fraud practised [especi-
 ally in the large  towns] of diluting milk sold
to the public with water, has recently called
forth a very useful and low-priced little in-
strument, (fig. c.,) called the " Milk Tester,"

                 Fig. o.
the invention of a Mr. George, by which the
purchasers can at once  detect, not  only 
M I L                 358                MIL
 whether water has been added to milk, but
 in what  quantity  the  addition  has  been
 made.  The printed directions issued with
 the instrument are as follows :—
   " Place the instrument in water, and drop
 on the rings until it floats at the line of the
 W, (water,)* then place it in the milk to be
 tested, and  its quality will be at once shown.
 For instance, should the instrument float at
 3, the mixture would be composed of three
 parts milk, and  one water; at 2, half and
 half; at  the  1,  one part milk, and three
 water.   Should  the instrument float  at
 any point between  the divisions, it must
 be allowed  for accordingly; for instance,
 should it float between the  M  and  the 3,
 the  milk  would  be three  and a half, to  a
 half water;  between  the 3 and 2, two and
 a half milk to one and a half water, and so
 on."
   The addition of a graduated glass which
 would show the amount of cream contained
 in the milk tested would much increase the
 value of the instrument.
   The instruments are sold wholesale at No.
 2  Adelphi  Arcade, Strand,  London,  [but
 may be found at most  of  the  opticians or
 philosophical  instrument  makers  in  the
 United States.]
   The milk  which is first secreted (formed)
 after  the  birth  of  the young, varies from
 any that  succeeds   it, particularly in  pos-
 sessing  a purgative property, -which  acts
 beneficially  upon  the  bowels  of  the off-
 spring. - In  the cow, this first, or "green"
 milk,  or " colostrum," is very nutritive, and
 contains  much curd of a peculiar  nature,
 which is coagulable  by heat, like the albu-
 men of egg.   On this account, it is  used in
 the country  parts  of England,  under the
 name of " beastings," for making a  kind of
 custard pudding.   The first milk, or colos-
 trum, of  the human female,  is  thin and
serous looking.   This first  milk  or colos-
 trum, in  animals generally, if examined
under the microscope, exhibits an intermix-
 ture of larger and  different globules from
 those of ordinary milk.
  It is, perhaps, needless  to remark, that
 the nutritive properties and wholesomeness
of the fluid depend,  upon  the health of the
  * la weighting the instrument with rings, in the
first instance, it may be observed that it is not at all
necessary that it should flo»t exactly at the line of the
W, for let it be either a little over or under  it, if an
equivalent allowance be made for it, in its immersion
in milk, the result must be correct.  The instrument
should be splashed into the water, or' moved briskly
about in h.  o dctich any air-bubbles  that may  have
adhered thereto, the ivory wetted, and the tester al-
lowed in  take its poi'inn of equilibrium before the
floating point be remarked.
 being or animal  by which milk is afforded.
 In the case of  mothers, therefore, who are
 decidedly unhealthy, or the subjects of any
 disease, scrofulous or otherwise, it is better
 for their offspring that they should  not be
 nursed by them.  And even in the case of
 the  healthy  mother, this secretion  is so
 liable to be affected and deteriorated  by ir-
 regularities in  diet,  by  emotions of  the
 mind,  and  by medicine  taken,  that  the
 greatest care, as all mothers well know, is
 requisite to prevent such  causes and effects
 being accidentally originated.—See Children
 —Nurse, ,]-c.
   Cow's milk is so largely used  as an article
 of diet (see Food) that its purity and  good-
 ness,  especially in  large  towns, become  a
 matter of much importance.  The following
 remarks on the  subject, from  the  Lancet
 Sanitary Commission,  are valuable.    The
 specimens of milk examined  were procured
 from milk-sellers in various parts of London.
   " From an examination of the table drawn
 up, it appears that,  out of twenty-six sam-
 ples of milk submitted to  analysis,
   " 1st. That twelve were genuine.
   " 2d.  That of  these, two showed a de-
 ficiency of cream.
   " 3d.  That eleven were adulterated.
   " 4th. That this adulteration consisted in
 all cases of water, the percentage of which
 varied  from ten to  fifty per cent, or one-
 half of the article.
   "5th.  That  in no case was chalk, size,
 gum,  sheep's brains,  or  any of  the  other
 substances occasionally used for the adulte-
 ration of milk, detected."
   These results are  more  favourable than
 might have been anticipated, from the belief
 generally entertained respecting the  gross
 adulterations to which milk, as alleged,  has
 been so constantly subject.
   In addition to the modifications which milk
 undergoes in the hands of  the dealer, there
 are those due to  the condition of the animal.
 The pasturage, the supply  of water, and  the
 temperature, all influence the state of  the
 milk as regards quality and nutritive power.
 Its wholesomeness depends upon the period
 after calving—milk not being in  good condi-
 tion for three weeks  or a  month after this
occurrence—upon the  health of the cow,
upon its food, and  upon the condition of  the
place in which it  is kept.  It is notorious,
that in many large towns, and in London espe-
cially, [and  in New York,] the  mode in which
extensive dairies of  cows are, or have been
lodged  and fed,  is   disgusting—most  un-
wholesome for the animaV, and, therefore,
for those who use their milk—very many of
the cows being  diseased, consumptive, and 
M I N                359               M 0 N
 stimulated to the last with fermenting brew-
 ers' grains.
   As an article of diet, milk is for the gene-
 rality of persons  most wholesome, for chil-
 dren especially, of whose food it ought to
 form in some mode or other a large propor-
 tion :  less heating than  animal food, it is
 equally nutritious.—See  Children.
   Some persons, both children  and adults,
 find new milk too rich, but can take it after
 the oily cream has been  removed  by skim-
 ming, or if it is diluted with water, or boiled.
 The addition of from one-third to one-half
 lime-water, will often cause milk to sit more
 lightly on the stomach.
   When milk is taken largely without other
 food, there is risk of the formation of a mass
 of solid indigestible  curd in the  stomach,
 which may cause  much  uneasiness, and  at
 times, in children, even alarming symptoms.
 Its expulsion by vomiting is the usual means
 of relief.  Some persons cannot take milk
 without  suffering  from  stomach  disorder
 and headache ;  and others, who suffer from
 chronic chest affections, find its use aggra-
 vate  the symptoms.   It  need  scarcely be
 added,  that except in these peculiar cases,
 milk, and milk preparations, form one of
 the most valuable resources  in  the dietetic
 treatment of the  sick.  Many invalids de-
 rive much benefit from  the  use  of  milk
 warm  from  the cow in the early morning.
 In some  cases, a  small  quantity  of black
 pepper, or a teaspoonful of rum or brandy,
 is added to the teacupful  of milk with ad-
 vantage.
   The whey, which is the serous portion  of
 the milk, freed from the curd and a portion
 of the cream, is light, nutritious, and ape-
 rient, and is perhaps too much neglected as
 a  beverage;  the  same remark  applies  to
 buttermilk, which is freed from the cream,
 but retains the curd.
   Those  who desire  more information  on
 the subject of the above  article, will find
 much in the  Reports  in the Lancet for Sep-
 tember 13th, 1851,  and for the two following
 weeks.
   Refer to Breast—Cheese—Children—Cream
 —Food, Sec.
   MIND—The immaterial part of our ex-
 istence—exerts so  marked, so powerful  an
 influence over the  conditions of our bodily
 health,  that it makes  the tone of the mind
 a weighty consideration in forming an opi-
nion respecting the ultimate issue of many
cases  of disease.   Under  such  articles  as
Faith,  Homesickness,  Hope, Fear,  &c.  the
subject  has been entered into as far as con-
sistent with our limits.
  MINERAL  ACIDS.—See Acid.
   MINERAL WATER.—See Water.
   MINIM.—See  Measure.
   MINT.—The mints  constitute  an exten-
 sive tribe  of  plants, well known for their
 powerful essential oils.   Three  species  of
 mint are  used  in  medicine—peppermint,
 pennyroyal,  and  green or spear-mint.   Of
 these, the  first is at once the most energetic
 and the most extensively used as a stimu-
 lant and carminative, either in  the form
 of its essential oil, of its distilled water,  of
 its spirit,  or most generally  of all as  a
 lozenge.   Peppermint-water  is  taken  in
 doses of one or  two fluid ounces ;  oil of
 peppermint,  of from two to five drops on
 sugar;   of the  spirit, a  teaspoonful may
 be taken at once.  A very powerful medi-
 cinal peppermint lozenge is made, which
 is extremely useful where the medicine is
 required.
   Refer to Carminatives.
   MISCARRIAGE.—See Abortion.
   MIXTURES—Are medicinalcompounds in
 the fluid form.  They may be simply com-
 posed of various  liquids  mingled  together;
 they may be  solutions, or they may contain
 insoluble powders, as in  the case of chalk
 mixture, iron mixture, &c.  In  the latter
 cases the addition of gum or of gum muci-
 lage, is  useful to  prevent the powder sub-
 siding as rapidly  as  it otherwise will do;
 but as  it will not prevent this altogether,
 care  should  always be taken to  shake up
 the sediment  in any  liquid medicine.   In
 mixtures which are likely  to be kept  for
 some time, especially in warm climates, all
 saccharine matters should be excluded,  to
 avoid  fermentation;  if this precaution  is
 neglected,  the  bottles will certainly  be
 burst.   In forming mixtures with  light pow-
 ders especially, such  as  magnesia,  ipeca-
 cuanha, &c. and  indeed with any powders,
 it must be  done in a mortar, adding at first
 only a  very small proportion of  fluid.   If
 much water is used at first, the mixture can
 never be completely and properly  effected.
   Refer to Medicines.
   MOLES—Or, as they are often called,
 "false  conceptions," have seldom, if ever,
 any  connection with  an  impregnated con-
 dition of the  womb, and arise from  causes
 quite apart from  this  state.   The popular
 idea that these formations are the result of
 conception  requires correction, for it might
 lead to  most erroneous and distressing as-
 persions on character.
  MOLES ON THE SKIN.—See Mothers'-
 MARK.
  MONKSHOOD.—See Aconite.
  MONOMANIA.—A  species of insanity-
disordered  or erroneous persuasions  of the
* 
M 0 N               360               MOT
 mind  on one  subject.   The  disease  may
 occur either  as  acute or chronic, and  take
 any form—suicidal, homicidal, &c. and may
 lead to incendiarism or theft, to  religious
 melancholy, or to the most absurd ideas and
 acts.
   Refer to Insanity.
   MONTHLY  DISCHARGE. — See  Men-
 struation.
   MORBUS  COXARIUS.—See  Hip-Joint
 Disease.
   MORPHIA.—See Opium.
   MORTARS and PESTLES—Are instru-
 ments  used  for  triturating,  bruising, re-
 ducing to  powder, &c.  the different medi-
 cinal substances.   They are made of various
 materials—iron, brass, marble, glass,Wedge-
 wood ware, &c,  the last being by far the
 most generally useful, and quite sufficient
 for all domestic  purposes, at  least in this
 country.   In emigrant life, an iron mortar
 might  be found  useful.  The Wedgewood
 mortar is  generally  made  of  the  form of
 those seen in  the apothecary shop.   The
 pestle has its head made of the same mate-
 rial as the mortar, and is fitted to a wooden
 handle.  The mortars with which medicine-
 chests  are fitted are generally too small, and
 are only suitable  for mixing powders,  &c.;
 there should therefore be added to the domes-
 tic laboratory a larger size—one  capable of
 holding about a pint will be most convenient.
 The  great advantage  of the  Wedgewood
 mortar is,  that while much stronger  than
 glass, it  is not, like marble or metal, acted
 upon chemically by different agents.  It may,
 however, be broken, if struck  sharply  with
 the pestle.  The pestle is used in the mortar
 sometimes  with  a beating or hammering
 action;  but  more generally it is used to
 grind or  triturate, while firmly  grasped.
 For  simply  mingling  powders, a  lighter
hold by the forefinger and thumb is  quite
 sufficient.
   MORTIFICATION,   or  Gangrene,  or
Sloughing—Is the death of a portion of the
living body occurring after violent or pecu-
liar inflammation of  the part—the appear-
ance of the mortification varying according
to the structure  affected.  A part in which
inflammation  is likely to terminate in mor-
tification is hot, painful, tense, and hard;
the colour  of the skin,  at first dark  and
angry-looking,  becomes  mottled,  and the
surface  exhibits  blisters filled with  dark
fluid; at this time the previous heat giving
way  to a temperature lower than  natural,
and the pain  diminishing; at last the  part
shrinks, becomes of  a dirty gray or  ash-
colour, and exhales a  fetid  odour.  Coin-
cident  with these local  symptoms, if the
j mortification  be  extensive,  or situated  in
 an important part, the constitution exhibits
 signs of collapse ; the face is pinched, cold,
 moist;   the  pulse quick and feeble;  the
 tongue  brown;  the mental  faculties de-
 pressed or disordered; the  natural func-
 tions are performed involuntarily;  and hic-
 cup is a very frequent accompaniment.
   Some parts are more prone to mortifica-
 tion  than others; but in all, impeded or
 deficient circulation of blood is  the origin-
 ator.  This may be caused  by weakness of
 the body generally,  by weakness of the cir-
 culation of a part, such as occurs in para-
 lysis, by impediment to the current of blood
 through the vessels large or small, by press-
 ure on  a main branch, as by a tumour, or
 on one  spot, as occurs on the back, in per-
 sons confined by exhausting disease, and by
 intense cold or heat, which destroys the tex-
 tures, or by the  use of unwholesome  grain,
 (see Ergot of Rye, &c.)  It  may  also occur
 from intense inflammation in persons  of full
 habit of body.  In the event of an inflamed
 part  showing symptoms of mortification, if
 a medical man  has  not been in attendance,
 he ought to be called without delay.   In the
 mean time, warm poultices may be applied,
 those made of oatmeal and bran are often
 useful;  but the best  applications, if pro-
 curable, are the chloride of soda or chloride
 of lime  solution, diluted in the proportion of
 a quarter to half an ounce of the solution to
 half a  pint of water, and used warm as  a
 lotion;  at the same  time, the strength must
 be supported with wine, strong meat-broths,
 &c. and rest procured  by means of opium.
 —See Opium.  When a mortified  or slough-
 ing part of the body is separating, its loose
 and dead  portions  are usually  cut  away
 with  scissors, to diminish the fetor; poul-
 tices  facilitate the separation, and after it
 has taken place, simple water-dressing will
 generally  be  found  most   suitable.— See
 Dressing.
   Refer to Inflammation, Sec.
   MOTHERS'-MARK.—The term is applied
 to stains, moles, and other marks, vascular
 and otherwise, with which a child is  born,
 and for which  many  fanciful causes are
 assigned.  The  most  important  mother's-
 marks  are the vascular  naevi.—See Chil-
 dren, page 110.
   MOTHER.—See Child-bed—Children—
 Hereditary—Nurse, &c.
   MOTION,   and   MOTOR   CHANGE.—
 Movement in  the living body is the  result
 of contraction  of the  muscles, or at least
 of the muscular fibres, either voluntarily or
 involuntarily;  this  contraction, whenever
 excited, giving  rise to expenditure of  the
rf 
                 M 0 U

substance of the acting fibres, or in other
words, to metamorphosis of some of the ele-
mentary constituents of the fibres, chiefly by
comb tuition  with the  oxygen of the  arte-
rial blood. This metamorphosis, which there
is reason to believe is an  essential of the
process,  is what is  meant by motor change.
—See Animal Hal—Blood—Food, Sfc.
  MOUTH.—The cavity which contains the
tongue  and  teeth, in  which  is  performed
the  important  process of mastication,  and
by  means of  which  articulate sound is
formed, is enclosed by the lips and cheeks,
by  the  upper and  lower  jaws, by  the soft
palate and  tonsils, by »the  "fauces" gene-
rally,  and  by  the  mucous  membrane,
stretching from  the  tongue  to  the lower
jaw.  It is further surrounded by the sali-
vary glands, which supply its moisture, and
which open by the ducts  into various parts
of its cavity.  The portions  of the mouth
are liable to different diseases. These, along
with other necessary  information,  are de-
tailed in the individual articles.
  Refer  to Aphtha—Palace—Saliva—Throat,

  MOXA.—A means of counter-irritation,
derived  from,  and long  practised  in the
East.  The true  moxa is  a  soft woolly sub-
stance, procured from the leaves of a species
of mugwort, which  is made into a cylinder,
and  burnt down upon the  skin,  causing a
deep eschar.
  MUCILAGE.—A thick semi-fluid,  formed
by the solution of  gummy or starchy  mat-
ters in water—such as  mucilage of gum aca-
cia, arrow-root mucilage, &c.—See Gum, Sec.
  MUCOUS  MEMBRANE—Is a  membrane
which lines certain portions  of  the  body,
and  which is itself covered on the surface
with an "epithelium"  of flattened cells, and
from which is secreted the  thick viscid se-
cretion  named  mucus.—See Mucus.  There
are two great systems of mucous membrane :
the one which  lines the mouth, nose, eyes,
throat, bronchi or air-tubes, and is also con-
tinued down the gullet,  and through the
stomach  and bowels to the vent;  the other,
the genitourinary  membrane, which  lines
the kidneys, bladder, &c.
  The affections to which mucous  mem-
branes are subject, are sufficiently entered
into   under such  articles  as "Catarrh,"
" Diarrhoea," &c, when the diseases of the
parts they line are  treated of.
  MUCUS—Is  the  thick,  somewhat viscid,
glairy secretion,  formed on the surface of
mucous  membranes.   Examined  under the
microscope it is  seen  to contain  numerous
round granular particles  or globules, simi-
lar to those which are  contained  in  pus or
      2 F
51                M U  S

 matter.  When a mucous membrane  is in-
 flamed, its secreted  mucus  becomes  thin
 and acrid, as all know it does in a cold in
 the head, which is simply inflammation  of
 the mucous membrane  lining the nostrils:
 when the inflammation is more intense, or
 of a peculiar character,  the mucus secretion
 is apt to be converted into a purulent one.
   Refer to Pus.
   MUMPS.—A contagious epidemic disease,
 which consists of inflammation of the  sali-
 vary  "parotid" glands,  situated on either
 side of the  lower jaw.   It commences with
 more or less fever; shortly, swelling at the
 angle of the jaw appears, and spreads gra-
 dually to the face and neck in the vicinity
 of  the gland, causing  much difficulty and
 pain  when  the  jaws are attempted  to  be
 opened:  on the fourth or fifth  day,  the
 swelling begins to subside.   Little treat-
 ment is required,  beyond  confinement  to
 the house, and the administration of some
 simple purgative.  The  patient is compelled
 to live on slop diet, from the impossibility of
 mastication; but if the  person be delicate,
 good  broth may be allowed.  Hot fomenta-
 tion and bran poultice  to the swelling will
 give some relief, and if the  pain and swell-
 ing are very severe, a couple or three leeches
 may be applied to  each side.  Mumps is a
 disease quite devoid of danger,  unless,  as
 has occasionally happened, though rarely,
 the inflammation becomes suddenly trans-
 ferred to the brain or testicle.
   MURIATIC  ACID,   or   Hydro-chloric
 Acid, or " Spirit of Salt."—See Chlorine.
   MUSCLES  and  MUSCULAR  FIBRES.
 —The muscles, properly so called, are the
 fleshy portions  of the  animal  frame,  by
 means of which the various  movements  of
 the body  are effected;  in fact,  all flesh is
 muscle devoted to this purpose.   The  mus-
 cles are composed of bundles of fibres bound
 together by cellular tissue, and these fibres
 can be divided  and subdivided  under the
 microscope, until  the  "ultimate  fibre"  of
 muscle  is  arrived  at;  this  ultimate  fibre
 containing within it other  "minute cylin-
 drical particles." These fibrillae are marked
 with  transverse  lines,  and constitute the
 striated muscular fibre  in contradistinction
 to  the non-striated  fibre,  which  composes
 the muscular coat of  parts  such as the
 alimentary canal, which are  not under the
 control  of the will.  The  muscles are at-
 tached to  bones, &c. for the purposes  of
 movement  by means of tendons.   They are
 largely  supplied with  nerves, (see Nerves,)
 and also with arterial blood, on the free cir-
 culation of which, indeed, the motor change
 of their  elementary constituents, and, con'
3! 
M U  S
."ti-J
M II S
Bequently,  their power  of action, depends.
When an animal has been goaded or hunted
into a state of nervous and feverish excite-
ment, and  killed,  the muscular fibres  are
left in such a condition as  to be unwhole-
Bome  for food, and quickly become decom-
posed and putrefied.  Had the powers  that
be, been more cognizant of this fact, and of
the influence it might exert upon their own
health, Smithfield would not have  stood so
long.
  Refer to Beef—Flesh—Food—Motor Change
—Tendons,  Sec.
  MUSHROOMS.—The fungus  tribe,  to
which mushrooms belong, contains a large
proportion  of poisonous members, and-even
those which are usually considered edible
are not always above  suspicion  in  this
country.  In  France,  Russia,  &c.  many
species  of  fungus are used, commonly and
largely, as food, and are very nourishing,
as they approach in some  degree animal
matter  in constitution.   Those who gather
mushrooms for food should be very certain
that they know what are mushrooms, and
this will be best  learned from those who are
practically acquainted with  the matter; it
may be added,  that even real mushrooms
which grow under trees are generally con-
sidered  unwholesome,  and  also  those  in
which the process of decay has commenced.
Dr. Christison says, " The poisonous fungus
has an  astringent  styptic taste, and,  per-
haps, also a disagreeable one, but certainly
a pungent  odour."  After poisonous  fungi
have  been  eaten, there is generally giddi-
ness,  dimness of sight,  and  debility, if the
symptoms appear quickly; but if they are
delayed they are more generally  those of
irritation, vomiting, purging, and pain.   In
a case of poisoning by fungi, treatment simi-
lar to that  recommended for "belladonna"
will  be  the best in the absence or during
the delay in the  arrival of a medical man.
—See Belladonna.
  MUSSEL.—See Fish, &c.
  MUSTARD.—Black and white mustards
are  plants  which  grow  wild  throughout
Europe, but  are cultivated for use;  they
are  often  confounded  with  the  common
charlock.   Black mustard has smooth seed-
vessels which grow close up to the stem, and
contain reddish-black seeds.  White mus-
tard has tough  seed-vessels, which spread
away from the  stem  and  contain  yellow
seeds.   The seeds of the black mustard are
more pungent than those of the white, but
the two are very commonly mixed  in the
manufacture of the common "flour of mus-
tard ;"  this  is   formed by crushing   and
pounding the seeds, and sifting.  The sharp,
burning acridity of black mustan. depends
upon  a volatile oil, which, however,  does
not pre-exist  in the seeds, but  is formed
on the  addition of water.  There is,  per-
haps,  no article in domestic use more largely
adulterated  than mustard.   The following
result  of  the investigation of  the  Lancet
Sanitary Commission sufficiently illustrate
the extent and nature of the fraud;  these
show—
  "1st. That genuine  mustard, whatever
be the price paid for it, is scarcely ever to
be obtained.
  "2d. That  the  whole  of  the forty-two
samples—bought in* London—submitted to
examination, were adulterated.
  " 3d. That  the adulteration practised in
every case was the same iu kind, varying
only in degree, and  consisted   in the  ad-
mixture of genuine mustard with immense
quantities of wheaten flour, highly coloured
with turmeric."
  Mustard, when used  in moderation as  a
stimulating  condiment, is wholesome.   Its
principal use in medical  practice is in the
well-known  mustard-plaster, or  cataplasm,
as a counter-irritant.   This  application is
made in various ways: when speedy ener-
getic action is required, it is best obtained
by mixing good fresh  mustard  with water,
as for the table, and spreading on calico or
paper.  It is well  to  interpose  a piece of
thin gauze or muslin  between the mustard
and the skin ; this does not in any way in-
terfere with  the action of the  application,
and prevents portions of the mustard  ad-
hering to the skin, and irritating it, after
the removal of the cataplasm.   Some  per-
sons erroneously mix the mustard with vinegar,
thinking to render its action stronger:  this
is a mistake, as it has the reverse effect.
Others mix with one third or one-half flour,
or bread crumb, which modifies the power
of the remedy, and is all very well when
modified and  longer-continued action is de-
sirable, not  unless.  The usual length of
time a mustard-plaster can be borne is from^
twenty minutes to  half an hour, and  even
in this time  it often produces blistering.
It always leaves for  some time a deep red
mark on the skin,  a fact not to be forgotten
in the  case  of females.  When mustard-
plasters are applied to anyone in a state of
insensibility, they should be removed within
the half-hour; if allowed to remain, should
the person  recover, troublesome ulceration
may be the result.
   From their familiarity and accessibility,
mustard-plasters are apt to be applied some-
what too indiscriminately, both domestically
and professionally, and in many  cases where 
M U T
363
N A  U
 a hot oran poultice  would be  much  more
 soothing  and beneficial.   They often cause
 much irritability, and if applied near  the
 spot  where  inflammation is going on, as
 in  the case  of  the throat, seem  rather to
 aggravate than to relieve.   In the case of
 a lady under the author's care, the appli-
 cation of a mustard-plaster to the lower
 part  of  the  spine  gave rise to effects  re-
 sembling those produced by the inhalation
 of  laughing gas.
   As an internal remedy, mustard is a safe
 and effectual emetic, in doses of one, two,
 or  three teaspoonfuls in six or eight ounces
 of water.  The  seed  of the white mustard,
 swallowed whole in  tablespoonful  doses,
 was,  some years ago, in much vogue as a
 stomachic remedy, but is now little used.
 It probably produced any benefit it effected
 by its mechanical action upon the aliment-
 ary canal.
   Refer to Counter-irritation.
   MUTTON—When tender, is the meat best
 adapted  for invalids  and persons  of weak
 digestive powers.  The best mutton chops
 are those cut out of the centre  of a leg.
   Refer to Broiling—Cookery—Food, Sec.
   MYRRH—Is  a gum resin, the product of
 a tree native  to Arabia, Abyssinia, and  the
 countries bordering on the shores of the Red
 Sea, from which the drug is chiefly brought.
 Myrrh is a stimulant expectorant, and enters
 into different medicinal compounds.
   The tincture  of myrrh forms one of  the
 most agreeable washes in affections of  the
 mouth, in the proportion of half an ounce
 of  tincture to half a pint of water; and a
 few drops upon the  tooth-brush is  a  most
 excellent habitual application  in cleansing
 the teeth, especially  if the gums are weak
 or spongy.

   NvEVUS.—See Mothers'-mark.
   NAILS.—The nails, like hair, may be  re-
 garded as prolongations from the epidermis,
 or outer skin.  They are formed of flattened
 cells  containing horny matter,  and spring
 from  a fold or matrix in the true skin, about
 two lines in  depth.   At the  bottom of this
 groove  or fold  there are numbers of pa-
 pillae, or  little vascular points,  from which
 the nail  is developed, and  is  continually
 being  pushed forward by the addition  of
 new matter to its root.   At first the nail is
 thin,  but it  acquires thickness in  its pro-
 gress  forward, bythe  addition of new layers
 of cells  to  its  under-surface,  these  cells
being also formed  by papillae, which  like-
wise serve to retain the nail in its place.
  Nails are apt to be cast off  after injury,
but the  principal  and  most  troublesome
affection  to which  they  are  liable,. and
particularly the  nail of the great  toe, is
"ingrowing"—that  is,  ulceration,  formed
by the edge of the nail,  and constantly kept
up by the irritation which produced it in
the first instance.  There are many pallia*
tive methods of treating this affection, such
as  the  use of  caustics, scraping the nail
away, &c.; but perhaps there is  no  certain
mode of treatment, but. the thorough removal
of the entire half of the nail up to the root,
on the  offending side.   This,  of  course,
requires to be  done by  a surgeon.  The
appearance of  the nails is  often  indicative
of constitutional  tendency,  particularly the
long curved nail of the consumptive.
   Refer to Skin.
   NAPHTHA.—The term is now  applied to
the transparent colourless fluid obtained by
distillation from  petroleum, a bituminous
substance, formed  probably by the action
of  heat upon beds of  coal. Naphtha has
been  recently lauded as a  remedy in con-
sumption, but it is not much in use.
   NARCOTICS —- Are  medicinal  agents
which diminish the activity of the nervous
system, produce sleep, and in most instances
relieve pain, but which  also are capable, if
given in small  repeated doses, of exciting
the nervous system ; by this they are distin-
guished  from the class  of medicines named
sedatives.  The  class of narcotics also in-
cludes anodynes.   The only narcotics in any
way  admissible  in  the domestic materia
medica  are—
  Camphor,
  Hemlock,
  Henbane,
  Hop,
  Lettuce,
  Opium,
  Strammonium.
  Refer to separate articles.
  NAUSEA—Or  the sensation  of sickness,
or of inclination  to vomit, is best  known
from individual experience of the  sensation.
  Although the  feeling of nausea itself is
referred to the stomach, and may be due to
causes connected  with that organ  simply, it
also very frequently originates  in disorder
in other and distant parts  of the body, a
fact which often  constitutes it a valuable
symptom.   Causes which act directly upon
the brain  are  among  the  most  frequent
originators of nausea, and  there is  every
reason to believe that  the  sensation from
which the  term is  probably derived—sea-
sickness—is primarily excited  in  the brain
itself.  As  all  know, a blow on   the head
occasions nausea and  vomiting;  severe
injuries in other parts of the body, such as 
X  A V
304
N  K 0
i  dislocation,  also  occasion  sickness  by
acting indirectly upon the stomach;   the
nausea of pregnancy is another example of
this sympathetic nausea.  Disgusting odours
are instances of the same thing.  The action
of drugs of  an emetic character must be
accounted  for by  their  influence  on  the
nervous system, for they act equally  well
as nauseants, if injected in solution into the
veins, as if they were swallowed.   Lastly,
the presence of indigestible food, or of bile,
&c. in the stomach  itself, will  alBO cause
nausea, which may also be  produced  by
simple over-distension  of the organ by gas
or fluid.  The instances  given  of  sympa-
thetic nausea will explain how it  comes to
be a valuable guiding symptom in the in-
vestigation of disease.   Incipient  or  ad-
vanced affections of the brain ; gall-stones;
stone in the kidney ; disease  of the womb ;
pregnancy, and many  other conditions of
various organs, giving  rise to the  sensation
of nausea, or to actual  vomiting.
  The complete relaxation of the nervous
system which  occurs in an  individual under
the influence of nausea, renders its existence
favourable to  the performance of  certain
operations upon the body, such as a reduc-
tion of a dislocation, or of a rupture. It is,
therefore, the  practice of surgeons  to induce
it  artificially—as by the administration of
tartar emetic—for  the above ends.   The
means of relief in nausea, and its very fre-
quent  accompaniment, vomiting,  must, of
course,  depend upon   the  cause.  When
dependent upon  brain affection,  remedial
measures are of but little  service, but in
this, as in  other cases, may be resorted to.
Effervescing   draughts,  with lemon-juice,
will often be  extremely useful.   Creasote is
effectual,  especially in  sea-sickness.—See
Creasote.   A  teaspoonful  of  magnesia in
a  glass of sherry has been  found  a  good
remedy,  but  one which is inadmissible in
head  affections;  a mustard-plaster to the
pit of the stomach may be used with advan-
tage.   When the nausea is thought to be de-
pendent upon the presence of bile or other
matters in the stomach, it is soonest relieved
by  exciting  vomiting,  which is  generally
easily effected, either by means of lukewarm
water alone, infusion of chamomile, or at all
events  by a  small  dose of  ipecacuanha.
After the stomach  has been cleared, effer-
vescing draughts will  be  at once grateful
and beneficial.
   Refer to Effervescing, Sec.
   NAVEL.—See Child-bed, Children, &c.
   NECK—The bond of connection between
the head and  the trunk of the body, is  per-
haps  the  most  important region  of  the
frame;  certainly it is so in a surgical point
of view, on account of the numerous import-
ant parts it comprises.   The figure, (oi.,|

                  Fig. d.
which represents a transverse section of the
neck, will  best show the position  of the
chief vessels,  &c.   1, 1 is one  of the ver-
tebrae of the neck, in front of which, some-
what flattened, as at rest, lies the oesopha-
gus, or gullet, (2;) and anterior to this, the
windpipe (3;) on either side  are placed the
great vessels  of the neck;  these are the
great,  or "carotid  arteries," (4,  4,) and
close to them—indeed, included within the
same covering or sheath—the internal jugu-
lar veins, (5,  5.)  All these parts,  besides
nerves, glands, the  external  jugular veins,
and  the muscles of the neck, are included
within  the surrounding  skin, (t>, 6.)  The
"thyroid  gland,"  (7,)  which becomes en-
larged  in swelled neck, or bronchocele, (see
Bronchocele,) lies in front of the  windpipe.
  Diseases which affect the  parts  situated
about the neck, such as its glands, &c. fall
to be considered under other  heads, and
need not be enlarged upon here ; and under
such articles  as  Hanging,   Gullet,  which
also includes  Choking,  Artery,  &c.  will  be,
found information concerning the accidents
to which this region and its parts are liable.
There  remains, however, for consideration,
the effect of mechanical impediments to the
circulation of  the blood in the neck, con-
nected either  with  clothing, or with those
muscular movements of which  the  part
under  consideration  possesses  so  wide  a
range.   Some  persons,  particularly those
with short  necks, or with  tendency to apo-
plexy,  epilepsy, &c.  are much  more liable
to  be  affected  than others,  by any thing
which,  even for a  very short time, checks
the  free flow  of blood through the veins, 
N  E C
365
NER
Downward, from the head;  and such per-
sons  ought to  be  especially careful that
nothing they wear about the neck becomes in
the slightest degree tight, not simply when
the face is looking straight forward,  but
when it is turned from side to side.   It has
occurred, that a person liable to head attacks
has fallen  down insensible, in  consequence
of  the simple  fact  of   turning the head
rather more to one side than usual, and thus
giving a little extra tightness  to  a  shirt-
collar.   It  is  well known,  too,  that  the
tight stock of the soldier has  been the cause
of numerous apoplectic and other affections,
in consequence of its effect  in  compressing
the large vessels of the  neck.   A similar
caution is requisite with regard  to children.
Accidents have occurred in consequence of
nurses and others tying too tightly (a very
common practice) the strings of the  night-
cap,  which,   perhaps,  become  still  more
tightened by some  movement during  sleep.
From a similar cause  arises  the danger
which  men  incur  from sleeping, without
unfastening  the usual clothing  about  the
neck; apoplexy may result.   But not only
may  head  affections result from  tightness
around the neck externally; it may, in those
predisposed, be the effect of the action of
the  muscles alone; these,  if  the  head is
turned  strongly to  one  side, exert  strong
pressure upon the veins and  impede  the
flow  of blood, damming  it up  toward  the
head.  On  this  account, persons  who  are
liable to overfulness of blood,  ought to be
on their guard against such sudden  move-
ments.
  Wry neck is caused by the undue perma-
nent  contraction of one or more of  the
muscles on one side  of the neck.  It is
remediable by a surgical operation.   A dif-
ferent form of wry neck, or, at  least, of an
affection closely resembling  it, is the  result
of paralysis of the muscles on one side,
permitting those on the  other to draw the
head toward their  own side.  Stiff neck is
the  result of  rheumatic affection of  the
muscles.
  NECROSIS.—Death of a portion of bone.
—See Bone.
  NERVOUS  SYSTEM   and NERVES.—
The  possession of a system of nerve  tissue
is one chief distinction between the animal
and the plant; the  latter exhibits no trace
of it, and even in some of the lowest  tribes
of the  former,  which  are  scarcely distin-
guishable from  vegetables, it has  hitherto
been undetected.  Where a nervous system
does  exist, it is  always found to be com-
posed of two parts, one  of  which is  white
and opaque in  appearance, and when exa-
      2 r 2
mined under the microscope, presents a tu-
bular or fibrous structure ;  the other is of a
reddish gray colour, and semi-transparent,
and  consists of cells or vesicles  filled with
granular  matter.   The  presence of these
two  forms of  nervous  substance seems es-
sential to  the  working, so to speak, of the
apparatus.  In the larger  nervous masses,
such  as the brain, the distinction is very
palpable,  as any one may verify who will
take the trouble to examine the brain  of a
sheep.  The  opaque white  nerve matter
forms the larger proportion  of  the brain,
spinal marrow,  and  nerves; the gray is
more sparingly distributed, and is evidently
the apparatus  in which the nerve force is ge-
nerated, the tubular substance  acting  the
part of the conductor.  This is more apparent
when the latter is thrown into the  form of
the  nerves, or  cords  of nervous  matter,
which are distributed throughout the body.
These nerves,  at their origin, are connected
with  the  gray substance, with  the vesicles
of which their fibres   are  intermingled.
Where  this  intermingling  takes  place, an
enlargement,  or,  as it is named, a "gan-
glion" is formed.   In  the  lower tribes of
animals,  in which the nervous  system is
simple in a degree corresponding with  the
simplicity of their structure, these  " gan-
glia," resembling  knots  upon the nerves,
are all they possess in lieu of a brain.  But
as the  scale is  ascended toward man, we
find the nervous system become much more
highly developed, and the nerve  substances
collected or aggregated into masses, which
are  carefully  protected  from all external
injury,  and  from which  the nervous cords,
or conductors, or, as they are usually called,
"nerves," proceed to all parts of the body,
each being  enclosed within its own proper
sheath,  and  dividing and subdividing, to be
distributed  to every portion  of  the frame,
although  to some, such  as the ends of the
fingers, lips, &c. their  branches are more
liberally allotted than to others.
  In  man, the great nerve  masses are di-
vided into the  brain, or cerebrum, (fig. cii. 1,
1,) the little brain  or cerebellum, (2, 2,) the
medulla oblongata, (3,) the  ganglia of the
special senses, (4;)   These parts  are all con-
tained within, and protected by the hard,
bony  skull.    Continued from the  medulla
oblongata at 5, there is the spinal cord, or
marrow, which is  contained within its own
special canal carried through the bodies of
the vertebrae  of the spine, and thus most
effectually guarded.   The  annexed figure
represents the base or  under side of the
brain.   The brain,  (see Brain,) which ia
man  and the higher animals constitutes so 
N  ER
366
N E R
Fig. cli.
large a mass of the nervous syBtem, is it-
Belf destitute of sensation;  for it may be,
and  after  accidents often is, cut, without
the individual—although perfectly conscious
—having the slightest sense of pain.   Nei-
ther does  its presence appear necessary to
the continuance of the mere animal life of
the body ;  for if—as has been proved by ex-
periment—the brain of such an animal as a
rabbit, be gradually and carefully removed,
the  animal  still  continues to live, and to
perform  the various functions of animal
life.
  The brain is  undoubtedly the organ upon
which the manifestations of will, intelli-
gence, memory, &c. depend^ and by which
the conscious  mind  of  man or  animal is
linked with the processes and actions of the
body, by means of  other portions of  the
nervous system.
  The cerebellum,  or little brain,  is  be-
lieved to be endowed with the function of
regulating in unison and  harmonizing  the
various muscular  movements.   The me-
dulla oblongata is connected with the  pro-
cesses of respiration, mastication, swallow-
ing, &c, and  on the due performance of
which the preservation of life depends.
  The ganglia of the special senses develop
the powers of  sight, smell,  taste, &c; and
lastly, the spinal cord  appears  to be most
essentially connected with animal life, par-
ticularly with the powers  of locomotion, in-
dependent of the conscious  mind of the in-
dividual, possessing in itself powers of sen-
sation unconnected with the brain.  These
powers  are exhibited in what are called the
" reflex" nervous actions;  that is to say,
supposing—as  sometimes occurs  from in-
jury, or is done for purposes of experiment
in animals—the  spinal cord is severed at
any  point, all sensation,  all power of tho
will over the parts of the body below the
line  of severance is  totally lost;  but yet
irritation, such as the  prick of a  pin  to
such a part as the foot,  will cause the leg
to be retracted—evidently showing  that the
sensation excited by the pin was felt, so to
speak, by the  spinal cord through  one set
of nerve  fibres,  and " reflected"  from it
again through another; causing contraction
of the muscles  of the  limb—independent
either  of the sense or will of  the individual.
   From the various masses within the head,
nine pairs  of  nerves proceed;  from the
spinal  cord or marrow, thirty-one pairs;
the former passing out at various  holes in
the skull,  the latter  between the vertebrae.
   In addition to the  nervous system above
described, there is the sympathetic, or gan-
glionic system, situated chiefly on the inside
of the spinal column, and characterized by
the possession of distinct separate ganglia
and  nerves, which are connected  with the
great nervous system on the  one hand, and
with the viscera  of  the  organic functions,
such as that of digestion, &c. on the other.
   As the diseases and disorders of the nerv-
ous  system are  treated of under other
heads, such as Paralysis, Delirium,  Sec, they
require no further mention here.
   Refer to Neuralgia.
   NERVOUS  DISEASE,  or Nervousness
—Is a term usually applied  to an indefinite
affection—a mixture of mental and  bodily
disorder and irritability, generally  the pro-
duct of weakness.  The active countryman,
the hunter, and those who take much exer-
cise in the open air, do not suffer from the ir-
ritability, or nervousness, which attacks the
sedentary—those who exhaust the  brain by
too great mental exertion, or  the  body by
dissipation.  Females are much more liable
to nervous disorder than males, independent
of hysterical  affection, which constitutes
one  of the  most marked  phases of the ma-
lady, and  many of the  remarks on which
apply to the present subject.
   In  nervous  disorders  there is  usually
great  susceptibility to external influences,
and at the same time mental emotions, whe-
ther of joy or grief, fancied or real, exert
much  influence over the body  and  its func-
tions.  The heart palpitates, the hand trem-
bles, the face flushes under the most trivial
excitement.  Much of this  is  undoubtedly
due to  constitutional  timidity; but it is
also notably increased  in debilitated states
of  the  constitution, and those who have
never been what is called   "nervous." are
 apt to become so in some particular condi-
 tions  of  impaired health.   The  affection, 
N  E T
367
N E U
 is indeed, very  nearly akin to hypochon-
 driasis ; it is essentially a disorder of weak-
 ness, «and is relieved by whatever increases
 temporarily  or  permanently the power  of
 the nervous system.  The temporary relief
 to nervous  sensations which is afforded  by
 alcoholic stimuli, is very apt to lead those
 who suffer from them to put too much trust
 in, and to resort too  habitually to the use
 of those palliatives—a practice which must
 be followed  by pernicious consequences;
 sometimes, too, opiates are habitually made
 use of, and are no less injurious.
   Undoubtedly,  when properly employed,
 alcoholic stimuli, and even opium, are valu-
 able in  the  treatment of nervous  disease,
 but they must never be substituted for more
 permanent  means of invigoration,  particu-
 larly regular and sufficient exercise in  the  open
 air, on foot or horseback, good nourishing
 diet, with a  sufficient amount of animal
 food, and attention to the  bowels  and the
 state of the  skin.   The  producing cause,
 whether excessive  mental exertion, seden-
 tary employment, late hours, or excess  of
 any  kind, must of  course  be  modified  as
 much  as possible.    The  shower-bath  is
 often recommended,  and  often useful  in
 these affections, but some  persons cannot
 bear the shock; when this  is the case, the
 cold or  tepid  douche down  the back  does
 much  good,  particularly if there  be  any
 tenderness of the spine on pressure, a fact
 which should always be investigated in those
 who  suffer much from nervous  disease:  it
• very commonly  exists and  is  overlooked.
 When  the  tenderness  is at all marked, it
 will  require special  treatment  by counter-
 irritation, &c.; but this, as well as the treat-
 ment of aggravated cases of nervous disor-
 der, will be best managed under the care  of
 a medical man.  In addition to  the  regula-
 tion  of the  bowels  by the warmer purga-
 tives, or by clyster, quinine and the prepa-
 rations of  iron are the most generally use-
 ful remedies ; tincture of valerian, sal-vo-
 latile, and stimulant carminatives  may be
 used as palliatives during an aggravated at-
 tack, but should be sparingly resorted to.
   Refer to Hysteria—Indigestion, Sec.
   NETTLE.—The  common  nettle  belongs
 to a tribe of plants which includes  the fig,
 the hop, and  others used  as food, and  is
 itself eaten when cooked, as a wholesome,
 almost as a medicinal article of diet, in some
 parts of the country.  It  is diuretic.  The
 fresh juice of the  nettle has  been highly
 recommended  in cases of internal  hemor-
 rhage,  particularly from  the   lungs  and
 womb.   The dose,  one teaspoonful three
 times a day —Refer to  Hemorrhage.
   NETTLE RASH.—See Skin.
   NEURALGIA—Literally, pain in a nerve
—is also  known as  "rheumatism  of the
nerve," or " tic doloureux."  It is perhaps
one of the most painful affections to which
the human body is liable.  In most instances
the pain is the only symptom ;  in some it is
accompanied with marked  constitutional or
local ailment.   The exact  nature of  neu-
ralgia is obscure; probably the one effect,
pain iu  the  nerve, may  arise from various
causes;  it is certain that some of the  most
intractable cases have been connected with
diseased growth of bone in different parts
of the head or face,  especially about the
canals  through  which  the nerves  pass;
other severe cases  have  been found to de-
pend upon  irritation excited  by foreign
bodies  acting  upon  some  of the  nerve
branches;  decayed  teeth  are  not  unfre-
quently  connected with  the disease.  The
most general seat  of neuralgic pain  is in
the head or face; but the fingers, the chest,
the abdomen, &c. may any of them  consti-
tute its site.  When the great nerve of the
leg is  affected with  neuralgia, the disorder
is known as "sciatica."
   The pain of neuralgia is described as a
"plunging," darting  pain  of the most in-
tense  and agonizing kind; but,  except in
long-continued cases, there is no external
mark—no  redness, swelling, or heat, to in-
dicate the disorder to others.  After a se-
vere attack of neuralgia the  skin is  often
left tender, and when the pain has recurred
frequently, exquisitely tender swelling  of
the part has been  known to come on.  The
access of  the  pain is usually sudden,  its
remission  equally so, and  it is generally
periodical  in its attacks:  it  is suspended
during sleep.   The suddenness of the pain,
its character—often  compared  to  severe
toothache—the  absence  of  inflammatory
symptoms, and its periodical returns,  suffi-
ciently mark the disease.
   The exciting causes of  neuralgia  are,
especially, damp and cold, or damp alone, if
combined with  malaria, such as cause ague;
exposure to currents of cold air, especially
if the individual is heated, frequently origi-
nates  the disease:   in  this  way railway
travelling  has  proved a fertile source  of
neuralgic affection.   Debility of constitution
renders the individual much more suscepti-
ble to those and other exciting causes; it
has  often, too,  been traced to  anxiety  of
mind.
   Some sudden attacks  of neuralgic  pain
in various parts of  the body have  been
traced to temporary stomach disorders, such
as superabundant  acid,  and have  disap- 
                 X E U               3(:

peared  as  soon  as  the cause  has  been
rectified.
  The severe pain which  attends neuralgia,
quickly drives the sufferer to seek medical
advice; and without doubt,  the safest plan
ib to have the exciting cause of the affection
detected if  possible, and  as  soon as possible
obviated, before  the disease  has become
fixed.  If the person is resident in  a climate
or situation likely to excite  it, some change
should,  if possible,  be made; this  will pro-
bably be most beneficial  if  the removal  be
to  a dry, warm  air;  but  should disease
have  commenced in  a  cold, dry  district,
change  to  a  moist, humid,  but warm one,
will probably offer most advantage.  If dis-
order of the digestion   exists, it  must  of
course  be  rectified, (see Indigestion;)  after
that, if the disease  still continues, quinine,
given in one or two grain  doses  every six
or eight hours, will  most  probably be  of
service.  Carbonate of  iron, in from  half
drachm to  drachm  doses, is a most useful
remedy, especially in weak constitutions;
but these are constitutional curative  mea-
sures which will  be most safely trusted to
medical  hands.   Blisters behind the  ears,
or at the back of the neck, are often valu-
able aids in the treatment of facial neural-
gia.   The late Sir  Charles  Bell is said  to
have found the following most successful in
some cases of obstinate neuralgia,  probably
caused by disorder  of the alimentary canal:
— One to two drops of  croton-oil  is mixed
with  one drachm of compound  colocynth
 Jiill, and of this one-twelfth, or five grains,
 i  given at bedtime,  along  with ten grains
of compound galbanum  pill.   The remedy
is more suited to  persons of strong habit of
body than to the weakly.
  During the paroxysms  of  agonizing pain,
any thing which will, or  is  likely to relieve
should  be  tried,  even in the absence of a
medical man.   A sponge or piece of flannel
dipped in boiling  water and applied as hot
as it can be borne over the site of  the pain,
will  often  allay  its severity, or remove it
altogether.   Opium internally may be given
in very severe cases, or rubbed on the  part.
Chloroform applied to the affected part  by
means of a piece of lint soaked in it, is a
very successful application, and should  be
tried if it can be procured.  [Aconitia made
into an ointment  in the  proportion of one
grain to the drachm of lard, and  then well
rubbed in, will also  be found to be very effec-
tual.]   Lastly,  the  author can say from his
own experience, that the Pulvermacher elec-
tric chain will,  in some cases, confer speedy
relief.   Leeches are sometimes of use.
  Earache  is a  form of neuralgia distin-
                 N I (J

guished from inflammatory earache ending
in abscess, by the neuralgic characters  al-
ready described.   It is of course treated as
neuralgia.
  Refer to Nerves—Sciatica, Sec.
  NEUTRAL  SALTS—Are  compounds of
an  acid  and an  alkali, in which  the  two
constituents completely neutralize  one an-
other ;  the resulting compound  having nei-
ther acid nor alkaline properties.
  NIGHT.—The period of darkness conse-
quent upon the absence of the  sun's rays,
is one which  unquestionably exerts  consi-
derable influence over the states and health
of the human  body.  The effect  of  light
upon the  body,  and the  injurious conse-
quences of its withdrawal, has already been
treated of, and to that article the reader is
referred  for information;  also  to  articles,
Early Rising,  Breakfast,  Sleep,  Sec.   With
the exception  of certain animals, fitted  by
their constitution for nocturnal activity, the
majority,  including man, are evidently in-
tended  by  Providence to  rest  and sleep
during  the hours  of  darkness;  animals
governed  by  instinct  do  so;  uncivilized
man for the most part does so;  but the
member  of a civilized  community neces-
sarily requires in  some degree to modify
these things, and is endowed with the capa-
bility of  doing   this,  within  certain  limits,
without injury to health ;  if these limits are
exceeded, he suffers.
  It is often asked,  "Is it not the same
thing whether  I sleep in  the  day or the
night, bo as I get enough ?"  It is not the
same thing.  Independent  of the argument
that the  natural laws  of  our constitution
can  never be infringed with impunity, and
that man cannot, without injury to health,
spend those hours  in sloth and sleep, dur-
ing which he ought to be active under the
sanative  influence of diffused daylight, ex-
perience has long testified  that during the
night many sources of disease act  more
energetically upon  those exposed to  them.
One often recorded experiment sufficiently
illustrates the  fact.  The colonels of  two
French cavalry regiments had to move their
respective corps  a  considerable  distance
during the  hot weather.  One,  thinking to
avoid the heat  of the day,  moved his regi-
ment during the night only ; the other fol-
lowed  the reverse plan.  The latter,  at the
end  of a week or ten days,  arrived with  hi«
men and horses  well, while the other  had
many laid up with sickness.
  As,  however,  in northern countries in
winter, the term  of daylight is too consider-
ably curtailed, and the hours  of  darkness
too prolonged to permit of their all being 
N  IG
369
N 1 T
emptied by other means, and  the  milk thus
drawn given to the child.
  The late  Sir  Astley Cooper's  favourite
jpent in sleep, it becomes a question which1 may be  covered with collodion.]—See Cat*-
portion of the  latter may be most advan- chu.   Various substances,  such as cow'<*
tageously  devoted to wakefulness, under the teats,  prepared  nipple  shields,  &c. have
influence  of artificial  light.   Experience been used to cover the nipple in such cases,
has proved, that to rise early and spend I but they do not answer well, and it requires
the morning hours by artificial light, is not'a very strong child to draw the milk through
by any means so salutary a custom  as to | them.    If the  nipples are harsh and dry on
add  to the latter part of the day  by the the surface,  glycerine  will probably be
same  means.   This is probably, in part, | found  of more service than catechu ; and if
due to the greater  activity of  the nervous they do  not heal up under these or similar
system in the after part of the day, causing applications, the  child must be kept from
the absence of  the  stimulus of the sun's .sucking for a short period, the breasts being
light *o be less felt.
  Refer to Sleep.
  NIGHT-BLINDNESS—Is a species of pe-|
riodical "amaurosis" to which some persons lotion in sore  nipples was composed of bo-
are liable, probably in consequence of the rax one drachm,  spirit  of wine  half an
retina having become exhausted  by  expo- ounce, and water (soft) sufficient to make
sure  to too great a light during the  day. up the half-pint lotion.
The  affection prevails chiefly  in  southern   Refer to Breast—Childbed, Sec.
climates.   It requires proper medical treat-1   NITRATES—Are salts, such as nitrate of
ment.   The glare of the midday sun should potassa, (saltpetre,) of which nitric acid is
be avoided.                              ! one of the components.—See Potassa.
  Refer to Amaurosis—Eye.                I   NITRIC ACID,  or Aqua-Fortis—Is one
  NIGHTMARE.—See Sleep.             j of the most powerful of  the mineral acids,
  NIGHTSHADE.—See Belladonna.      j and is  strongly corrosive.  It  is obtained
  NIPPLES.—The  nipple  of  the  female from  saltpetre by distillation with  oil of
breast is  chiefly composed of  tubes which vitriol.   Pure nitric acid  is composed of
give passage to the milk.   During  preg- nitrogen and oxygen gases, in the propor-
nancy,  and at childbirth, it ought  to be- tion of one of the former to five of the latter,
come more prominent and increased in size; and should be  colourless.   It is  usually met
but sometimes, from the pernicious pressure with in  the shops of a light straw colour,
of the stays in  early life, it has become so and contains water.
imbedded in the breast that it cannot bej   Nitric acid  is  used externally by  sur-
developed ; consequently, when the time of > geons as a caustic, or rather as a corrosive.
suckling arrives, it  is perfectly impossible Internally it is employed as a tonic, espe-
for the infant to seize it.  This is a  state cially in some  forms of dyspepsia and liver
of things which often gives  much trouble, disorder ;  the dose is from two to eight drops
causes the individual much pain and suffer
ing, and not unfrequently lays the founda
tion of abscess  of the breast.    When this
condition of the nipple exists, every effort
should be made during the time of pregnancy,
to get it into a better and more  prominent
state, by means of  the  glasses adapted to
the  purpose, or by  suction exerted by the
mouth of an adult: after childbed, the same
means  should  be  assiduously  practised.
The greatest  suffering, however, connected
with the nipple during  nursing, is in  con-
Bequence  of its becoming  excoriated and
chapped.   This  may be  greatly prevented,
if, during the latter months of pregnancy,
trouble  be taken to bathe the nipples night
and  morning with a  mixture of brandy and
water, one part of the former to three or
four of the latter.  When the nipples are
inclined to become sore from nursing, which
is  generally within the first fortnight, the
best, and indeed  almost a certain remedy, is
the tincture of catechu, [or of galls, or they
24
well diluted with water.  Diluted nitric acid,
composed of one part of the common com-
mercial acid,  and nine parts of water, is
used  as  more  convenient than the  strong
acid.   Of this,  the dose is  from  twenty to
thirty drops.
  Poisoning by nitric acid,  or  aqua-fortis,
sometimes occurs, and must be treated in a
manner similar to that  recommended  in
poisoning by muriatic acid, under the  article
" chlorine."
• NITROGEN GAS—Is one  of the element-
ary gases, important from its forming nearly
four-fifths of our atmosphere, and from its
numerous  combinations.— See  Ammonia—
Azote—Nitric Acid, Sec.
  The existence of nitrogen  in animal mat-
ters was  formerly thought to constitute one
great distinctive  mark  between  them and
vegetable substances, but  this idea  is now
known to  be   erroneous.   Certainly,  the
abundant presence of nitrogen in  the  con-
stituents of the  animal kingdom is trulj 
X I T                370                 N 0 S
first to frighten, by attaching  exaggerated
importance  to  every slight  symptom,  and
then to fleece those  they have  thus  gulled.
Persons who are affected with  the disorder
in question, by  confiding in some  medical
man may speedily be relieved.
  NODE—Is an enlargement  of a bone,
caused  by inflammation of  the bone itself,
or of its covering " periosteum ;" the shin
bone  is very liable to the disease, often in
consequence  of  venereal  affection.   While
active inflammation of the part is present,
perfect rest, leeches, fomentations, poultices,
and  other remedies, internal and external,
recommended  in  inflammation  generally,
may be  used, and afterward blisters.   A
medical man should be called in.
  NOISE in  the EARS.—See  Ear.
  NOLI-ME-TANGERE—Lupus.—SeeSKiN,
Diseases of.
  NOSE.—The organ of smell is so situated
above  the mouth, that by it the odour of
whatever is put into the latter must be per-
ceived in the first  instance.   The  visible
portion of the nose is chiefly made  up of
bone at the upper part or bridge, of carti
lage at the expansive nostrils. The internal
portion of the  nose consists of a cavity—
which  communicates with the  throat, at 6
fig.  ciii.—formed in the bones, which  are
     characteristic,  compared  with  its  more
     sparing  amount in vegetables;  but  it is
     more than  probable that  animals,  in the
     first instance, derive the greater part of their
     nitrogen from vegetables, which  constitute
     the medium for its conveyance to them from
     the inorganic kingdom.
       Refer  to Aliment—Blood—Food, Sec.
       NITRO-MURIATIC  ACID, or  Aqua-Re-
     gia—As  it  has been called from  its power
     of acting upon gold,  is used  in  medicine
     as  a tunic, and it is a very  valuable one.
     It may  be prepared  sufficiently well by
     mingling equal  measures of  nitric  and
     muriatic acids in  their undiluted  condition,
     and allowing  them to stand  for a few
     minutes  before water is added.  The  dose
     is from four to eight drops, well diluted in
     water.
      NITROUS, or Nitric Ether, or Sweet
     Spirit of Nitre—Is prepared by the action
     of nitric acid  upon alcohol.   It  is one of
     our most valuable  diuretics, being also sti-
     mulant  and diaphoretic, and is much used
     domestically as a remedy in common colds,
     &c, and to increase the flow of  urine.   The
     dose is from half a drachm to a drachm and
     a half,   given  either  in water  or gruel.
     When badly made, or  too long kept,  sweet
     nitre is apt to contain much acid, which may
     cause pain at the  stomach.  The fact may
     be  known  by the  ether effervescing with
     carbonate of soda.
      NOCTURNAL DISCHARGES—[Seminal
     Weakness]—Of seminal fluid are apt  to
     cause much  uneasiness and physical debility
     in those, generally young men,  who are the
     most frequent subjects  of them.  Unless
     very excessive, there is no reason that  they
     should be  regarded in the almost morbid
     way they often are.  Abundant  exercise,
     cold bathing, either general  or local, and
     where there is not much debility, the disuse
     of alcoholic stimuli, the avoidance of what-
•    ever may tend to  excite the secretion  in
     question, and the use of the tincture of mu-
     riate of  iron, in ten or  fifteen drop  doses
     twice or thrice a day, will, in  most cases,
     effect a  cure.   It is of great  importance,
     along with these measures, to keep the bow-
     els perfectly open; and for this purpose,gentle
     salines,  senna, castor-oil, sulphur and mag-
     nesia, from  half a  drachm to one drachm
     of each for a dose, in milk, or cool clysters,
     are preferable to pills which contain aloes.
      In such cases, one caution is of the high-
     est importance, Avoid the advertising quacks.
     The  painfully nervous state of the mind  in
     those who  suffer from the above affection,
     render them most  timidly credulous, and
     this fact  is made use of by designing knaves,
Fig. ciii.
expanded in such a manner as to offer a wide
extent of the membrane (fig. ciii. 11 on which
the nerves of smell (2, 3)  are distributed,
to the action of the air bearing the odorife-
rous particles.   The two nostrils are sepa-
rated from each  other by a bony cartilagi-
nous "septum," or division ;  they are lined
by the mucous membrane which secretes the
peculiar  mucus  of the nose.   This  mem-
brane is continuous with that of the  eyes,
through  the  canal or " lachrymal  duct,"
(see Eye,) which conveys the superabundant
tears into the nostril;  it is also  continuous 
N OS
371
NUR
 with that 01 the throat.   As might  be ex-
 pected, the no^e, from its  position, is much
 exposed to accident.
   Fracture of its bones is not uncommon,
 and, like other accidents  to the organ, is
 liable to be followed  by much bleeding.   If
 the nature of the accident is  indicated by
 the alteration  in shape and mobility of the
 parts, &c,  the nose  may,  if a medical  man
 is  not at  hand, be  restored somewhat  to
 shape, by a bystander, the fingers on the
 outside  being  assisted, if requisite, from
 within, by means of a firm quill,  or piece
 of wood covered with lint,  passed  up  the
 nostril.   After the displacement has been
 rectified, the person should be kept perfectly
 quiet, the injured parts covered with cloths
 dipped in cold water, and,,if  the habit  of
 body is full, a sharp purgative administered,
 for the  possibility of the  inflammation  ex-
 cited  extending to the brain  must not  be
 forgotten.
   Bleeding from the Nose.—See Hemorrhage.
 The  nose, like the ear, is very liable to be
 made by children the receptacle for  any
 thing that will pass into it; beans, buttons,
 stones, or  the like.  A few minutes  before
 commencing this article,  the author  was
 called upon to extract a considerable piece
 of tobacco pipe, which a child had pushed
 up the nose almost out of sight.  When the
 articles  introduced swell,  by absorption of
 moisture, there is often  considerable  dif-
 ficulty in their extraction.   Sometimes they
 have been in the nose, unnoticed, for days or
 weeks, and are not discovered  until inflam-
 mation of,  and perhaps discharge of matter
 from, the lining membrane attracts attention,
 a  reason, when such  symptoms occur in a
 child, for always examining the nose for the
 presence of foreign bodies.   The extraction
 of  a foreign body from the nostril is always
 best done by a surgeon : others are very apt
 to  make the  matter worse by pushing the
 foreign body farther in.   If, however, cir-
 cumstances render it desirable to attempt
 the extraction  without waiting, it  must be
 done by  means of the flat end of a probe, or
 of a bodkin, bent about the  eighth of an inch,
 nearly at right angles with the rest of the
 instrument, which bent end being carefully
 passed beyond  the body, must be used as a
 hook to draw it out.  Sometimes, when the
 foreign body is not very far in  the one nos-
 tril, if that on  the  opposite side be closed,
 and the  child can be made to blow forcibly
through  the other, the obstruction will be
shot out.
  The lining membrane of the nose is liable
to  become  inflamed  and  ulcerated.  In a
mild case, washing with warm water—if ne-
 cessary, by means of a syringe—containing
 a little carbonate of soda in solution, will
 be of service.  It is a common popular error
 to suppose that the nose communicates with
 the brain: it is sufficient  to remark that it
 does not.
   NOSOLOGY.—The scientific classification
 of diseases.
   NOSTALGIA.—See Home-sickness.
   NOSTRUM.—See Quackery.
   NOURISHMENT.—Refer  to  Aliment-
 Digestion—Food, &c.
   NURSE—for Children.—The subject of
 wet-nursing, and the objections to it, have
 already been alluded to under article Chil-
 dren.  When a wet-nurse is absolutely neces-
 sary and resolved upon, the,selection is best
 left to the medical man, who will endeavour
 to procure one whose confinement was  as
 nearly as possible at the  same time as that
 of the mother whose child she is to nurse;
 he may at the  same time avail himself of
 the aid  of the microscope in  examining the
 milk, if there is  much power of choice.  The
 following characteristics of a good wet-nurse
 are laid down by M. Devergie, who, in 1838,
 had  the responsibility of  choosing a nurse
 for the  infant Count of  Paris.   " A good
 nurse should be from twenty-five  to thirty
 years old, strong in constitution, full-chested,
 of sanguine, lymphatic temperament, brown-
 haired,  having white healthy teeth  and well-
 coloured lips.  She should have  pyriform
 breasts  with well-formed nipples, and with-
 out too  much development of veins.  The
 milk  drawn into a spoon should be white,
 with  a  slight bluish tint, its  taste saccha-
 rine ; it should not be too thick."   In scru-
 tinizing, however, the physical qualifications
 of a wet-nurse, it is of the highest import-
 ance  that the  mental   ones—disposition,
 temper,  &c.—should not be  overlooked ;
 for, independent of the influence which may
 be exerted upon the infant by the psychical
 qualities of the being from which  it draws
 its first nourishment, we know  that  the
 emotions of the  mind always  do affect  the
 milk  in some peculiar way, and cause  in-
 jury  to  the  child—nay,  death  itself from
 convulsions has been  the consequence to an
 infant whose  mother had,  shortly before
 nursing  it, given  way to violent   passion.
 The late Sir Astley Cooper held the opinion
 that  the anxiety of a mother  for her child
 during  teething,  by  acting  on the  milk,
 gave it  an aperient, and,  therefore, a salu-
 tary property.  Again, all nurses well know
 how  much  the quality of  their milk is  af-
fected either by food or medicine;  and this
is another  reason why a  wet-nurse should
be selected, if possible, who is likely to have 
                 NUR               3

(uflicient  self-control to regulate  her diet.
The difficulty in this is one, at least, of the
objections to wet-nurses,  especially if kept
in the houses of their employers, where they
are tempted with unaccustomed and richer
food and drink.
  The return  of menstruation, in  a nurse,
is always an  objection, although  perhaps
not an absolute one, if merely an occasional
occurrence: the  child, however, should be
withdrawn from  the breast during the pe-
riod,  and managed as if nursed  by  hand,
(see Children,) the breasts being kept duly
emptied by artificial means.—See Child-bed.
In  the  event  of slight  indisposition  in a
nurse, the  same  plan  may be  pursued.
Perhaps  no  diet  is  more suitable  for  a
wet-nurse than one which embraces a large
proportion of  milk and  farinacea, with a
moderate  proportion of  animal food;  and
much mischief is often  done to both  nurse
and infant,  under the idea that  an  extra
allowance of stimulant  is required during
nursing, from the very first. Strong, healthy
women require it not, and are better with-
out it;  some  derive much benefit from a
moderate  allowance of malt  liquor,  after
the first two or three months, while others,
who are  deficient  in  vital  and  digestive
power, require  it from the very first.   Per-
haps nothing can show  more strongly than
these facts,  which are well known to  every
medical man, the folly of laying down any
fixed  rule respecting the  use  of  alcoholic
stimuli by mankind generally.  Medicines
taken by the nurse may be so directed as to
benefit the  child, particularly such aperi-
ents as castor-oil, senna, &o.   Saline aperi-
ents and  acids generally cause griping in
the infant.
  With  respect  to nurses who have  the
charge of children in the nursery, it is suffi-
cient  here to remark, that good health, at
least, should be insisted  upon, particularly
if the children sleep with  them.
  Refer to Breast — Child-bed — Children —
Milk,  Sec.
  Nurses for the Sick.—Really good sick-
nurses, who understand their business, are
difficult to meet with, especially in the coun-
try : and  it is  to be lamented,  when  it is
considered how much of the success of the
best-directed treatment  depends  upon  its
being carried out and seconded by  good and
judicious  nursing.  A very young  nurse is
not desirable,  and,  perhaps, few are fit for
the office under thirty years old; but a very
old  one is  still more objectionable,  when the
infirmities, and  often the irritabilities, of
age have  come on :  after sixty this is too
often the case.
72                NUT

   It is sufficiently obvious that those whose
 duty it is to wait upon the sick, to suffer
 the necessary confinement, loss of rest, and
 other depressing  influences, should  them-
 selves  have health as good ns possible, and
 be possessed of strength and stature  suffi-
 cient to  enable them to give all  requisite
 aid in lifting, &c.  Activity, and order, nnd
 cleanliness,  both in their own persons and
 about those they wait upon,  are  indispen-
 sable.   All  bad  habits, such as  snuffing,
 smoking, and it, perhaps, must  be added
 drinking, are insuperable objections;  like-
 wise the habit or necessity of making un-
 usual noises, such as humming, or habitual
 cough.  Neither  should nurses  be  great
 talkers:  some  patients  are much annoyed
 with the garrulousness  of their attendants.
 A nurse ought to be a light sleeper, awake
 to  the  slightest call or  movement, and no
 snorer—a light mover about a room.
   A good and obliging temper is,  of course,
 highly desirable; equally so, sufficient good
 judgment in the management of the whims
 nnd peevishness of the  sick, and  to direct
 any little conversation   into proper  chan-
 nels, avoiding  all narrations of  previous
 experiences, which are  very apt  to be in-
 dulged in.
   Some amount of education is absolutely
 necessary—especially the  ability to  read
 writing.  Without it the most serious mis-
 takes may and have occurred.
   In enumerating the  qualifications  of a
 good nurse,  it is not expected that all these
 are to be found combined  and in perfec-
 tion  in one  or every  individual,  but some
 approximation, at least, to them  should be
 attempted.   Of  course,  in  addition to the
 natural qualifications,  experience in  the
 management of the  sick is more or less
 requisite,  and  the  more skilled  the  nurse
 in  the  performance of  the  needful  opera-
 tions of the sick-room,  of course  the more
 valuable.  While laying down the qualifi-
 cations for  good nurses, one word may be
 said to those who  employ them.   If active,
 cheerful attendance is required, it must not
 be forgotten that this is almost physically
 impossible, if a nurse be kept day after day,
 and  night  after night,  confined in a close
 sick-room.   Even  if averse to it,  both for
 her own sake, and for that of the patient, a
 nurse ought to be made to go  out  in the
 open air for exercise, for at least an  hour
 in the day.  There are few cases which will
 not admit of  some member of tne  family
 taking her place for that time.
   Refer to Bed—Bedroom, Sec.
   NUTS.—See Chestnuts—Filberts,  &c.
   NUTMEGS—Are the  produce  01  a tree 
NUX
373
CEDE
 resembling the pear-tree, which is a native
 of the islands of the Indian Archipelago ge-
 nerally, but its cultivation has been much
 circumscribed  by the narrow policy of the
 Dutch.  The nutmeg is  the  kernel  of the
 fruit,  which is  about the size of a peach,
 and is enclosed in a shell, over which is
 spread the  arillus, which is  the mace of
 commerce.—See Mace.  The  properties of
 thenutmeg depend upon a fragrant essen-
 tial oil  which it  contains.  This is some-
 times  partially extracted  by  heat, and the
 nuts  afterward sold as  fresh  ones, being
 covered with powdered  lime.   This  cover-
 ing with lime,  however,  is also sometimes
 resorted to  simply to prevent the  attacks
 of insects.
   Nutmegs, as  articles of diet, possess the
 advantages and disadvantages of spices ge-
 nerally.
   Refer to  Mace—Spices, Sec.
   NUX  VOMICA—Is the seed of a tree—
 the strychnos nux vomica, a native of India
 and the neighbouring countries.  Its active
 principle is strychnine, one of  the most en-
 ergetic poisons known,  though a valuable
 remedy in proper hands.
   Strychnine is now much used for destroy-
 ing vermin, and occasionally proves fatal to
 the human subject by design or accident.
 The symptoms produced in poisoning, either
 by nux vomica or  by strychnine, come on
 quickly, in  the  form of violent spasms, af-
 fecting the  entire  muscular  system,  and
 death  ensues from spasm of the muscles of
 the chest  producing suffocation.   Emetics
 in the first, instance, cold affusion, and,  per-
 haps, stimulants, may be used in such cases,
 but there is no known  antidote.   Medical
 assistance should be procured without delay.

   OAK BARK—Is a  powerful astringent,
 and may be used for the same purposes as
 others of the  class.   For domestic use, it
 has the advantage of generally being easily
 procurable.  It is  used  in the form of de-
 coction, made by putting  from an ounce to
 an ounce and a half of oak bark into a quart
 of boiling water, and boiling down one-half.
 In relaxed sore-throat it is a useful  gargle,
 [and in tender nipples it forms an excellent
 wash.]
  Refer to Galls.
  OATS—As an article of diet, are generally
 ranked next after wheat  as regards nutri-
 tive power, the latter holding the first place
 fn consequence of  its containing a larger
 amount of gluten;  in  some respects, how-
 -ver,  the oat is the superior grain.—See
 Grains.  The oat  is  most largely used in
Scotland:  the  seed is there  "kiln-dried,
         ,2 Q
stripped of its husk and delicate outer skin,
and then coarsely ground," in which state
it constitutes "Scotch oatmeal."   It may
be  thought  that  the  cheapness of the oat
might prevent its meal being  adulterated,
but in the recent examination of the subject,
by  the Lancet Sanitary Commission, it was
found, that  much of  the  oatmeal sold  in
London is adulterated with barley-flour, a
much less nutritious  article  of diet.   In
England oatmeal is chiefly used for making
gruel, (see Cookery;) but the meal, or rather
oat-flour, prepared in England, is of very
inferior quality to the Scotch, and even when
meal is  made professedly in imitation of the
Scotch preparation, it is a very poor substi-
tute. In Scotland, oatmeal is most largely
employed for the well-known  " porridge,"
which constitutes the  breakfast of a great
proportion of the population,  and almost
universally of  the children of all classes;
and except,  perhaps, for  a few persons, a
more wholesome  one could not be found.
In  a few individuals,  the use  of  oatmeal
causes  heart-burn, and  occasionally sick-
ness, and, of course, must  then be abandon-
ed.   One of  the most  beneficial properties
of  the oat,  especially in  the  form of the
Scotch meal,  is its aperient power; in  many
children,  the use of  oatmeal porridge for
breakfast will  entirely correct a tendency
to  constipation.   The  proper  method  of
making  oatmeal porridge is, to have the re-
quisite  quantity of water  boiling  upon the
fire, and to  sprinkle the meal into it from
the hand, stirring constantly,  not  only  at
the time, but  during  the  twenty minutes
that the mixture should be boiled.   Suffi-
cient salt for seasoning  is to be added
during the process. In Scotland the stirrer
is generally made of wood.  When the mix-
ture is boiled sufficiently, it must be poured
into a saucer or  soup-plate, till it is  suffi-
ciently cool.   It is generally eaten with milk,
but  buttermilk, treacle, or beer  are also
used.  A pint of water, and a tea-saucerful
of oatmeal, will make  a good soup-plateful
of porridge.   When oatmeal, coarsely pre-
pared, is too largely  used, especially  in  a
dry state, it  may cause concretions in the
bowels, (see Concretions,) but this effect never
follows its proper moderate employment.
  Refer to Grains—Groats—Poultice, Sec.
  OBESITY.—See Fat.
  OBSTETRICS.—The art of midwifery.—
See Childbed.
  OCCIPUT.—The back part of the head.
  OCCUPATION.—See Artisan.
  (EDEMA—Is the term applied to the swell-
ing caused by the effusion  of serum into the
cellular tissue beneath the skin.—See Dropsy 
                 IES  0

  (ESOPHAGUS.—See  Gullet
  OIL—From oleum, derived from the name
of the olive which yields the well-known oil.
  Oils are  the  products of either the vege-
table or animal kingdom.  They are divided
into fixed oils—which also include the fats
—and volatile oils.  Oils  are  also divided
into drying and  non-drying, according to
their power of solidification  by absorption
of oxygen from the air.
  Fixed oils vary from the most limpid fluid
to the hardest suet, according to the amount
of solid or  fluid fatty matter in their com-
position ; all fixed oils, and animal  fats,
being separable  into two, and often three
different principles.  One, named oleine, re-
mains fluid at the lowest  temperature ; the
next, margarine, has a higher melting point,
and  the  third, stearine, the  highest of all.
The  separation—under the influence of cold
—into oleine and margarine may often be
witnessed in olive-oil in winter.  Fixed oils
are further distinguished by  their leaving a
greasy stain on paper, which is'not dispelled
by  heat, and by their power of forming
Boaps with  the caustic alkalies.
  Volatile  oils are of  great variety;  the
odoriferous properties of the vegetable king-
dom  depending  on their  presence.   These
oils  are generally limpid, should be colour-
less,  but are, for the  most part, slightly
yellow.  Their taste is usually pungent.  Like
the   fixed  oils,  the  volatile oils  cause  a
greasy stain upon  paper,  which, however,
entirely  evaporates under the  influence of
heat, thus affording an easy test of adulter-
ation with  a fixed oil, which is sometimes
proctised.
  Some  volatile oils, such as turpentine, oil
of  lemons,  juniper,  &c.   are  composed
simply of  carbon and hydrogen.   Others,
such  as lavender, peppermint, &c. &c. also
contain  oxygen in  addition,—camphor be-
longs to this division,—and a third section,
those of garlic, mustard,  &c. have sulphur
added.
  The principal fixed oils  used in medicine
are
     Almond-oil,           Linseed-oil,
     Castor-oil,            Olive-oil,
     Croton-oil,            Codliver-oil.
  They  all possess, more or less, aperient
properties.    Almond-oil is  chiefly used as
an external application.  The  reader is re-
ferred to the separate articles for further
information.
  Volatile  oils are also used chiefly for their
pleasant flavour, and  for their  stimulant
carminative properties.   They form a long
list—amber,  aniseed,  bergamot,  cajuput,
camphor, cassia  and cinnamon, chamomile,
4                 OLI

 cloves,  copaiva, cubebs, dill, fennel, jtiui-
 per,  lavender,  lemon,  marjoram,   mint,
 orange,  peppermint, pennyroyal, pimento,
 rosemary, rue,  savine, sassafras, turpen-
 tine, kc.
   OINTMENTS—Are  greasy or unctuous
 preparations, about the consistence of firm
 butter.   They are much less used as dress-
 ings in modern practice than  they formerly
 were, and their number might be  reduced
 with much advantage.  They have been sup-
 planted by the more elegant, cleanly, and
 in every way superior, water-dressing.  Oc-
 casionally, a greasy application is requisite,
 and then  nothing answers  better than per-
 fectly  fresh   lard, or  sweet  olive-oil,  or,
 when fresh,  the simple ointment,  contain-
 ing spermaceti or wax to  give additional
 firmness.   The form  of ointment for  pur-
 poses of  counter-irritation, inunction, &c.
 is sometimes  convenient, but  even this, as
 in the case of tartar emetic, might be often
 avoided.
   The ointments most likely to be useful for
 domestic  practice are antimonial ointment,
 gall ointment,  hydriodate  of  potash oint-
 ment, mercurial and  red  precipitate oint-
 ments, simple  or  spermaceti ointment, sul-
 phur ointment, and zinc ointment.
   The composition of these is given under
 the head of the active ingredient they con-
 tain.  Simple spermaceti ointment  is  made
 by melting together spermaceti five ounces,
 white wax fourteen drachms, olive-oil twenty
 ounces, stirring continually till the mass is
 perfectly  cold.
   One of  the great objections against oint-
 ments  is, that so many of them,  if kept,
 become rancid, and thus  form a most irri-
 tating application.
   Refer to Dressing.
   OLD  AGE.—See Age.
   OLIVES—The product of the Olea Euro-
 po?a,  or  olive-tree,  though  used   in the
 form of preserved olives, are  better known
 as the source of the well known
   Olive,  or Salad-oil, which  is procured
 by crushing from  the  perfectly ripe  fruit.
 Good olive-oil is  of a  pale yellow colour,
 and should be almost free from either smell
 or taste.  It is often  adulterated with the
 inferior  fixed  oils.   As an article of diet,
 olive-oil agrees  well with many, and some
 persons find it useful as an aperient, but it
 is very weak in action.  In  pregnancy, how-
 ever, with irritable and yet  confined bowels,
 it occasionally answers better than the usual
 castor-oil.   Olive-oil is most  used  in medi-
 cine as an external application, both as an
 addition  to ointments  and  as a liniment-
 See Ammonia—Camphor, Sec.
37 
OME
375
OP1
   OMENTUM,  or  Caul. — A  membrane,
 more  or  less  covered with  fat, which  is
 spread over the intestines.  It probably acts
 as  a protection against cold.   The  great
 loading of the  omentum with fat is one  of
 the chief causes of  the protuberance of the
 abdomen  in very corpulent people.
   ONANISM. —The crime of  Onan—self-
 pollution—requires  no further notice here,
 than to put parents on their guard respect-
 ing  their children,  in connection with this
 ruinous  vice, acquired at  school, and in-
 dulged in, in ignorance either of its  sin  or
 evil consequences.  Some of the most la-
 mentable instances of youthful decrepitude,
 nervous affections, amaurotic blindness, and
 mental debility and fatuity  in  early life,
 which come before medical men, are trace-
 able to this wretched practice.  Whenever
 young people, about the age of puberty, ex-
 hibit unaccountable symptoms  of debility,
 particularly about  the lower  limbs, with
 listlessness  and  love of solitude, look dark
 under the eyes, &c, the possibility of vicious
 practices being  at the root of the symptoms
 should not be entirely lost sight  of. [A phy-
 sician should then be at once consulted, and
 his directions strictly observed.]
   ONION and  GARLIC—The   former  of
 these  well-known vegetables may be con-
 sidered either as a condiment or  as an ar-
 ticle of real nourishment.  In its raw state,
 (especially  the  onion,) by  virtue  of the
 volatile oil it  contains, is  a powerful sti-
 mulant, but one only to be used with advan-
 tage and  impunity by the owners of strong
 stomachs, who  intend  for  the  time being
 to  eschew  civilized  society.    Under this
 proviso,  the onion  may  really, at  times,
 prove of much value as  a  stimulant.  By
 boiling, the onion is deprived of much of
 its pungent volatile oil, and becomes  an
 agreeable, mild, and nutritious vegetable.
 It is less wholesome either fried or roasted,
 a portion of the volatile oil  being retained,
 and  empyreumatized,  and thus  rendered
 very irritating  to the stomach.   The onion
 possesses  diuretic   properties.   A roasted
 onion,  cut in half, and the centre scooped
 out,  is a frequent domestic  remedy applied
 to boils,  with  a view  of hastening  their
 breaking.
  Garlic is a more powerful stimulant than
 onion.   When applied  to the skin,  either
fresh or  in  a pulp, it  acts like a  mustard
 cataplasm. Garlic is diuretic,  and possesses
wther properties, but its  abominable smell'
is quite sufficient to exclude it from use,
when so many more efficient an I agreeable
substitutes are obtainable.
  ONYCHIA—Is a  species of  ulcer  very
 difficult to heal, situated at the side of, and
 underneath the nail.   It is usually depend-
 ent on general constitutional debility, which
 requires to be attended to.—See Debility—
 Tonics, Sec.  The  local irritation  about the
 nail may be treated by poultices, and after-
 ward by the mercurial black wash, but the
 disease will probably require  the attention
 of a medical man.
  OPHTHALMIA—See Eye.
  OPINION,  MEDICAL.—A  medical  opi-
 nion on a case of disease includes, first, the
 " diagnosis," or conclusion arrived at re-
 specting the nature of the disease ; second,
 the conclusion as to the  appropriate treat-
 ment; third,  the "prognosis," or opinion
 respecting the ultimate termination of the
 case.   Under  the articles   " Diagnosis,"
 "Medicine, Science of," and " Prognosis,"
 these points are sufficiently entered into.
  OPIUM—Is the milky juice, dried, of the
 seed-vessels of the common garden poppy:
 it is perhaps the most  useful remedy in the
 entire list of medical  agents  used by man,
 and has probably given more  relief to hu-
 man suffering than any  physical means we
 are  acquainted with.
  Opium may be procured from other  spe-
 cies of poppy, but that above named is  its
 regular source-  The drug is chiefly col-
 lected in Asia Minor, in Egypt, and in Hin-
 dostan, but has  been  made in Britain.  It
 is procured  by making oblique  incisions
 about half through the external wall of the
 unripe poppy capsule or  seed-vessel, and
 allowing the milky juice to  become   par-
 tially dry,  when it assumes a brown colour,
 and  tenacious  consistence; at  this stage
 the opium is generally gathered by scraping
 it off the capsule by  means  of a stick  or
 some other instrument, by which it is trans-
 ferred to the receiving vessel—a cocoa-nut
 shell or the like; it is then further dried, after
 which it is, in some places, packed in leaves,
 in masses of various  size,  or, as in Egypt,
 made into rolls or small flat cakes.   Opium,
 when bought as imported, is apt to contain
 much impurity; by far the best  condition,
 therefore, in which to purchase it for direct
 use is the properly prepared powder, which
 must be kept  in a well-closed  bottle.   The
 preparations  of  opium  used  by  medical
 men are very numerous;  the most useful
 of these only will  be referred  to in  this
 article.
  Opium is most familiarly known in  its
 action  upon  the  human body, first, by its
power  of  compelling   sleep—its  sedative,
soporific, or narcotic property; and second,
by its power of relieving pain—its anodyne
property.    These actions,  however,  are 
») p I
376
0 P I
much varied,  and others  are  developed in
accordance with  the  influence of  circum-
stances,  either  permanent  or  accidental,
such as the dose and mode of administra-
tion;  the  state of the  person  taking it at
the time,  whether physical or mental, his
temperament,  previous  habits,  &c.   It is
well known,  that  among  the  Orientals,
opium is employed rather as  a  stimulant,
as we use wine, than as a sedative, and its
use for this purpose has very widely extend-
ed of late years  in  this  country.   When
taken with the  above  view, the dose  re-
quires  to  be  small—that  is, comparatively
bo, according to the habits of the individual
—and if sleep approaches, it requires to be
resisted.  After this state,  if it occurs in
those who are  stimulated by opium, a state
of  unusual physical,  and especially  of
mental activity is excited, accompanied with
exalted  brilliancy of  ideas;   after  some
hours this subsides, leaving drowsiness, in-
activity, and low spirits.
  If, however, the dose of opium has been
a large one, or if the individual give way
to the  inclination to  s'eep which follows
even a moderate dose, heavy slumber is the
result, varying in duration according  to
the dose of the drug  and other contingent
circumstances.   Such is the. more ordinary
medicinal effect of opium;  but whether the
effect produced be one of excited, or of se-
dative  action, pain  is  either  modified or
wholly subdued for the  time being.   When
the effects of an ordinary  dose  of opium
are passing off, most  persons  experience
some amount  of uncomfortable  sensation ;
dryness of the mouth, headache, low spirits,
and sickness;  this latter  symptom  espe-
cially is sometimes so distressing as almost
to debar the  use of opium in  certain indi-
viduals.
  Sometimes, opium produces  neither sleep
nor the  pleasing excitement so valued by
its votaries ; but gives rise  to feverish rest-
lessness, headache, thirst, &c.    This may
arise from constitutional peculiarity, from a
Btate of previous feverish excitement, from
the drug  having been swallowed too soon
after a meal,  or from other causes.
  In whatever way it is conveyed into the
system,  whether by  the  stomach, by  the
skin, or by external application,  &c, opium
seems to exert its peculiar effects upon the
brain and nervous system; it further mo-
difies  the secretions, particularly those of
the mucous membranes; it checks the flow
of  bile, and  powerfully   constipates  the
Dowels : but it determines to the skin, and
causes sweating.  The  constipating action
sf opium  is sometimes  one of its chief in-
1 conveniences; but in those who consume it re-
 gularlj', this effect generally soon passes off.
   The action of opium upon the  system is in
 the first place greatly modified by custom ;
 persons who habitually take it for purposes
 of intoxication, find it necessary gradually
 to increase their dose if they wish to expe-
 rience the—to them—agreeable influence:
 such  persons, when  consulting n  medical
 man,  ought always to inform him of their
I habit; otherwise, when ordering what would
 be only a suitable dose for the generality of
I persons, he may be prescribing  little more
 than  a tithe of the ordinary amount con-
 sumed by his patient.  It is, perhaps, need-
 less to point out that  serious consequences
 might result.  Again, the existence of cer-
 tain diseases, particularly of a spasmodic
 or painful  character, very greatly modifies
[ the power  of opium over the system ; this
 is peculiarly exemplified in such diseases as
 lockjaw, &c.   Persons, even, who are ordi-
 narily very susceptible  to the  action of
 opium, when  suffering  severe  pain, can
 often  take it in considerable quantity, with-
 out experiencing  its  usual effects, or,  in-
 deed,  any effect beyond relief to pain.  Age
 is  another  circumstance,  which,  affecting
 the power of action of all medicinal agent9,
 seems peculiarly to do so in the  case of
 opium, its influence augmenting in a rapidly
 increasing proportion, as the earliest epoch
 of life is  approached.   Indeed,  during  the
 first two or three years of life,  it is impos-
 sible to exercise too great caution in the  ad-
 ministration of opium ; many accidents  are
 known to ensue  from  its careless, or igno-'
 rant,  or criminal use, and doubtless many
 more  there  are which never come to  light.
 A single drop of laudanum has been known to
 prove fatal  to a young infant.  Even in  in-
 fancy, habit, nevertheless,  enables  compa-
 ratively large doses of opium to be given,
 but the most lamentable results accrue to
 the constitution, and, ultimately, death it-
 self  may  be  the  consequence.   No one
 should be  tempted  to give opium in any
 form to a child, unless under medical sanc-
 tion, or under the pressure of some of such
 circumstances as are pointed out in various
 parts  of this work,  (see  Children;) and
 when  it must be given, it should be in  the
 form  of laudanum, in the  most cautiously
 graduated  dose.  To an infant under two
 months old, one-quarter to one-third of a
 drop only should  be given at once, and re-
 peated at intervals of an hour,  if required;
 and  even  in  this way, no unprofessional
 person should venture to exceed  the amount
 of one single drop of laudanum to an infant
 under six weeks old. 
0P1                377                 OPI
  Poisoning by opium, either by accident or
design, is a very common occurrence.  The
symptoms  generally  set  in from  iialf an
hour to an hour  after  the drug has been
swallowed, but this circumstance depends
partly upon  the form  in which  the poison
is taken,  the effects of the  drug being  de-
layed  longer when solid  opium has been
employed,  than when, as  usually happens,
it has  been its fluid preparation, laudanum.
The symptoms  are giddiness and  drowsi-
ness, from which  the person may be roused
by  noises, shaking, &c;  but this  quickly
passes into  apoplectic stupor,  with slow,
"stertorous" [snoring] breathing; and, ulti-
mately, if the case proves fatal, into death,
with  or without convulsions—these  being
most  common in children.  In  addition to
the above symptoms, the face  is pale  and
ghastly, the  surface cold,  but may be  co-
vered  with perspiration ;  the  urine is  un-
passed ; the pupils of the eyes are generally
contracted;  and the odour of opium may
possibly be detected in the breath.
  The treatment of a  case of poisoning by
opium must, in the first  place, be to pro-
cure the evacuation of the poison from  the
stomach.   For this purpose a medical man
may use  the  stomach-pump;  but  others
must  attempt it  by emetics.—See Emetics.
If sulphate of zinc  (white vitriol)  be pro-
curable, half a drachm should  at once  be
given,  dissolved in water; or five grains of
sulphate  of  copper  (blue  vitriol)  in  the
same way ; or mustard or salt may be tried
if neither of  the above are at hand;  or ipe-
cacuanha  combined  with  a  stimulant—a
couple of teaspoonfuls  of sal-volatile or of
brandy; or the throat may be irritated with
a feather.  In  some  cases,  vomiting  and
even  diarrhoea  occur  spontaneously,  and
certainly diminish the danger.  When  the
stomach   has been  cleared,  but  not   be-
fore, vegetable acids—lemon-juice, vinegar,
cream  of tartar—may  be given freely ; or
strong coffee, without either milk or sugar.
—See  Coffee.  At the same  time, every
means must  be  used to  keep the  patient
from lapsing into lethargy; cold, or alter-
nate cold and hot water may be dashed over
the body;  mustard plasters used between
the shoulders, and continual movement kept
up.   This is usually,  and very properly,
done  by keeping the patient  in continual
motion for many  hours  between two assist-
ants.   Lastly, galvanism or electricity may
be used, and  artificial  respiration kept  up.
A  most remarkable case of recovery,  the
result  of  the persevering  employment  of
these two  agents—galvanism and artificial
respiration — is  recorded  in  the  Lancet,
        2g2
March 27th, 1852, by Dr. Herapath, under
whose care the case occurred.
  In this case,  a "small teaspoonful" of
laudanum was  given by mistake to an infant
but thirty-nine days old, and the whole re-
tained.   The case is cited as an instance of
how much may be done  by persevering and
well-directed efforts to save life.
  Tannin, the  active principle of oak bark,
has been recommended in opium poisoning.
It is perhaps  not much to be depended on,
but in  the absence of  other  remedies a
strong decoction of the bark might be used.
It must be remembered, that in poisoning
by opium, partial consciousness may be re-
stored, and yet  the patient, if unattended
to, may relapse  and die.  It has been sug-
gested that many of the symptoms  of poi-
soning by opium are the result of the dry-
ness of the lining  membrane  of the  air-
tubes—which  is  one of  the invariable con-
sequences—preventing the due oxygenation
or purification  of the blood.  The fact should
not be lost sight of, especially as it  may be
remedied by making the patient inhale steam
freely.
  The quantity of opium required to destroy
life may probably be  stated at from four to
five grains of  solid opium as a dangerous
dose to an adult, and from a drachm and a
half to  two  drachms  of  laudanum,  and
upward.   The average time in which death
ensues,  in consequence  of poisoning  by
opium, is  twelve hours; but it may occur
considerably earlier.
  Opium as a  medicine is useful in  a great
variety of diseases,  but  as  its employment
is mentioned under the separate articles, it
is unnecessary  to repeat the information
here.  The most useful preparations of opium
are—
Opium in powder.—To  be  kept in a  well-
  stopped  bottle.   Average dose for  an
  adult,  one grain.
Tincture  of opium,  or laudanum—which
  contains one grain of solid opium in nine-
  teen minims.  Average dose for an adult,
  fifteen to twenty minims, or about twenty-
  five to thirty drops.
  Of all the preparations of opium, this is
the most generally useful and valuable, and
the safest.  Its  dose  may be regulated to
the minutest proportion, and when properly
made, it keeps well.
Tincture  of opium with camphor, or pa-
  regoric—which contains  one  grain of
  solid opium  to the half ounce.  Average
  dose for an adult,  one drachm to  three
  drachms.
Compound opium powder with ipecacuanha,
  or Dover's  powder—which contains one 
OPI
378
0 R A
  grain of lolid opium in ten.—See Dover's
  Powder.
Compound opium powder with chalk—which
  contains  one grain  of  opium in  forty.
  Average dose, twenty to forty grains.
  As  external  applications, the soap  and
opium liniment, and the opium plaster, are
both useful.
  There  are  many other preparations  of
opium used, but the above  would be ample
for  the  best-stored emigrant chest;  and
therefore for any home use.  Persons gene-
rally will find it more advantageous to pur-
chase the preparations  ready  made, but in
some  cases  it may be  requisite  to make
laudanum themselves.
  To  make  Laudanum:—Take  of opium,
sliced, three ounces ;  water, thirteen fluid-
ounces by measure.  Macerate the opium in
water, in a  wide-mouthed bottle, for a cou-
ple  of days, shaking up occasionally;  and
then add  twenty-seven ounces of rectified
spirit of wine;  macerate for ten days or a
fortnight,  and  filter.  Of  course  a much
Bmaller quantity may be made  at once, ob-
serving the same proportions.
  Laudanum and paregoric are best admi-
nistered  in water;  Dover's powder,  or the
compound chalk powder, in some thick sub-
stance, such as gruel.  When solid  opium
is given, it is best in the form of pill, with-
out admixture.   Laudanum is  sometimes
used as an external application, being put
into poultices,  &c:  it is also  used  to  rub
on the gums in toothache.  It  must not  be
forgot, that  in  any of these ways,  if em-
ployed incautiously, or  in excessive quan-
tity, it  may affect the system,  and even
prove dangerous.   For the use  of laudanum
in clysters,  the  reader is referred to the ar-
ticle on the subject.
  In addition to the preparations of opium
above mentioned, two others require notice;
one of these, the valuable, though secret,
Battley's Sedative Solution, will be found
noticed under its special article; the other,
morphia, is the special sedative or narcotic
principle of  opium.  Opium is a very com-
pound body, and includes other principles,
on  some of which its stimulant and other
powers more particularly depend; morphia,
therefore, being separated  from these,  is
more  purely sedative, and  is not found so
frequently to occasion the  disagreeable af-
ter  effects which often  follow the  use of
opium;  in other  respects,  its action and
application are the same.
  Morphia, on  account of its insolubility,
is  generally prescribed  in the form  of the
more  soluble acetate or muriate of morphia.
The latter is the best and more certain pre-
 paration :  dose, from  a quarter to  half n
 grain.  The graduated morphia lozenge is a
 most effectual  and comparatively agreeable
 remedy in irritable cough :  ten or fifteen of
 the lozenges may be taken in the course of
 the same number of hours.   In  Edinburgh,
 the  same  lozenge, combined  with ipecacu-
 anha, is made, and is  very useful  in many
 cases.
   Refer to Poppy—Dolby's  Carminative—
 Godfrey's Cordial, §c.
   OPODELDOC—Is an old name,  seldom
 used now by medical  men,  applied to ex-
 ternal stimulating embrocations.  The cam-
 phorated soap liniment is  the  form  most
 usually indicated by the term, popularly.
   [OPTIC NERVE.—The nerve of vision.]
   OPTICAL DELUSIONS—The result of
 diseased or of disordered  action—are not
 uncommon.   Under the term may  be in-
 cluded the more obvious disorders of vision,
 such as those  in which one-half of an ob-
 ject, or one-half of a  word only are per-
 ceived.   From  this  state,  up  to  that in
 which figures  of persons, either known or
 unknown, are seen, either constantly or pe-
 riodically, every form of optical delusion is
 met with.   Such  cases are generally con-
 nected with disorder in the head, either in
 the  form of disease of the  brain itself, or
 are occasioned by sympathy with disordered
 function in other parts of  the  body, more
 particularly the stomach.
   ORANGE.—This well-known  and whole-
 some fruit is  imported chiefly from  the
 countries bordering the Mediterranean. The
 two varieties—the bitter or Seville orange,
 and the  sweet orange—are  too well known
 to require description.  The perfume of the
 orange-flower is highly valued, and the dis-
 tilled water is used on the  continent as an
 antispasmodic  and anodyne ; it is  recom-
 mended  as extremely useful in hysteria, in
 doses of one or two ounces.
   In this country, the chief direct  medi-
 cinal use of the orange is derived from the
 rind, which yields  an  agreeable, aromatic,
 stimulant  bitter;  the rind  of the  bitter
 orange  is usually ordered, but that of the
 sweet may also be used, though it  is less
 powerful.   A  confection,  an infusion, a
 syrup, and  a tincture  of orange-peel,  are
 all used.   A  very good  infusion may  be
 made,  simply, from  an ounce  of the  dry
 bitter orange-peel, twenty ounces of boiling
 water being poured over, the whole allowed
 to stand  for twenty minutes, and  then
 strained; the  addition of a quarter of an
 ounce of lemon-peel to the above quantity
, may be made  with advantage.  The dose,
 as a stomachic, is a wineglassful twice a day. 
ORB
379
OVA
  Of the  sweet variety of the orange, the
  China,  the  Maltese  and St.  Michael's are
  best known in England; the finest descrip-
  tions of the fruit have a smooth,  thin, dark,
  rind.  The  juice of the sweet orange con-
  tains principally mucilage, sugar, and citric
  acid, and  is  one  of the most  wholesome
  vegetable juices we possess, particularly in
  the chamber of  sickness; the cellular pulp
  of the orange, however, in which the juice is
  contained,  is  very indigestible,  and when
  swallowed, as it often is by children,  is apt
  to produce  disorder,  passing through  the
  bowels unchanged.  It is a good plan, in the
  case of young children,  to give the orange-
  juice squeezed into a glass.
   ORBIT.—The cavity in the skull in which
  the eye is placed.
   OSMAZONE—Is the animal principle on
  which the peculiar and agreeable flavour of
  cooked meat depends.  It is most  manifestly
  developed in  deooctions of meat,  such as
  soups, &c.
   OSSIFICATION.—The formation of bone.
  "The first  development of bone  is com-
  monly preceded  by  the formation of a car-
  tilaginous (gristly) structure, which occupies
  the place the bone  is afterward to  take;
 and it has been commonly considered that
 the bone is formed by the ossification  of the
 cartilage, (gristle.)  This, however, does not
 appear to be the case, for none of the  pecu-
 liar substance of the cartilage—chondrin—
 can be found in perfect bone."  "The pro-
 cess  of true bone  formation  always com-
 mences  in the immediate neighbourhood of
 blood-vessels, which pass down into canals
 excavated in the substance of the cartilage ;
 the spots where these vascular canals are
 especially developed, are termed centres of
 ossification.   We usually find  one of  these
 in the centre of the shaft of a longbone, and
 one at each  end  ; in the flat bones, there is
 generally one in the middle of the surface,
 and one in each of the  principal projections.
 Up to the period  when a bone attains its full
 dimensions, the parts which contain distinct
 centres are not connected by osseous (bony)
 union, but only by cartilage, so that they
 fall apart when  this decomposes; the pur-
 pose of this is  to allow an  increase in the
 size of the bone by the growth of cartilage
 between  its detached  portions, which car-
 tilage  may give  place to bony structure,
 when there is no further need of increase."*
 —See  Epiphysis.
  After  the  formation of bone  has  been
 completed, the  changes which take place in
its  component  particles  appear to go  on

           * Carpenter's Physiology.
  slowly. But should injury be inflicted, either
  in the form of fracture, or as a consequence
  of disease,  by  which a portion of bone is
  destroyed,  the  formation  of  new  bone is
  often extremely rapid, and,  in the course of
  time, extremely perfect; the new structure
  in every way resembling the old.   The re-
  union of fractures by the  formation of new
  bone [callus] has already been alluded to
  under  article Fracture.
   As all are aware, the bones of young ani-
  mals are much more cartilaginous than those
  of older ones ; they contain much more ani-
  mal  matter, which, as life advances, dimi-
  nishes, and gives place to a larger proportion
  of mineral ingredient.   It is not, however,
  in the  bones alone that  this tendency to
  increase of mineral deposite—ossification—
  is observed ; the body, generally, in old age,
 becomes more  rigid,  and  bony deposite is
  found in structures that do not ordinarily
 contain it.   Some  structures are, however,
 much more obnoxious to  this than others.
 It is  matter of popular  information that
 the heart  is very liable to be  the seat
 of ossification in advanced life.  This occurs
 more especially in the structure of its valves,
 and  in connection with them;  (see Heart;)
 also in the coats of the arteries which sup-
 ply its  own  muscular substance,  a  change
 which is often found to have been associated
 with  symptoms of " angina pectoris."  This
 tendency, however, to the  deposite of bone
 about the  arteries of the heart,  extends
 throughout the  arterial system  generally,
 causing these otherwise elastic tubes to be-
 come rigid, and  thus impairing the import-
 ant power  they  possess in  health  and  in
 early life of assisting  to propel each wave
 of blood which  the heart contraction com-
 mences through  the body.—See Circulation.
 This  change in, and  enfeeblement  of, the
 power of the arteries,  is one great and ori-
 ginating cause of many of  the diseases' of
 old age.   Other parts, such as those con-
 nected  with  the  larynx, &c, are  liable  to
 become converted into bone as life advances.
 The subject could not profitably be pursued,
 further here.
   Refer to  Bone — Cartilage — Fractures,
 Sec.
   OVARIUM, or  Ovary —Is the  recep-
 tacle  in which are contained,  either in plant
 or animal, the germs of the future seed  or
 egg.  The  ovary in the human  female is
 liable to a  variety of diseases,  such  as in-
 flammation, &c, which  often give rise  to
 many  obscure symptoms in  organs appa-
rently quite disconnected with those which
are the  primary  seat of  the  irritation.
Dropsy of the ovary is one of the most gene- 
0 V u
3
80
O X  G
 ral affections of the organ ; tapping or other
 operations may be required for its relief.
   OVUM—Literally, means  an egg.   The
 term is generally applied to the germ of the
 future being, after it has  been fertilized by
 the male :  previous to that, the term ovule
 is used.   After fertilization, the ovule of
 the  plant  becomes  the seed ;  that  of the
 animal, the  egg, in  which and from which
 the future animal is formed, either out of
 or within the body of the mother.—See Egg.
  OXALIC ACID—Is one of what are call-
 ed the  vegetable acids, being  found ready
 formed—in combination with  potassa—in
 various  plants, such as the common wood-
 Borrels,  the common  sorrel, the garden rhu-
 barb, &c.  It is also formed in  some dis-
 ordered states within the animal  body, and
 is excreted in the urine, in combination with
 lime.—See Urine.  Oxalic acid may  also be
 formed by the action of nitric acid on sugar
 or starch,  to which  bodies it  approaches,
 nearly,  in  composition,  being  formed  of
 carbon,  oxygen and hydrogen, in  certain
 definite  proportions, or in other words, of
 carbon and oxygen, along with  the elements
 of water.   Oxalic acid is generally met with
 in the form of small  white crystals.   #xalic
 acid  is not now used  medicinally; formerly,
 it was so,  in the form of the  wood-sorrel,
 which  was employed for  the purpose  of
 making  febrifuge  acid drinks, whey, &c.;
but  there  are  many  substitutes, such  as
lemon-juice, better adapted for  the purpose,
and less suspicious.
  What is  known  in the  shops  under the
name of  " essential salt of lemons,"  or  salt
of sorrel, is a compound of oxalic acid with
potassa,  and was  formerly obtained  from
the wood-sorrel.
  Oxalic acid derives its chief importance
here  from  its  frequent effect  as a  poison,
either by accident or design.  The accidents
have generally^  arisen in consequence of ox-
 alic acid having been sold or  taken  in mis-
take  for Epsom salts, the crystals of  the two
 closely resembling one another.  The precau-
 tion of tasting a single crystal would be suf-
ficient to detect the difference.
  The symptoms produced by  poisoning from
 oxalic acid vary considerably.  When a large
 dose has been swallowed, the chief effect is
 complete prostration of strength, in fact, a
 Btate of collapse, accompanied  with  stupor,
in which the  patient  dies, often  within thirty
minutes after taking the poison.  Severe pain
 at the stomach usually comes on  soon after
 the poison has been swallowed;  but this, and
 vomiting, which also generally occurs  and
 continues with great  severity, may be absent.
 The vomited  matters are strongly acid, and
dark  in  colour.   The rapidity with which
death often ensues after a poisonous dose of
oxalic acid has been swallowed, renders it
almost impossible, in many cases, to procure
medical assistance in time;  it  is, therefore,
highly desirable that the most prompt mea-
sures should be adopted by those around.
The principle of treatment is based on  the
fact that the very  soluble oxalic acid itself
forms with lime especially, and with magne-
sia, insoluble and, therefore, comparatively
less hurtful compounds.   Chalk or whiting
(the carbonate of lime) mixed up with water,
is the best possible antidote, and should be
given freely: ifthisisnot at hand on the emer-
gency, a portion of old mortar [from the ceil-
ing] should be taken as a substitute, rubbed
up with milk and water, and given as quickly
as possible; or, instead of it, magnesia.   If
none of these remedies can be procured, very
copious draughts  of water should be given
to promote  vomiting, which  in  any case
should be excited,  if it has not been already
occasioned by the poison.   There was  for-
merly a prejudice against giving water largely
in oxalic acid poisoning, from the fear that
it  might favour the solution and passage of
the salt  into the  blood; the practice has,
however, been found advantageous, provided
free vomiting  is  encouraged.  Of  course,
while these measures are  in  progress,  me-
dical aid should be sought.  Should the pa-
tient survive the poisoning, symptoms of irri-
tation of the stomach and alimentary canal
must  be  expected, which will require  the
most  soothing  treatment, chiefly by demul-
cent medicines  and diet, and  it may be  by
leeches to the pit of the stomach.
  OX-GALL.—The [inspissated] gall or bile
of the ox has been much lauded as a remedy
in habitual constipation.  A few years  ago
it  was extensively tried, and  undoubtedly
proved, and does prove serviceable  in cer-
tain cases, but, perhaps, having been over-
praised,  it seems to have  become  again
almost too much neglected.   In some cases
of constipation in pregnancy, it answers ex-
tremely well, and is very safe.  Its prepara-
tion for  medicinal purposes is simple,  all
that is required being  to place a quantity
of fresh ox-gall in a flat dish, in a sufficiently
warm situation—such as an oven—and per-
mit evaporation to go on, till the  gall be-
comes sufficiently  firm to make into pills, of
which from five to ten grains weight may be
taken once or twice a-day.   Besides  acting
as an aperient, ox-gall has been said  tu  as-
sist digestion.  This may be, either from its
bitter  giving tone to the stomach, or from
its giving its own chemical aid to the sc.u-
tion of certain constituents of the food. 
                   OXY

   OXIDE or BISMUTH.—See Bismuth.
   OXYGEN GAS—Is one of the elementary
 bodies, and if one is more important than
 another,  it, perhaps, is  entitled  to the first
 place.  Its  name, derived from two  Greek
 words, was given in consequence of the er-
 roneous idea that it  was the sole  cause  of
 acid properties in bodies;  it has also been
 named "empyreal  air,"  "dephlogisticated
 air,'.' &c.   Oxygen gas,  in  mechanical mix-
 ture with nitrogen,  constitutes the  atmo-
 sphere which surrounds our globe, (see Air,)
 and on its presence, in  due proportion, de-
 pends the continuance of animal existence,
 the phenomena  of  combustion, &c.  Whe-
 ther the  nitrogen gas with which oxygen is
 mingled in the atmosphere fulfils other ob-
 jects or not, it certainly does the important
 one  of  diluting  it,  and  of tempering its
 potent agency, which, were it  not  for this
 dilution,  would act with such chemical en-
 ergy as must quickly prove destructive to
 organized life upon our  globe, as at present
 constituted.
   Oxygen, in combination,  forms what are
 called basic oxides.  These are bodies such as
 potassa, soda, oxide of iron, &c, which tend
 to unite  with its next class of compounds,
 the acids.  Besides these, oxygen forms com-
 pounds which do not exhibit aptness for en-
 tering into combination.
   Further, oxygen,  by uniting  in different
 proportions  with the same body—such  as
 nitrogen, may give rise  to a variety of very
 different  compounds.   Oxygen has  never
•been separated  in a  palpable  form; it  is
 known by its effects.  The  important part
 which  oxygen  plays in the various  fulfil-
 ments of  animal life  and existence has ren-
 dered the foregoing notice necessary. Under
 such articles as Animal  Heat,  Air, Blood,
 Digestion,  Motor  Change, Respiration, &c, the
 reader will find those fulfilments and effects
 sufficiently entered into.  The employment of
 oxygen in the form of inhalation, as a reme-
 dial agent in various  diseases, has often been
 proposed,  but never established in practice.
   OXYMEL.—A mixture of honey and vine-
 gar.   Simple oxymel is  made in the propor-
 tion of five pounds of honey to seven ounces
 of acetic  acid, and eight ounces of water.
   Oxymel of squill is made by mixing four
 ounces of  squill  vinegar with half a pound
 of honey.
   The above are pleasant and useful prepa-
 rations in some forms of catarrh and cough.
 and may either be used  alone, or combined
 with other medicines.
   OXY-MURIATIC ACID.—The  old  name
 for chlorine.
   OYSTERS.—Respecting  the  wholesome-
31                P A I

 ness of this well-known shell-fish, much dif-
 ference  of opinion exists  among medical
 men;  nutritious, especially when uncooked,
 they  certainly are, but their digestibility
 in all  probability depends  greatly upon the
 person by whom they  are eaten.   Some,
 whose stomachs generally require much con-
 sideration, can eat oysters  in  moderation
 with  impunity:  Dr. Paris, however, con-
 demns  them  for  invalids.  Oysters  have,
 though rarely, like other  shell-fish, caused
 symptoms of irritant poisoning.
   OZONE—Is  a " substance" of penetrating
 odour,  which,  according to M. Schonbein,
 who has paid much attention to the subject,
 is  constantly  liberated  in greater or less
 quantity in the atmosphere, according to the
 development of electricity.  He  has  ascer-
 tained it to be generally  most abundantly
 developed during  winter  while  there  is
 snow,  or during stormy weather in summer.
 From these circumstances, and from its pro-
 perties in respect  to the respiratory,func-
 tions,  M.  Schonbein is disposed to attribute
 to this substance the production of some of
 those  epidemic catarrhs—influenza,  &c.—
 which so evidently depend op atmospheric
 causes.  By others, ozone is considered to be
 oxygen in a peculiar condition.   The subject
 is one of  much interest.

   PAIN.—The sense of pain, lik/». other sen-
 sations, originates  in the nerves,  and very
 generally appears to be located  ir the  parts
 where their  ultimate branches terminate;
 the perception  of pain, however, by the sen-
 tient being, must depend  upon the  brain,
 the  sense . of  it  being conveyed to that
 organ by  the nerves.   This we know, cer-
 tainly, to  be the case, for if the nervous com-
 munications with the brain are cut off, as by
 injury to  the spinal cord, (see Nerves,) or  if
 that organ itself is oppressed, as in s'upor,
 there  is no sensation, and  consequently no
 pain.  There may be the appearance of sen-
 sation, and of pain being felt, in consequence
 of reflex  action, as explained under article
 Nerves, but it is appearance only.   If almost
 any portion of  the healthy body,  is in-
 jured, pain is  felt, because the universally
 distributed nerve branches are injured in the
 process, and, as might be expected, the sen-
 sation is referred to the seat of the injury;
 but pain being felt in  a  particular part, 01
 as if in a particular part, is not necessarily
 indicative of injury at the place where it  is
 felt; it may arise from irritation of the nerve
 cord which supplies the part, at almost any
 part of its course.   This is most strikingly
 exemplified in the cases of persons who have
 suffered amputation of a limb, and who often
3 
PAI
382
PAI
experience the sensation of pain, as if in the
member they had lost.  Similar, in some de-
gree, to the above, are the sympathetic pains
observed in some cases of disease ; such, for
instance,  as  the  pain at the point of the
shoulder from affection of the liver, the pain
in the knee which is so general an accompa-
niment of hip-disease, or the pain in the legs
which may result from acid in the stomach.
Pain,  therefore, although a  most valuable
guide in  the  investigation of disease, is by
no means an  unerring one, and must not be
too implicitly trusted.
  The  faculty or  power of feeling pain, the
"sensibility" of  the various parts of the
animal body, when in a healthy condition,
varies greatly, depending in a great measure
upon the supply of nerves they receive; thus,
Buch parts as bones, tendons,  ligaments, &c.
are generally but little sensitive ; when, how-
ever, they become inflamed, they are acutely
so.   Further, it  would  seem  that certain
affections of the central parts of the nervous
system  greatly increase  the  sensibility to
pain, as well as diminish it, more particu
larly affection of  the spinal cord.  Such  is
the case  in  hydrophobia, lockjaw,  &c, in
which  every  portion of  the  surface of the
body becomes painfully sensitive.
   Lastly, in  functional disorder, or irritabi-
lity of the nervous system,  such as occurs
in hysteria, there is often intense suscepti-
bility to  pain, as well as to  other outward
impressions;  but this evidently depends on
very different causes, and requires very dif-
ferent treatment from the cases above men-
tioned.—See  Hysteria.  Pain  is  not at all
times referred  to the terminations of the
nerve; in  neuralgia either of  the head or
face, or affecting the great nerve of the thigh
and leg—sciatica—the pain  is often  com-
plained of in  the site of the main cord of the
nerve itself.
   Pain varies greatly in kind, as  all know ;
it is dull  and  aching,  sharp and cutting,
throbbing, tingling,  smarting, burning, &c,
these  differences  depending in some  mea-
sure upon the part affected.   Inflammation
of the skin is generally accompanied with
pain of a burning, tingling, or smarting cha-
racter ; that  of a "serous membrane," such
as lines the chest, causes pain that is sharp
and cutting,  which is the case  in pleurisy:
the pain  of  toothache is dull, aching, and
throbbing; the pain of spasm is  sharp, but
distinguished from that of inflammation by
not being aggravated by pressure.
   It is probable—and cases of hysteria jus-
tify the supposition—that some persons  are
much  more  acutely  sensible  of pain  than
others • it is  certain that some bear it much
better, both  physically and  mentally, than
others.   It is sometimes  of  importance  to
ascertain this;  it may be done at times, by
remarking, when it is necessary to apply a
blister, how far the irratibility, either men-
tal or physical, is excited  by  it.
  Pain is not an  unmitigated evil; were it
not for its warning, we should be liable, un-
wittingly, to  inflict  all manner  of injuries
upon our bodies.   We see this  in  cases in
which the sensibility to pain  is impaired or
destroyed, in consequence of  disease  of the
brain, or of paralysis  of the nerves of sensa-
tion.  In  the former case more especially, ns
has already  been alluded to in  this work,
serious results may follow forgetfulness of
this fact; the feet, either of an adult or of n
child, may be parboiled, or a mustard plas-
ter  may  be kept  on the skin till the most
severe effects are produced,  simply because
the warning symptom of pain is, for the time
being, in abeyance.   This is no imaginary
possibility, and it is  one  the occurrence of
which  should deservedly  bring down the
censure of gross carelessness upon any one
under whose  management it  might happen.
  The absence of sensibility  to pain, in con-
nection with cases of  apoplectic stupor, &c,
is what we may expect.   It sometimes, how-
ever, occurs  while the mental faculties  re-
main  active; this, when  it does happen, is
generally after some  severe  accident, such
as an extensive burn or the  like  which
seems to overwhelm the nervous system.  In
such  cases the severest operations may be
undergone without suffering, but the synip-'
torn is one of the most fatal  import.
  The presence or absence  of pain, or its
alleviation, is by no means a  light considera-
tion  in  the treatment of disease; the mere
Bensation of it exerts a great call upon the
system, and it  is quite possible—indeed the
author has, he believes, seen  it—for a person
to die from severe pain alone: hence  the in-
estimable value of those modern discoveries,
the anaesthetic, or pain-relieving powers of
chloroform and ether, which, by saving a
patient the exhausting shock of the pain of
a severe  surgical operation,  place him in a
much more favourable condition for recovery
than he would be without their aid—a con-
sideration which  far outbalances the few and
far-between fatal accidents which have un-
deniably followed the  use of the above agent*.
It is the fact of the exhausting tendency of
pain  which  renders  opium  so  valuable a
medicine, and  one the existence of which
so abundantly testifies of the beneficence of
our Creator, who,  in conferring upon man
the liability to suffer  from the warning pang
of pain as a necessary adjunct to hits present 
PAI
383
PAL
being, has also given the means of its alle-
viation.
  Although, however, it may be advisable in
most  cases to  alleviate or annul pain, and
when it is very severe, imperative to do  so,
it is possible  to sacrifice too much to the one
object.  Generally speaking, it is not difficult,
for a  time at least, to overwhelm the sensa-
tions  of pain by powerful doses of anodynes;
and although, as far as can be done, con-
sistent with other means of treatment, suf-
fering should be relieved, it may not be de-
sirable totally to annihilate what is,  in many
cases, an index of the progress of a disorder;
neither can it be advisable to sacrifice to the
one object—the  alleviation of pain—other
considerations of more vital and lasting im-
port.   In other words, it would not be right
to give, for instance, a large dose of opium
to  annul a present pain,  with the  risk or
certainty of interfering with some of the se-
cretions or excretions of the body, such as
that  of  the bronchial membrane,  the due
performance  of which must be  absolutely
necessary to the ultimate well-being of the
patient.   This  point is dwelt upon  because
it is one on which the public require a little
enlightenment.  To unprofessional  persons,
the man who  most quickly relieves  that
which every patient thinks the most promi-
nent symptom of his case—pain—naturally,
perhaps, appears to be the superior practi-"
tioner to one who does so more  slowly ; but
yet, the latter may be following, by far, the
safer, and one may add, more  conscientious
practice, and be much more likely to conduct
his case, in the end, to a  successful issue,
than  if he had sunk other considerations
before the one—the relief of  the  present
pain.   The relief of pain by anodynes (see
Anodyne) has been chiefly alluded to in the
foregoing remarks, these being the remedies
which were most likely, from their  remark-
able power of subduing pain, to be  resorted
to,  to the exclusion of other  really  more
important indications and methods  of treat-
ment.  There are, however, other means of
alleviation, which cannot strictly be called
anodynes, but which may, in many cases, be
used  with much advantage, without being
open to the objections which hold good against
opium and the like.  Of these, heat, especial-
ly when combined with moisture, is at once
the most  useful and generally applicable;
cold may answer the purpose in some cases,
but not generally, except in pain affecting
the head.   The position of the body, or of a
limb,  the mechanical support of a  painful
part,  either to relieve its natural weight or
to take pressure off the  site  of the pain,
and throw it on  some sound texture;  the I
abstraction of blood by leeches, or scarifica-
tions—as  shown in the case of the gums,
which, by relieving the swelling and tension,
also relieve the pressure upon the extreme
nerve-branches—and  many other remedies
applicable to the relief of pain,  are to be
kept in mind.  Lastly, the kind  word  and
the gentle tone are anodynes, which, though
they may not relieve real pain, will  yet,
either in rich or poor, make  it more bear-
able, and while incapable  of  harming,  give
the double blessing on them that bestow and
on them that receive.
  Refer to Nerves—Opium.
  PAINTS  and  PAINTING.—The inju-
rious  effects exerted  upon  the health of
those who occupy newly painted houses or
rooms  is  a circumstance  too frequently
overlooked.  That living in, and especially
sleeping in  rooms which have been newly
painted with " oil colours," does  occasion
uneasy feelings, such as headache, &c, most
can testify;  but that  the effect produced is
more  than transient uneasiness, is  evident
from the fatal influence the  same circum-
stances exert upon birds, &c.
  Refer to Lead.
  PAINTER'S  COLIC —See  Colic  and
Lead.
  PAINTER'S PARALYSIS.—See Lead-
Palsy.
  PALATES.—The palates are divided into
hard and soft.  The former is the  rigid  roof
of the mouth, which, commencing behind
the upper teeth, extends  backward,  and
merges into the soft palate, which is a fold
or curtain of the  mucous membrane lining
the mouth,  and  from the centre of which
depends the uvula, a small rounded projec-
tion which any one may see  by examining
his own throat in a glass.—See Uvula. From
each side of the uvula proceed two arched
"pillars"  or folds of membrane, an anterior
and a posterior, between which, on each side,
is placed the tonsil.—See Tonsil.  The  soft
palate, during the  act of swallowing,  pre-
vents the regurgitation of food into the nose,
while, at the same time, the arched pillars
above described, by closing over the root of
the tongue, keep  the morsel from  passing
back into the mouth.  The membrane within
the mouth, which covers the hard palate, is
liable to be the seat of small  blisters,  par-
ticularly in those who suffer from some forms
of indigestion ;  in such cases, of course, the
cause, and not the effect, requires treatment.
—See Indigestion.   The hard  palate is oc-
casionally deficient at birth, and to so great
an extent as to  require the introduction of
a metallic plate to fill up the  gap.   In such
cases  the fissure often ex-ends through the 
PAL
384
PAL
6oft  palate, dividing the  uvula into two
parts.   These "congenital" affections  are
usually associated with hare-lip, and, like
it, require the operative aid of the surgeon
for their reparation.  Fortunately,  recent
improvements in the  mode of operating,
particularly by  Professor  Fergusson,  of
King's College, have rendered the measures
resorted to much more generally successful
than formerly.
  Refer to Nose—Throat—Tonsils—Uvula,Sec.
  PALLIATIVES — Are  remedial  ageuts
which  aim rather at relieving urgent symp-
toms than at curing or removing the disease
which  these symptoms indicate.   Too often
it happens that the  palliative Is all that is
left for even the highest skill to  administer,
and if that skill cannot hinder the breaking
of the " golden  bowl," or  the snapping of
the " silver cord"  which binds the  living
man to life in  this world, it  is  much to
be thankful for that  there  are  means  and
remedies which mitigate  the pangs of fatal
disease.  There are  diseases which baffle
the most searching  investigation, not only
in the living body  but  in the dead;  and
there are others which, although recognised,
are so, only to tell  that  (in the present stale
of our knowledge) they are beyond the reach
of human aid to cure.  In such, the pallia-
tive  only remains ;  and  if this  be the case
with  educated skill, how often, rather how
generally, must it  be so with  the  limited
knowledge  of the unprofessional.   On  this
account, in a work  like the present, ad-
dressed to the latter, palliative treatment
occupies a large space amid the remedial
measures recommended  as being  " most
safely usable  by those who are put in pos-
session of the information."
   Refer to Pain.
   PALM-OIL—Yielded by the fruit  of a
species of  cocoa-nut, is  brought  to  this
country as  a substance of the consistence of
butter.  It  is used as an external  applica-
tion for similar purposes  as the olive and
other  oils, but is in no way superior.
   PALPITATION of the  HEART—Is un-
usual action  of that organ, of  which  the
patient is  sensible.   It  may take the form
either of a fluttering sensation about  the
region of the heart, perhaps extending into
the  throat, or  it  may  amount to violent
beating, either regular or irregular.
   The liability of the heart's  action to be
 increased by exciting emotions of the mind,
 almost of  any  kind, whether of fear or of
 joy,  renders palpitation a very  common
 affection, and when it  occurs only under
 occasional circumstances like the above, one
 which cannot be considered otherwise than
a  perfectly  natural  occurrence.   When,
however, palpitation arises on every trivial
occasion,  either of mental  emotion or of
physical exertion,  or without  occasion at
all, as it often does, even during rest in bed,
then it requires attention, not  solely on
account of the discomfort it gives rise to, but
because it may lay the foundation of disease
of the  organ which is so constantly subject
to over-excitement.   It  has already  been
stated  in this  work  that  heart affections
have been observed to become more common
after seasons of much public excitement of
any kind—an effect traceable  only to the
frequent disturbance of the organ by the
passions or emotions.
  Palpitation of the heart, independent of
disease, is most liable, indeed is very liable
to occur in the young of both sexes, and in
females particularly, soon after the age of
puberty—in  the latter being very generally
associated with  hysterical  tendencies;  in
such cases, it is met with in its most aggra-
vated forms,  and often  of such violence as
to  prove  truly alarming.   In any case the
tendency to  palpitation is more common  in
the nervous temperament, and  is increased
by  whatever  gives  undue predominance  to
that temperament,  such as indolence, luxu-
rious habits, and the indulgence  of feelings
and imagination  artificially excited; and
having once begun, it is kept up and aggra-
vated by the continued attention with wh!ch
the mind is apt to dwell upon  the  ailment.
The individuals subject to it easily imagine
themselves  the subjects  of heart disease,
watch   every motion almost of  the  heart,
and thus, under the influence  of their own
imaginary fears, produce the very symptoms
they dread.  This  nervous condition (for it
is generally nothing else) is  only to be got
rid of  by those measures  which give a more
vigorous  and  healthy tone  both  to  mind
and body.  The  false excitement of imagina-
 tive literature  (if it has been  indulged in)
must  be exchanged for a  more healthy
mental aliment, something which  calls for
some healthy mental interest.   This must,
of  course, be regulated in some measure by
the habits and tendencies of the person, but
where  it can  be adopted,  the pursuit  of
 some  branch  of natural history, botany,
 geology, or any other out-door occupation,
 such as gardening or sketching from nature,
 are the best pursuits; they occupy the mind,
 and draw it  away from its  own  morbid
 fancies, even in the time of exercise, which
 is  rendered doubly invigorating by the men-
 tal excitement which accompanies it. Along
 with these means a system of diet (see Food)
 calculated to give good blood nourishment 
PAL               385               PAL
 Bhould be adopted; heated and ill-ventilated
 rooms, above all  things, are to be avoided,
 early hours observed, and if a feather bed has
 been habitually lain upon, a firm hair or wool
 mattrass should be substituted.   One article
 of diet requires especial mention, as  being
 peculiarly injurious  in  such cases;  tea of
 any kind is better avoided, but green tea is
 absolute poison;  coffee  is scarcely  allow-
 able, and cocoa or milk should invariably be
 substituted for either of the above more sti-
 mulant beverages ;  wine or malt liquor may
 be injurious, or the reverse,  according to
 the previous habits  of the patient and  the
 nature of the case ;  if depression or debility
 follow their withdrawal,  the tendency  to
 palpitation is certain to be increased.   In
 addition  to these  measures, regulation of
 the bowels, the use of the shower-bath, or
 better, of the douche down  the spine, and
 occasional  mustard  plasters on  the  chest
 or between  the  shoulders, are all useful,
 especially if, as frequently happens in cases
 of aggravated  palpitation,  any tenderness
 of the spine is found to  exist.   In cases of
 nervous palpitation, medicine is not  much
 called for, unless to  remedy other disorders,
 such as indigestion.   Some patients  derive
 much  benefit from  a  teaspoonful  of  the
 ammoniated tincture of valerian, taken twice
 or three  times  a day in water, to which, if
 there is much nervous irritability, ten  drops
 of tincture of henbane may  be added  ; sal-
 volatile in teaspoonful doses is often useful,
 especially if there is much flatulence ;  or
 ether,  either sulphuric  or chloric, may be
 taken  in ten or fifteen  drop doses,  either
 alone or with the above-mentioned remedies.
 The ethers, however, are  more  generally
 serviceable as remedies during an attack of
 palpitation  than  when  taken  regularly.
 When  palpitation  is habitual and severe, a
 medical  man should be consulted, especially
 if the  mind is at all uneasy.   His examina-
 tion will detect  the real  nature of the  affec-
 tion, and his  advice will be most likely to
 indicate with  certainty the remedies which
 will most quickly relieve that which, tljough
 but a functional disorder, may, if neglected,
 become  an organic  disease.   With respect
 to palpitation dependent on disease of the
 heart,  enough has been  said in the article
 devoted  to the subject of heart disease in
 general.
   PALSY or  PARALYSIS—Is loss of sen-
 sation, or of the power  of motion, in  parts
 naturally possessed  of those endowments.
 The affection varies considerably in kind
and degree.   There  may be loss  of sensa-
tion merely, either of a  part, or the  whole
body, without the power of motion  being
         2 H                             25
 impaired, but  this is comparatively rare -
 generally it  is the power of motion whicA
 is lost or diminished,  that  of sensation
 being often not affected at all, and  when  it
 is, only slightly  so.   Paralysis of  motion
 may be confined to a single finger, to part
 of a limb, or to the whole of one.   It may
 extend only  to the lower extremities, while
 the upper portion of the body is functionally
 unaffected, or one  entire side of the body
 may be totally or partially deprived of the
 power of  motion.   In a few cases it occurs
 that general  paralysis of all the muscles of
 voluntary motion has taken place, life being
 carried on for some time by the involuntary
 functions solely.—See Nerves.
  Palsy or paralysis of one side of the body,
 wliat  medical men call  " hemiplegia,"  is
 much more common than the other forms of
 the disease, and may occur at any age, even
 from infancy upward, but is  most general
 after middle life, and more frequent in males
 than  females;  it takes place  under very
 opposite and varied conditions  of the sys-
 tem.   When  a person has suffered from an
 apoplectic attack, the result of effusion of
 blood into the substance of the brain, from
 the giving way of a vessel,  if recovery takes
 place,  it is very generally trammelled with
 paralysis.—See Apoplexy.
  The rupture of a vessel in the brain  is
 one common  originating  cause of paralysis.
 It is one, however, which may occur without
 there being  any  decided  apoplectic symp-
 toms at all;  there may be  slight effusion of
 blood in the head, but not more than causes
 at the  moment transient faintness and con-
 fusion.   It  may be (if  the  attack occurs
 during sleep) not even that, but either with
 or without it, paralysis is found to have oc-
 curred, either total or partial, and  remain-
 ing partial, or gradually increasing for some
 time after its  first appearance.  Another
 form of paralysis is that arising from a more
 decided state of general debility, in which
 the brain partakes, and in which the struc-
 ture itself gives way.  It is often the disease
 of over-worked literary men, or  men  of
 business,  and is apt to end  quickly, in  a
 softened  state  of the brain,  with mental
 imbecility, and perhaps  general paralysis.
 Palsy may,  of  course,  arise  from  other
 causes which act upon and injure the struc-
 ture of the brain, such as tumours, violence
 to the head, &c, but the above are the most
 common, and are sufficient to notice here.
  Whatever the cause, it  is  always found
 that when the  brain  proper is the seat of
the disorder,  the paralysis of the body takes
place on the side  opposite to that portion oi
 " hemisphere" of the brain which is affected. 
P A I,                 386                  PAL
  The symptoms which precede an  it tack
of paralysis ate so very similar  to those
which have been described  as  be'ig  the
forerunners of apoplexy, that it is needless
again to go over them.  The most frequent,
however, is the complaint of  numbness and
prickling sensation throughout a whole limb,
or affecting only a  portion of it, such as a
single finger.   Such symptoms  in old per-
Bons, or in the predisposed, should never be
neglected.
  When a person  has  suffered from  a
'■ stroke of palsy," or a " paralytic seizure,"
by which is generally understood the para-
lysis of motion on one side  the body, the
loss of power may be complete,  the  arm
and  leg lie perfectly inert as  far as  the will
is concerned,  and the face is generally more
or less affected in a severe case,  the  side on
which the  paralysis exists having a rather
relaxed  appearance, while the features are
drawn  toward  the  other, in consequence
of the muscles of the sound  side still con-
tinuing  active,  and  being  unresisted  by
those on the paralyzed side.  This is much
more visible under any of the mental emo-
tions which usually affect the features, such
as laughing, the muscles on the  sound side
only acting, while the paralyzed  side  of
the  face remains perfectly unmoved.  Under
this condition of circumstances, the  speech
is affected, articulation  is thick in conse-
quence of  one  side  of the  tongue being
also paralyzed, so  that when this organ  is
protruded  it is drawn to one side; swallow-
ing  is at the  same time in some degree im-
perfectly performed.
  These are the symptoms of a severe attack
of paralysis,  but they are often developed
in  much less intensity; the leg alone may
be affected, or the leg and arm, leaving the
face and head  intact,  and the mind per-
fectly clear.  In a great number of cases
the  paralytic symptoms, after  reaching a
certain point, go no further, remain  station-
ary  for some time, and then begin to  amend;
the  arm and leg recover power, the features
regain their  wonted expression,  and the
speech is well  articulated.   This  amend-
ment may go  on to complete recovery ; but,
generally, it  stops short of  this, and  the
person,  though  comparatively well, is  not
t fully restored ;  the leg is not lifted as for-
merly in walking, but  drags a little;   the
hand  and arm do not regain their former
skill and accuracy in executing  accustomed
acts, such as  writing, even though the face,
if it has been  "drawn," is perfectly  re-
stored.   In this state of partial recovery
numbers  continue for years  capable  not
only of enjoying  life, but  of executing
many or most of its  duties.   It  is a  state,
undoubtedly, which requires care in diet,
and in exertion, whether physical or mental,
and which  involves many restrictions and
self-denials, but none  perhaps  to which  a
well-regulated mind will not cheerfully sub-
mit.   Indeed, it does happen that individuals
who,  previous  to  an attack of paralysis,
have  been  dyspeptics, or invalids  under  a
lax system  of living, finding, after its occur-
rence, the vital necessity of greater careful-
ness,  absolutely enjoy better general health
than previously.
  When a portion of the body, such  as the
arm,  remains  permanently paralyzed,  it
usually, after a time,  wastes in muscular
bulk, partly owing to the want  of exercise
which necessarily occurs, but partly also to
the diminished power of the blood  circulat-
ing through it,  which certainly takes place.
The  difference in the power of the pulse in
a sound and in a paralytic arm is very per-
ceptible,  and experiment has demonstrated
that in the latter  the animal temperature is
habitually lower.   In connection with these
conditions of paralyzed limbs, it should be
borne in mind that they have less power of
resisting differences in heat or cold;  a varia-
tion  in temperature which would not affect
a  sound  limb being apt to injure  a para-
lytic  one ;  water which  would  not be  too
hot for the former, producing a scald in the
latter.  In addition  to the  local effects of
paralysis, there are general ones which often
accompany the condition:  these  are usually
connected with the excretions;  the  bowels
particularly are apt to be very costive, and
to require much care.
   The mind  may not be  much  affected  at
first, not perhaps for years, but the  temper
is apt to become irritable, a point which
ought to  be remembered with  indulgence
by others.   As age,  however,  advances,  in
most cases, the memory fails, and the mind,
even the most powerful, becomes gradually
weakened.  It is enough to recall to the re-
collection the touching accounts of the last.
days .of  some of  our great men, such  as
Walter Scott, who have suffered from para-
lysis, to  illustrate this fact.
   Such  are  the best-marked symptoms
which accompany and   follow that  very
common disease,  a "paralytic stroke," the
disease of the mental labourer. Many of the
warning symptoms  of paralysis have been
detailed under the  head of apoplexy, and
the precautionary measures pointed out; in
the same article too the means recommended
to be adopted in  the different forms  of apo-
plexy, either threatened or  actual, will ap-
ply  to the severer cases of paralysis. When 
PAL
387
PAL
 a person becomes affected  with paralysis
 without apoplexy being  developed,  when
 debility, faintness, and loss of  power are
 the  most  prominent  symptoms, it is not
 often that very active treatment is required:
 the cause of the disease is probably beyond
 the  reach of art to remove,  and the object
 must be to place the system in a  state which
 will in no way favour a return or  increase of
 the attack, but which will give every chance
 of recovery  by the natural powers of the
 system.   If  the attack of paralysis has oc-
 curred, in a  person of very full habit, the
 chances are that apoplexy has accompanied
 it, and if so, depleting measures will pro-
 bably be requisite: these, of course, should
 be,  if possible,  under medical  direction;
 but  if this is  unattainable at the time, they
 may be  carried out as recommended, and
 under the precautions enjoined i3 the case
 of apoplexy.
   When the attack of paralysis is accom-
 panied with faintness  and only partial loss
 of consciousness, in the absence  of medical
 assistance, a  teaspoonful of sal-volatile in
 a little water will  be as suitable a remedy .
 as any other, and may be repeated once or
 twice in the course of  the first hour or two.
 If the depression continues, the individual
 should  be placed  in  bed with  head  and j
 shoulders tolerably well elevated, and kept i
 perfectly quiet; if the bowels  are confined,
 a gentle aperient of castor-oil,  or of rhu-
 barb and  magnesia,  should be  given, and
 light nourishment, tea, gruel,  and the like.
 The warmth  of the feet, and particularly of
 the affected side, must  be  strictly attended
 to.  If, eitlier at the time of the  seizure, or
 afterward, there is much  pain in the head,
 flushing of the face, and appearance of ful-
 ness, leeches, from six to eighteen, may be
 applied, or half a-pint of blood taken from
 the  back of the neck by cupping; but in
 these  cases  much caution  is always re-
 quired in the abstraction of blood.  In such
 a case as the last more active  purging will
 be admissible.   Mustard  plasters  to  the
 calves of the legs may in some cases be ad-
 vantageous.   The great essential, however,
 is the most  perfect  quietude;  with  this,
 time will be  the best restorative,  the diet
 being kept light and free from stimulants,
 and the bowels attended to.   If the urine
 become scanty in quantity, cream of tartar
 drink (imperial) will be of service, or five
grains of carbonate of potassa,  with five
grains of nitrate of potassa, may be given
twice a day  in a  wineglassful  of  water.
Moderate friction  with the hand  to  the
affected.side is not only soothing and com-
fortable in most cases, but probably expe-
 dites the returning strength.  Exertion of
 any kind must be very slowly and gradually
 resumed ; but all this will be  regulated  by
 a medical attendant, under whose care the
 case  must be placed.   In some cases ot
 severe paralysis the  natural functions are
 performed involuntarily, and  much trouble
 is required to preserve cleanliness.
   The case in which  the  lower  limbs are
 paralyzed, the upper portions of the  body
 being unaffected, is named "paraplegia."
 It may be owing to disease  in the brain,
 but is more generally caused by disease or
 injury to the spinal  marrow.—See Nerves.
 It  is  generally  a  very  hopeless disease.
 When the result of  injury, the  symptoms
 are  of course developed at once, and, in-
 deed, are so in some  cases of  disease ; but
 generally they come  on  gradually,  with
 weakness of the lower limbs or starting in
 them, very often with a sensation as  if in-
 sects were crawling  over  the skin.   Such
 cases  always  imperatively call for proper
 medical assistance ; in them unprofessional
 persons can do but  little beyond attend to
 comfort  in  position,  to  cleanliness, which
 is apt to be much  interfered with, and to
 the prevention of bed-sores, &c, which are
 are very  apt  to form.—See Bed.
  Cases of local  palsy are not uncommon;
 of  these, the disease, amaurosis,  already
 treated of, which is a palsy of the nerve of
 sight, is  an example.   One hand  is  not un-
 commonly  affected  with  paralysis in the
 course of a  single night; the affection  is
 generally attributed to pressure having been
 in some way exerted upon the nerves during
 the time of  sleep ;  a blister on the  forearm
 will very often remove the symptom at once ;
 it is better, however, to apply to  a  medical
 man for  advice, for the attack may depend
 on other causes.  Paralysis of one side  of
 the face, depending upon injury to the nerves,
 and sometimes resulting from exposure  to
 cold,  when it  occurs,  is apt to excite  more
 than needful alarm.  When the  result of cold,
 one or two doses  of calomel and  colocynth,
 or calomel and compound rhubarb  pill, a
 blister and a grain  of quinine  three times a
 day, are  the best remedies.
  In the  Journal of  Psychological Medicine, a
 case of paralysis  of the tongue, the result of
 a violent fit  of passion,  is recorded.   The
power of articulation was lost for some days,
but returned  under the  use of electricity.
 Workmen in  lead, and, according to  some,
those who are exposed to  the influence  of
mercurial or  arsenical vapours, are apt  to
suffer  from  paralysis  of the hand, "dropt
hand," as it ia called.
  Lead palsy  usually  occurs  in  those who 
P A N
3S8
PAS
have been long exposed to the  influence of
the poison, and the majority  of  those  at-
tacked have suffered from lead colic.   The
attack is preceded by lassitude and feeling
of numbness, and by  stiffness  of  the  parts
about to be affected, the loss of power gra-
dually coming on.  In a few cases, loss of
sensation is also observed.  Lead palsy is
not confined to the hand and arm, but affects
other portions  of the body, although  the
former is its most frequent site.   The most
dangerous form of  this disease affects  the
muscles of respiration which move the ribs,
and  proves quickly  fatal.  No  treatment
likely to be effectual could be undertaken by
unprofessional persons, and the disease is  not
one likely to occur apart from medical aid.  It
is well here to reiterate the caution to those
who are employed amid lead or its prepa-
rations, that they should observe the utmost
cleanliness, especially at meals, for there is
good reason  to believe that the poison often
finds its way into the system from careless-
ness on this  point.—See Colic, Lead, Sec.
  Shaking palsy, in one  form, is  generally
the result of old age;  in another it is more
traceable to  direct disease of the brain, and
is very apt to occur  in those wh6 have drunk
freely.   It  comes on very insidiously, and
even under the best care is a very hopeless
affection as regards cure.  This is a different
affection from the "mercurial tremour," with
which those  who work in that metal, such as
gilders, are liable to be attacked.
  Refer to Apoplexy—Nerves, Sec.
  PANACEA.—A remedy eapable of curing
all diseases—it is, perhaps, needless to add,
an imaginary one—a " myth."
  PANADA.—A food for children and inva-
lids, best made by boiling for  a  length of
time in water, or milk and water, thin Blices
of bread previously well dried  in  the  oven.
—Refer to Children.
  PANCAKES.—The well-known  article of
food; they are unsuitable for invalids.
  PANCREAS.—The  pancreas (fig. civ. 1)
                 Fig. civ.
is a narrow gland from six to seven inches in
length, which  is situated  behind  the lower
portion  of the stomach, (fig. civ.  2.)  It is
sometimes  compared in  shape  to a dog's
tongue.   It secretes a fluid somewhat re-
sembling the Baliva, which is poured into the
duodenum (fig. civ. 3) through  a "duct,"
which enters the bowel by the same opening
as that which conveys the bile, the two fluids
mingling with  the digested food pulp, or the
chyme, at the same time, and neutralizing
its acid  properties.
  Refer to Alimentary Canal—Digestion.
  PAPILLA—Is a small eminence upon the
surface of an organized body.   The minute
points visible  upon  the tongue  are called
the papillae.
  PAPIN'S DIGESTER.—See Digester.
  PARALYSIS.—See Palsy.
  PARAPLEGIA—Palsy  of the lower  por-
tions of the body.—See Palsy.
  PAREGORIC, or Paregoric Elixir.—An
anodyne.  English paregoric is also called
"camphorated tincture of opium," or com-
pound tincture of camphor;  of this, half an
ounce contains one grain of opium.   Scotch
paregoric, also  called " ammoniated tinc-
ture of  opium," is  four  times the above
strength, containing four grains of opium in
every half-ounce.  These preparations should
be purchased ready made.
  Refer to Opium.
  PARENT.—See Hereditary—Marriage
—Idiocy, &c.
  PARIETAL BONE.—See Skull.
  PAROTID  GLAND—Is  one of the glands
which secrete the saliva.   It  is situated a
little below and in front of the ear, and fills
up  the  space  beneath the "angle" of the
lower jaw.   Its "duct," which conveys  the
saliva into the  mouth, opens between  the
gum and the cheek opposite  the second dou-
ble tooth.  It is this gland which is swollen,
inflamed, and  painful, in the "mumps."
  PAROXYSM.—A  periodical accession or
aggravation of certain symptoms of a disease;
an attack of toothache may be called a  pa-
roxysm ; there are paroxysms of ague,  of
mania, &c.
  PARSNIPS—Contain a  considerable pro-
portion  of saccharine matter, and are nutri-
tious, but often disagree with weak stomachs.
They are considered diuretic.
  PARTURITION.—See Child-bed.
  PASSION.—It is sufficient here  to allude
to the serious  effects which  may  follow the
indulgence of violent passion.  Those who
give way to it are often themselves sensible,
either during the paroxysm  or at  its close,
of  unusual sensations about the region of
the heart.  There can be no question that 
                  PAS                3

this important organ is much influenced by
these violent mental emotions, one of which
may lay the foundation of that disease which
another may ripen into sudden death.   And
what a death!
  PASTRY.—See Confectionary.
  PATELLA.—The knee-cap, or knee-pan,
is the small, somewhat oval, or heart-shaped
bone, which is contained within  the tendon
of the  " extensor" muscles of the lower ex-
tremity, serving at once to protect the im-
portant joint which  it covers, and to give
proper  direction to the  muscular power on
the forepart of the limb.   The  knee-cap is
very liable to  be fractured, or rather torn
across,  in falls  where the  individual, in the
endeavour to save himself, violently exerts
the muscles of  the limb; a painful shock, as
from a blow, is  felt, and the power of extend-
ing or  advancing the  limb is instantly lost.
When examined, the deficiency occasioned by
the absence of  the upper  half of the  knee-
cap is  at once apparent, this being drawn
more or less up the forepart of the thigh by
the action of the muscles.   When the knee-
cap is broken, as it sometimes is by direct
violence, the displacement is not so great,
but the accident is generally more serious,
owing to the violence injuring the knee-joint
generally.  The treatment of transverse frac-
ture of the knee-cap might, with care, be
managed by an  unprofessional person in the
absence of a medical man.  The  principal
object in the treatment  of this accident is,
to remedy the displacement or drawing up-
ward of the upper fragment of the  bone,
which  takes place in consequence of the
muscles of the  thigh, with which it is con-
nected, being set free from the counteracting
power  of their attachment to the upper part
of the bone of the leg, their common tendon,
in which  the  knee-cap is imbedded,  being
torn through, as well as the bone.
  It must be evident to  any one, that by
placing the limb as represented,  (fig cv.,) by
which  the aforesaid muscles  are rendered
lax,  not only  will their tendency to   draw
                  Fig. cv.
up  the upper  fragment  be obviated,  but
the position will  permit of the bone being
again  brought  down to  its proper place.
Accordingly, the first part of the  treatment
        2 h2
89                PEA

 of this accident is to place the entire  lower
 limb, as represented,  on an inclined  plane
 made of any convenient material, and cush-
 ioned of course; this  being  done, and  the
 displaced fragment drawn as nearly as pos-
 sible into its natural position, and in contact
 with the lower fragment which does not  un-
 dergo displacement, some  additional  means
 must be employed to keep the parts steady.
 For this purpose, many different kinds of ap-
 paratus have been used; probably the most
 easily managed will be the simple one  re-
 presented in the cut.   This  is  formed by
 laying a strip of stout bandage, longitudi-
 nally, on each side of the injured bone, (cv.
 1;) these strips are then secured by a few
 turns of  two  circular  bandages, (2,  2,)
 passed,  one round the lower part of  the
 thigh, the other round  the upper part of the
 leg close  above  and  below  the fractured
 bone: the ends of the longitudinal bandages
 (1) being then tied, the apparatus is com-
 plete.  It will be advisable to add to the in-
 clined plane some additional protection, as
 represented by the dotted line, (3,) to obviate
 the chance of the  limb slipping off the  ap-
 paratus.   It has  been  observed  that  those
 who have suffered fracture  of one knee-cap
 are more liable  than others to suffer from a
 similar accident on the other leg.  This is,
 probably, accounted for by the fact, that in
 a large proportion of  cases, the  two  frag-
 ments  of the  "patella"  which  has been
 fractured  are not perfectly closely united,
 and that the person is, therefore, more liable
 to suffer a fall similar to  that which pro-
 duced the first accident.  Some individuals,
 moreover,  are  more liable to  suffer from
 rupture of the tendons generally than others.
 The  knee-cap sometimes  suffers displace-
 ment.—See Knee.  [After such an accident,
 the patient should wear a laced knee-band-
 age for several weeks.]
   PATENT  MEDICINE.—See Quackery.
   PATHOLOGY.—The science of the nature
 of disease.
   PEA.—The common garden  pea,  in  its
 fresh or green state, and when eaten young,
 is wholesome and digestible; but when it has
 advanced  toward ripening, the  outer skin
 becomes very tough and  indigestible, and
 passes through  the bowels unacted  upon
 by the digestive organs—in this condition
 it  is very liable  to lodge  in the  folds, or
 " sacculi,"  of the colon, or large bowel.  If
 old peas are eaten regularly, and the bowels
 are at all torpid, a large accumulation of
 these pea-skins  may   take  place, and at
 length give  rise  to troublesome irritation
 and  diarrhoea.  A dose of compound colo-
 cynth pill,  or  of caator-oil,  is the best 
r* E A
3!)0
P E L
remedy.—See  Diarrhoea.   Peas  in  their
young state contain a considerable amount
of saccharine matter, but,  when  ripe and
Ay, they, like  others of the leguminous-or
pulse tribes, contain much vegetable caseine
—analogous to the curd of milk;  indeed, so
largely is this the case, that the Chinese
make from  peas a kind of cheese, which
can  scarcely be  distinguished  from  that
made  from  milk curd.   Dried   peas  can,
of course, only be used as human food with
advantage  when reduced  to softness,  or
when ground  into  flour; when  thus  ren-
dered  digestible, they contain   more real
nutriment, that is plastic matter,  adapted to
building up the animal frame, than even wheat
or oats.—Refer to Diarrhoea—Grains, Sec.
  PEACH—The well-known fruit, is, when
ripe, sufficiently digestible if eaten in mode-
ration.  The peach tribe derive their chief
interest, in a medical  point of view, from
the hydrocyanic, or prussic acid, which is
obtained from various parts  of the plants by
distillation.   Peach-kernels  yield  it largely,
also the  blossoms and the  young leaves;
preparations from these, therefore, must be
employed with  great caution.  An infusion
of the dried  leaves of the  peach has been
used in cases of worms.
  PEARS—Are apt to disagree with  many
persons.
  PEARL-BARLEY.—See Barley.
  PEDICULL— See Acari.
  PELVIS—Literally,  means a   basin,  the
term  having  been given to  this  particular
region of the  body from  its fancied  re-
semblance to that utensil.   The pelvis (fig.
cvi.)  is the  irregular  structure of bone
which  supports  the spine, at 1,  and which
rests  upon  the  thigh  bones,  the round
"heads" of which are fitted  into the cups,
or cavities,  2, 2.—See Hip.  The pelvis is
exposed essentially of three different bone
masses ;  two of these, the "ossa innonniiita,'
{?j, 3,) form, together, the sides nnd  fore-
part of the pelvic  cavity, being united in
front, (4.)   The back part of the pelvis is*
formed  by the  " os sacrum," (;"),) a  trian-
gular bone, which  fits  like  the wedge or
key-stone of an  arch between the two side
bones of the structure.   On  the top of this
bone, which appears, and may be regarded
to be a number of vertebra;, or spine bones,
cemented together, the  spine is placed; its
central  canal or cavity, which encloses the
spinal  marrow,  being continued down the
centre of the sacrum—in which the holes
(7, 7) give passage to small nerves.  The
side  bones, (6, 8,)  although  in  the  adult
they are united into one  piece, are not  so
in early life, but  are in three divisions: for
the sake of convenience in describing, &c,
anatomists retain these distinctions even in
the adult bone.   A little consideration will
show any  one  how much  strength  is im-
parted to the important bony construction
above  described, which  is,  moreover  bo
placed or balanced, with respect to other
portions of the body, as to throw the weight
on those portions of itself best  calculated
to sustain it, and the whole upon the thigh
bones in  the most advantageous  manner
possible.  Further,  the whole structure  of
the pelvis is made  as light as can be  com-
patible with  strength.   The sacrum  bone
(5) is the lightest, bone of the body for its
size;  and, in the  arrangements  of these
pelvic bones  generally,  wherever  ligament
can be substituted for bone, we find it is so;
thus,  for instance,  the two holes (9, '.») in-
stead of being filled up with bone, have mere-
ly a thin, light ligament stretched across.
  There is considerable difference in shape
between the male and female pelvis ;  the
latter being  more  broad, ample, and ex-
panded  than the former, in, every way—a
matter of  necessity in  child-bearing  par-
ticularly,  so as  to afford sufficient room
for the  passage of  the  infant, the head  of
which is, for the most part, adapted to pass
through  the pelvic cavity by a series  of
turns.   The near adaptation, in  most cases,
of the infant head  to the passage through
the almost  unyielding  pelvic bones, must
obviously make it a matter  of the highest
importance, that in the female these bones
should attain their full expansion and de-
velopment ;  this they do in the majority of
instances, but in Borne cases,  particularly in
consequence of disease, the  room afforded
in the pelvis becomes seriously diminished,
so as to make  ordinary child birth  impos-
sible.  In such instances,  the life of  the in-
fant  is almost certain to  be  sacrificed, and 
P E N
391
PER
 that of the mother to be put in great ha-
 zard ;  in  either case, a contingency which
 none should incur knowingly.  If, therefore,
 either in consequence of  disease in early
 life, such as rickets, or of natural deform-
 ity, or accident, there is reason to suspect
 deformity of  the  bones of the pelvis, the
 female who is  the subject of it should not
 enter into the bonds of marriage, without
 its first being ascertained that child-bearing
 is possible without danger to life, and this
 can be ascertained by medical examination.
 If, after marriage, causes previously undis-
 covered,  or which have come  into  action
 afterward,  should render ordinary  child-
 birth  hazardous  from contraction of the
 pelvis, there yet remains the possibility of
 a living child being preserved by the  induc-
 tion of premature labour;  it is, however, a
 question,  how far  it  may be  right to enter
 into marriage  under such a proviso.  The
 cavity of  the pelvis  is  inferior to, but con-
 tinuous with   that  of the abdomen;  the
 contents,  or "viscera," of the two being
 continuous.—See Abdomen.  Fracture of the
 bones  of  the pelvis   occasionally  occurs in
 consequence of accident.  It  is  always a
 serious mishap, from the circumstance that
 the violence which is capable of fracturing
 these strong bones must, in all probability,
 injure some of the  important parts—the
 bladder  especially—which  they  naturally
 surround  and guard.   The accident  is not
 likely to be detected by an  unprofessional
 person: if suspected, soothing measures to
 the painful parts, hot fomentations, poul-
 tices, and leeches would be advisable; the
 body being placed in  the most easy position,
 and, perhaps, a bandage a foot broad sewed
 round the hips—surgical  assistance being
 procured  without delay.
   Refer  to Abdomen—Bladder—Hip—Spine,
 Sfc.
   PENNY-ROYAL—Is one of the mint tribe,
 found in wet places in England, and  in Eu-
 rope  generally, [as well as  in  the United
 States :] it was formerly much more esteem-
 ed than it is  now.   It possesses  the same
 properties as the mints generally.  It  is said
 to have the power of driving away fleas.
   PEPPER.—Four species of  the peppers
 are used by man—two dietetically and partly
 medicinally, the black and.long  peppers;
 two strictly medicinally, the cubeb pepper,
 and the matico.—See Cubebs—Matico.  Long
pepper occurs in the  form of cylinders, from
 an inch to an inch and a half in length, these
being made up of numerous little pepper-
corns, or berries, compacted together; it is
often  used as a substitute  for the  next spe-
cies, tie  black pepper, both  being brought
from the East Indies and from  the neigh-
bouring islands.
  Black pepper  is  the  fruit of a  trailing
plant, the berries being produced on spikes
or stalks  to  which  they  closely  adhere.
When half ripe they are red, and in this
state are gathered ; in drying they become
black and shrivelled,  assuming the  form of
the common  black pepper  corns.   When
allowed to ripen, they are divested  of their
husks, and then form white pepper, which
is  milder than the black.  The aromatic,
stimulant,  and  carminative  properties of
pepper are too well known  to require de-
scription : they may often be conveniently
taken advantage of  when stimulants are
required ; ten to twenty grains  of  ground
black pepper may be given at once,  if given
in milk.   Black pepper has been used as a
remedy in ague, and  might be tried in the
absence of other  more certain  medicines.
A confection  of black pepper is  used as a
remedy in piles.  Peppers, even when whole,
are liable to  adulteration; still  more when
ground.  In the investigations of the Lancet
Sanitary Commission, it is stated, " Some
years since it was not uncommon  to meet
with artificial pepper-corns."   " This spu-
rious pepper was made of oil-cake, common
clay,  and  a  portion  of Cayenne  pepper,
formed into a mass, and granulated by being
first pressed thrpugh a sieve, and then rolled
in a cask."  Of course the adulterations of
ground pepper are more easily effected.  In
the report of the  above investigations, an
extract  from Mitchell's  "Treatise  on the
Falsification of Food," states, "In the state
of powder, pepper is nearly always adulter-
ated, substances being sold for the  express
purpose.  It is often  mixed with the pow-
dered husks of mustard," which  are openly
sold for this purpose,  as is also  the sweep-
ings  of the pepper warehouses,  under the
name of ' P. D.,'  or pepper dust."  In addi-
tion to the above, linseed-meal, wheat-flour,
pea-flour,  and sago-meal,  are also  used to
adulterate ground pepper, and were detected
in various samples by the Lancet commis-
sioner.  Jamaica pepper, or Allspice, is an
agreeable aromatic, applicable to the same
purposes as aromatics generally.  The pow-
der may be given  in  doses of from ten to
thirty grains.
  Refer to Capsicum.
  PEPPERMINTS.—See Mints.
  PERCUSSION—In  medicine is the pro
cess of eliciting sounds from any portion of
t'he body by striking upon it, or  some inter-
posed medium, by means  of the fingers, or
by an instrument adapted for the purpose.
The  object of eliciting  those  soui_ds,  and 
PER
392
PER
 the  mode in which, to the  educated ear,
 they give information  of the condition of
 the parts beneath, has  been sufficiently ex-
 •Tained in the article Lunc
  PERFORATION.—The'term in medicine
 is chiefly used  to express the formation of
 an  aperture  in some portion of the  coats
 of the alimentary canal, which  allows  the
 escape of a  portion of the contents of the
 stomach or bowels into the cavity or sac  of
 the  "peritoneum," thereby  causing   ago-
 nizing paiu,  severe  inflammation,  and  in
 almost every instance death.  As the escape
 of a small portion of the contents of the in-
 testines is sufficient to occasion these severe
 symptoms and fatal consequences, a very
 small opening may be the occasion of death.
 The most common  sites of the perforation
 are the  stomach, or the small bowel near its
 junction with the large—in the  latter case
 usually  occurring in the progress of  fever,
 and being occasioned  by ulceration.   The
 occurrence  of perforation in  the stomach is
 often for some time preceded by dyspeptic
 symptoms, pain,  especially after food, and
 perhaps vomiting.  Females, especially those
 of a weak, lymphatic, or scri^ulous consti-
 tution,  are more  liable to it than males;
 but it may happen in all constitutions, and
 without previous symptoms.   When perfora-
 tion occurs, and the contents of some part of
 the intestines escape, there is sudden, intense,
 agonizing, burning pain, perhaps vomiting,
 and there is extreme depression  or collapse
 of  the  system  generally.  In such a case,
 the hope of saving life is  very  faint, even
 under the most skilful treatment,  and  of
 course a medical  man should at  once be
procured.  All that unprofessional persons
can  do  is to  mitigate  the  intense agony,
which opium alone can  relieve.  Full  doses
of whichever of its preparations are most
easily procurable  may be given,  and  re-
peated at short intervals until some  relief
is obtained.   Heat to the bowels  may afford
some  comfort.  If there is much vomiting,
the opium will, as in all similar cases, pro-
bably be best retained if given solid, in the
form  of pills—of one  grain each in such a
case—opiate clysters, containing each thirty
to forty drops of laudanum may be service-
able.  When  there  is  great  depression,  if
the person survives some time, stimulants,
wine or  brandy, are given.
  Refer to Inflammation.
  PERICARDIUM.—The bag in which the
heart is  enclosed.—See Heart, Carditis, Sfc.
  PERICRANIUM.—The membrane which
invests  and  adheres to  the  bones of the I
 skull;  in other  bones the  corresponding j
 membrane is named the periosteum.
   PERINEUM—The space at the fork of
 the lower limbs between the fundament and
 the generative organs.
   At  this spot the operation of cutting for
 the stone, in males, is  usually  performed.
 Falls, with the legs  astride any body suffi-
 ciently narrow to allow it to bruise the peri-
 neum, are apt to be followed  by serious
 consequences, bloody urine   or complete
 stoppage.  For the same  reason, the prac-
 tice of " hoisting," carrying an  individual
 astride upon a piece of  wood, either in  the
 way of practical  joke  or punishment, is
 seriously to be condemned.
   PERIODICITY.—The recurrence  at regu-
 lar intervals of marked phenomena in  the
 progress of vegetable or of animal life, is
 at once one of the most interesting, one of
 the most certain, but at the same time—as
 to cause—one of the  most  obscure  facts in
 the range of scientific inquiry.   Among
 plants a daily periodicity is so well marked,
 both  as  regards  their opening and their
 closing, that it is  familiar to all: even  the
 children  know  when the   daisies  and  the
 clover " go to sleep;" and  the famous  Lin-
 naeus  constructed,  or rather arranged, what
 he called the floral clock, from the times of
 the opening and shutting of certain plants.
 It is sufficient to allude  to the  different  but
 regular times of leafing and  flowering of
 tree  and  plant, to the certain  returns of
 " seed-time and harvest," to  confirm  that
 what  holds good in  the revolution of  the
 twenty-four hours  does so throughout  the
 year.   In the animal kingdom periodicity
 is  equally well marked : each kind carries
 its yoting a certain time; with slight varia-
 tion, the  changes  from  the cradle  to   the
 grave  in  man,  progress  in  well-marked
 periodical  order.   What   is  observed  in
 health is seen also in disease.  The  regular
 return of the paroxysm in the  quotidian,
 the tertian, and the quartan ague;  the  re-
 gularity with which the  eruptions of scarlet
 fever,  small-pox,  or  measles, appear  and
 decline, all  tell of  the same  thing;   the
 nightly hectic of  the consumptive  patient
 does so also.  These are  well-marked  in-
 stances, so much  so, that  they cannot fail
 to attract attention ; but there are, doubt-
 less, numberless others  in  the progress of
 disease, equally interesting and important,
 but unobserved.   The causes of periodical
 changes are generally very obscure ; some,
 unquestionably, such as  the lunar influences
 upon the tides, the effect of prolonged heat
 and light, as from the  sun, in stimulating
I vegetation, we can readily distinguish  and
[ appreciate,  but  the  majority are  beyond
 our ken.   Some may be connected with the 
                 PER

hidden springs of life, others are more than
probably linked  with  the  barometric  and
electric  changes  which  are  continually
going on in  the  diurnal revolution of the
twenty-four hours.  The  following  table,
drawn up some years since by Dr. Laycock,
of York, in some degree indicates the nature
and connection of periodical changes:—
>3               PER

   In connection  with  the above.  Dr. Lay
 cock remarks, "What effect have barometric
 variations on animal life, and especially on
 the  phenomena of epidemics 1"   Huxham
 specially refers to the  phenomena of inter-
 mittent fevers as being probably influenced
 by barometric variations through the vary-
 ing pressure of the atmosphere on the veins.
 More recently, Sir D. Barry took up both
 the pathological and physiological views of
 Huxham, and in the same spirit observes—
 "IstJ It being now evident that the blood
 in the veins is placed under the influence of
 atmospheric pressure,  it would be curious
 to trace  the connection which  appears to
 exist between diseases generally, intermit-
 tent fever for example, and the daily atmo-
 spheric variations.   The reader will see at
 once that facts countenance these specula-
 tions.   2d. Has  the electricity of  the  air
 or the magnetism of the earth any influence
 on vital phenomena ?   If any, we may infer
 a priori that  the  results would be seen in  *
 the nervous system. Now, according to  the
 table, the period of increased excitement in
 the  insane  commences  when  the  electric
 tension of the air and  the variation east of
 the magnetic needle are at a minimum, and
 vice  versd.   The unpleasant  influence   of
 thunder-storms is well known to persons of
 nervous temperament,  and to those predis-
 posed to disease of the  nervous system ; and
 as these occur most usually in the evening,
 we should look for nervous attacks at that
 time.
   The whole subject of periodical changes
 has  hitherto  been too  little attended  to,
 when its importance and the  magnitude  of
 the scale on which these changes take place
 are considered.  Under the article Influenza
 it was  stated that,  during  the occurrence
 of that  epidemic,  remarkable  barometric
 changes were  observed.
   PERIOSTEUM.—The  membrane which
 closely  adheres to, and invests the bones,
 except at their articular or joint-forming
 surfaces.—See Bone—Node, Sec.
   PERISTALTIC—The contractile, worm-
 like  movements of the  intestines.
   PERITONEUM.—The peritoneum is  the
 " serous" membrane which lines  the abdo-
 men, covering both its walls and its contents
 —the viscera.   The peritoneum is, in its in-
 terior, what is called a  " shut sac."  It con-
 tains simply the  serous fluid which it  se-
 cretes, and which facilitates the movements
 of its interior surfaces, and, consequently,
 the various movements of the  bowels,  &c.
 upon each other.   The parts  which the  pe
 ritoneum covers, all lie exterior to its cavity,
 the outer sides of the   " sac" being folded
 Table of the Meteoric and Physiological Events
   occurring at the Barometric hours, during a
   solar day of twenty-four hours.
     4 to 5 o'clock a.m.
 Barometer  at its minimum height.
 Minimum of electric tension, nearly.
 Intermediate  minimum  variation east of
   magnetic needle.
 Minimum of temperature.
 Hour at which several flowers bloom.
 Certain moths escape from the chrysalis.
 Minimum consumption  of oxygen.
 Onset of cholera, epidemic diarrhoea, Egyp-
   tian ophthalmia, and quotidian ague.
 Period  of increased  excitement  in  the
   insane commences.
 Hours of  alleviation of  symptoms and of
   sleep in hectic and infantile fever.
     4 to 5 o'clock p.m.
 Barometer at  its minimum height.
 Minimum of electric tension.
 Minimum variation east of magnetic needle.
 Certain moths escape from the chrysalis.
 Termination of a  paroxysm of quotidian
   ague.
 Onset of a  quartan ague.
 Exacerbation  of fevers;  accession of hectic
   fever.
 Period  of increased excitement in the in-
   sane begins.
     8 to 10 o'clock A.M.
 Barometer at  its maximum height.
 Maximum of electric tension.
 Maximum variation east of magnetic needle.
 Maximum excitability of the circulation.
 Maximum of  muscular power.
 Period  of increased excitement in  the in-
   sane, ends.
     8 to 10 o'clock p.m.
 Barometer  at  its maximum height.
 Maximum of electric tension.
 Maximum variation east of magnetic needle.
 Meteoric  lightning and  thunder  storms
  appear.
Certain insects escape from  the chrysalis.
Consumption of  oxygen at its minimum.
Minimum of muscular power.
Minimum excitability of the circulation.
Hour of natural sleep.
Period of increased excitement in the in-
  sane ends.
Paroxysm of a quartan ends.
3 
PER
394
P H 0
over them.   In dropsy of the belly,  the
water is effused into the cavity of the "sac."
Wounds which open the peritoneal covering
of the  bowels are always extremely dan-
gerous, from the liability of this membrane
to become violently affected with spreading
inflammation.
  PERITONITIS —Peritoneal Inflamma-
tion.—Also arises from other causes, such
■s prolonged parturition and the like.—See
Inflammation.                        #
  PERSONS FOUND DEAD.—See Death.
  PERSPIRATION.—See Skin.
  PERUVIAN BARK—See Bark.
  PESSARY.—An instrument used to sup-
port the womb, when displaced.—See Womb.
  PESTILENCE.—See Epidemic.
  PETECIILE— Are  spots  which appear
upon the  skin in  certain forms of fever.
They often resemble  and are mistaken for
lea-bites.    Petechiae  frequently  assume
different   colours  and  forms,  differences
,'hich have lately been assumed as one of
 he distinctive marks between the typhus
■.ind typhoid forms of fever.
  PETROLEUM—Literally  "rock-oil,"  a
liquid  bituminous substance  which  flows
 rom the  clefts of the rocks in some  coun-
tries.   Like  other oils, however, its origin
 s in the first  instance vegetable.   In Trini-
dad it  occurs in beds or lakes.  Petroleum
ias been recommended as an  external  ap-
plication in rheumatism, and in skin diseases.
it is not much used at present.
  PHAGEDENIC.—A  term  applied to  a
form of ulcer, which, from its  rapid exten-
sion, gives the  idea of the  tissues  being
eaten away.
  PHARMACOPOEIA—Is a book or system
which includes the medicinal agents, their
preparations and  mode of preparation, au-
thorized by the principal, legally constituted
medical authorities of the kingdom:   also
the measures  and weights  which are to be
employed  in dispensing the medicines.   In
the United Kingdom  there  are the  three
 1>harmacopoeias,  (of England,  Scotland,  and
 reland,)  which,  although  they agree  in
general arrangements,  and in the general
recognition of medicines and their prepara-
tions, yet  differ in  so many important par-
ticulars, as to cause not only confusion in
many instances,  but  even  danger.   Thus,
for example,  under the head  of Paregoric,
it was pointed  out  that  the preparation
which goes by that name in Scotland con-
tains four times as much opium as the pare-
goric  of England, a  difference quite suffi-
cient to  give rise to poisoning.   Medical
mrn and druggists must, it is true, or ought,
to he  alive  to all such differences;  but
others are not, and even in the compound
ing of prescriptions accident* are possible,
through inadvertence.   An individual who
has received a prescription from a practi-
tioner in any  one of the  three  kingdoms,
ought, if sending it to be made up in another,
to mention the fact.  It is the safest plan.
New pharmacopoeias are issued by the vari-
ous colleges at intervals of years, with such
alterations  and amendments as the progress
of  medical and  pharmaceutical  science
render necessary.  A new London Pharma-
copoeia was issued in 1851.  The medicines
alluded  to in this  work are generally in ac-
cordance with it.  [The Pharmacopoeia of the
United  States is  revised  every  ten years,
and is  that by which all  preparations are
made.   As  it differs in  some points from
those of Great Britain, the reader  should
abvays  ask the apothecary in  relation to
the difference in the  strength of  an article,
before giving it as directed in the English
works, lest he do  harm.]
   Refer to  Medicines—Measures—Weights.
   PHARMACY.— The  art of  preparing
medicines.   [This art  is  now the business
of a special set of  intelligent men  in the
United States, who  are designated as phar-
maceutists  or apothecaries.  By the apothe-
caries' code of ethics they are not permitted
to prescribe medicines.]
   PHARYNX.-See  Throat.
   PHLEBOTOMY.—The cutting or opening
of a vein for the purposes of blood-letting.
—See Blood-letting.
   PHLEBITIS.—Inflammation of the veins.
—See Vein.
   PHLEGM.—Mucus.—See Mucus.
   PHLEGMASIA DOLENS.— See Swelled
Leg.
   PHLEGMON.—The  term  is  generally
used in  connection with inflammation, as in
erysipelas,  which affects the cellular tissue
beneath the skin.
   PHOSPHATES. — Compounds  of phos-
phoric acid.—See Phosphorus—Soda, Phos-
phate of, Sec.
   PHOSPHORUS—Classed among the ele-
mentary bodies of matter, is interesting in
this work,  less for its medicinal  properties
or preparations than for the share it takes
in the composition of animal bodies and for
its extensive economic uses.
   After its discovery in 1669,  phosphorus
was prepared from  urine; it is  now  chiefly
procured from bones, and is made in large
quantities for  the manufacture of the vari-
ous kinds of lucifer and other "instantane-
ous lights," of which it forms the essential.
   When pure, phosphorus at an ordinary
temperature looks   and  cuts  like  darkish 
P H 0                895               P H 0
 coloured  wax;  it is  very inflammable, and
 when cut or handled should be kept under
 water.  It is usually sold in moulded sticks :
 Us luminous properties in the dark are sub-
 jects of popular information.
   Phosphorus in the form of its salts, that
 is, phosphates  of lime, magnesia, potassa,
 &c, exists in the soil, whence it  is, in this
 compound  state, absorbed  by  vegetables,
 and by them handed over to  the animal
 creation ;  in  the seeds of the grains,  espe-
 cially,  phosphorus exists in comparatively
 large proportions.
   In the  animal  body,  phosphorus is  an
 essential   constituent of  the   albuminous
 (see Albumen) and fibrinous compounds: it
 enters  into the composition  of the  substance
 of the brain and nerves in considerable pro-
 portion, and largely into that of the bones,
 to which  the phosphatic earthy  salts give
 much  of  their solid firmness.    As phos-
 phorus is contained in the various tissues
 of the body, it of course exists in the blood,
 and in  milk, which is suited to  be the sole
 nutrient of the living animal; it also exists
 in the  excretions,  as stated above, in  the
 urine, and also  in  the discharges from  the
 bowels.
   Various preparations of phosphorus have
 of late been brought forward as  medicinal
 agents, but do not require notice here.   For
 Phosphate of Soda—See Soda.
   The large use made of phosphorus in match
 manufactories invests it with great interest,
 and the peculiar manner in which, under care-
 less management, it has been found to affect
 the health of  a few of the work-people,  de-
 mands  attention from its hygienic import-
 ance.   Some persons who  have  been  em-
 ployed  for a length of  time in  a lucifer-
 match factory, become affected with disease
 of the lower jaw;  portions of the  jaw-bone
 become " necrosed," or die, cause  abscesses
 in their vicinity, and are  either cast off by
 the natural processes, or  require  to be  re-
 moved  by the surgeon.    In some cases,
 nearly  the entire jaw has  thus been  lost.
 Probably, constitutional  predisposition has
 something to do with the  liability to this
 phosphorus disease, but,  at  the  same time,
 there is no question that, in  other manufac-
 tures, free ventilation of the places in which
 the processes  are going on, and strict atten-
 tion to cleanliness on the part of the work-
 people,  must prove great preventives.  It is
 said that saucers filled with turpentine, dis-
 tributed about the workrooms, by absorbing
 the phosphoric  vapours,  are  a safeguard.
There is, however, a  prospect that by the
use of phosphorus in its  peculiar "amor-
phous"  condition,  for the manufacture  of
 lucifers, not only may the evils attending
 the manufacture be prevented, but also the
 accidents which have occurred from children
 sucking the common lucifers, and  thereby
 being poisoned.  The  following account of
 the amorphous phosphorus, is at once very
 interesting, and well illustrates one of the
 most curious points in chemistry—the exist-
 ence  of the same body in most opposite con-
 ditions and possessing most opposite quali-
 ties.   The extract is  taken from a paper
 read  by Dr. George Wilson before the Royal
 Scottish Society of Arts, in April, 1852.
   " The simplest lucifer match consists of
 a splinter of wood dipped into melted phos-
 phorus, and then covered with gum or glue.
 More frequently, phosphorus is  associated
 with  chlorate or nitrate of potassa, and with
 sulphur or sulphuret of antimony. The em-
 ployment  of  such materials  necessarily
 renders  the manufacture a very hazardous
 one, from the risk of fire; and  in  certain
 of the continental states, the preparation of
 lucifer  matches  has been  absolutely pro-
 hibited,   Another  and quite unexpected
 hazard was soon found to attend  their ma-
 nufacture.  The work-people were attacked
 by  a very painful, and often fatal disease
 of the jawbones, which became carious, oc-
 casioning in many cases death,  in  several
 the loss of the  upper and  under jaw,  or
 other severe mutilation and  disfigurement,
 and  always much suffering.  The German
 surgeons, who  have paid great attention to
 this distressing disease, refer it to the  ab-
 sorption of the vapour of phosphorus, given
 off chiefly during the drying of the matches,
 but  likewise at  other stages of  the manu-
 facture.  Phosphorus, also, is  well  known
 to act as a poison when swallowed  in  the
 solid  form; and as it occurs in this condition
 in lucifer  matches, fatal  accidents have
 more than  once  occurred from  children
 sucking them.  The red or amorphous phos-
 phorus is much less combustible  than ordi-
 nary  phosphorus, and not at all poisonous.
 To  prepare  the  new  substance, ordinary
 phosphorus  is  melted  in a peculiarly con-
 structed retort, and kept for some hours at
 a temperature  of about 500°  F.  A very
 singular change is the result of this heating,
 during which the phosphorus combines with
 caloric, and renders it latent, but does not
 otherwise undergo  any chemical   altera-
 tion.   The original phosphorus was a pale
yellow, or white transparent  body, so com-
bustible  that it must be kept under cold
water, and when brought into the air grows
luminous even  at the  freezing point, and
enters into a full blaze at a temperature of
about 150°  F.   By the prolonged heating 
                  PH R                3

 it bjcomes a s«ft opaque  mass,  which is
 easily pulverized, and then forms an uncrys-
 talline powder of a scarlet, crimson, purple-
 brown, or brown-black colour, so incombus-
 tible that it may be exposed in summer in
 the  open air, nnd handled with impunity ;
 nor  does it grow luminous till it is about to
 enter into  full combustion  at the tempera-
 ture of 482° F.  It is further so harmless to
 living creatures, that more than a hundred
 grains have been  given to dogs  without
 doing  them  any injury.  Although,  in its
 free state,  it is  sparingly combustible, yet,
 when it  is  mixed with the ordinary ingre-
 dients of lucifer matches, such as sulphur,
 or sulphuret of antimony  and chlorate of
 potassa,  it  kindles readily.  In proof  of
 this, matches made with amorphous  phos-
 phorus were shown to ignite  as  easily as
 those made with ordinary phosphorus. And
 it was  stated,  that  they  would  soon be
 manufactured on the large  scale,  and sold,
 it was believed, as cheaply as  the common
 matches."
   The following are stated as some of the
 advantages  connected with  the use of the
 new form of phosphorus, that—1.  "It in-
 volved much less  risk of destruction of life
 and  property by fire ; 2. It was more suit-
 able for  matches  intended  for warm  cli-
 mates; 3. It was not poisonous in the solid
 form, so  that matches  made with  it would
 be  comparatively  harmless if sucked or
 chewed ;  4.  It gave off no vapour at ordi-
 nary temperature, so  that  it could not oc-
 casion disease in the match-makers."
  One more word about phosphorus.  It is
 constantly being  abstracted from the soil
 by vegetables, especially by those, such as
 the grains,  used by man and animals.  If
 this  constant withdrawal of its phosphates
 from the  soil  is not  compensated for, it  be-
 comes incapable of developing its  vegetable
 produce  in  plenty and perfection; hence,
 cultivators  resort  to bone-dust, and  other
 expensive means of making  up to the  earth
 in one way what they draw from it another.
 Urine contains phosphorus abundantly, but
 every method is resorted to to conduct the
 vast stream of phosphates, which issue from
every large city, or from many a farm-yard,
by the most expeditious road, into that sea,
which is  at the same time bearing vessels
freighted with foreign manures!
  PHRENITIS.—Inflammation of the brain.
—See Brain.
  PHTHISIS PULMONALIS — Pulmonary
Consumption.—See Consumption.
  PHYSIC—See  Physician.   Among the
lower orders in some places, the term physic
is applied solely to purgative medicines.
                 PHY

   PHYSICIAN, «'M. D." on  " Doctor, oi
 Medicine."—These titles are  rightfully as-
 sumed  [in  England] by those,  only, who
 have undergone, successfully, the examina-
 tion instituted  by  colleges or  universities
 legally  chartered to grant such titles or de-
 grees.  The conventional meaning of the
 term physician, is, one who treats internal
 diseases of the body alone, in contradistinc-
 tion to  surgeon, one whoBe province is the
 treatment  of external   disorders and  the
 performance of operations, and to accou-
 cheur, one who  devotes himself solely to the
 diseases of women, and  particularly to the
 management of child-birth.   To  these may
 be added what was formerly the apothecary,
 and  is  now the "general  practitioner."
 These divisions into physician, surgeon, ac-
 coucheur, and apothecary, arose [in England]
 at a time when the science and practice of
 the healing art was very  different from what
 it is at present.  The  physician was  the
 only educated man, as Chaucer says—
    '' In all this world ne was  ther non him like
     Tn  ppeke of phipike and  of surgerle."
 He  probably practised  the higher depart-
 ments of surgery, as well as medicine strictly
 so called.   The ordinary surgeon added  to
 his emoluments by  the trade of  the barber,
 and  the apothecary was the  mere  vendor
 of drugs.   The separate department of the
 accoucheur is comparatively of receit date.
 Time and the tendencies and requirements
 of the age  have abundantly changed these
 old distinctions, chiefly with respect to the
 position and  standing of the general  prac-
 titioner. The physician  and surgeon have
 been advancing in  scientific requirements,
 but the  general practitioner has approached
 them so closely, that all  seem likely before
 long to merge in one profession in name, as
 they now, in great measure, do in practice.
 The  surgeon cannot be a good surgeon, in
 the proper sense of  the word, (not meant to
 designate a mere operator,) unless he is also
 a good physician ; and the physician, if he
 does not handle the knife, must be a good
anatomist to practise his profession properly.
In large towns,  and  in certain districts, the
distinction into  pure physician and into pure
surgeon is maintained, and, as at present,
with advantage,  at least when  age, expe-
rience, or peculiar talent have fortified the
titles; but the  great mass of medical men
must be " general  practitioners,"  highly
educated, and fitted for every  duty of the
healing  art.   With such a class the kingdom
is rapidly filling, and many of  its members,
whatever their title, stand, and will stand,
among the foremost in their profession, and
must be the " consulting men" of f-iture
96 
PHY                397                PIC
 years, when time and experience, combined
 with talent and industry, have given them a
 claim to the honour.  The  high education
 of all  medical men is now levelling  every
 distinction.   As long as  the  education  of
 the physician was so infinitely superior to
 that of the medical profession at large, the
 prestige which attached to the title was  its
 just due.  It still is its just due as the
 tribute to the mark of high attainment, but
 it is not just when paid to the exclusion of
 the profession  generally, the members  of
 which, as a body, whatever their title, must
 now, or at least in a few years, be  all as
 nearly on a level as the difference  between
 man and man permits.  Nay, more, the me-
 dical profession, as the education of its mem-
 bers is now conducted,  must become the
 most highly intellectual  body of men  in the
 kingdom. The studies of a medical man must
 embrace the widest possible range, from the
 simplest truths of mathematics and  of natu-
 ral philosophy, to the latest developments of
 practical psychology,  and  within this  range
 their knowledge  is real,  true knowledge, the
 knowledge of the manifestations of God in
 his  works ; and  their deductions from that
 knowledge  must be  the  alleviation of the
 physical, and many of the mental  evils  of
 fallen man, and  higher  still, their  preven-
 tion ; for it must  ever be to the honour  of the
 medical men  of  the present age, that though
 their bread may be said to be  got through the
 misfortune of their fellow-men, they have been
 ever the foremost  to point  out how these mis-
 fortunes are to be avoided—they have  been the
 first rousers, and  the chief leaders of the sani-
 tary movement everywhere.   In large cities,
 and in the metropolis especially, there al-
 ways will be, probably in  an increasing de-
 gree, (and it is expedient there  should,) a
 division of labour among medical men. One
 will take*the  skin, another the eye,  another
 the chest, and so on,  as his particular de-
 partment, and will attain such acquirements
 in connection with  his own  department,  as
 will give  him an  extra  claim to confidence
 when that is concerned, especially in  obscure
 or difficult  cases; but this cannot  be with
 the kingdom at large, and in the provinces,
 the great mass of disease  must continue to
 be  the care  of the  general practitioners,
 whose experienced  leading members must,
 under the present system  of education, be-
come what the physician has been.
  The above  remarks may appear  to some
irrelevant to the present work, but the pub-
lic generally require some  enlightenment  as
to the present constitution  of the profession,
ind on the bearing of its different members |
          21
 to one another.  [In the United States this di-
 vision of labour among practitioners does not
 exist, though some devote themselves more to
 the  practice of one  branch than  another.
 When the family physician desires assistance,
 he will know where to seek it; and it is better,
 therefore, for each person to have his regular
 medical attendant,  than to seek for himself
 one who  is especially celebrated in one class
 of complaints.  Above  all things let  him
 avoid every practitioner whose  reputation is
 the  result of newspaper  puffing, as well as
 the officious advice or opinion  occasionally
 offered by such vendors of drugs as  disgrace
 the title of "apothecary."  To treat diseases
 or injuries should be the  sole business of the
 physician, except  when  located  in  small
 communities.]
  Refer to Practitioner, General—Surgeon.
  PHYSIOGNOMY.—See Countenance.
  PHYSIOLOGY.—The science of the func-
 tions of  living bodies, generally and  spe-
 cially.
  PICKLES. — Vegetable  substances pre-
 served in  vinegar.  Even when well pre-
 pared they are not very  digestible, but the
 generality of those purchased are deleterious
 on another account—the more or less amount
 of copper which they contain ;  this poison-
 ous addition being made  to impart the fresh
 green  colour  so  generally  desired by  the
 purchasers and consumers of these articles.
 The  recent investigations of the Lancet Sani-
 tary Commission  on this subject disclosed
 the fact  that all the pickles examined con-
 tained more or less copper; in some it ex-
 isted in poisonous quantity.  The slightest
 impregnation with this poison cannot  be too
 strongly condemned, but it is probably used,
 at times, in ignorance, for even some cookery
 books  openly  advise  its   employment to
 "green" pickles.   Fortunately, the  detec-
 tion of this adulteration, even in a small pro-
 portion, is easy.  If a perfectly clear  and
 bright piece of iron (wire  will  do) be  im-
 mersed for a few hours in the vinegar  of the
 pickle, if copper is present the metal  will
 be deposited in  a perceptible, though thin
 crust upon the iron.   "Another very sim-
 ple and  efficient method of detecting  the
 presence of copper in pickles, is the follow-
 ing :—Put three  or four drops of the sus-
 pected vinegar on  the blade  of a  knife;
 add  one  drop of sulphuric acid, and heat
 the  under surface of the  knife  over  the
 flame of a  candle.  The  vinegar in evapo-
 rating will deposit the  copper  upon  the
iron, if any be present."   In the investiga-
tions  of  the  Lancet,  it was  ascertained
■" that the pickles which contain the largest 
PI L
398
PI L
quantity of copper  are those which consist
entirely of green vegetables, as girkins and
beans."
  Sulphuric  acid,  which  is  detected  in
pickles, comes more under the head of vine-
gar adulteration'-.—See Vinegar
  PILES, or  Hemorrhoids—Are tumours
which form at the verge of the anus or fun-
dament, and  may be situated either within
or without the bowel;  they are either what
are called "blind," or they are  bleeding
piles.   Piles  are often constituted by  an
enlargement or "varicose" condition of the
veins situated about this part, this enlarge-
ment being  caused by  whatever  tends  to
obstruct the  return of the  blood  through
the veins  of the abdomen generally; thus,
affections of  the  liver, constipation,  with
overloaded bowels,  pregnancy,  &c, are  all
frequent  causes of  this form  of  piles, in
which the swellings are generally smooth,
and of the colour of the surrounding skin.
Generally, the tumours vary in size accord-
ing to the operation  of the acting obstruc-
tion ; if they have occurred in consequence
of pregnancy, they diminish or  disappear
after  child-birth ;   if  loaded  bowels have
been the cause, a dose of suitable aperient
medicine  relieves  the  effect.    Sometimes
the enlarged veins become filled with  a
fibrinous deposit from the blood, and  then
the tumours are permanent.   Another form
of pile is more of the character of a morbid
growth: in it the tumours are more generally
internal, and are red, florid, and uneven on
the surface, and often very painful.  From
the causes of piles already stated, it may be
imagined that the sedentary, those who are
most liable to suffer from constipation and
liver disorder, are also most likely to be the
subjects of piles ; the same may be expected
to be the case with women who  have borne
large  families.  If  the causes which first
produced  the disease do not  continue  in
active  operation, or are guarded  against,
the hemorrhoidal   tumours may  continue
long quiescent, and give little trouble ;  but
if from any  cause, whether neglect of the
bowels, cold, the abuse of purgative medi-
cine, &c, they become inflamed, much suf-
fering  is induced;  the state is then called
a "fit of the piles," which  lays the indivi-
dual up  from active  exertion.  In  other
cases, instead of inflammation, bleeding may
occur,  and every time  the bowels are re-
lieved a considerable amount of blood may
be lost by stool.
  The  preventive treatment  of piles is of
the first importance, and the causes of the
disease pointed out, will at once suggest
the remedies, which are, chiefly, a sufficient
amount of exercise and proper  reguli.fion
of the bowels, with avoidance of food of too
heating and  stimulating a  nature.   If the
liver  is apt  to  get too  loaded  it must be
regulated; (see Biliary  Disorders;)  but in
doing this and also in regulating the bowels,
it  is  of some  importance what aperient
medicines are employed.   Aloes,  from their
power of acting upon the rectum or lower
bowel, are often said, when  taken too con-
stantly, to produce  piles, but their effects
in this way  have  perhaps  been  somewhat
overrated.  Certainly, if taken  habitually
in quantity to irritate, they will both cause
piles  and aggravate them  when  existing;
but, on the other  hand,  the effect of aloes
in thoroughly unloading the lower bowels,
and in stimulating the  liver, renders the
medicine a  very efficient  remover  of the
causes of piles.  The moderate use of aloes,
therefore, when an aperient is often required,
need not be entirely eschewed by those who
suffer from piles, unless  they find by expe-
rience that the affection is aggravated by
the use of the drug.  The  other aperients
most useful in piles  are,  when active effect
is  required,  castor-oil or  senna  infusion;
when a milder  action is  required, rhubarb
and magnesia, the electuary of senna, or the
saline  medicines,  such  as  Epsom salts in
small doses,  largely  diluted,  will be found
useful.  Sulphur combined either witfi an
equal part of cream of tartar,  or of calcined
magnesia, forms one of the bfcst of the mild
aperients in piles;  of either mixture a tea-
spoonful may be taken for  a dose, the first
in treacle, the second in  milk. It must be
remembered  that,  except  for unavoidable
purposes, purging is to be avoided in those
subject to piles, and that mild easy action
of the bowels is to be encouraged;  above
all, such a state of bowels as permits the
faecal mass to become so hard as that it irri-
tates or scratches the piles  in  passing, must
be  avoided.  This  is apt  to  occur if the
bowels  have  been constipated for a day or
two, in which case it is  advisable to use  a
small clyster  of warm water, [or thick flax-
seed tea,] so  as to soften the contents of the
bowel  previous  to  evacuation.  Indeed, in
those  subject to piles, clysters—if  care be
taken not to irritate with the pipe of the instru-
ment—form a most valuable adjunct to other
means of prevention or of treatment.—See
Clyster.
  When, from any cause, inflammation, or a
"fitof the piles," is induced, the first essen-
tial is rest in the horizontal posture, so as
to give every facility for the  return  of the
blood  from  the affected  parts;  the  diet
should be reduced,  made as coolirg as pos- 
PIL
399
PIL
  sible, and the bowels kept lax by some of
  the  means pointed out above.  If the in-
  flammation is severe, four  or five leeches
  may be required ; if not, warm fomentations
  and steaming will often give relief; at other
  times the cooling lead lotion, or an ointment
  made with half a drachm of  goulard ex-
  tract, rubbed up  in  an  ounce  of lard, will
  be  most  serviceable.  When piles  show a
  tendency to bleed, and indeed  in any case
  when they are decidedly developed, a medi-
  cal man should be consulted;  not solely on
  account of the pain and inconvenience re-
  sulting from  the  presence of the  tumours
  themselves, but because of the constitutional
  tendencies they exhibit.   The treatment of
  bleeding piles is often a delicate matter.  If
  the loss is so great as to be manifestly weak-
  ening the patient, there can be but little doubt
  that it must  be  stopped, and  may be with
  safety;  but at other times it is a safety-valve
  which cannot  be closed  without hazard, as
  long as the cause which first opened it con-
  tinues.   That is to say, instead of stopping
  the loss of blood from the piles by direct ap-
  plications, it must be done by constitutional
  remedies, adapted to diminish the plethora,
  either local or general, which originated the
  disorder; in this case, the preventive treat-
 ment of piles generally, as already stated,
 must be resorted  to.  Apoplexy and other
 diseases  have  followed  upon  the  unwary
 closure  of bleeding piles.  After constitu-
 tional treatment,  however, piles may con-
 tinue to bleed  merely from local causes; in
 this  case  the  drain is injurious, and must
 be stopped.  Many remedies  for the stop-
 page of bleeding  piles are used.  Common
 pitch, rolled into three-grain pills, and two
 of these taken twice a-day, is sometimes
 very efficient.   Cream of tartar alone,  in
 teaspoonful doses,  taken stirred in water,
 answers well  in some cases.   Mr.  Vincent
 recommends, especially when protrusion of
 the bowel also takes place, that after  each
 evacuation, a  small injection, composed of
 one grain  of sulphate of iron or green vi-
 triol, should be thrown 'into the bowel, and
 retained.   When inward piles are protruded
 at the evacuation of the bowels, it is  very
 important that they should be returned to
 their proper site as soon as possible; other-
 wise  they  are  very liable  to inflammation
 and  strangulation.  A piece of linen, well
 oiled, is the best medium for  exerting the
 pressure requisite for this operation.  When
 piles reach a certain point they may require
 a  surgical  operation for  their removal.
 [This operation should not  be  too long de-
layed, as the constitution  is sometimes very
much shattered by permitting the disease,
 and especially the open form of it, (bleeding
 piles,) to remain too long unchecked.]
   Refer to Rectum—Leeks—Veins, &c.
   PILL.—This well-known and convenient
 form for the administration of medicine is a
 mass  of medicinal substance,  of such  con-
 sistence as to permit  of its  retaining  the
 globular form into which it is  made.  Pills
 may be made simply  of the  active ingre-
 dients they contain, with the addition  of a
 little syrup, gum mucilage, or treacle, to give
 coherence ; but when the active ingredients,
 as, for instance, calomel, are not sufficient,
 either as  regards bulk or consistence,  to
 form a pill in this way, then some additional
 substances must be used; the most common
 are bread crumb,  hard or Castile soap, soft
 extract of liquorice, or conserve of roses.
 Of the above, the pills  made with conserve
 of roses  or with  treacle retain their soft*
 ness for the greatest length of time ; pills
 made  with  bread crumb  especially, soon
 become very hard; it is, however, very con-
 venient for  the extempore preparation of
 some  pills, such  as those of  calomel  and
 quinine.  AVhen used, the bread, which must
 be stale, is crumbed in  the mortar with the
 fingers; it is then rubbed well up with the
 active ingredient; and, lastly, formed  into
 an adherent mass  by the addition of a  few
 drops  of gum mucilage, or of syrup.   When
 hard soap is used  to form pills, it must first
 be scraped into thin shavings  before it is
 mingled with  the other  substances.   The
 soap may be in sufficient quantity to form a
 mass without other addition, or a little  mu-
 cilage, or  syrup,  or  glycerine may be  re-
 quired.  Soft extract of liquorice or con-
 serve of roses generally requires to be sim-
 ply  rubbed  up  with  active  ingredieuts.
 Glycerine  has recently been  used as  an
 addition, in small  quantities, to pill masses,
 for the purpose of keeping them moist,  and
 answers very well  for the purpose.  A little
 fixed oil of any kind will also preserve soft-
 ness.—See Glycerine.
   After the composition of the  pill, its  size
 and  consistence are  important considera-
 tions.   Pills are frequently made too large,
 that is to  say, five grains in weight.   Not
 only is a pill of this dimension uncomfort-
 able to swallow, but there is some chance
 that the whole does not  become dissolved in
 the stomach.  A  pill  of three grains  in
 weight  will  generally  be found the most
 convenient and effective size.   A pill must
 neither be too soft nor too hard, but in  the
 matter  of consistence  something must  de-
pend upon the length of time it is to  be
kept; pills that will  be  used in the course
of a few days or a week, may be made witb 
PI L
400
PIL
less attention to this object than those which
are to be kept an  indefinite period.  When
the latter is Ihe  case,  conserve of red roses
may be employed, or spirit of wine added
to pills, such  as the  compound colocynth.
which contains resinous matters, or as stated
above, a  few drops  of  glycerine  may  be
added to the pill mass before rolling.  It is
not likely that for domestic purposes a " pill
machine" would be procured; the best me-
thod, therefore, of  dividing  a  mass  into
separate pills will  be  to weigh out  twenty-
four grains of the  pill mass at once, and  to
divide this as nearly as possible into eight
equal parts, or  pills,  rolling each between
the finger and  thumb, and when they are
put together, adding a little flour, magnesia,
or liquorice powder,  to  prevent their ad-
herence.   Pills which are likely to be  kept
for some  time  before use, should be  pre-
served in a well-stopped  or corked bottle,
but never in a box;  in  the  latter  they often
get so hard as to be completely useless, and
are apt to pass through the bowels perfectly
unchanged,  in  the aged  especially.  For
domestic use,  either  in this country or  in
emigrant life,  it is the most desirable  plan
to purchase compound pills, either in the
mass or  ready  rolled; as, however, it  may
prove useful, the composition of some of the
most generally serviceable pills will be here
given.
  The most useful purgative  pills for do-
mestio store are—
  The Compound Rhubarb Pill.—Mild  ape-
rient.
  The Compound Colocynth Pill.—Active ape-
rient.
  The Compound Gamboge Pill.—Very aetive
aperient.
  Blue Pill.—Best procured  and kept  in
mass.
  Plummers' Pill.—Alterative  and  diapho-
retic—procured  either in mass or rolled.
  Compound Galbanum Pill.—Stimulant and
carminative—procured either in mass  or
rolled.
  Expectorant or Cough Pill.—See Influenza.
  Many other forms of pill are ordered, and
used, but it would  serve no good purpose to
burden either the memory or the  medicine-
chest with them, especially as their compo-
sition is given when they are recommended
in this work.   Those above enumerated will
be ample store—others may be made up  as
required.
  The Compound Rhubarb Pill, one  of the
best, mild<st, and  safest aperients, is  thus
made:—Take of
  Rhubarb, in powder..........4 drachms.
  Aloes, in powder.............. 3   "
  Myrrh, in powder.............2 drachms.
  Hard Soap, scraped..........  \    "
  Treacle sufficient to form a  pill mass.
  (Oil of caraway is  often mixed with  this
pill, but it renders it more disagreeable to
most persons.)
  The dose of the compound rhubarb pill is
from three  to twelve grains.  It  may be
kept, either in powder, to be made  up with
treacle (or syrup  or gum mucilage) when
required, or it may be kept in a soft mass,
wrapped in oiled silk, or ready rolled.  Per-
sons going to warm climates would  find the
form of powder  the best  in which  to keep
this pill, preserving in a well-stopped bottle.
  The compound rhubarb pill  may be taken
alone,  or, in some cases, combined with one-
third either of blue  pill  or calomel, espe-
cially in cases of biliary disorder.
  The  Compound Colocynth Pill is, perhaps,
more extensively used in  this country than
any other purgative of the kind.  It is con-
siderably more active than the compound
rhubarb.  The compound  colocynth pill is
thus best made:—Take of
  Aloes, in powder, (see Aloes,) \ of each 8
  Scammony, in powder........../drachms.
  Colocynth,  in powder.......... )  .    ,  .
  Sulphate of Potash, in powder t °,r ea?h l
  r,- r  •      ,      r       1  drachm.
  Ginger, in powder...............J
  Rectified spirit sufficient to make into a
     pill  mass.
  As the remarks,  both  as to combination,
keeping, &c. which  have been made on the
compound rhubarb pill, apply  exactly to the
compound colocynth, it  is unnecessary to
repeat them  again.   A very good addition
to the  compound colocynth pill is that of a
drachm of ipecacuanha powder to the quan-
tities given above;  in other cases, when it is
desirable to soothe, and to prevent  griping,
one-third of extract of henbane, as  ordered
in the Edinburgh Pharmacopoeia, is a most
valuable addition.
  The  Compound Gamboge Pill is of less mo-
ment, as a store pill,  than the above, but it
is valuable for very strong individuals, who
require powerful medicine, and where eco-
nomy  is an  object.  It   is thus made:—
Take of
  Aloes, in powder...........")   of each
  Gamboge, ditto.............j  3 drachms.
  Ginger...........................  1   ««
  Soap..............................  4   "
and  beat into a mrtss to  form pills.  The
dose is from three to  twelve grains.
  Blue  Pill  and Plummers' Pill,  as stated
above, should be procured ready made, and
kept in mass, in well-closed pots ;  the latter
pill, however, will keep well ready rolled.
  Compound Galbanum Pill.—-See Galbanum 
P I M
401
PL A
   Expectorant, or Cough Pill, as given under
 article Influenza, is thus made:—Take  of
   Opium, in powder............  25 grains.
   Squill, ditto.....................  80    "
   Ipecacuanha, ditto............  60    "
   Camphor, ditto (see Camphor
     Powder).......................  90    "
   Gum Ammoniac, ditto........  120    "
   Rhubarb, ditto.................  60    "
   The above pill  will keep well, either in
 powder or  rolled, and will  be found the
 most useful and convenient form  of cough or
 expectorant medicine, either in emigrant life
 or elsewhere, particularly in chronic cough.
   Many other combinations of pill might be
 enumerated, but  the  above, along with the
 information scattered throughout  the  pre-
 sent  work,  ought  to  be  guide sufficient to
 any  one  of moderate  intelligence.   Pills
 may  be made, either in a mortar, or, if the
 substance  used is in  small quantity,  on  a
 Blab  or Dutch tile, by means  of a spatula.
   [Pills under the above names are directed
 by the United  States Pharmacopoeia, though
 the  proportions vary a little,  but any  good
 apothecary  will be able to explain the dif-
 ference, which does  not  materially affect
 the dose.   Many of the " Indian" and other
 quack pills are made from these  directions,
 but as the vendors  are unprincipled, and sub-
 stitute common drugs for those  usually di-
 rected, they should always be avoided.  It
 is a good  rule to  distrust any medicine of
 which the composition is kept  secret.]
   Refer to Medicines, See.
   PIMENTO—Allspice.—See Pepper.
   PIMPLES.—See Skin.
   PINE-APPLE—The well-known fruit, is
 rather hazardous for those of weak digestive
 powers.
   PINS  and  NEEDLES—Occasionally get
 fixed in the throat, from the careless and
 reprehensible  practice of holding  them  in
 the mouth.—See Gullet.   When  swallowed,
 they generally work their way to, and  show
 themselves at, some distant part of the body.
 Very recently, the author extracted a good-
 sized sewing-needle from the thigh of a  child
 about two years old.  The needle could only
 have  entered the body by being  swallowed,
 and, indeed, its course into the  thigh could
 in some measure  be traced  by symptoms
 which had been exhibited some  time before
 ,ts appearance at the surface.
  PITCH —See Tar.
  PLACENTA.—The after-birth.—See Af-
 l- r-birth.
  PLAGUE.—This disease, so well  known
to all by name, and, happily, by name  only
in this country, belongs to the class  of ma-
lignant fevers.  Its contagiousness has  been
       2i2                              :
disputed, but is testified by the best autho-
rities who have had practical acquaintance
with the subject.   The last time the plague
visited this country was in 1665, the period
of the Great Plague of London ; since  then,
however, it has appeared in, and ravaged
various parts  of  Europe—as in Marseilles
in 1720, Moscow in 1771, and Malta so late
as 1816.  Egypt, Asia Minor, and Turkey
are,  at present,  the  countries principally
liable  to   the  visitations of  this  fearful
scourge;  and, whatever  other influences
may be at work to foster its  germs, and to
perpetuate its presence in these lands,  there
cannot be  the smallest doubt  that the total
neglect and ignorance of the simplest laws
of health materially add to the evil.
  The symptoms of  plague  are thus  de-
scribed by  Dr. Gregory:—"A  feeling of
great languor  and  lassitude  ushers in  the
attack of plague,  which, for the most  part,
happens toward evening.  There  is always
a cold stage,  though  it is seldom of long
duration.  Heat of skin, headache, and gid-
diness succeed.   The pain of the head is
referred to the  temples and eyebrows; the
eye appears heavy, dull, and  muddy.   The
expression of countenance changes in  a re-
markable  manner.   Sometimes  there is a
wild and  furious look; sometimes a look
claiming commiseration, with a  sunk eye
and contracted feature. The most striking
of all the early symptoms of plague is  the
staggering, and the sudden extreme prostra-
tion of strength.  A strong tendency to void
the urine is generally noticed.  The stomach
is very  irritable,  and  rejects almost  every
thing presented to it.   The tongue is  white
and moist.  The bowels are sometimes tor-
pid, and at  other times loose, the evacua-
tions  being always  highly  offensive.   The
speech falters.  The pulse is at first small,
hard, and quick ;  but  after the appearance
of buboes it often becomes fuller and softer.
It is  sometimes intermittent;  in point of
frequency its average  may be  stated at 100.
The heat of the skin is seldom very intense.
The head is occasionally perfectly clear and
collected ;  at other times stupor occurs im-
mediately  after the formation of the hot fit.
Some cases of the  disease are ushered in
by a violent fit of mania; the greatest in-
difference  with regard to recovery prevails,
and is always reckoned a most unfavourable
symptom.
  "After  one,  two,  or, at furthest,  three
days,  pains in the groin and arm-pits  an-
nounce the formation of buboes. Those  pains
are often highly acute, and, unless speedily
followed by the swelling of  the gland,  the
patient dies delirious.   In women, the arm 
P L A
W2
P L A
pit, in men the groins, are chiefly affected.
Carbuncles  appear at  the same  time, but
Indifferently on all parts of the body.  Pe-
techiae and vibices are much more frequent
than carbuncles, which, it appears, do not
occur  above once  in  twenty cases.   The
fatal termination is sometimes preceded by
violent hemorrhages from the mouth, nose,
or intestines.
  " The  duration of  the disease is very
various.   A few cases are on record where
the patient died  within  a few hours from
the invasion.  To many it proves  fatal dur-
ing the first paroxysm or period,  which in-
cludes  the time from the evening of the
attack to the  close of the following night.
The third and  fifth days are, however, upon
the whole, those  of the  greatest danger.
The former is  the usual  period of the ap-
pearance of bubo;  the latter of the  abate-
ment  of  the  febrile  symptoms.    If the
patient survives the fifth day, and the bubo
is fully formed,  he may  be considered as
nearly out of danger.  The convalescence,
indeed, is always very tedious, from the ex-
treme  debility  which the  disease leaves,
and the  patient's  life is not unfrequently
again put into imminent hazard  from the
occurrence of  gangrene in the extremities.
  " In the malignant form of plague every
variety  of treatment has been  tried, but
with so  little  effect that  it may be con-
sidered  as  a  disease  nearly beyond the
reach of  medicine.  The violent  headache
which  occurs during the  first twenty-four
hours seems to  point out the propriety of
blood-letting, and it is recommended  by the
general custom  of Turkish practitioners ;
but in the  hands of English surgeons  it
proved of no avail. In the  cases in which
it was tried it did not  appear, however, to
make  matters  worse.  Where mercury can
be brought to  affect the mouth it appears
to be of some  service, but it is seldom that
sufficient  time  is  afforded for this specific
effect of the remedy.  Ether and laudanum
are valuable medicines in allaying the irri-
tability of the stomach.   Wine and  opium
are of no use during the violence  of the
disease, and bark can seldom be  retained.
This is much to be regretted; for  wherever
it can be made to stay on the stomach, even
in those severe cases where carbuncles and
vibices appear, its good  effects are conspi-
cuous.  Camphor, bark, and wine  are given
with much advantage during the  period of
convalescence.    Emetics,  purgatives,  and
the cold  affusion have been tried,  but  it
does not appear that  they are of any ser-
vice.  Diaphoresis can seldom be produced,
owing  to the   disposition  to vomit;  but
wherever it can be produced, the symptoms
seem to be unmitigated by it.
  "The latest period of the  contagion  of
plague, or that between communication witl
an affected individual and the appearance,
is extremely  short, and liable to very little
variation.   It is  scarcely ever  less   than
three days, and it seldom exceeds six.   In-
stances, indeed, are recorded of  the disease
not appearing until the tenth day, but these
cases are rare.
  " The contagion spreads to a very small
distance only from the body of the patient.
The consequence  of which is  that the dis-
ease is seldom if ever communicated ex-
cept by actual contact.
  "The dead body does  not  communicate
the disease so readily as the  living.   This
appears to be well understood in Turkey;
but that the contagion is sometimes received
from the dead body cannot be  doubted.
  " The contagion of  plague  is readily im-
parted to fomites, in which it  may lurk for
a very  long time, more particularly if ex-
cluded  from the air."
  Refer to Fomites.
  PLASTERS—Are compounds of adhesive
tenacious  substances.   Many are,  princi-
pally, compounds of an oxide of lead and
oil,  others of wax and  resin.  " Plasters
should  not adhere to the hand when cold;
they should be easily  spread when heated;
and  should remain tenacious  and  pliant
after they are spread ; but should not be bo
soft  as to run when heated  by the  skin.
All plasters become too consistent and brit-
tle when long kept; but in this  case,  those
which are unctuous may be remelted by a
gentle  heat, and  some oil added to them."
Plasters are not so commonly  used as mere
external applications  as they were at one
time, but amid the poorer classes they are
still very favourite and much trusted reme-
dies, and in some cases are  unquestionably
serviceable.
  Plasters  may either be simply adhesive,
such as the common diachylon or the isin-
glass plaster ; they may be protective, suet
as the lead ; warm, like the cumin, &c.
  The most useful platers are-
Adhesive or Diachylon Plaster.
Belladonna.........Anodyne.
Cantharides........Blistering.
Cumin...............Warm & stimulant.
Galbanum...........Warm & stimulant.
Isinglass.............Adhesive.
Lend..................Protective.
Mercurial...........Discutient.
Opium................Anodyne.
lioborans or Iron..Supporting.
Soap..................Adhesive.
2-a 
P L A                403                PL E
   The above plasters  may be employed for
 the purposes indicated, and should always,
 if possible, be procured ready spread.   As
 a general  " strengthening"  plaster,   the
 roborans,  or iron plaster, is perhaps  the
 best, and undoubtedly gives much comfort
 and support in many cases, especially those
 in which  there is much weakness  of  the
 back.   In such cases  it cannot be used in
 better  form than that spread on dimity,
 which  is now sold  as prepared  by  ma-
 chinery.  It may, however,  be spread on
 leather.  Either  the  cumin  or galbanum
 plasters may be used for the same purposes
 and be prepared in the same  way, but they
 are more stimulant, and sometimes produce
 uncomfortable or unbearable irritation on
 delicate  skins;   indeed, any plaster  will
 cause this with some people.  Lead is least
 liable to do so.
   Lead plaster,  spread on soft leather or
 dimity, is one of the best protectives in  the
 tendency to or formation of bed-sores.   If
 kept long after it is spread, however, it  be-
 comes  brittle,  cracks  off, and is useless; it
 is therefore better kept in roll,  and spread
 when  wanted.   With  exception of the  ad-
 hesive  plasters, however,  required  in  the
 treatment of the wounds, &c, all the  others
 are  but occasionally required, and may for
 the most part be dispensed with. The most
 useful  adhesive plasters are the common
 diachylon and the soap plastor.  These may
 be bought beautifully spread by machinery,
 and in  this country this will always be  the
 most advantageous mode of procuring them;
 but persons, such as  emigrants, proceeding
 to warmer climates, should never get them
 thus  prepared—otherwise, when they come
 to unfold their plaster for use, they will find
 it one adherent mass, and perfectly useless;
 they should take  the  plaster with  them in
 roll as it is sold—it can then, when required,
 be spread on any material, such as calico,
 or even paper, by means of a heated knife,
 or flat piece of iron, if no better material is
 at hand.   The common plaster spatula  is
 neither  expensive nor cumbersome,  and
 might very well be added  to  an emigrant's
 outfit.   When used it should be heated suffi-
 ciently  to melt the  plaster when  the flat
 surface is applied to the end of the roll, the
 melted plaster being allowed to  drop on the
 material on which it is to be spread.   When
 sufficient  has been melted, it  is  then to be
spread  evenly and thinly by means  of the
edge  of  the  instrument.    When  spread
plasters are  warmed  for application,  the
unspread side should always be held  to the
heat.   When plasters  are  to be  removed
from  the  skin, they should  always be well
warmed through by warm water.
   It is a common popular error to suppose
that the plasters used in the treatment of
wounds  exert  some   healing  influence;
whereas  they are  only used to  keep the
severed parts in as close apposition as pos-
sible,  in order that the natural healing power
may be exerted.  It is requisite  to notice
the error, for it might in some cases inter-
fere with the  use  of  substances, such  as
gums, &c, as plasters, which  might be ad-
vantageously used as such.
   Refer to Blister—Dressing— Wounds, Sec.
   PLASTER of PARIS—Sulphate of Lime
—Gypsum—Has been   noticed in  various
parts  of this work as an occasional adulte-
ration in confectionary, &c.   It is some-
times used in the treatment  of fractures.
   PLETHORA—Fulness—Is  the term ap-
plied  to that condition of system  in which
the blood is  superabundant, both in quan-
tity and quality, over what the requirements
of the body  call for.  It is  a  condition not
uncommon among the well-fed and indolent,
in whom  the  digestive organs continue in
full vigour.    Individuals of  the  sanguine
temperament, while leading  a life  of mental
activity and anxiety, have  greater powers
of activity than most  others, but they, in
many instances, border upon plethora, and
if they become so placed that their former ac-
tivity is eitlier uncalled for or interfered with,
provided there is not much mental anxiety,
they quickly become plethoric; the vessels
are overloaded with rich blood, and instead
of the former power of exertion, oppressive
languor and inactivity  succeed ; in fact, the
whole of  the functions, and the brain and
nervous  system  especially, are  weighed
down  and clogged; there is  mental slug-
gishness,  heavy sleep,  and  inaptitude for
exertion.  This  last symptom is too often
mistaken for weakness ; the person labour-
ing under the mistake  resorts to additional
food and  stimulants—it need  scarcely  be
added, only to increase the  evil.  An indi-
vidual in this condition, it  may be  said, is
ripe for inflammation ;  if cold be taken, it is
very likely to  light  up inflammatory action
somewhere, and once lighted up, the action
is very liable to be of the severest kind.
  Should febrile disease of any kind, as for
instance small-pox, or erysipelas,  or rheu-
matic  fever,  be excited in the constitution,
the symptoms  run high, and  the case is verj
likely to become one of danger.  For similai
reasons, accidents are  not  well borne—at
least their after-effects are often such as to
put life in danger. 
PLE
404
PLU
  Persons who are in a plethoric condition, I
not unfrequently get relieved by some na-
tural  effort:  piles  show  themselves  and
bleed,  or the  nose bleeds, or spontaneous
diarrhoea comes on; and instead  of the indi-
vidual being  weakened, he  feels stronger
and lighter than before—a true indication
of the real  state of matters.  The evil re-
Bults  of mistaking a  state  of  oppression
from plethora, of false debility (see Debility)
for one of weakness, must be evident to all.
Even  the pulse  is liable to deceive, and in
these  states of oppression to seem  low and
weak, but  it  is  essentially different  from
the pulse of  debility.   The latter,  if the
finger is pressed even  slightly  upon it, is
extinguished at  once;  but the pulse of op-
pression  seems rather to resist the pressure,
to become stronger, and to beat up  against
the finger,  rather  than to give way.  As
might be expected, plethoric individuals are
often the subjects of apoplexy.   A state of
plethora  must always  be one,   if  not  of
danger, at least  of hazard, nnd  ought to be
guarded against; its well-known causes na-
turally direct the attention to the best modes
of prevention.
  If a person suffering from  plethora is
threatened with  an immediate attack, such
as apoplexy, the condition  cannot  be too
soon or too actively removed.  Bleeding, in
Borne way,  free  purging, and low diet are
the immediate remedies;  but, in  the absence
of any threatened attack, it is not advisable
to invoke the aid of these powerful agents;
the condition  should be  reduced gradually
and steadily by  the formation of, and per-
severance  in, modes of living suited to
counteract the tendency.  When a man suf-
fering from the  effect  of plethora gets rid
of his unpleasant symptoms  by a " coup,"
Buch as  the loss of a basinful of blood, by
a few calomel  pills  and black draughts, he
is probably highly  pleased to be so easily
rid  of his enemy, and  by means which in-
volve  no self-restraint  or giving up  of in-
dulgences; so, trusting to the repetition of
the same remedial  measures, he puts no
check upon  himself, and when the plethora
again reaches a certain  height, he again
bleeds and purges, and this  goes on till he
is overtaken some  day with an apoplectic
attack, or till  he becomes the subject of or-
ganic disease.   It is a false and most pre-
carious security.
  Persons who have a tendency  to plethora
must  have exercise, they must use up their
blood and  muscle in active motion;  but in
doing this, especially at first, they must be-
ware of over-doing it.  It will not do for a
plethoric man to commence  a new  system
| of living for health, with violent exertion-
 otherwise he may precipitate the very evi]
 he  dreads;  some  overloaded vessel may
 yield  under the increased  tension  caused
 by the muscular exertion and excited cir-
 culation.  Plethora, to be reduced, must be
 so steadily, but gradually ;  active exercise,
 increased as the ability to take it increases,
 must be balanced with aliment proportioned
 to the amount taken, stimulants being rarely
 if ever permissible, or required, and  animal
 food in very moderate proportion.   Early
 hours, and curtailment of the time devoted
 to sleep,  is desirable.  In most cases, tepid
 bathing is preferable to either hot or  cold,
 and, either by it or by sponging, the skin
 must  be  kept  active.  The  bowels require
 especial  attention, and  are  better  rather
 lax than  otherwise; any slight  tendency
 to plethoric  oppression being counteracted
 by acting upon them by the  compound colo-
 cynth, or compound colocynth and  blue pill,
 or by small, largely diluted  doses of  Epsom
 salts,  or by Seidlitz powders.  If the kid-
 neys are inactive, the infusion of broom, or
 of dandelion,  carbonate of potash,  or the
 nitrate of potash—saltpetre—may be taken,
 or the super-tartrate of potash—cream  of
 tartar—used in the form of imperial, as a
 common drink.
   Refer to Apoplexy—Debility—Fat, Sec,
   PLEASURE.—The cheerful  excitement
 of the mind, by what is called pleasure, is
 rather a preservative of health than a re-
 medy in real sickness, when the less stimu-
 lant but cheering tonic of hope is the better
 adapted  mental remedy.    Pleasurable re-
 laxation  there  must be, both for mind and
 body, and especially for  the young; and
 they act unwisely, who, instead  of  direct-
 ing the mind  to sources of, and  leading it
 to find its happiness in innocent,  cheerful,
 well-directed relaxation arid pleasure, would
 make  this world  one never-closing work-
 shop,  or have it a perpetual valley of tears.
   Refer to Dancing.
   PLEURA. — The   " serous"  membrane
 which lines the chest and covers the lungs.
 —See Lungs.
   PLEURISY.—Inflammation of the  pleura.
 —See Lungs.
   PLICA, or Plica Polonica.—A peculiar
 disease of the  hair which occurs  in  Polan'i
 and the adjacent countries.—See Hair.
   PLUMMERS' PILL—Also  called  com-
 pound calomel pill, is one of the  most use-
 ful alterative  and  gently diaphoretic pilli
 or remedies in general use;  it rarely acti
 on the bowels, and  may be taken for a con-
 siderable time without affecting the system.
 Plummer's pill also contains  a preparation 
PNE
405
POI
 of antimony.  The dose is from three to ten
 grains.
  Refer to Mercury—Pill, Sec.
  PNEUMONIA.—Inflammation of the sub-
 stance of the lungs.—See Lungs.
  POISON. — Considerable  difficulty has
 been experienced in giving such a definition
 of  the word  poison as  shall,  while  suffi-
 ciently  inclusive,  be  sufficiently precise.
 Some substances, such as strychnine, cor-
 rosive sublimate, &c. &c, can never be con-
 sidered  otherwise than as poisons, in  every
 sense of the word, but  when  cayenne or
 common pepper, cream of Jartar, even com-
 mon salt, and  other  substances not unu-
 sually used in food, have been found in large
 doses to act as  poisons, it  becomes  very
 difficult to frame a  correct definition of
 the term.  Mr. Taylor, in  his Manual of
 Jurisprudence,  says — "Perhaps  the  most
 comprehensive  definition  which can be sug-
 gested is this:—A  poison is a substance
 which, when taken internally, is capable of
 destroying life  without acting mechanically
 on   the  system."  Some  substances,  how-
 ever, act as  poisons through the skin, such
 as  those of infectious diseases ;  others, pro-
 bably,  through the  lungs.   Poisons  are
 usually classed under  the three  heads of
 irritant, narcotic, and narcotic-acrid  poi-
 sons.  Of the first, arsenic and the mineral
 acids are examples; of the second, opium
 and  henbane;  of the third,  alcohol and
 strychnine.   As the treatment to  be im-
 mediately adopted  in  cases of  poisoning
 by  various substances, is  given sufficiently
 when these substances are treated of, it is
 unnecessary  to  repeat it here.
  It may be received and acted on as a general
 rule, in cases of poisoning, that the sooner
 the ejection of the poisonous agent from the
 stomach can  be  procured the better.   In the
 majority of instances, perhaps, nature effects
 this in a more or less perfect manner before
 any remedy can be employed;  indeed  the
 occurrence of vomiting is often  the  first
 symptom  of the action  of the poison.
  These natural efforts, however,  must not
 be alone trusted to, even if they take place,
 and, in almost every case, the best thing that
 can be done is to excite full, free  vomiting.
 This may be brought  about by any of the
 emetic substances so often mentioned, but
 Bulphate of zinc,  or white vitriol, when it
 can  be procured,  is the agent generally pre-
 ferred for the purpose.  In its absence, salt
 or mustard [or alum] may be used, and are
 almost always procurable;  indeed any  other
 emetic at hand should be resorted to—an in-
fusion of the root of the sweet violet, in the
absence of others, or chamomile tea, or warm
water in abundance; the action of vomiting
being also excited by irritating the throat
with the finger, or with a feather.
  Next to the evacuation of the poisonous
substance, its neutralization is important;
indeed, in the case of such poisons as  the
mineral  acids, it is to  be  the first object.
It is unnecessary to repeat here the proper
remedies which  more especially neutralize
the effects of different poisons, as  they  are
given in their proper places ; but, as a gene-
ral rule,  milk, oleaginous  substances, and
demulcent fluids, such  as  linseed-tea,  or
barley-water, or hasty pudding, will be use-
ful, if given freely, in protecting the coats of
the stomach from the contact of the poison,
and  by interfering with the absorption  of
the latter into the system.
  Lastly, it must be an  object to counteract
the effects of the poison upon the system at
large; as in  the case of opium, the narcotic
influence is combated with  forced  exertion,
coffee, &c, or, in poisoning by prussic acid,
by stimulants and cold affusion.
  When  poisoning  is known  or  suspected
to have occurred, the first thing is to procure
proper medical assistance as quickly as pos-
sible;  nothing must stand in  the way of that.
The  next is,  to ascertain the nature of  the
poison, if possible, and  the amount taken—
the remedial measures which may be known,
either  by reference  to  such works as  the
present,  or from  other  sources of informa-
tion, being adopted  as  quickly as  may be.
All vomited,  and  other matters—such  as
evacuations from  the  bowels—which may
contain trace of, or afford clue to the poison,
must be reserved  for the inspection of  the
medical man.  Sometimes, individuals, from
throwing away, in the excitement of  the
moment, the poisoned food, or whatever it
may be, have found themselves unpleasantly
situated, and objects of  suspicion.   If there
is any idea that there has  been  criminal
proceeding connected with  the poisoning,
some responsible person should secure what-
ever may guide in the investigation of  the
truth, and place  all under lock and key, and
seal,  till the arrival of the authorities : food
and  vomited  matters should  be sealed  in
suitable vessels.
  The  symptoms which would  give rise to
the  suspicion of  poisoning  having taken
place,  are those of  sudden  illness shortly
after taking food or medicine, the individual
having previously been  in good health, or,
at least free from the peculiar, and generally
violent, symptoms developed,  particularly
those indicative of irritation of the stomach
and bowels, or of narcotic or irritant influ-
ence upon the nervous  system.   When poi- 
P01
406
POI
bods are either given or taken for criminal
purposes, the symptoms usually show them-
Belves quickly and severely, on account of
the dose of the deleterious substance being
generally large.   At the same time it is to
be remarked,  that  the presence  of much
food on  the stomach, sleep,  and  intoxica-
tion  have all been known to retard the de-
velopment  of symptoms  from  even  large
doses of poison.   If a  number  of persons
who have partaken  of  the same  dish  are
seized  shortly after with  symptoms of ill-
ness, the suspicion  of poison is, of course,
greatly strengthened.
  It is perhaps necessary, however, to cau-
tion all against a too hasty assumption of
the fact of  poisoning, at least as far as the
criminal implication of others is concerned
If there is suspicion, it will in any case be
better  to take such measures as  may be
thought  requisite,  as  quietly as  possible,
until the bearings  of  the case  have been
examined by competent persons.
  This caution is necessary, for there are
diseases, such as British cholera,  [cholera-
niorbus,] which not unfrequently first break
out shortly after a meal, and  spasms of the
stomach are not uncommon with some after
food ; perhaps the disease which has most
frequently given rise to suspicion of poison-
ing—doubtless on account of  its all but uni-
versal fatality—is "perforation," alluded to
a few pages back.
  In connection  with  the above  remarks,
the following, from Taylor's Medical Juris-
prudence's  important:—"It seems highly
probable, that the mere  fact of  a person
eating a full meal after long fasting, will give
rise  to symptoms resembling those of irri-
tant poisoning."   "Mr. Holland, of  Man-
chester, has communicated two cases of this
description.  In one the symptoms were very
violent and  the patient nearly died, in fact
was  laid out  for dead: the  other patient
suffered from  severe   gastralgia—nervous
pain in  the stomach—for several weeks.
Poisoning was at first  strongly suspected,
but the  suspicion was  removed by the fact
that others in health had partaken of the
same food,  principally potatoes mixed  with
gravy, without any injury, and there was
no reason to suppose that any irritant poi-
son could have been mixed with the food.
The two who suffered were extremely weak
and exhausted from long  fasting, and were
observed to eat their food, which was  quite
wholesome,  voraciously."   Further, it must
be remembered that, although symptoms of
poisoning may be distinctly traceable to the
effects of a  meal recently eaten, it by no
means follows that  the  poisoning has  been
the consequence of something added, either
intentionally or accidentally, to the food ;  it
may be the  consequence of changes  which
have taken place in  the food itself: many
casualities from this cause are recorded.  In
Germany, numerous  deaths have occurred
in consequence of sausages prepared in that
part of Europe undergoing a peculiar kind
of putrefactive fermentation, which renders
them highly deleterious.   In  this country,
the flesh of  animals  which have  died from
disease has  not unfrequently been known to
give rise to  symptoms of poisoning.  Fat or
oily food, when  in a state of decay, seems
peculiarly  injurious—salmon, bacon,  &c.
having in this state  been found  poisonous.
At a festival held  in the canton  of Zurich
some years  ago, at which about tiOO persons
were present, nearly two-thirds of the num-
ber were affected with  symptoms  of poison-
ing, in consequence of partaking of meat
which  had become  slightly tainted, and of
hams—probably the injurious article—which
had been badly cured:  some of the number
affected died.  Shell-fish, it is well known,
will, in some persons,  produce  symptoms
of  poisoning at any time, and  in certain
states  are probably deleterious for all.—See
Mussel—Oyster—Copper, Sec.   A recently
noticed source  of  poisoning requires men-
tion.   It is that which might ensue from the
flesh of game birds—partridges especially—
which  have  been destroyed by feeding on-
grain steeped in arsenic and scattered about
for the purpose of destroying other birds.
It is said  that partridges thus destroyed are
not found lying on their sides like dead birds
generally, but are found sitting as if in life.
It is to be  feared that birds found thus,
fresh,  and in good condition, might, by un-
scrupulous  or ignorant persons,  be sold  aa
other game.
   It has been mentioned, that the common
garden rhubarb contains  oxalic  acid—not
in sufficient quantity to injure in  the mode-
rate use; but when used largely, especially
in  some constitutions, it may give  rise to
unpleasant  symptoms   connected  with  the
kidneys.
   Liebig records a singular mode of fatal
poisoning, which occurs in Germany "from
the drinking of  what is called the feather-
white wine."  This poisonous wine is wine
still in a state of fermentation, which is
increased by the heat of the stomach.  The
carbonic acid gas  which is disengaged pe-
netrates through the coats of the stomach,
through the diaphragm, and through all the
intervening  membranes, into the air-cells of
the  lungs, out of which it displaces  the at-
mospheric air.  The patient  dies  with all 
POL
407
POO
 the  symptoms of suffocation caused by an
 irrespirable gas.  The best antidote in this
 form of poisoning is the inhalation of am-
 monia.  The  development or formation of
 poison within  the body itself is  a subject
 which has been but  little investigated.  The
 characteristic ingredient of the urine, urea,
 if retained in the  circulation, acts as a
 narcotic  poison.  Oxalic  acid  is certainly
 formed within the body;  perhaps  prussic
 acid.  When the faecal  contents of the ali-
 mentary canal, especially of the large bowel,
 are  long  retained and  reabsorbed into the
 circulation, as  they undoubtedly are, they
 exert  effects  somewhat akin to poisoning,
 and the author believes he  has traced ex-
 treme temporary depression of the system
 to this cause alone.
   In  connection with  poisons, the  fact—
 more than once  alluded to in this work—
 must not be lost sight of, that it is possible
 for  the  long-continued  daily  reception of
 even minute doses of certain poisonous sub-
 stances, at last, by " accumulation," to exert
 pernicious effects upon the system.—See
 Mercury—Lead, Sec.  This must not be con-
 founded with the criminal, secret,  slow poi-
 soning so often recorded as the practice in
 ages gone by, a crime which it is more than
 doubtful could be practised  in  the present
 day without certain  detection.
   Before  leaving the subject of poisoning, it
 is requisite to advert to the influence which
 habit  exerts over the effects exercised  by
 poisons on  the human  subject.   All know
 how largely the habitual consumers of opium
 can  increase their doses, and that the same
 is observed  with respect to other drugs,
 chiefly of the  narcotics; but the most re-
 markable instance of this power of habit is
 in the case of the " arsenic eaters" of Sty-
 ria and adjacent provinces, of whom it is an
 ascertained fact that they habitually con-
 sume  large and poisonous doses  of  solid
 arsenic, not only without injury, but with, it
 is alleged, apparent  benefit to health.—See
 Wounds,  Poisoned, and  the various articles
 on poisonous agents.
  POLYPUS—Is a tumour, the result of the
 morbidly  excessive  growth of the mucous
 membrane lining a cavity.   It is most fre-
 quently met  with in the nose and in the
 womb, but also occurs in the ear, &c. Polypi
 vary much in texture, in some cases being
 easily  torn, and bleeding after the  least
injury, at others being firm and almost car-
tilaginous; their colour  is usually gray or
yellowish, and  they possess but  little sensi-
bility ; they are  generally attached to the
surface whence they spring  by a narrow
neck.  The chief inconvenience which results
from polypus in the nose is the interruption
to breathing through the nostril, at  night
especially ; the affected person can only lie
with the  mouth open, which  therefore be-
comes most uncomfortably parched.   When
polypus, however, in this situation, increases
to a large size, it necessarily  displaces the
adjacent parts, such as the soft  palate, or
distends the nostrils.  In any  case, polypus
is so uncomfortable a companion, that its
removal is generally sought.   This must, in
all cases, be effected  by the surgeon, by
means of ligatures, scissors, or forceps, and,
therefore, proper surgical advice  should be
resorted to.  Occasionally, polypus in the
nose will yield to the persevering use of
astringent powders, such as that of  burnt
alum, or it may be regularly touched  twice
a day with tincture of steel by means of a
camel-hair brush.  Polypus  of  the  womb
cannot possibly fall under the cognizance of
unprofessional persons*
   POMEGRANATE —This anciently known
tree, a  native of  Asia  and   Africa,  [and
growing in  the  Southern portions of  the
United States,] is cultivated in warm  coun-
tries generally.  The flowers, the  rind of
the fruit, and the bark of the  root  have
been used in medicine  as astringents, but
the most  general remedial use in  modern
medicine has been that of the  root bark as
a remedy in tapeworm ; for this purpose it
is extensively used in  India.   Dr. Christian
says, " it seems scarcely ever to fail if pro-
perly used."  "The original  mode of ad-
ministering it is to steep  two ounces of the
fresh bark in two pints of water for twelve
hours, then to boil the whole  down to one
pint, and to  give  a  wineglassful of  the
strained decoction  every  two hours till the
whole is taken."   ." Sometimes joints of the
worm begin  to come  away in  less than an
hour after the last dose ;  but often the  doses
must be repeated several successive morn-
ings before they take  effect; and  it is right
to repeat  them occasionally for four or five
days after joints have ceased to come away.
Laxatives should be administered  from time
to time.  The remedy  sometimes causes
nausea  and  vomiting.  The  fresh root is
most efficacious.  It  is  probable that the
recent introduction of the kousso, and the
greater  attention directed  to  the employ-
ment of the  root of the male fern, as  reme-
dies in tapeworm, may supersede  the use of
the pomegranate root in this  country, but
in many situations the latter drug might be
procured where neither of the  former could
When given in powder the dose  of pome-
granate  root is twenty grains.
   POOR. —While poverty is  so  great at. 
POO              408                POO
aggravation of  the  evils  of sickness, it is
unfortunately  too often  one of its most
general causes.  It is a perfectly well ascer-
tained fact  that physical  deprivation and
physical disease are  to one another as cause
and effect; and, however sad the reflection,
that the insufficiently fed  and clothed, and
hard-worked labourer, has much less chance
of prolonged health and life than those more
fortunately placed.   The following extracts
from  Dr.  Combe's  "Physiology of  Diges-
tion," put this in a strong light:—" If over-
feeding be the prevailing  error  among  the
middle and  higher classes of the commu-
nity, the opposite  condition  is as  unques-
tionably that of a large  proportion  of  the
labouring  poor.  Pressed upon all sides by
the powerful competition both of constantly
improving machinery and of a superabun-
dant  population, the manual  labourer  is
impelled to  undergo  an  amount of ever-
recurring  bodily exertion which far exceeds
the natural powers of his constitution, even
when  supported by  the  fullest supply of
nourishment:  and when, as often happens,
along with this  excess of labour, his food,
from inadequate wages, the size of his fa
mily, or his own injudicious management, is
defective in quantity or in quality, the con-
sequences to his health and  happiness  are
disastrous in the highest degree.
   " To those who have never reflected on the
subject, it may seem  like exaggeration  to
Bay that,  as a general fact,  at  least nine-
tentlis of the lower orders suffer physically,
morally, and intellectually, from being over-
worked and under-fed ; nnd yet I  am  con-
vinced that  the more  the  subject  shall be
investigated, the more deeply shall we  be-
come  impressed with the truth and import-
ance of the statement.  It is true that very
few persons  die from actual  want of food ;
but it is  not  less certain that thousands
upon  thousands  are annually cut off, whose
lives have been greatly shortened by excess
of labour and  deficiency  of nourishment.
It is a rare thing for a hard-working artisan
to arrive  at a good  old age.  They  almost
all become prematurely old, and die off long
before the natural term of life.  It is in this
way that,  as remarked by  Dr.  Southwood
Smith, the mortality of a country may be
considered as  an accurate indication of the
misery  of its inhabitants.   According  to
Villerme\  the  rate of  mortality among the
poor  is sometimes double that among the
rich.   Thus it is found,  he says, that  in  a
poor district  in France  one hundred die,
while in  a rich department only fifty  are
carried off; and that, on takibg  into  ac-
count  the whole population of France,  a
child born to persons in easy circumstancee
has  the  chance  of  living forty-two  and a
half years, while one born of poor parents
can look for no more than thirty.
  " These are striking facts, and their truth
is  confirmed by every day's  experience in
Britain as well as in France.   Many causes
concur to  produce this melancholy result,
but among the principal is, unquestionably,
the disproportion so generally existing be-
tween toil and  nutrition.   In  the  army the
operation  of the same principle  has long
been recognised  in  the  inferior strength
and  health of  the privates compared with
the officers.  The officers being better fed,
better  clothed,  and better   lodged  than
the common  soldiers, bear up successfully
against  fatigue  and  temporary privations,
by which the latter are overwhelmed.  Dur-
ing epidemics, too, the poor, from  their im-
paired stamina,  almost  invariably become
victims  in a proportion far exceeding that
of the more wealthy classes.   This  is,  no
doubt, partly owing  to their greater intem-
perance and  want of cleanliness;  but even
these vices  often derive  their origin from
the same root—the want of adequate repose
and comfortable sustenance.
  "The bad  consequences of defective nou-
rishment are not confined in their  operation
to the  bodily constitution of the labouring
poor.  Their minds also are deteriorated.  The
pressure of poverty  is unfavourable to  the
growth  of refinement  and  morality, and
crime and turbulence are never bo much to
be dreaded as during times of scarcity and
manufacturing or agricultural distress.
  " Among the poorer classes, the children
as well  the  parents  suffer both physically
and  morally  from insufficient food.   Their
diet being chiefly of  a  vegetable nature,
and  consisting of porridge,  potatoes, anu
soups, with very little butcher meat, proves
far  from  adequate   to  carry on vigorous
growth  in the one,  or repair waste in  the
other: hence arise in the young an imper-
fect development of the bodily organization,
a corresponding deficiency of mental power,
and a diminished capability of resisting the
causes of disease. In workhouses and other
charitable institutions, ample evidence  of
these deficiencies obtrudes itself  upon our
notice in the weak and stunted forms and
very moderate capacities of the children."
[Though true in Europe, there are few, if
any poor in  the United  States  that do  not
obtain a sufficiency of meat;  and  the chil-
dren of the  most miserable  are  often  ex-
tremely well developed.]
   Happily the recent changes with respect
to the importation of food have modified in 
POP                409                P 0 R
 some degree the force of the above observa-
, tions, but they still hold good in too  many
 instances.  The fact of the connection be-
 tween  deficient  nourishment,  clothing, &c.
 and  the production of disease, ought ever
 to be kept in mind by those who have the
 management  of their inferiors in intellect
 or in worldly means.
   Many of the evils attendant on  poverty
 are, unquestionably, out of the power of the
 poor themselves to rectify, but many others
 connected with the subjects of ventilation,
 cleanliness, &c, &c, which do so much to
 ward  off the incursions of disease, are in
 most instances in their own hands.
   Those who are taken, either by the  calls
 of duty, or by the dictates 'of benevolence,
 to visit the poor in sickness, have  many
 prejudices, theoretical  and practical, to en-
 counter. It is marvellous  the dread of fresh
 air or of "cold water," the faith in quack
 nostrums  and  old  women's  receipts, the
 constant anxiety that food should be taken
 and stimulants administered,  and the per-
 verse  disobedience  of   the directions of a
 medical  attendant.  All  these, and many
 others which are  met  with,  ought  to be
 special objects for good advice, for kind and
 rational explanation.   The more leisurely
 visits  of a clergyman, or of others who visit
 the  poor,  may well  be in part devoted to
 instruction on  these points, if  the  power
 of imparting  the information  is possessed,
 as it ought to be, by  every educated person.
   Refer to Bed-room—Drainage—Houses—
 Water, Sec.
   POPLITEAL SPACE.—The  hollow of the
 ham behind the knee.
   POPPY — Papaver somniferum,  or opium
 poppy, is the common  cultivated poppy of
 the  gardens, of various hues,  varying from
 red  or purple  to white. Its principal  pro-
 duce,  opium,  has already been treated of.
 The capsules or seed-vessels of the poppy,
 when dried, are used for their  narcotic pro-
 perties, owing  to  the  opium which   they
 contain.  In order to have  the  dried capsule
 in the most efficient  state, that is, contain-
 ing  the largest amount of  opium; it should
 be cut green before it  is fully ripe.  When
 the seeds have been matured the seed-vessel
 is much exhausted.   Poppy  capsules are
 principally used in  the form  of  decoction
 for purposes of fomentation.   To make the
 decoction,  rather more than  an  ounce of
 the  capsules, well broken up, is to  be added
 to each pint of water, and the  whole boiled
 for a quarter of an hour.  This preparation
 often proves soothing and  relieves pain.
   Syrup of poppy is made from the poppy
 capsule, but is a preparation which should
      2K
be  absolutely  abandoned  as  dangerous.
There  is always  considerable variation in
the amount of opium contained in the cap-
sules, and  this variation is  necessarily en-
tailed upon the syrup prepared from  them,
a most dangerous contingency in a prepara-
tion of opium—for such it is—the use  of
which  is in  a  great measure confined  to
children;  half a teaspoonful has proved
fatal to a  child six months  old, and  yet
larger  doses are often given.  The calcula-
tion of the proper strength of syrup of pop-
pies is  about one  grain of opium to  the
ounce.   If an opiate syrup is to be employed,
it ought to be made with as  definite propor-
tions as any other preparation of the drug.
  Although the poppy seed-vessel possesses
such powerful narcotic properties, it is re-
markable that  the seeds are  entirely free
from them, and are mild and pleasant  in
flavour.  They contain a fixed oil, and in
some parts of Asia are converted into  bread
or cakes.
  Refer to  Opium.
  PORRIGO.—A  disease of  the scalp.—See
Skin.
  PORK.—The flesh of the hog is generally
and justly  considered the most indigestible
animal food in common  use.  In Dr. Beau-
mont's  table, showing the average time re-
quired  for the digestion of different articles
of food, pork (fat and lean together) is shown
to  require  above  five hours for  digestion.
There  is no doubt  that much  of the indi-
gestibility of  pork is due, not only to  the
fat, ostensibly existing as such, but  to  the
large  amount of  fatty  matter mixed with
the muscular fibres:  at the  same  time,
pork, more than other meat, seems to  exert
marked  injurious effects.   In  some  few
cases, even symptoms of poisoning have fol-
lowed the use of pork as food;  but in these
there  probably must have   existed  some
peculiar "idiosyncrasy," or  the meat  must
have been diseased.  It is by no means un-
frequent, however, for  severe diarrhoea  to
be the  result of a pork diet continued  for
two or  three days in succession.  This often
occurs  in the  families of the poor after the
pig has been killed.  [In the United States,
especially in  the winter, or during "killing
time," pork is the principal  article of diet,
and seldom disagrees with  those who then
partake of  it.]
  Refer to  Bacon.
  PORTER —The well-known beverage, is
brewed  from  malt very highly dried.  Dr.
Paris says, " Much has been said upon the
fraudulent  adulteration of this article, but
we are  inclined to believe these statements
have been  exaggerated."   Mr.  Donovan, 
                  P 0 R                4:

however, affirms that, until the interference
of the legislature, porter was liable to every
species  of adulteration.   In  the  Medical
Circular, for June  30th, 1832, the following
observations  occur in connection with this
subject:—"If we  are to  believe the  asser-
tions of previous writers, supported by the
evidence adduced in connection with numer-
ous excise prosecutions during the  last few
years, the adulteration of malt liquors has
been practised to a very considerable extent,
both by the brewers  and  the  publicans.
The  following is a summary, exhibiting a
list  of the substances said  to have  been
thus employed,  together  with  the effects
they are intended to produce :—
  Quassia, gentian, wormwood, broom-tops,
nux vomica, and strychnine, to impart bitter-
ness, in lieu of hops ; capsicums and grains
of paradise,  (in  concentrated  tinctures,)
ginger,  corianders, orange-peel,  and  cara-
way seeds, to give pungency and  flavour;
opium,  cocculus  Indicus, nux vomica,  to-
bacco, extract of poppies, and  the  tincture
and juice of henbane, to communicate  in-
toxicating properties, or "strength;" molasses,
colouring, sugar, burnt sugar, and corian-
ders, as substitutes  for malt; sulphuric acid,
(oil of vitriol.) alum, green vitriol, and com-
mon salt, to impart an  appearance of age;
and  "foots," pearlash,  Scotch  soda,  and
some of the articles before named, as "head-
ing," or to  give the beer the property of
bearing its "head," or ''froth."
  The  following list of  articles,  said to
have been seized at different breweries and
brewers' druggists' laboratories, is copied
from the " Votes   and  Proceedings of  the
House of Commons," published some years
since.   In many cases heavy penalties were
inflicted on the offending parties:—"Coocu-
lus Indicus, multum, (an  extract of coccu-
lus,) colouring, honey, hartshorn shavings,
Spanish juice, orange powder, ginger,  grains
of paradise, quassia, liquorice, (root,) cara-
way seeds, copperas, capsicums,  and mixed
drugs, (various.)"
  Some of the articles in the above  lists  are
virulent  poisons.   Such   are  opium,  nux
vomica, henbane, tobacco, cocculus Indicus,
and extract  of poppies.   We have reasons
for stating that the three latter are  those
only which we may suspect meeting with in
beer at the present day.   The use of coc-
culus  Indicus  has been  recommended by
several writers  on brewing.  One  of these
conscientious gentlemen (?) states  that  "it
is impossible with pure malt and hops alone
to produce a strong-bodied porter," and then
directs  the employment of «' cocculus Indi-
cus, grains of paradise, and nux vomica, for
0               POR

that purpose."  Another author, equally base
and ignorant, orders "81bs. of cocculus to
be used  for  every  ten quarters of malt;"
and adds, "it  gives an inebriating quality
which passes for strength of liquor; it pre-
vents second  fermentation, and,  consequent-
ly,  the  bursting of the  bottles  in warm
climates."  The latter assertions are utterly
unfounded, and are mere excuses for adulte-
ration. Another author informs  his reader*,
that "6 lbs. of  roast sugar and  1 lb. of cori-
anders are equal in strength and intoxicating
qualities to a bushel of malt."   In a work
published about six years since, it is stated
that "cocculus Indicus is commonly smug-
gled out  of the hands of the druggist into
those of the  brewer, in common soda bar-
rels, with  three  or four inches of Scotch
soda at the top and bottom of  each;" and
also, that "it forms the principal ingredient
in B.  E., or  black  extract, which  is osten-
sibly prepared  for tanners, but  its real des-
tination is the beer-cask."
  Mr. Taylor, in his Manual of Jurisprudence,
says, " According to Dr. Ure, the best London
porter always  contains opium;"  but  adds,
" in repeating Dr. Ure's experiments, I have
not obtained any results  indicative of  the
presence of opium in this liquid."
  Of course,  the  fact  that  fraud  and adul-
teration may render such an article of human
consumption  as  porter  most  deleterious,
does not in  any way afford an  argument
against  its  use when properly and  truly
manufactured,  and  there are few  medical
men who will  not  testify to the highly  be-
neficial effects which follow the use of good
porter in many cases.   It is, in  fact, a most
admirable tonic, superior to any other form
of malt  liquor, and especially so  because
it is less likely to  disagree and to become
acid on the stomach than the other varieties
of malt beverage;  neither is it so likely to
give rise to gravelly deposites in the urine in
the predisposed.  Dr. Prout recommends the
use of porter  in diabetes, not only for its
tonic  properties, but as less likely to  prove
injurious in many cases of that disease than
any other drink.
   In convalescence from acute disease, por-
ter is a strengthening medium  most grate-
ful to the  patient.   In  order  to prove of
service,  porter  must  not be  flat;  it is,
therefore,  better for  invalids,  at least, to
drink it bottled.
   PORT WINE—Belongs to the class  of
"dry and strong" wines, being put down in
Brande's tables,  as containing an  average
of  22-96 per cent, of alcohol.   The colour
of port is due to  the colouring matter of the
grape husk,  which  is pressed out in the pre- 
PO s
411
POS
 paration, nl-,ng with a considerable amount
 of astringency and extractive matter, from
 which the white wines are free.   The large
 percentage of spirit contained in port wine
 is, of course, not all the result of the natu-
 ral fermentation, but is  added on  account
 of the depraved taste which has rendered
 it necessary for  foreigners to add spirit to
 the genuine wine  to render  it marketable
 in Britain;  spirit, too, which for the most
 part must remain in the wine in an uncom-
 bined  condition.   Probably,  no  wine  im-
 ported into this country,  or, in many cases,
 professed  to be  imported,  is liable to  the
 same extent of adulteration as port wine, an
 immense amount of deleterious stuff being
 sold under the  name, especially when  re-
 tailed in small quantities, or direct from the
 wood.   In such cases the poor often suffer;
 probably,  after  illness, they  may be able,
 or enabled to purchase,  it may be one, or
 perhaps a  couple  of  bottles  of port;  the
 liquid being frequently drawn   from   the
 cask and put into their own bottles, it need
 scarcely be  added, that  it is often worse
 than  nothing.   There are few medical men
 at least, who will decry the virtues of port
 wine as a remedy, either  in some stages of
 acute illness or in most convalescences ;  but
 if it is  to be of  any service it must be  ge-
 nuine ;   those,  therefore, who  charitably
 interest  themselves in the wants of their
 poorer brethren, should keep this in mind,
 and, if inclined to aid  with the often most
 welcome gift of  a  little wine, send  it from
 their  own cellar, instead of  giving money
 for its purchase.  Good  port wine  is often
 one of  the most valuable remedial agents
 in the hand of the physician:  in  the  low
 stages of low fever, in diseases of  debility
 generally,  and in convalescence  from most
 of the exhausting diseases.   Gargling with
 port wine  in relaxed sore-throat is a good,
 but,  perhaps,  somewhat  unnecessarily  ex-
 pensive remedy.
  POSITION.—The position,  either of  the
 whole body or of the affected  part, in those
 suffering under illness, or from  the effects
 of accident,  is one of  the most  important
 considerations  connected with  treatment;
 it is,  moreover, one frequently overlooked,
 particularly by unprofessional persons.   Al-
 though  the  structural  arrangements  and
 vital activities of the  living  body counter-
 balance the influence  of  gravity  under  or-
 dinary circumstances,  the  latter  force is
 apt, more or less, to exert its power, when
weakness and  long constraint in one pos-
ture  diminish  the  powers  of its  counter-
agents.   It is undoubted that  the muscular
movements, which are continually going on
with most persons  in health, tend greatly
to assist  in regulating and  equalizing the
distribution of the  blood and other  fluids;
even in the healthy, the temporary want of
this assisting power is shown  in the liability
of the feet or legs to become slightly swollen,
in consequence of long sitting or standing
in one posture.
   In regulating position, it has for the  most
part to be done, either with reference to the
relaxation of the muscles, to facilitate the
flow of the blood or other fluids within the
body, or to obviate  pressure on any portion
of the  body.
   The regulation of position,  with reference
to the  relaxation  of certain muscles, or sets
of muscles, is most  generally required  after
fractures; and the  principles on which this
relaxation is to be adopted have been  suffi-
ciently alluded to under  the article Frac-
tures itself.   This muscular relaxation may
also be an object in  the treatment of wounds
which  run transverse to  the fibres of the
muscle directly underneath, such as trans-
verse wounds of the thigh.—See Wounds.
   The regulation of position  with reference
to the flow  of the  blood or  other fluids is
often of immense importance, and too often
neglected.  The blood may have a tendency
to gravitate toward the most dependent parts
of the body, either from general or  from
local causes.
   In some diseases  accompanied with great
exhaustion, and, indeed, in many aged peo-
ple, independent of disease, it would  appear
as if the  forces which  circulate the blood
lost the power of counteracting the force of
gravity, even in the  horizontal posture;  con-
sequently the blood is apt to accumulate in
the most dependent  parts.  In  the lungs
especially this is  the  case,  and there is
every reason to  believe that congestion or
accumulation of  blood  in  these  organs in
the first place, giving rise to a kind of in-
flammation in the second, may be the conse-
quence of long continuance in one position,
as on the  back.  In such  cases care ought
to be  taken, when  practicable, to  change
the position.  Stagnation or  congestion of
blood occurs, in the majority of instances,
from  some obstruction  to the circulation,
either at its centre—the heart—or in conse-
quence of mechanical  impediment  acting
upon the veins of the part or parts involved,
such as happens  from the pressure of tu-
mours, or of the  pregnant womb upon the
large veins of the abdomen, &c.
  Again, at all times, in the healthy body,
when in the erect posture, there is the force
of gravity to be overcome in the return of
the blood from  the parts lower  than the 
P 0 S                412                POT
heart  to  the  heart,  and for  this  special
provision is made, most remarkabl}, in the
numerous  valves with which the veins of
the lower  extremities are  provided;  any
deficiency in these valves (see Veins) favours
the gravitation of blood.  In all the above-
named  instances,  position  is of  the  very
highest importance, not only as regards the
comfort of the patient and  the  treatment
of the disease, but sometimes  as  a  matter
of safety.—See Veins.
  While position is  to be  considered  and
taken advantage of, as a means of facili-
tating the  flow of blood through the veins,
it is also a  useful auxiliary in regulating its
passage through  the  arteries, for it makes
a very considerable difference, whether the
propulsion  of  the blood  by the heart  and
arteries  is exerted  against the  force  of
gravity, or not.  This is well shown, when
there  exists from  any cause a tendency to
fainting.  This condition, as pointed out in
the article on the subject,  depends upon
diminished circulation of blood through the
brain; it must, therefore, be evident to all,
that in the erect  posture, when the blood
has to be driven upward to the head, against
the force of gravity, a much greater exertion
of power is required than if it had  merely
to be  sent in an horizontal direction, as  it is
when  an  individual  is  lying  down,  and,
consequently,  that in fainting, in which the
action of the  heart is much enfeebled, the
usual treatment of laying a person almost
flat is the most  rational  plan which can be
adopted;  it, moreover, illustrates well the
influence  of  position.  In  a tendency to
apoplexy, or to overfulness about the head,
on the other hand, it is a matter of safety
that all positions, such  as  stooping when
awake, or sleeping with the head low, which
favour the arterial flow to, or impede the
venous flow from the head, are to be avoided.
On precisely similar grounds as the  above,
position is highly important in wounds in-
volving severance of vessels.   It must be
evident to all,  that in the case of an artery
being wounded, the most  rational mode of
preventing—which it will do entirely some-
times—or at least of impeding the effusion
of blood, must be to place the wounded part
in such a position  that the force of gravity
must  act as strongly as possible against the
force  of the  circulation; in other  words,
that if  an  artery of the  hand is wounded,
lees blood will be lost  by holding the hand
and arm straight upward, than  in any other
josition, (see Artery;) and further, that the
very same  principles in reverse must apply
in the case of  the veins.  It might also seem
is if  common sense  alone  would be suffi-
cient to tench persons generally such simple
facts, but it  is not so.   It  is not very long
since a woman  nearly lost her life in  Lon-
don, in consequence of  the giving way of
one of the veins of the leg, from ulceration
—she almost bled to death  because not one
of those around had knowledge sufficient to
lay her flat down, nnd to elevate the bleed-
ing leg above the level  of  the rest of the
body.  Her life "was saved  in consequence
of the fortunate  arrival of Mr. Wakley, to
an inquest, who, of course, at once obviated
what  might have been a fatal  contingency,
the result of ignorance.   The  regulation
of position, with  reference to the escape of
fluids, such as matter from  any part of the
body, requires attention : surgeons generally
take care that it is properly seen to, but it
might  escape the  notice of uprofessional
persons.   As a  general  rule, parts should
always be pla#ed so that any discharge  from
them  may have  as free  escape as possible.
It is this fact, in cases of abscess, which
often  makes the  artificial  opening of the
surgeon preferable to the natural one of the
disease.   He chooses the  point  for his inci-
sion where the matter can have the readiest
escape; that is,  the lowest  portion of the
abscess,  in the  natural  and unconstrained
position of the portion of the body in which
it is situated.
  Position, with reference to pressure  upon
different parts  of the  body, particularly in
persons long confined to bed, requires much
attention; it has been  already alluded to
under articles Bed, Bed Sores, &c.
  There  are  many other points connected
with the important subject  of position, but
the foregoing remarks—directed  rather to
principles than   to  details—will probably
serve to attract a little more attention  than
is often given to  considerations so closely
linked, not only  with comfort, but with the
safety  and well-being of the  sick and in-
firm.
  POSSET.—An  old form of domestic pre-
paration for the sick, made with milk curdled
by means of treacle, beer, &c.
  POTASH,  or Potassa, or Potashes, ob
Vegetable Alkali—One of the fixed  alka-
lies and a compound of the metal potassium
with  oxygen, is  very  widely distributed
throughout nature; in  the soil, in vegetable
and animal bodies, it is an  almost constant
ingredient.
  Many preparations of potash are used in
medicine ; the most generally used are—
  Potash, in its pure form of caustic potash,
especially in its solution, the liquor potass*:
  Bicarbonate, or supercarbonate of potash;
  Acetate of potash; 
POT                 413                 POT
  Bitartrate, or supertartrate of potash, or
cream of  tartar;
  Chlorate of potash;
  Nitrate of potash ;
  Hydriodate or iodide of potash ;
  Tartrate of potash with soda, or Rochelle
salt.
  Potash  derives its name from its source
and mode of manufacture. It is procured by
" lixiviating," that is, mixing and  steeping
vegetable ashes  in water, and evaporating
the solution or " lye" which results.   From
this solution,  potash, in the form of a car-
bonate, is obtained, but  the process  being
very roughly carried out, yields, of course,
a very impure material, the  " pot-ashes" of
commerce, which are  brought chiefly from
Russia and  North  America.   The  rough
potash is  purified in various ways, either in
the country of its manufacture or after im-
portation.  When  imported in  a  purified
state  it is sold as "pearl-ash,"  and after pu-
rification  in this country,  as purified  pearl-
ash, or carbonate of potash.  This must not
be  confounded with bicarbonate or super-
carbonate of potash, which is the more ge-
nerally used medicinal preparation.   There
is  great  variation  in  the amount  of car-
bonate of potash obtained from various ve-
getables, but weeds yield it most abundantly
after  burning.   For  example, while  oak-
wood  yields but 1-53, and beech-wood 1-45,
in every  thousand  parts, the fern  yields
6-26,  thistles 35-7, wormwood 73-0, and the
common fumitory 79-0, in every thousand.
Pure  carbonate of potash  is sold in the form
of a white, granular salt, which is very de-
liquescent ; that is, becomes moist or partly
dissolved, in consequence  of attracting  mois-
ture from the atmosphere.
  Bicarbonate of potash occurs in crystals,
but is more generally sold in the form of a
white  powder.  It is,  while applicable to
the same  purposes, a much milder prepara-
tion than  the carbonate.
  The solution of pure potash, or "liquor
potassae," is very similar in its medicinal
action to the above preparations ; in its un-
diluted condition it  is  caustic, and acts as
an irritant poison.
  All  the  above preparations of potash are
antacid, diuretic,  and  cooling; the simple
carbonate, however, is but little used as a
medicinal agent.   The bicarbonate, in  doses
of from ten to twenty grains, dissolved in
a couple of ounces of water, may be  given
when  its  antacid action  is required ; for
diuretic purposes the doses must  be at least
double the above.   The dose of the " liquor
potassae," or potassa solution, is from ten to
twenty drops, diluted in the same way.  The
      2 k 2
bicarbonate of potash is  often use-  along
with an acid in forming effervescing draughts
in febrile diseases;  for the amount oi acid
requisite, see article Effervescing.   In some
disorders of the liver, and where there is  a
tendency to the formation of red gravel in
the urine, potash, especially the liquor po-
tassae, is one of our most useful remedies.
A very good  combination is  fifteen  drops
of the solution  in  a  teaspoonful of  dan-
delion tea:  this may  be taken  at least
twice a-day.   A very good preparation of
potash, " Brandreth's solution," is used by
some in preference to the common potash
solution.   It  is  requisite that those who
regularly, or for any  length  of time, take
these preparations of potash on account of
red gravel  or other diseases,  should  be on
their guard,  lest too  continued a use of
the remedy may induce other disorders as
bad, or probably worse than the existing one,
The author could, in one case, traoe a sud-
den breaking up of the nervous system with
alkaline and  phosphatic  urine, to  no  other
cause than the long and incautious use of
potash to obviate a  tendency to red gravel.
As mentioned under article Fat, the use of
potash solution tends to diminish that con-
stituent of the body.  Potash  is preferable
to soda as an antacid in gout, from its form-
ing a more soluble compound with the pecu-
liar acid of that disease.—See Gout.
  Poisoning by  potash  solution has  some-
times occurred;  in this case,  diluted  acids,
milk, demulcent drinks,  or oil will be the
best remedies.  The  acetate  of  potash,  a
compound  of acetic  acid and potash, is
chiefly used as a diuretic, and  as a remedy
in skin diseases—the dose from thirty grains
to sixty, well diluted in water: it may act
upon the bowels.
  Chlorate of potash  is generally sold in
the form of flat, white crystals; it is cooling,
and  a good saline remedy in  inflammatory
fever; it is most valuable, however,  as  a
remedy in thrush or  "aphtha," (see Aph-
tha,) and in cases of sore mouth generally
—the dose five to fifteen grains, dissolved in
water, for an adult.
  Bitartrate of potash, or cream of tartar,
is a compound of potash with tartaric acid.
In its impure state, in which it forms a gray
or brown  concretion,  it is known by the
name of argol or winestone, and is formed
inside the casks in which new wine is kept.
The coloured, impure, crude tartar is puri-
fied, dissolved, and  the solution gradually
evaporated.   In this process crusts form on
the surface of the solution, which  are suc-
cessively skimmed  off, whence the  name
" cream of tartar" is  given to the purified 
P 0 T
414
P O T
preparation; this is  generally  sold in the
form of white powder, which feels gritty in
the mouth, and gives  a pleasant acid taste.
Cream of tartar is used to form the  cooling
pleasant drink "imperial," which by most
persons may be taken freely.   In doses of
from sixty to one hundred grains, cream of
tartar given, stirred into  half a tumblerful
of water—it will not dissolve—is  one of
the best diuretics we have ; in doses of two
or three drachms it acts as a mild laxative.
—See  Jalap.   Some  persons cannot take
cream of tartar in any form without suffer-
ing from  irritation  of  the kidneys.  An
overdose might produce inflammation of the
stomach.
  Nitrate of potash, or saltpetre, a compound
of potash and nitric  acid, is now brought
chiefly from India, where  it is  obtained by
"lixiviation," or by dissolving  the  nitrates
of lime, soda, and potash, out of the soil in
which  they exist in large quantity ; the lixi-
viation being conducted over wood ashes. In
this way the other nitrates are decomposed
by the potash of  the  ashes, and  nitrate of
potash  or saltpetre  formed.   Nitrate  of
potash may be also formed artificially, as it
was  in France during  the war, when the
British cruisers interrupted the foreign sup-
plies  to  that country, at  a time when the
salt was so largely required in the formation
of gunpowder.   It is  made by throwing up
large compost heaps containing lime in some
form or other, either mingled with decaying
animal  matter, or watered regularly with
urine.   These heaps are allowed  to remain
two or three  years unmoved, during which
time, by slow decomposition, nitric  acid is
formed in combination  with the lime,  and
the nitrate of lime being then dissolved out
by water, is easily converted into nitrate of
potash by decomposition.  At present, how-
ever, " a great part of the nitre (nitrates of
potash) used for the manufacture of powder,
in France, is obtained  in Paris, from  the
lower stones of the houses, which are con-
stantly in contact with the liquids  of  the
streets and drains.  The lime of the walls
is gradually dissolved  by the  nitric acid
formed ;  the walls lose their coherence  and
firmness—hence the name of wall corrosion,
given to this injurious  formation of nitre.
The potash of the nitre is generally derived
from bricks, and  even the mortar contains
some  potash, which  gradually  decomposes
the nitrate of lime, aided by  the superior
crystallizing  power  of  nitre,  so that  the
latter  salt is formed.   But,  generally, in
order to obtain all the nitric acid as nitrates,
potash must be added to the liquid obtained
 from the scrapings of the walls by lixivin-
 tion with water.
   Saltpetre is usually sold in crystals  of
 various sizes,  or in the form of ciystallino
 powder; its taste is peculiarly cooling.   In
 doses of twenty grains, dissolved in two  or
 three ounces of water, it increases the flow
 of urine, and  is most frequently given for
 this purpose.   In large doses, such as  half
 an ounce or more, it occasions  pain  at the
 stomach,  and  vomiting,  with  extreme de-
 pression of the system, and may thus prove
 fatal.   Free dilution with some demulcent,
 such as thin gruel or barley-water, induce-
 ment of vomiting, and counteraction  of the
 depression by stimulants, would be the most
 appropriate treatment.
   Hydriodate of potash, or iodide of potash,
 is a compound of  iodine,  or rather of iodic
 acid with potash;  it occurs in the form of
 white, and, when well formed, cubical crys-
 tals.  It is a preparation  now much used by
 medical men, but is  not a  remedy  calcu-
 lated for domestic administration.  It may,
 however,  be  used in  the form  of its oint-
 ment in bronchocele, or "full-throat"—
 See Bronchocele.  It is very liable to adulte-
 ration.
   Tartrate of potash and soda,  or Rochelle
 salt, chiefly requires  notice from  its being
 the  active ingredient  of the  well-known
 " seidlitz  powders,"  which  consist  of the
 common soda and tartaric acid, (effervescing
 powder,) with the addition of a drachm of
 the tartrate of potash and soda  to the alka-
 line  powder.—See Seidlitz.   Rochelle  salt
 may, however, be used alone as an aperient,
 well dissolved  in  water,  in  doses  of from
 one to six or eight drachms; its action is
 rather milder than,  but  resembles that of
 Epsom  salts; the taste,  however, is  much
 more agreeable.  Rochelle salt also is sold,
 generally in crystals, but may be bought in
powder.
  POTATO. —This  well-known tuber, in-
troduced into Ireland in the  sixteenth cen-
 tury, from  America,  by Sir AValter Raleigh,
not  only  forms   a  daily article of  food
throughout a large proportion of the civil-
ized world, but, unfortunately, owing to the
ease with which it is cultivated, has become
the staple article of  nutriment to millions.
 As an addition to other and more nutritive
food, the potato is most invaluable;  as the
 Bole  article of diet, although capable of sup-
 porting life, it is a wretched material,  and
 any  combination  of circumstances  which
 induces or  compels a population to depend
 upon it  in too  great  a degree, must be re-
 garded as most unfortunate.   ' 
                  POT

  The potato, undoubtedly,  contains  the
elements  of nutrition, that is, starchy  and
gummy matters,  (see  Food,) capable  of
sustaining the  respiratory processes,  and
also "plastic material,"  adapted to build
up the muscular and other constituents of
living animal  bodies.  But those plastic ma-
terials are so deficient in quantity, and their
amount is so small compared with that of the
other constituents of the tuber, which, more-
over, contains a very large amount of water,
that a man living solely upon  potatoes must
consume a very large quantity to keep him-
self in health and strength, even if  he  can
do  the latter  when undergoing any thing
like exertion.   From seven to  ten pounds of
potatoes per day is by no means an unusual
amount  for  a labouring Irishman  to con-
sume ; but the ten pounds of  the root con-
tain no more real nutriment than one pound
and a half of good wheaten bread, although
they afford abundant respiratory or carbon
material.    In  consequence  of  the less
amount of muscular, "plastic"  nutriment
contained  in his food, the Irish labourer is
less adapted for continued exertion than the
Englishman on his wheat and meat, or the
Scotchman on  his   oatmeal. — See Oats.
Moreover, it  has been remarked, that the
constitution of the Irish  labourer  is apt to
give way earlier in life than that of the men
of the sister kingdoms, and he is certainly
more liable to  be the victim of epidemic
disease.
  A remark of Liebig's well illustrates the
value of the  potato  as an article of nutri-
ment.   He says, " A horse fed on potatoes
and compelled to work, loses  weight; when
he  does no work, his weight remains un-
changed."   Thus evidently  showing that
the root  is unable  to  supply the  loss  by
"motor change," when active muscular ex-
ertion is undergone.
  As an addition simply to other varied and
more nutritious aliment, the potato must be
esteemed  most valuable ; it supplies the na-
tural desire for vegetable food, and affords
it of a kind well adapted to promote the
health of  the system  in one of its most  di-
gestible forms.  The appearance of true sea
scurvy in  so  many  parts  of  the  kingdom,
during the period when,  in consequence of
the potato blight, the population  generally
were compelled to use drier and more animal-
ized food in unusual proportion, sufficiently
indicates  how much  we owe, in the matter
of health, to the regular intermixture of the
potato with our  ordinary diet; and it is a
questionable system of dietetics which, ex-
cept from some  very cogent reason,  ex-
cludes the weW-cooked potato from the din-
5                POL1

ner-table  of the invalid:  the  well-cooked
potato, for nothing can be more indigestible
than a  badly-cooked one.  It  is, perhaps,
superfluous  to  point out  that a  well-boiled
potato should break down in a mealy form to
its very centre;  by well boiled is not meant
excessively  boiled,  for  when  this  is done
much of the nutriment of the root is lost.
In Dr. Beaumont's tables, roasted and baked
potatoes are said to take but two and a half
hours for  digestion, while boiled potatoes
take an hour longer.
  Potatoes which boil " waxy" are peculiarly
unwholesome,  and often pass through  the
bowels  unchanged; the same may be  said
of early potatoes, not the early kinds when
matured or ripe, but as they are  generally
used in  an immature condition.   Mashed
potatoes do not generally get sufficiently
mingled with the saliva to secure the full
digestion of their starchy constituents.—See
Digestion.   Potatoes soaked with gravy and
dripping from roasted meat, though suitable
for  persons of  strong  digestion, are very
liable to disagree with dyspeptics.
  Potato  starch, in the form  of " British
tapioca," is a very wholesome preparation.
  Potato  spirit  or  brandy has been found
more thaji usually  deleterious.
  Refer to Food—Fecula.
  POTENTILLA  TORMENTILLA. — See
T0RMENT1LLA.
  POULTICE.—A poultice is generally un-
derstood to be  an application adapted to
afford  moisture and   generally  warmth,
through the medium of some soft substance;
or rather it ought to afford these essentials,
for, too  often, cold dampness, or  hardness
and  irritation,  are  the only effects derived
from the ill-made  and badly applied  poul-
tices with which nurses are apt to indulge
their charges.
  As above stated, any soft substance which
will retain heat  and moisture may be used
to form  a  poultice; but some materials  are
better adapted  than others for the purpose.
The  substances most  generally  used  for
poultices  are bread, linseed-meal, oatmeal,
arrow-root, carrots, turnips, &c; with these
are  often  intermingled lard, milk, honey,
treacle,  yeast, &c.;  bran, so often recom-
mended in this  work as a medium for  ap-
plying  heat and moisture, can  scarcely be
considered as a poultice properly so called.
The mustard cataplasm is  also, sometimes,
called a poultice, but improperly.  The name
cold poultice is also used.
  The essentials of a good poultice are that
it shall  be perfectly smooth and  free from
lumps or hardness, that it shall be as soft
and moist as possible without being sloppy,
4: 
                  P 0 IT                41

and  that  it shall  have  sufficient bulk  to
retain  both  its warmth and moisture  with-
out being too heavy. No  material, perhaps,
offers more facility for making a good poul-
tice  than  bread, and accordingly we find
that the
  Bread poultice is, perhaps, more commonly
used than  any other. It is made either with
water or milk, but the latter is a very doubt-
ful addition, and the same may be said  of
the grease or lard often added to this  form
of poultice.   The milk is apt to  turn sour,
and can answer no better purpose than the
water; and  when a greasy poultice is used,
the bread is not requisite.   The best  mode
of making a bread  poultice is to break the
crumb of bread into a hot basin, pour  boil-
ing water  over it sufficient to soak it tho-
roughly, and allow it to stand covered over
for a few  minutes  by the side  of the  fire;
any superfluous moisture being drained off,
the pulp should be thickly spread upon a
piece of cloth of the requisite size.  In  some
cases it is advisable to interpose a piece  of
thin muslin  between the poultice  and the
surface on which  it is  placed.  The  tem-
perature at which a poultice is to be applied
must vary according to circumstances, but,
generally, the  best is that which is  most
agreeable  to the patient; occasionally it  is
useful to have it as high  as it can be borne.
After a poultice is applied  to the body, it is
a good plan to  cover the  part, either with a
fold of flannel or  with oiled silk, to  assist
in retaining the warmth  and moisture; the
latter, moreover,   prevents  the  moisture
which necessarily exhales from the applica-
tion damping the  clothes,  &c,  often a very
great inconvenience in badly applied  poul-
tices.  Indeed, the  bad management of poul-
tices generally amid the poorer classes, con-
stitutes a serious objection to  their use;
they are often  either  made so  sloppy  as  to
wet every thing around,  and to put the pa-
tient in great risk from cold, or they are
made so small and stiff as very quickly to
become caked  and hard  upon  the surface,
particularly if not  sufficiently  often  re-
newed.  Even  in  the most favourable cir-
cumstances a poultice requires renewal  at
least three times in the twenty-four hours.
   The cold  bread poultice is  often conve-
nient, and  must be made simply with cold
instead of hot water.
   The  bread  poultice  may be made  the
medium for various medicated applications;
thus hot  decoction of poppy " heads,".  &c.
may be used instead of hot water, or goulard
may be added to the cold  poultice with  ad-
vantage.  It  is a  necessary caution, that
the material  used  for  these  medicated
6                P 0 U

poultices should  not, after use, be  thrown
where  it  can be  picked up by poultry.
After the bread poultice, probably the
  Linseed-meal  Poultice is  more  generally
used than  any other.  For  this  purpose,
ground  linseed,  free  from grit,  should be
procured.  To  make  the poultice,  a suffi-
cient amount  of boiling  water  is  to  be
poured into a hot basin, and  the meal stir-
red  in till the whole is  of the proper con-
sistence ;  the mass  being beaten  smooth
before use, is then to be spread evenly upon
the cloth.  This forms a very smooth poul-
tice  when well made,  and the oil which the
linseed  naturally contains  tends to  keep it
soft.  It is rather more  stimulating than
the bread poultice : occasionally it is made,
by mistake, of the whole seed instead of the
meal.
  The  Oat-meal Poultice may be made in a
similar way to the linseed ;  but, although
oats contain a considerable amount of fatty
matter, it is not sufficient alone to make an
oily poultice, like the linseed; it is therefore
very common to add a little lard; this, how-
ever, must not  be done when the oatmeal
poultice  is,  as  very  generally made,  the
medium for the
  Fermenting or  Yeast Poultice,  which is best
made by adding yeast, in the proportion of
two  tablespoonsful to the  quarter pound of
meal, [cornmeal  answers well,] to a ready-
made oatmeal poultice, mixing thoroughly,
and, if requisite, heating to  a proper tem-
perature.  If oatmeal is not at hand, flour
may be used.  This poultice is a very com-
mon ap] lication in cases of mortification or
of fetid sores.
  Arrow-root,  made  as for  the table, was
recommended by the late Dr.  A. T. Thomson,
as a soothing poultice in irritable sores and
the like.
  Other substances, such as carrots, turnips,
&c, are often recommended and  used as
poultices,  but they possess   no  advantage
over those already named, and are objection-
able from their smell; they may, however,
be  used, and  indeed  any  soft  substance,
consistent with cleanliness,  which  will re-
tain warmth and moisture, when bread and
meal are not procurable, or  when their use
in this way is an  object.   When medicated
poultices are required, as mentioned above,
it is better to make the bread poultice  with
the  infusion or decoction  of the  medicinal
! agent.   In this way the
i   Hemlock Poultice may be made, or it may
 be formed as ordered in the  Dublin Pharma-
 copoeia, thus:—Take of dried hemlock leaven
 an  ounce, water a  pound  and a  half by
 measure, boil down to a pound, and add of 
POL
417
POW
 the powder of hemlock leaves sufficient to
 make  a poultice.  This  poultice  is  often
 effectual in subduing the pain of cancerous
 and painful sores.
   Honey, treacle, &c. are not desirable ad-
 ditions to a poultice.
   Bran Poultice.—See Bran.
   Few applications are more generally used,
 either in regular or domestic  surgery, than
 poultices, and, in  their proper place, few
 are more useful.   It is worthy of remark,
 that the most ancient poultice on record is
 that of figs, applied  to King Hezekiah, by
 the direction of the prophet Isaiah.
   In painful swellings, attended with inflam-
 mation, such as  boils in inflamed wounds
 and the like, or for promoting the discharge
 of matter, no application is more suitable
 than the  poultice.  For  the uses  of the
 large  hot bran poultice in  internal affec-
 tions, see Bran—Heat.  Tp the use of poul-
 tices, however, there is  a limit,  not always
 well observed,  particularly  in the case of
 wounds and ulcers.  Up to a  certain  point
 they are most valuable—beyond it they do
 harm ;  instead of soothing and encouraging
 sufficient  discharge, they attract the blood
 too  strongly to  the part, increase beyond
 measure the  discharge, and  encourage the
 formation of  " proud  flesh."   It  is  only
 practical  experience which  can teach the
 appearances indicative of the precise time
 when a poultice  should be left off, but it
 may be guessed  at  when healing processes,
 which have been going  on favorably,  seem
 to come to a stand-still or retrograde ; when
 the  discharge  rather  increases than dimi-
 nishes,   and  the surface and  edges of the
 sore seem to become full, and at the same
 time pale and flabby.
   After poulticing  has  been carried  suffi-
 ciently far, the simple water dressing (see
 Dressing) is in most cases most suitable—it
 is cooler, pleasanter, and not so  like a hot-
 bed  as   the common poultice.   Some sur-
 geons, and among them the celebrated Mr.
 Liston,   substituted the water dressing in
 all cases for the poultice. Indeed, the a"bove
 gentleman used  to say, the  nurses of his
 hospital wards had forgotten how  to  make
 "a  poultice," of  which  he  says,  in his
 Operative Surgery, " the very name  is asso-
 ciated   with  putrefaction and nastiness."
 That Mr. Liston  carried  his  prejudice
 against  the poultice too far,  may be sus-
 pected from the fact, that many of the first
Burgeons  of the  day continue to take ad-
vantage of it;  but that  the water  dressing
uay.be substituted in many cases is unques-
tionable ; and it is  certainly a much more
elegant  and agreeable, application  in every
 way.  It does not, however,  in  all  cases
 answer the purpose of the poultice;  indeed,
 that it does not act in the same way is evi
 dent from  the  fact that when a sore has
 been  stimulated,  as above described,  by
 over poulticing, the  substitution  of the
 water dressing quickly  gives  it a  more
 healthy character,  thereby  proving  its less
 excitant character.
   Somewhat similar, in principle at least,
 to the lint and oiled silk application is the
 Spongio Piline, introduced  a few years ago
 as  a substitute for the  poultice.   This, the
 invention of  Mr.   Marckwick,  consists of
 sponge cut up  into fragments, and felted
 into a mass with cotton wool, a layer of this
 mingled  material  being  backed  with  a
 waterproof varnish.  The  mingled  sponge
 and cotton will of course absorb moisture
 freely and retain it, and therefore in  some
 measure  act  as  a poultice.  The author,
 however,  cannot from  his  own experience
 speak favourably of its effects ; in moderate
 sized  pieces it  certainly does not  answer
 well, but where large sheets of the material
 —as for  a whole  limb—are required  and
 used, it may probably be very useful.
  Refer to Dressing—Heat, Sec.
  POULTRY—As food must be considered
 under the divisions of the oily and non-oily.
 The flesh of the first class, including ducks,
 geese, &c, is certainly difficult of digestion,
 and  perfectly inadmissible,   even   when
 plainly cooked, for invalids.  The flesh of
 the  non-oily kind, such  as  common fowls,
 turkeys, &c, is more soluble in the stomach,
 but it is far from  being as  easily digested
 as generally imagined ; certainly  it is not
 equally digestible with tender mutton.  The
 flesh of  this  description  of poultry, as  of
 chicken, for example, is more likely to agree
 if boiled rather than roasted.   The flesh of
 poultry, when digested, does not, probably,
 prove  so stimulant  to the system as that of
 the  larger animals;  it is  therefore more
 useful in many cases of convalescence, when
 animal food is first permitted.
  "In the boiling and roasting  of poultry,
 the  flesh  of which is white,  and contains
 little blood, the temperature of the inner
 parts,  when the flesh has been well-cooked.
 seldom exceeds 130° or 140°.   The flesh of
 poultry or game is therefore sooner dressed
 than flesh which contains  much blood,  such
 as beef  or mutton."*    The broth  made
 from chicken or fowl offers  one of the best
forms  for giving  animal  nourishment  in
early convalescence.
  POWDER.—The form of powder is a very
* Liebig'i Chemistry of Food. 
PO w
418
PRE
common one for the administration of medi-
cines, as in this  way the peculiar actions
of the drug are more readily and certainly
developed.   Powders,  generally, are  pre-
pared on the  large scale by " drug grind-
ers," but as in the process the drug is very
liable to extensive adulteration, some  per-
sons prefer preparing  their own powders,
although it is a very troublesome process.
As  drugs  are more  liable to  spoil  in the
form of  powder, emigrants and others may,
in some  instances, find it an advantage to
powder their own.  An iron mortar is gene-
rally tt^ed for powdering  crude drugs ;  and
if these  are at all acrid, or indeed  in any
case, it  is  an advantage  to have it fitted
either with  a wooden cover, or with a  lea-
ther fastened round both mortar and  pestle.
A fine sieve is required  to separate the finer
portions of the powder  from  the coarser.
Dr.  Christison remarks  in his Dispensatory;
—" The most prompt and effectual mode of
obtaining fine powder is to use the mortar
And sieve alternately—that is, to  sift away
the  finer particles as soon as partial  pul-
verization  is  accomplished, to  pound  or
triturate again what  remains on the sieve,
to sift this as soon  as a little more  fine
powder is formed, and  to repeat the alter-
nate trituration  and sifting frequently, till
the  whole substance has passed through the
sieve.   In this way much time is saved, and
much  less  of the  finest  powder is lost by
being  driven off in triturating or pounding
the  coarser residue."  As simple powders
of the majority of the  drugs used in medi-
cine are prepared,  it would  take up  un-
necessary space  to enumerate  them here.
The most useful compound  powders admis-
sible for domestic use are the
  Aromatic powder.
  Compound chalk powder, with opium,
  Compound ipecacuanha, or Dover's pow-
der.—See Dover's Powder.
  Compound jalap powder.—See Jalap.
  These are better purchased, particularly
the  compound chalk with opium, but may
be made.
  The compound  aromatic powder is made
by reducing to fine powder equal parts of
cinnamon, cardamom seeds, and ginger.
  Powders  ought  always  to be kept in well-
closed  bottles,  otherwise they  lose  their
medicinal properties; some, such as squill
or aloes, become  damp  and caked  into  a
mass.
  Powders  are generally administered in
some  thick vehicle, such  as preserve, thick
gruel, or the  like;  if given in thin fluids,
nuch as tea, &c, they are  apt to sink to the
bottom,  and are partly lost.
i   PRACTICE.—The old saying that '• prao
 tice  makes  perfect," is  applicable  to  th«
 practice  of  medicine,  but  it  is  with snnu
 reservation; a reservation  which is not  al-
 ways taken  into account by the public, nor
 admitted by a certain class—the "practical
 men"—in the  profession.   Without  prac-
 tical experience it is certain no man can be
 either physician or surgeon, however great
 his theoretical knowledge;  but it is equally
 certain, if practical experience  alone  be
 trusted to, it will  do but little  to bring its
 possessor  up to his proper position  as  re-
 gards medical science, and must often leave
 him  at fault, when he  ought not to  be  so,
 particularly in  cases which differ from the
 ordinary routine.   Neither years nor extent
 of practice can make the man a good prac-
 titioner, or, at  least, as good a practitioner
 as he ought to be, if he neglects those aida
 and  appliances in the  investigation  and
 treatment of disease, which  the  industry
 of his numerous brethren  are  daily bring-
 ing  forward.   The  public may draw  their
 own  inferences.
   PRECORDIAL  REGION.—The forepart
 of the chest over the heart.
   PRECIPITATE.— Something  thrown
 down;  in chemical language,  the term is
 applied to a substance which is separated in
 a fluid, by decomposition, and which falls to
 the bottom.
   PRECOCITY—Untimely maturity—is oc-
 casionally seen in  the development of the
 body, and can only be regarded as a form of
 disease.  Precocity of mind is by no means
; uncommon in  children, and  in too  many
 instances  is  equally significant with undue
 physical   development,  and  much to  be
 dreaded.   The  morbid excitability of brain
 is but the result  of disease,  and  gives  no
 promise of supereminence in after-life.   As
 a general rule,  a precocious, or "strikingly
 clever" child, cannot be too much kept back
 from mental exertion; every effort should
 be made to divert the tendency to cerebral
 excitement,  and by encouraging  physical
< exertion,to divert- the nervous power to the
| body at large:  too often the reverse system
I is practised.
   PREDISPOSITION.—See  Disease, Hb-
j reditary—Marriage, &c.
   PREGNANCY—Is the  condition of  a  fe-
 male between the periods of conception and
| delivery.   The  state  is to be considered,
 both as regards the symptoms which usually
 indicate its existence, and also with respect
j to the bodily disorders which are most com-
 monly associated with it; some  of the symp-
 toms, moreover, are also disorders   It ia
 usually considered that  pregnancy cannot 
P RE
419
PRE
 take place before the establishment of men-
 struation,  and,  as  a general rule, it does
 not, but  cases  are  recorded  in which  it
 does.  The suppression  of the above  func-
 tion is, also, always regarded as one of the
 most unequivocal proofs of pregnancy, but
 it is  not by any means invariable;   cases
 have been  known,  in which the secretion
 has appeared during the whole period  up  to
 the time of delivery, and in many it is mani-
 fested for  one. two, or three months  after
 conception.  The  swelling of  the breasts,
 another sign of pregnancy, does not always
 occur, in a marked manner, if menstruation
 goes on, and it may also be excited sympa-
 thetically  by the  presence of tumours,  or
 by other causes of irritation  connected with
 the womb.   The breasts, also, may increase,
 simply from accumulation of  fat; in this
 case they do not afford the somewhat knotty
 feeling to  the hand  that they do in  preg-
 nancy, but are smoother and more uniformly
 increased  in size;  probably,  too, the in-
 creased  deposition  of fat  is general.   For
 the  first  few weeks after pregnancy, the
 abdomen is  flatter  than usual, that is, be-
 fore it begins to enlarge.  The countenance
 undergoes  an alteration, better known' than
 to be described; the features look sharper,
 and  the eyes larger than heretofore;   these
 appearances,  however, are  more strongly
 manifested  in  some women  than others.
 Among the earliest and best known of the
 symptomatic  disorders of  pregnancy  is
 nausea, with sickness.   This is  sometimes
 developed very early in the condition,  occa-
 sionally within the first few days,  but  more
 generally not for two or three weeks;  it  is
 most usual in the  morning,  on the female
 first rising, but, in some cases, is almost con-
 stant,  and  is then very distressing.  Tooth-
 ache  is  not an  unfrequent attendant  on
 pregnancy in all its stages.   Salivation,
 that is, a  constant  flow of saliva into the
 mouth, causing constant spitting, is another
 though not very common  symptom.   Irri-
 tability of  the bladder is common.  Heart-
 burn is most general in the latter stages of
 pregnancy, but may be suffered from in all.
 In many, there is no very definite  symptom,
 but a general feeling of unrest, with irrita-
 bility of temper, &c.   As  pregnancy ad-
 vances, other symptoms,  or symptomatic
 disorders show themselves; but, frequently,
 after the first few months, the health which
has been disordered, undergoes a remark-
able  change  for the better,  and  continues
good up to  the period of child-birth.   When
this change occurs,  as a sequence to symp-
toms of the first  stages  of pregnancy, and
the general symptoms of the condition re-
main, any doubt of the true state of the
case, if such has existed, may be laid aside
Some women never enjoy such regular gooo.
health, as they do during  the entire nine
months  they carry their child.  About the
sixteenth  week, a little before or after, the
symptom  of "quickening"  occurs.   This
is popularly, but  erroneously, thought to
indicate the period when the child first be-
comes endowed with life;  indeed, so fully
has this error been  embraced, that upon it
a principle of English law involving life and
death has been established.   The child is
living from the commencement of pregnancy.
The  symptom of quickening is  occasioned
by a sudden  change of the position  of the
womb, consequent upon its increase in vo-
lume ; after quickening, however, the move-
ments of  the child  are more perceptibly
felt.   Quickening is generally accompanied
with temporary sickness and faintness, and
with a sense of alarm for a short time. After
its occurrence, the  abdomen enlarges more
perceptibly.  Milk  is now, or even  before
this, found in the breasts, and the capability
of its expression from them may be taken
as a  corroborative, but  not as  an absolute
sign  of  pregnancy, for  it may occur inde-
pendent of  that  condition, and in  women
who  have already borne children, milk is
apt to linger in the breasts for a consider-
able period.  The nipple is sensibly enlarged
after conception, and, in most cases, is sur-
rounded by a more or  less coloured  ring,
the "areola,"  as  it is  called by medical
men.   In  some females,  especially thos?
with dark hair and skin, the areola is often
extremely deeply coloured, of  the deepest
brown—from this shade it is of every va-
riety, and in some  is  absent altogether;
it, therefore, is not an invariable sign of
pregnancy, for the reason, more especially,
that it is sometimes witnessed without that
condition.
  The urine  is found to be  in some cases
altered  during  pregnancy,  particularly in
the later  months.   If  a portion of the  se-
cretion is  allowed to stand four and twenty,
or six and  thirty hours, a greasy-looking
scum, with a cheesy smell, and  presenting
peculiar appearances under the microscope,
is found on the surface.  This does not show
in all cases.
  From  the remarks above  made, it may be
gathered,  that  although  there  are  many
signs  and  symptoms of pregnancy, there is,
probably,  not one which  can by itself be
depended  upon in doubtful  cases. In most
instances,  the combination  and perfect de
velopment of a certain number of the above
symptoms make the case  certain ;  but it 
                 PRE               4

m>iy happen, that there is much difficulty
in coming to a satisfactory conclusion, espe-
cially in the  earlier stages, and if  there is
any desire for concealment.  Medical men
are often unjustly blamed,  and now and
then laughed  at, for having, in the earlier
Btages of pregnancy, treated the disorders
thence resulting as ordinary ailments, cha-
racterized by the same symptoms.   Where
there is reason, as in the case of marriage,
to expect pregnancy,  this is not  likely to
be the case, for if the  examination of the
practitioner did not lead him  to the  fact,
it  is probable the female herself would in-
timate  the possibility of  her symptoms
arising  therefrom.   In those  cases, how-
ever, in which pregnancy can neither be ex-
pected nor suspected, especially if  there is
reason for an attempt at concealment, it
must be obvious to all  how little, compara-
tively, there may be to lead to  a conclusion
which is not  looked for; and, further, how
delicate  must  be  the  position,  and  how
guarded  the  opinions  of  a medical  man
so situated.   Were these  matters better
understood, and their  difficulties more ap-
preciated, his—often only apparent—errors
in these matters would be more charitably
regarded.
  By the fifth month of pregnancy, all the
symptoms have  for the most part become
evident, but there are disorders which more
generally show themselves during the latter
part of the period.   One of the most frequent
of these is costiveness, occasioned, doubt-
less, in part, by  the mechanical obstruction
caused by the  enlarged womb.  The legs
are apt to become  swollen, or their  veins to
enlarge, from  the  same cause  acting upon
the large veins within  the abdomen.  The
impediment to the flow of blood  also ex-
hibits itself in the  formation of piles, which
may cause much inconvenience during the
last months of pregnancy.
  Cramp in the  lower  limbs, caused by the
pressure of the enlarged womb upon  the
nerves,  often causes much annoyance, and
sympathetic nervous pains throughout the
body  are not uncommon.   Irritability  of
the bladder is apt  to be much  increased at
this  time; headaches,  too,  occur  in some
women, and may be of great severity, threat-
ening convulsion.   The above  is rather a
formidable array of the ailments from which
many pregnant women  may suffer, and some
unquestionably do suffer,  and  severely so ;
but very many ore free from the  majority
of them, except perhaps  in  slight  degree.
As  said above,  some  women  never  enjoy
such perfect health as they do when "in the
fumily way."
■20                PRE

   The proper management of the disorders
 incident to pregnancy will certainly do niuc*
 to alleviate their inconveniences.
   The first which generally requires atten-
 tion,  is the  sickness.   This  may in  some
 measure be prevented by attention  to diet,
 and by the avoidance of nil articles of food
 which were  known to disagree, or which
 are found  to disagree; for the rule which
 holds good in  the ordinary state does not
 always do so in pregnancy.   Effervescing
 draughts, made with soda and tartaric acid
 or lemon-juice, (see Effervescing,) are useful,
 and to each  may be  added from half to a
 whole teaspoonful of  sal-volatile.   A me-
 dical man  may possibly add a drop or two
 of the medicinal prussic  aid  to each dose,
 but this must be left to medical regulation.
 If there is much acidity, the bi-carbonates
 of soda, or potassa, or the fluid  magnesia
 will be found useful, and  at the same time
 check the vomiting.   In cases of debility, a
 teaspoonful of calcined magnesia, in three
 parts of a wineglassful of  sherry,  may be
 given with advantage.  In obstinate heart-
 burn and indigestion, with or without vomit-
 ing, a wineglassful of  the  infusion of co-
 lumbo,  in  combination with  soda,  potash,
 or magnesia, is  one of the best remedies,
 and may be  taken twice, or, if requisite,
 thrice a day.   In cases of extremely obsti-
 nate vomiting, creasote (see Creasote) may
 be tried.   The  tincture of  nux vomica,  in
 twenty-drop  doses, will very  likely prove
 serviceable,  but can  only  be  given  with
 safety by a medical man.
   The  costiveness of pregnancy  is often
 more troublesome to manage, as the usual
 convenient aperient pills  are inadmissible,
 on account of the aloes they contain.
 '  Castor-oil  is  the  most generally useful
 and safe aperient when it can be taken re-
 gularly, but  very many find  it  impossible
 to continue its  use for long, in consequence
 of the nausea  it occasions.  Those whose
 bowels  are very  easily moved,  sometimes
 find the finest olive or salad, oil answer well
 in tablespoonful doses.  Senna infusion may
 be safely taken in the pregnant state, and
 in those who  are of full habit, small, well-
 diluted doses of the neutral salts, such  as
 Epsom  or  Rochelle, are  extremely useful.
 Rhubarb and magnesia is a safe combina-
 tion, but generally too mild.   The  regular
 use of some  form of clyster, (see  Clyster,)
 which is found to be sufficiently efficacious,
 is one of the  best methods of regulating the
 bowels  in  pregnancy,  and  regulated they
 must be  in  some way;  there  is  nothing
 more likely, not only to increase the uncom-  •
 fortable sensations incident to the condition 
PRE
421
PRE
 itself, but to render delivery more difficult,
 and recovery from it more liable to accident,
 than ap habitually constipated condition of
 the  bowels.   When piles occur,  it is gene-
 rally in connection with costiveness.—See
 Piles.  Irritability of the bladder,  charac-
 terized by constant desire to pass urine, is
 sometimes very obstinate, and, in the later
 stages, in which it  depends on the mecha-
 nical  pressure  of the enlarged womb, very
 difficult to remove.  It is most likely to be
 alleviated by the use of a broad belt or band
 passed round the  abdomen, so  as  to give
 adequate mechanical support to the enlarged
 womb: indeed, the belt will not  only often
 relieve  the  above  troublesome  symptom,
 but will remove many of the other uneasy
 or painful sensations which accompany the
 latter stages of pregnancy.   When,  along
 with irritability of the  bladder,  the  urine
 is scanty, high-coloured, and deposits red
 sediment on standing,  ten-drop doses  of
 the  solution of potash taken in barley-water,
 twice or three  times  a  day, will probably
 give much relief.  In weakly and debilitated
 constitutions, ten drops of the tincture  of
 muriate of iron, in  a wineglassful of water,
 twice a day, will be  perhaps a  better re-
 medy.   Malt liquor is apt  to increase the
 urinary irritation,  and  must  therefore  be
 avoided; and, if stimulants  are required,
 wine and water, or weak brandy, or  gin and
 water substituted.
   Cramp, being dependent on a mechanical
 cause, is difficult to remove.  It  may, how-
 ever be  alleviated by the use of  the abdo-
 minal belt, and by strict attention to the
 state of the bowels and digestive organs;
 indeed, during  the  whole period of  preg-
 nancy, carefulness  and moderation  in diet
 will  be  found to influence  greatly  for the
 better many of the casual  inconveniences.
 —See Cramp.
   Swelling of the legs,  and of their veins,
 being dependent, like cramp, on mechanical
 causes, is to  be relieved by attention to me-
 chanical modes  of  treatment, particularly
 by care  that no unnecessary accumulation
 in the bowels adds  to the obstruction to the
 return of the blood through the veins, keep-
 ing the feet  and legs up as much  as  pos-
 sible;  bandaging, friction, &c. are all useful
 in relieving the  condition.—See Veins.
   The breasts should be left as free as con-
 sistent  with  appearance, and the  nipples
 especially attended  to.—See Nipples.   Head-
 ache, if continued and severe in pregnancy,
is  a  symptom  which must  not be  over-
looked ; it  may simply be owing to costive-
ness, or other slight temporary causes, and
be easily removable.  But if it is  continued,
         2L
 severe, accompanied with  flushing of the
 features,  fulness  or redness of the  eyes,
 throbbing of the  vessels of the head and
 neck,  medical assistance should be sought
 without delay; in the mean time, the  mea-
 sures  recommended in cases of threatened
 inflammation of the brain  are to be carried
 out more or less actively,  according to the
 severity of symptoms.   Convulsions some-
 times  occur in pregnancy:  a medical man
 must  see the case without a moment's un-
 necessary delay, if possible; but  if delay
 must occur, the patient  should  be managed
 as recommended under article Convulsion, or
 as directed in the remarks  upon  the  same
 affection  after delivery.—See  Child-birth.
 Fainting  is a symptom which may be of
 grave  import: its cause should be  investi-
 gated  by a medical  attendant;  in the mean
 while, it  must be  treated  as fainting gene-
 rally,  unless it is dependent on loss of blood,
 as in abortion.—See Abortion.
   Troublesome itching  eruptions  on the
 skin, sore and ulcerated mouth, are all apt
 to be  attendant on  the  condition  of preg-
 nancy ; they are  to be  treated in  the or-
 dinary method, (see Aphtha—Skin, Sec.,) but
 are often incurable, and  disapppear only
 after delivery.
   The  above  are  the  chief physical con-
 siderations connected with  this most im-
 portant  phase of  human   life;  but  this
 article would  be  very  incomplete  without
 some allusion to those moral disorders and
 requirements, which exert so powerful an
 influence over the  well-being and well-doing
 of both  mother and infant.   And  it may
 be remarked, that without attention to the
 physical  health of the body, the  moral
 atmosphere is much more liable to be dis-
 turbed, and that the mind is  much more apt
 to become irritable, especially if the digestive
 organs are disordered—as they often are—
 by the too  great indulgence in food, which
■is frequently thought to be not only allow-
 able, but  desirable in the  pregnant state.
 The same effect follows  the indolent habits
 so often indulged in.  Unless prohibited for
 cogent reasons,  regular  sufficient  exercise
 ought to be taken daily, up to the  time of con-
finement—nothing  tends  more to  preserve
 the health of  the  body  or  cheerfulness
 of the mind.  It  is not by  any means de-
 sirable for  a female, during pregnancy, to
 withdraw from the performance of the ordi-
 nary active duties of  life; the mental engage-
 ment resulting therefrom is most beneficial,
 and prevents the  thoughts from reverting,
 as they will do sometimes, to disagreeable
 or gloomy subjects.  At the same  time, a
 woman, during pregnancy*  ought to be freer 
PRE
4'2i2
PRE
from anj of the severer and more harass-
ing occm ntions, and, as much  as  possible,
kept from  mental uneasiness,  nnd spared,
as far as can be, those  things which excite
unpleasant emotions in the mind.   That the
infant is affected by the mental condition of
the mother is undoubted ;  she cannot be too
careful  in  keeping  guard over herself, not
for her child's sake solely, but for her own
in future years, when that child  may dis-
play tendencies which it  owes to the ma-
ternal  influence in the first period of its
existence.
  The  morbid longings of pregnancy have
been  already alluded  to.—See  Longings.
The probable extension  of pregnancy is im-
portant, if only as  a matter of convenience,
to enable the mother to  calculate and  make
the necessary arrangements for her confine-
ment; but its precise duration, or the  num-
ber of weeks or days required to  complete
its  term, not unfrequently becomes of the
most serious moment us a point of law, on
which may hinge the inheritance of fortune
or of title,  or the happiness and  fair fame
of families and individuals.  The generally
allowed calculation for the duration of preg-
nancy is forty weeks, or 280 days,  from the
last menstrual period;  but, evidently,  such
a calculation must be liable to some varia-
tion;  in law, all births  which  occur before
the thirty-eighth  week  of pregnancy are
considered  premature;  those after  the for-
tieth week, as protracted  cases.  It is cer-
tain that cases are frequently protracted
beyond  the fortieth week of calculation at
least, and  that these generally prove  male
births.
  The subject of false  pregnancy is of con-
siderable interest and importance: the fol-
lowing  remarks  from  Dr.  Montgomery's
Signs and Symptoms of Pregnancy are instruc-
tive, and may put some on their guard: —
"It is  necessary," says  the  author,  "to
notice a condition  of the female system of a
remarkable kind, most  frequently observed
about the turn of life, when the catamenia,
becoming irregular, previous  to their final
cessation, are suppressed  for a few periods,
and at. the  same time, the stomach being out
of order, nausea or vomiting is experienced,
the breasts enlarge, become sensible, or even
slightly painful, and sometimes a  serous or
sero-lactescent fluid exudes from the nipples
and orifices of  the  areolar tubercles.   The
abdomen grows fuller and more prominent,
especially in women of full habit  and con-
stitutionally  disposed  to  embonpoint;  and
the abdominal enlargement progressively in-
creases, partly from deposition of  fat in the
integuments and  in the omentum, but still
more  from distension of  the  intestines  by
flatus, which, passing from one part to an-
other, communicates a sensation  like that
produced  by the  motion of a foetus.  The
nervous system is generally much disturbed
and the  woman feels convinced  that she is
pregnant—an idea which, at the time of life
alluded  to, is cherished by the sex with ex-
traordinary  devotion, and relinquished with
proportionate  reluctance,  and  not  unfre-
quently  at the  end of the supposed gesta-
tion, the delusion is rendered complete, and
almost assumes the character of reality,  by
the occurrence  of periodical pains strongly
resembling labour."
  The occurrence of abortion  during preg-
nancy, and the precautions to  be adopted
when  the tendency exists, or indeed  at any
time,  having been already treated  of under
the head  of Abortion,  it is unnecessary to
reiterate them here.
  Refer to Abortion—Child-bed—Pelvis, Sec.
  PREMATURE  BIRTH.—One which oc-
curs before the thirty-eighth week of preg-
nancy.  In  most cases  the occurrence  of
premature confinement  is to be sedulously
guarded against, for it  cannot be  expected
that  children  generally, born  out  of due
time,  can  be as strong as those whose birth
is  in  every respect regular.   Cases, how-
ever,  do occur in which, both on account of
the mother's safety and as the only possible
chance of having a living child produced at
all, it is  necessary  to induce  premature
labour.—See Pelvis.   The induction  of pre-
mature  labour can, of  course, only  be en-
trusted  to the  hands  of the  skilful.—See
Child-bed—Pregnancy, S$c.
  PRESCRIPTION.—A medical  prescrip
tion is  the  form, with  directions,  in which
a medicine, or medicines, are  ordered, or
" prescribed," by a medical man.  In  Eng-
land,  both prescriptions and directions are
usually  written in Latin.  In Scotland, [and
in the  United  States,]  the directions  are
very generally given in English ; and though,
perhaps, the method is not so consistent aa
that  which preserves  the  same  language
throughout, it is safer and more convenient.
In  former times prescriptions  were much
more complicated than  they are now, gene-
rally  at least;  and certainly the simplicity
may be  regarded as  a sign of  increased me-
dical  knowledge, and of greater confidence
in the action of medicines.  Some persona
even  contend  that in  prescriptions there
should be no intermixture of medicines, but
that  one  only should be given  with a  cer-
tain definite object,  and allowed to  operate
unembarrassed  by the presence of others.
It is  not difficult to show how materially 
PRE               423               PRE
  this would interfere with the efficiency of
  practical medicine,  at least in the  present
  state  of our  knowledge.   Many  persons
  seem to imagine that because a medical man
  can sit down and  write off a prescription in
  a few  minutes, it is  quite as easy for him to
  give it  when  requested.   This erroneous
  impression does not extend so much to phy-
  sicians practising only as such, but it often
  operates to the*injury of the general practi-
  tioner, who is  not unfrequently, when per-
  sons are leaving his vicinity either tempo-
  rarily or permanently,  asked  for  his pre-
  scription of medicine they have been taking,
  while at the same time there is but little idea
  of its  being paid for.  A moment's reflection
  will show that this prescription is as  much
  a work of  skill, and the result of previous
  labour,  as  the design  of  the  artist, and
  that, moreover, in furnishing it, the medical
  man is  probably  interfering with  his own
  remuneration at some future time, when the
  prescription is made to stand in lieu of his
  advice.  Some general practitioners refuse
  their prescriptions altogether; this they are
  not justified in doing; but if they do furnish
  them, they are quite entitled to their guinea
  fee.  Another  error with  respect  to pre-
  scriptions is, that one, having been found of
  service at  some former time, is very gene-
 rally had recourse to  at another; in  some
 few cases the  act  may not  be  followed by
 any particular injury, but, generally, it is a
 very foolish system, and persons who can
 afford to fee a physician, but prefer, instead,
 to take advantage  of some old prescription,
 deserve to pay in a little inconvenience for
 their stinginess.
   PRESERVED PROVISIONS.—The ten-
 dency  of all dead  organized matter  which
 contains moisture  is, at  ordinary tempera-
 tures, to undergo chemical change, (see Pu-
 trefaction,)  or, in other words,  the  various
 vegetable and  animal  products,  when de-
 prived  of life, decay.  Yv'hen these products
 are such as are employed  for food, it  of
 Course  becomes a matter  of considerable
 importance to  counteract this tendency to
 decomposition,  by  which the articles  are
 speedily  rendered  useless.   It becomes  of
 importance  to preserve them as perfectly,
 and for as long  a period  as  possible.  The
 preservation of provisions may be effected-*—
 1st. By  cold, that is,  by keeping them  at a
 temperature below  that at which  putrefac-
 tion takes place.  2d. By heat, which acts
 by hardening and coagulating the albumen
 and  other  constituents  so  that  they are
more  disposed  to resist  chemical  change,
or by heat and  dryness combined, so  that
the water, which is  essential for the  pro-
 cess of  putrefaction, is removed.   3d. By
 the use  of certain agents, or antiseptics
 (see Antiseptics,) which impart the power of
 resisting decomposition;  and 4th.  By ex-
 cluding the action of the atmosphere, the
 oxygen of which is requisite for the putre-
 factive process.
   The  preservation of  articles of food by
 keeping  them at a low temperature is suffi-
 ciently well known; and among such nations
 as the Russians, whose  climate during the
 winter months is one of unvarying frost,
 the preservative  action of cold  is  largely
 taken  advantage  of.    Cattle, poultry, &c.
 are killed  at  the  commencement of frost,
 allowed to become frozen throughout, and
 in this condition are brought to market  at
 the large winter fairs;  fish are treated  in
 the same way, and are  thus  preserved for
 months in a perfectly fresh and wholesome
 state;  provisions thus preserved, only re-
 quiring the  precaution  of being gradually
 thawed  before  use, by immersion  in cold
 water.   In this country  ice, as all know, is
 now largely used  to pack salmon, and fish
 generally, in summer  time.  This mode of
 preserving  provisions by means of  cold  is
 evidently, however, capable of but  partial
 application, and is usable only under limited
 circumstances.
   The  action of an elevated temperature,
 such as is employed in cooking food, must
 be regarded as retarding rather than com-
 pletely  withstanding  putrefaction;   it  is
 therefore inapplical ie,  except  as a  mere
 temporary expedient.   When heat is com-
 bined with dryness, it  acts much more  per-
 fectly as  a preservative.   This  is exempli-
 fied  in the preservation fof  years  of the
 bodies of men and animals who  have pe-
 rished in the African  deserts; and also in
 the practice, more especially of the Indians
 and  others of the South  American pampas,
 who preserve their beef  by  cutting  it in
 strips and hanging it to dry in the hot sun in
 a  current of air:  preserved in  this way it
 will keep  for a considerable time.
   In the case of vegetables, which contain
 so large an amount of water in proportion
 to their solid and nutrient material, the pro-
 cess  of  drying is peculiarly applicable, and
 seems likely to be largely employed  as the
 means of furnishing fresh  vegetable  food
 for ships, in a compact  and easily carried
 form, when in addition to the desiccation,
 compression is also resorted to.  This double
 process  "appears recently  to have been put
 into  execution  with very considerable suc-
cess, under the patent of M. Masson,  head
gardener  to  the  Horticultural  Society of
Paris.   This  gentleman  has  succeeded in 
PRE
4'24
PRE
preserving in a very perfect manner various
descriptions of  vegetables and  fruits;  the
substances  thus preserved  are  dry and
shrivelled, contain  but  tittle water, and it
is evident from their appearance that a very
essential part of the process of preservation
consists  in  the abstraction  of the  water
which forms so very considerable a portion
of the weight  and bulk of nearly  all vege-
tables  and  fruits.  When vegetables thus
prepared  are immersed in water  for some
time they swell up,  become soft and tender,
and resume, to a great extent, the appear-
ance, colour, and flavour proper to them in
the fresh state.  M. Masson has  managed
to preserve completely, spinach,  Brussels
sprouts,  cabbage,  beans,  peas,  sliced car-
rots, parsnips, potatoes, apples,  &c.
  " It  is  stated that a cubic yard of these
dried and compressed vegetables contains as
much as  16,000 rations, and that they are
of better flavour and much cheaper than
the vegetables preserved in canisters."
  The  preservation of  provisions by their
impregnation with  antiseptic  agents,  such
as salt,  is perhaps more  extensively prac-
tised than any other method.   Salt, sugar,
spices, vinegar, spirit,  and fumigation  by
burning wood, which  is in fact preserving
by means of creasote, are the most common
preserving methods, and for many purposes
answer perfectly, both as regards the agree-
ability, and, within  certain limits of use, the
wholesomeness of the food to  which they
are applied. They have, however, the draw-
back of being,  in themselves, partly chemi-
cal additions to food, and  also of inducing
chemical  changes,  which  modify,  at least,
the quality ano> digestibility of the aliment.
Moreover, salt extracts (" draws out") from
meat some  of  its  most important nutrient
constituents.   Liebeg, in  his Chemistry of
Food, remarks—" It  is universally known
that in  the salting  of meat,  the flesh is
rubbed  and sprinkled with  dry  salt,  and
that where the salt and meat are in contact
a brine  is formed, amounting  in bulk to
one-third of the fluid contained  in the  raw
flesh.   I have  ascertained that  the brine
contains  the chief constituents of  a con-
centrated soup, or infusion of meat,  and
that, therefore, in the process of salting, the
composition of  the flesh is changed ;  and
this  too,  in a  much  greater degree than
occurs in boiling.   In boiling, the  highly
nutritious albumen remains in  the mass of
flesh; but in salting,  the  albumen is sepa-
rated from  the flesh ;  for when  the brine
from  salted meat  is  heated to  boiling,  a
large quantity  of albumen separates as  a
coagulum.
  " It  is  now easy  to  understand  that  in
the salting of meat, when this is pushed  so
far as  to produce  the  brine above  men-
tioned, a  number of substances are  with-
drawn  from  the  flesh,  which are essential
to its  constitution,  nnd  that it  therefore
loses in nutritive  quality in  proportion  to
this  abstraction.  If these  substances be
not supplied  from other quarters, it is ob-
vious that a part of the fle#h is converted
into  an  element  of respiration—certainly
not conducive to good health.   It is certain,
moreover, that the health of a man cannot
be  permanently sustained   by means  of
salted meat,  if the quantity be  not  greatly
increased, inasmuch as it cannot perfectly
replace, by the substances it contains,  those
parts of the  body whicli have been expelled
in consequence  of  the  changes of matter;
nor can it preserve in its normal  state the
fluid distributed in  every part of the body,
namely, the juices of the flesh.  A  change
in the gastric juice,  and consequently in
that of the  products of the digestive pro-
cess, must  be  regarded as  an inevitable
result  of  the long-continued use of salted
meat;  and  if, during  digestion,  the  sub-
stances necessary to the transformation of
that species of  food be taken from  other
parts of the organism, these parts must lose
their normal condition."
   From the  above objections, the process of
preservation by exclusion of  the action of
atmospheric  air  is free; it does not preserve
by inducing  change, but, like cold,  by pre-
venting it.   This  mode of preserving food
is yearly assuming more importance and
being  more  largely practised.  J he action
of the  atmosphere may be prevented in
various ways, as by covering  the  articles
with melted fat, &c.; but the most perfect
method, and that which is most largely re-
sorted to, is the  enclosure  of  the  food in
cases from which the air is then expelled,
and  which  are  made so impervious  as to
prevent the access of air;  upon the perfec-
tion of the  air-excluding  process,  both at
the time and permanently, depends entirely
the preservation of the article.
   The following description  is taken from
the Lancet:—"The article to be preserved
is placed semetimes in the raw state, but
generally cooked, in a  tin canister, the lid
of which is soldered down, but is perforate 1
with a small aperture or pin-hole.   It  i3
then subjected to the action of either steam,
boiling water, or a muriate  of lime  bath,
until the contents of  the canister, if not
previously dressed, have become about two-
thirds cooked.  The aperture in the  cover
is then closed, and the  canister and its con- 
                 PRE

tents are once more submitted for a shorter
period—that is,  until the  article  is  com-
pletely dressed—to  the operation of  heat.
As soon as it has become  cold the  canister
is covered over with a coating of paint;  its
preparation is then complete, and it is then
removed to the proving room.  The proving
room is simply an apartment, the tempera-
ture of which has been raised to the degree
most favourable to decomposition.   If the
operation has been well performed, the top
and  bottom of the  canister, as also in some
cases the  sides, will have fallen  in or have
collapsed to some extent; this indicates the
exhaustion of the air within, and is regarded
by the manufacturer as a  tolerably correct
proof that  the  process has been properly
conducted.   If,  however,  after  some  days'
exposure  in the proving room,  the top and
bottom of the canister first become flat and
subsequently  even convex, it is a  certain
sign  that the contents have  not been well
cured, and that thej* are not in  a condition
to keep for any length of time:  such canis-
ters have  therefore either to be rejected, or
else subjected to the  process over again.
*  *  *  It should be known that it is not
only boiled provisions which may preserved
by the above process,  but roasted also, with
but a little extra care."
   The preparation and employment of pro-
visions preserved in a fresh condition are
important  both  in a  sanitary  and in  an
economic point of view, independent of the
means of luxury which is  thus afforded—it
might be,  and will probably be, a  cheap
luxury.
   In all situations, as on board  ship, where
access to  fresh  provisions in their usual
state is necessarily curtailed or denied, the
preserved provision store is most invaluable
as a  means of preserving health;  and those,
such as emigrants, who meditate a long sea-
voyage, unless they are satisfied that the
ship they embark in is well supplied with
fresh preserved  food,  ought, if possible,
to have a small  private store.  The recent
notorious disclosures in connection with the
preserved meats provided for the use of the
navy, might prejudice some against this
description of food ;  but  there  are  many
establishments at which preserved food can
be procured of  the  most excellent  kind;
and  there is, perhaps, some reason to sup-
pose that in the  case of the navy provisions,
the evil may have resulted partly in conse-
quence of  careless  stowage.  This ought,
therefore,  to  be guarded against—an acci-
dental blow, or corrosion of the solder  by
damp, which makes an aperture no larger
        2 l 2
!5                PRE

 than a pin-hole, being sufficient to spoil the
 entire contents of a canister.
   As regards the  economic advantages to
 be derived  from  the  employment  of pre-
 served provisions, it is sufficient to advert
 to  the  facts, that in  South America, the
 cattle are slaughtered for the sake  of their
 hides, horny parts, bones, &c, and-that the
 flesh is  wasted;  that in Australia,  sheep
 have been boiled down for the sake  of their
 tallow  alone.   How  great  would  be  the
 boon to  England, could this locally super-
 fluous flesh  be preserved for use!
   Charcoal, from  its  remarkable power of
 absorbing  gases,  is sometimes used   as  a
 preservative in which  articles  of food are
 packed.  Lastly, such preparations as the
 "Patent Meat  Biscuit," manufactured in
 the United States, which gained one of the
 medals at the Great Exhibition, offer other
 forms in which nourishment may  be pre-
 served in a  concentrated state.   " This new
 and useful  preparation of  concentrated
 meat and bread can be prepared for use in
 the shortest time as a soup.   One pound of
 this meat biscuit contains the nutriment of
 five pounds  of the best beef, the extract of
 which  is combined and baked with the
 finest flour,  forming the most portable and
 convenient  diet  known.  It  is eminently
 adapted  for  emigrants, travellers,  and for
 ordinary use in families, &c.  Its  easy di-
 gestibility and highly nutritious properties
 render it very valuable for invalids and con-
 valescents,  and generally for  use  in hos-
 pitals."  It is sold at the  agency,  2 St.
 Peter's  Alley,  Cornhill,  [and in the large
 cities in  the United States.]
   Extract  of beef, said to  contain  in one
 ounce  the  nutriment  of a  pound,  as pre-
 pared by Mr. Robertson, of Manchester, is
 a somewhat analogous preparation.
   Pemican, which " consists of the  mus-
 cular fibre of beef, baked  and  reduced  to
 a coarse powder," is  another form of pre-
 serving  animal food worthy  of attention.
 For much  of the  information  contained in
 the above article,  the author is  indebted to
 the Lancet papers on the subject.
   Refer  to Antiseptics.
   PRESSURE. — The effect of continued
 pressure upon the living body  may be re-
 garded  either as a cause of disease or as a
 curative agent.
   The effect of  pressure  in  altering the
 shape, &c. of even the hardest portion of
 the  animal  frame, is well known.   The sa-
 vage Carib employs it to flatten the skull of
 his children into  a hideous  deformity,  by
 him thought  beauty ; and  the civilized fe-
4! 
P R E
421;
p It I
male  too often has  recourse to  it,  with
equalW false ideas of proportion, to mould
the ribs at her waist into a state of perma-
nent conti action.  Both instances show how
even the bones may be affected by pressure
from  without,  applied over  an extended
surface.  When  the surface of pressure is
small the bone is  absorbed, as evinced  by
the hollow often formed in the breast-bone
of  shoemakers  who  have  for many  years
pressed  the  " last" against the  one  spot.
The effect of pressure upon the surfaces of
the body, if  long  continued,  is to  cause
thickening, as seen in the horny hand  of the
labourer, or in the  corn from the tight  shoe.
When, however, pressure  is  too suddenly
and continuously npplied to surfaces unused
to it, especially in debilitated states of body,
instead of giving  rise to  thickening  it is
apt to occasion mortification, or at  least
ulceration.   This  effect of pressure is one
of  the most serious  complications of most
long-continued illnesses, in which the  diffi-
culty, and often almost the impossibility, of
moving a patient, or at least of preventing
continued pressure upon the most prominent
points of the body,  are a source of  much
suffering  on the one hand, and of anxiety
on  the  other.  In a  long  case of  fever it
may happen, especially if there is neglect,
and, at times, under  even  the most atten-
tive management, that ulcerated or "slough-
ing" spots form on the back of the  head,
the  tips  of the ears, the points of the
shoulder-blades, between the hips, &c.  To
alleviate these  effects there  are  the va-
rious  inventions of spring apd water beds,
elastic  cushions, &c.—See Bed, Elastic—
Fever, Sec.
  The effect of pressure, as a curative agent,
is often  valuable.   Thus,  when thickening
of a part, or of a limb, has followed inflam-
mation, the  continued and even pressure of
a bandage, or of an elastic  covering, will do
much  to hasten its  reduction.   Tumours,
such  as  bronchocele, will disappear under
well-applied   pressure.    Bleeding  which
threatens life, may be stopped by pressure
properly applied, (see Artery;) and  lately
the power of pressure has been used—espe-
cially in Dublin—as a remedy in  aneurism,
acting by interrupting the circulation of the
blood  through the vessel  with which the
aneurismal tumour is connected.  The con-
tinued pressure of the atmosphere upon the
surface of our bodies  at ordinary elevations,
by its variation, as indicated by the  changes
of  the   barometer,  probably  exercises  a
greater influence upon our health and sen-
sations  than is generally  suspected.  The
distressing  effects  experienced  from  the
' diminished  pressure, in  part at  least,  by
 those who  ascend  great heights, is  well
l known.—See Air.
j   PRICKLY HEAT—Is  a  peculiar  affec-
 tion  of  the skin, which  affects  those who
1 live  in  hot climates, especially  when first
I resident, and which also  occurs in hot Bum-
 mers  in this country.   The following  de-
 scription of  the  late Dr. James  Johnson,
 from his experience of the affection in India,
 is often  quoted:—"The  sensations arising
 from  prickly heat are perfectly  indescrib-
 able, being compounded  of  pricking, itch-
 ing,  tingling, and many other feelings for
 which I have no appropriate appellation."
 " It is usually, but not invariably, accom-
 panied by an eruption of vivid red pimples,
 not' larger  in  general  than a pin's  head,
 which spread over the breast, arms, thighs,
 neck, and occasionally along the forehead.
 This  eruption  often disappears   in  great
 measure when we are sitting quiet, and the
 skin  is  cool; but no sooner do we use any
 exercise that brings out a perspiration, or
 swallow any warm or stimulating fluid, such
 as tea,  soup, or wine, than  the pimples be-
 come  elevated,  so as to  be  distinctly seen,
 and but too distinctly felt."
   In reference  to the imagined dangers of
 repelling this eruption,  Dr. Johnson  con-
 tinues,  "Indeed, I  never saw it even re-
 pelled by the cold bath, and in my own case,
 as well as in many others, it seemed rather
 to aggravate the eruption and disagreeable
 sensations, especially during the glow which
 succeeded immersion.   It certainly  disap-
 pears suddenly, sometimes on the accession
 of other diseases, but I never had reason to
 suppose  that its disappearance occasioned
 tbem.  I have tried lime-juice, hair-powder,
 and a variety of external applications, with
 little or  no benefit; in short, the only means
 which I  ever saw productive of  any good
 effect in mitigating its violence, till the con-
 stitution got assimilated to the climate, were
 light  clothing,  temperance  in  eating  and
 drinking, avoiding all exercise in  the heat
 of the day, open bowels,  and last, not least,
 a determined resolution to resist with stoical
 apathy its first  attacks.   To sit quiet and
 unmoved under its pressure, is undoubtedly
 no easy task ; but if we can only muster up
 fortitude enough to bear with patience the
 first  few minutes of  the assault, without
 being roused into motion, the enemy, like
 the  foiled tigers, will generally sneak, and
 leave us victorious for the time."
   PRIVIES AND WATER-CLOSETS.  -The
 faulty  regulation, insufficient  nupply,  or
 even total want of these  necessary append-
| ages to  every habitation, are  the  sources of 
P RI                427               PRO
 some of the greatest nuisances, especially of
 our large towns, are most fertile sources of
 disease in crowded localities, and have pre-
 sented, and still present, great difficulties in
 the way of sanitary reformation.  In country
 places, the difficulty of procuring a sufficient
 supply and proper arrangement of the water
 requisite  for a closet, renders privies almost
 matters of necessity.   This, under the  cir-
 cumstances, is a matter of less consequence,
 provided these places are situated at  a suffi-
 cient distance from the house, and are kept
 properly  regulated and  cleansed; though,
 too, they  may, be rendered almost as conve-
 nient as water-closets, [by means of  a  pro-
 perly constructed pan, such can be obtained
 from most of the  plumbers  in the  United
 States.] It is desirable, from time to time, to
 throw into the cesspool of a privy some  dry
 absorbent material, such  as earth, lime, &c.
 If  peat charcoal could  be more  easily  pro-
 cured,  it  would probably be found the  best
 material for this purpose.  These, and simi-
 lar places, should  never  be cleansed out in
 warm weather ;  if they  become offensive,
 chloride of lime in some form should  be em-
 ployed about the place, or thrown into  the
 cesspool,  until cool  weather permits   the
 removal of the nuisance.
  In towns  and  crowded places,  privies
 should  never  be permitted, but efficient
 water-closets,  with well-constructed   drains,
 (see Drainage,) substituted ;  and  one  should
 be  attached to every house, both for  the
 sake of cleanliness and of decency.
  The  evils  which result from  the  inade-
 quate  provision of the  accommodations in
 question,  in  the  more crowded and  poorer
 districts  of  "large towns  and populous
 districts," are thus alluded to by the "Com-
 missioners of Inquiry," in the Report pub-
 lished in 184").  After describing  the great
 deficiencies in such  places as Nottingham,
 Manchester,  Ashton,  and  London, it is  re-
 marked, " It is unnecessary to dwell upon
 the extensive injury to health, decency, and
 morals, which  such defective arrangements
 inevitably entail."  These places being re-
 sorted to by great numbers, and under no
 regulations  as to cleansing,  are  constantly
 in the most disgusting state of filth, and are
 the causes of as great injury to the  health
 of the inhabitants in their  immediate  vi-
 cinity, as  any of the numerous  influences
 that we have already brought under notice.
 But the injury is not alone confined to the
health  of the occupants—the owners  of the
houses  also suffer  great losses.   Many in-
stances occur where  the walls  of the  ad-
joining houses are constantly wet with fetid
fluid,  which  frequently affects  the  atmo-
 sphere of the rooms, so as to render it im-
 possible  to keep food for one single night
 without  its becoming tainted.   The deteri-
 oration of property from  these causes is
 very considerable. Added to this, a constant
 loss is incurred  by the  inability of tenants
 to  pay their rents, from sickness.   It is
 commonly alleged that it is useless to im-
 prove the houses  inhabited  by the  poorer
 classes, because there are no public regula-
 tions  to  enforce attention to their constant
 cleanliness, and that, in the absence of such
 arrangements, they would soon recur to
 their former condition.
   These   allegations  have  probably  been
 drawn from the fact of  such large numbers
 of the poorer classes  being found to  exist
 in  their  present  miserable  abodes, where
 they are obliged  to tolerate  the scenes of
 filth around  them, to which  they  become
 inured by habit, and continue to live among,
 from  the difficulty of finding  better  resi-
 dences.  It is certain that,  under such cir-
 cumstances,  better habits  cannot  be ac-
 quired, nor, if in existence, are they likely
 to be  retained.  It cannot be denied, that
 the poorest classes would most  readily ap-
 preciate  any improvement which affords the
 means of  speedily removing  the  present
 accumulations of filth  from  the vicinity of
 their  houses, and  which  would  free  them
 from  their  injurious  consequences.   Such
 amelioration of their dwellings, by improv-
 ing their health, and enabling them to fellow
 their employments with fewer interruptions
 from sickness, would also increase the means
 at their disposal for paying their rents,  &c.
  Refer to Drainage.
  PROGNOSIS—Is the opinion of a medical
 man respecting the ultimate issue, (possible,
 probable, or certain,)  of  a case  of disease.
 The formation of  a  prognosis  involves a
 great variety of considerations. Independent
 of the nature of the disease  itself, the con-
 stitutional tendencies of the patient, here-
 ditary  or acquired, must be  duly weighed:
 the age,  the mental condition, the external
 circumstances, and many others have all to
 be taken into account.  Thus, for instance,
 in a person threatenened with consumption,
 who has  lost relatives,  more or less,  from
 the disease,  the prognosis must be  a more
 unfavourable one than when the disease is
 apparently—if we  may so speak—accident-
 ally developed; or, again, in a case  of dis-
ease of the heart, occurring in a man forced
to engage in bodily labour for his bread, the
prognosis will be of a graver character  than
when the same disease affects a man at ease
as regards this world's goods.
  When  a medical man sees a patient, if 
x               PRO
                 PRO                4i

the case be at all serious, either  the  indi-
vidual or surrounding friends are usually
very anxious for a prognosis, an opinion, as
to the ultimate issue of the case.  In many
cases it is  possible to give  this decidedly
and  at  once, and if it can be, it  ought to
be done;  but, in many cases, it is impos-
sible to  come to any conclusion, and at least
a  second  visit, if not  more, must be paid
before a just idea of the termination can be
approached.
  Some medical  men  are in the habit of
giving, generally, a bad prognosis, that is,
they express their opinion of the worst pos-
sibilities.   This may arise  from  constitu-
tional tendency to regard the dark  side of
matters, but more generally it originates in
a selfish wish to serve their own reputation ;
if  the patient dies,  they  are right; if  he
recovers,  they have the more credit in the
cure.   However  politic  the  course,  it is
neither  considerate  nor honest, for it sacri-
fices the feelings of relatives, at least, to a
Belfish expediency, and causes unnecessary
anxiety.  In some  measure,  however, the
public are themselves  to blame in the mat-
ter, from the little consideration often shown
to a  medical man if his prognosis of a case
turns out to be  erroneous,  especially if a
favourable opinion has been given and  an
unfavourable event  ensued.   It ought to be
remembered that even in health, day by day,
sudden  chang'es to severe and dangerous ill-
ness, or to  sudden death, are  not unfre-
quent ;  and if in health, how much more in
illness ?—changes which it is impossible for
the most  skilful and observant to foresee.
Again, a medical man is  often most unde-
servedly censured in another way.   A case
is perhaps submitted to his  examination at
an  early  stage,  before  its  more  marked
characteristics  have shown themselves, and
he perhaps  gives an encouraging opinion;
after a  time the  case  gets worse, more se-
rious symptoms  are  developed,   another
opinion  is taken, and this  time the sentence
of the first  consulted is reversed;  the last
given prognosis proves correct, and, too often,
without reflecting upon the  altered aspect
of the case in the one and in the other ex-
amination,  the  gentleman  first consulted
falls under the  unjust  imputations of those
connected with the  patient.   The case is a
common one.
  The habit of giving a favourable prognosis
when not justified by the  state of  the  case,
cannot  be too strongly condemned.   It is
often practised with a view to sustain the
spirits of  the patient and others; but while
every reasonable cheerful  hope is to be held
out,  if death must close the  case, for the
sake of  higher  considerations  than those
of this world, for the soke of sparing the
aggravated shock which must fall upon rela-
tives when the fatal truth in all its intensity
and all its nearness falls upon them, a tem-
pered it may be, but yet a true prognosis
should be given.
  Refer  to Death—Diagnosis—Opinion,  Me-
dical.
  PROLAPSUS—Is  a  slipping  or falling
down of any internal portion of the body,
so that  it appears externally.  The term is
most commonly used with reference to pro-
lapsus ("falling  down") of the  womb, (see
Womb, Sfc.,) and  also to  prolapsus of the
lower gut at the fundament, "coming down
of the bowel," as it is  often called.   This
accident is not uncommon in childhood and
in the aged, but  occurs at any age, fre-
quently in connection with  piles.  Coming
down of the bowel often happens from chil-
dren being permitted to sit too  long on the
chamber vessel  after a movement of the
bowels;  it is often,  too, a  consequence  of
irritation from worms or from stone in the •
bladder.   The extent to which  the gut is
protruded  varies  from  the  slightest  pos-
sible  to  a considerable length, causing a
red or purplish  swelling, according to the
length of time the protrusion has existed.
  If quickly attended to, the  protrusion is
usually easily returned  by pressure exerted
by the  fingers,  through the medium  of a
piece of  greased  cloth,  the  person being of
course laid in the horizontal posture.  If,
however, the protrusion has been neglected,
and allowed to continue unreduced for some
hours, it becomes in a measure strangulated,
congested  with   blood,  and  consequently
swollen,  and is  then sometimes very  diffi-
cult  to  return.  In such a case a medical
man will probably be required, and, indeed,
ought to be called ;  in  the  mean while, by   (
gently squeezing the neck of the  protrusion,
and exerting gentle  pressure  upward, hav-
ing previously freely applied grease of some
kind to it, efforts may be made to effect its
return.   When protrusion of the gut occurs
habitually, a medical man  should investi-
gate the cause, so that any source of irrita-
tion may be removed ; the bowels should be
kept perfectly lax, so as to prevent strain-
ing,  and in  children, especially, too  long
sitting  at  stool  prevented, the  seat being
made so high that the legs cannot touch the
ground.
  Cold injections and astringent lotions in-
jected into the bowel are often useful.  Ai
recommended by Mr. Vincent, a small quau-
tity of a solution of one grain  of sulphate
of iron  to the ounce of rain or  distilled 
PRO               429               PRU
water may be thrown into the bowel after
each relief, and retained.   Bathing the loins
regularly with cold water will be of service.
  Some cases of protrusion depend on causes,
such as iuternal piles, which require a sur-
gical operation for their removal.   Persons
liable to  prolapsus of the gut, often expe-
rience much comfort from wearing the form
of bandage,  fig. cvii.   This consists of a
                  Fig. cvii.
sponge (1) which must be moistened—or of
some soft or smooth hard material, which is
applied to the fundament, and kept in place
by means of straps, which are best made
of elastic material;  the strap (2) fastening
behind and (3, 3) in front to a belt passed
round the body. A bandage something simi-
lar to the letter T—article Bandage—will,
with the requisite pad, answer the purpose.
  Refer to Piles—Rectum, Sec.
  PROSTATE  GLAND.—See Bladder.
  PROTEINE.—A name given to  the sup-
posed basic constituent of the animal prin-
ciples—albumen, fibrine, and caseine.  Much
controversy has taken place respecting it.
  PROTRUSION—Of  various  portions  of
the body may  take  place  either  through
natural or artificial openings.—See Prolap-
sus—Rupture, Sec.
  PROUD-FLESH. — See  Granulation—
Ulcer, &c.
  PROXIMATE  CAUSE—In  medicine,  is
the most immediately traceable cause  of
the symptoms of a disease; thus, in British
 cholera, [cholera morbus,]  the proximate
 cause  of  the  vomiting  and purging is the
 irruption of acrid bile in undue quantity into
 the stomach and bowels; the remote cause is
 that which gives origin to the superabund-
 ance and acridity of the bile, probably excess
 of carbonaceous compounds in the  blood.
   PRUNES—The dried fruit of the common
 plum  contain a considerable  quantity of
 sugar,  and when  cooked,  as  stewed,  are
 wholesome, and at the  same time  laxative.
 —See  Purgatives.  Unless softened by stew-
 ing, prunes are  indigestible.
  PRURIGO—A papular  affection  of  the
 skin, attended with troublesome itching.—
 See Skin.
  PRURITUS.—Itching of  the skin.—See
 Skin.
  PRUSSIC ACID, or  Hydro-cyanic Acid
 —Exists  in  the distilled waters,  princi-
 pally of the peach tribe, as  of the bitter
 almond, but is  usually formed artificially.
 It is  a compound of the three elementary
 gases,  nitrogen,  hydrogen, and carbon.   Al-
 though called an acid, its acid properties
 are  but feebly  developed.  The  odour of
 hydro-cyanic acid is powerful  and  peculiar,
 and pungent to the nostrils; it is often com-
 pared  to that of the bitter almond.   Pure
 prussic acid is sometimes  prepared,  but
 quickly decomposes ; it is usually  met with
 in a diluted form, and that which is used in
 medicine is, or ought to be,  made of  a cer-
 tain regular strength.   The use of medici-
 nal prussic acid in  the hands of a medical
 man are most valuable; it acts as  a power-
 ful  sedative, allaying  pain,  sickness,  and
 nervous irritability ; it is, too, a most  ad-
 mirable addition to lotions  for various pur-
 poses ; but in any form could not safely be
 had recourse to as  a domestic  remedy.
 Poisoning by prussic acid is, unfortunately,
 not of  rare occurrence, and, in most  cases,
 it destroys life so rapidly that little  if any
 time is afforded  for the employment of anti-
 dotes—at  least  by a  medical man; it is,
 therefore,  important  that the best remedies
 in such cases should be immediately had
 recourse to, although  too  often, from  the
 powerful nature  of the poison and the quan-
 tity swallowed, all is in vain.
  When a  large dose of prussic acid has
been swallowed,  "the symptoms may com-
mence  in the act of  swallowing, or  within
a few seconds. It is rare that their appear-
ance is delayed beyond  one or two  minutes.
When the patient has been seen at  this  pe-
riod he has been perfectly insensible; there
is convulsive respiration at  long intervals,
and he appears dead in the  intermediate
time.   The breath  commonly exhales a 
PSO
430
PUL
strong odour of the acid.   The finger nails
have been found of a livid  colour, and the
hands firmly clenched.  When a small over-
dose has been taken, the individual has first
experienced  weight and  pain  in  the head
with  confusion  of  intellect, nausea, and a
quick pulse; although these symptoms are
sometimes slow in appearing.   It  has  been
stated that those who die  from  a large dose
of this poison uttered a shriek or  scream—
the fact is very doubtful."*
  Many  antidotes have been proposed for
employment in cases of poisoning by prussic
acid, but few of them are likely to be avail-
able in so sudden and, generally, so unlooked-
for  an emergency.  The cold affusion—that
is, water  as  cold as it  can be procured—
dashed freely over the  body, the head' and
spine especially, is a remedy generally avail-
able.  Ammonia, eitlier in the form of sal
volatile, or hartshorn, &c, is to  be given and
its  vapour inhaled; or  better still, but  not
so likely  to  be  at  hand,  chlorine  in some
form.  Thirty drops of  the solution of chlo-
ride of lime, or of chloride of soda, may  be
given at once in a little  water, their vapour
being at the  same time inhaled ;  this  may
be more abundantly evoked  by  the  addition
of  an acid.   Artificial  respiration,  (see
Opium,)  should  be  had  recourse to, and
galvanism, if available.   To  repeat:  the
best antidotes are—cold affusions;  chlorine,
Bwallowed, and in vapour; ammonia, swal-
lowed, and in vapour; artificial respiration.
  PSOAS.—Belonging to  the  loins.   The
psoae muscles are large muscles connected
with the loins, &c.  A psoas-abscess is one
originating in the loins.
  Refer to Lumbar.
  PSORA.—The itch.
  PSORIASIS.—A  peculiar disease of the
skin.—See Skin.
  PTISAN, or  Tisane.—A vegetable infu-
sion or  decoction,  generally of a mucila-
ginous character, which  may be drunk freely
by,  and is given freely to the sick.   Barley-
water is a ptisan.  Ptisans are extensively
used  in   France, and  in many  different
forms.
  PTYALISM.—The affection of the consti-
tution by mercury.—See Mercury.
  PUBERTY—Is that important transition
epoch in human life, when childhood passes
"nto youth, the forerunner of manhood and
womanhood.  In  English  law,  the  time  of
puberty is  considered in the male  to  be  at
fourteen  years of age,  in the  female, two
years later ;  but these periods must be  ge-
nerally considered quite  sufficiently early,
* Taylor's Jurisprudence.
 as regards this latitude at least;  in warmei
 clim.ites  the  period of  puberty probably
 arrives a little sooner, but not so much so
 as generally has  been imagined;  more de-
 pending upon  the  natural constitution of
 the  individual, and upon the influence of
 external  circumstances.    The  important
 changes and excitements  undergone by the
 constitution at the period of puberty, ne-
 cessarily render  it a critical period, when
 disease,  to which a latent tendency exists,
 may be roused into activity.   At this time,
 therefore, a stricter watch than usual should
 be kept upon the health of the young,  and
 any  unusual  symptoms at once  submitted
 to the  judgment of a medical man.—See
 Menstruation.
  PUDDINGS—Are  articles  of  diet,  the
 principal ingredient of which  is some fari-
 naceous material—at least such ought to be
 the case when they are made for invalids.
 The  puddings  most generally admissible and
 best adapted for the sick-room are the light
 egg and flour,  or "twenty minute" pudding,
 as it is ofteu called ; the  simple rice, sago,
 or tapioca pudding, the boiled bread pud-
 ding, &c.  In  making baked  puddings, the
 eggs are generally put in previous to baking,
 and  in  general cookery  this may answer
 very well.  But when nutriment, and at the
 same time extreme  lightness, are  requisites
 for an invalid, it  is better to cook the fari-
naceous  article,  such as  sago,  bread,  or
 whatever it may be, thoroughly [u the milk,
 and, while it is perfectly hot, to  break  the
 egg into it, and beat them well up together.
 In this way the  egg  is  quite sufficiently
 cooked, but its albumen is not hardened, as
 it must  inevitably be when  baked along
 with the other materials.
  Of  course, greasy puddings generally are
unsuited for invalids, and for the same rea-
 sons butter or  sauce must be forbidden.
  PUERPERAL. —Connected  with child-
bed.—See Childbed.
  PULMONARY. — Connected   with   the
lungs.
  PULSE.—The term pulse may be applied
 to the beating  of  the heart and arteries ge-
 nerally, but it is more usually restricted to
 the sensible beat or stroke  of  an  artery
 which is felt by the finger placed  over  and
 slightly pressed upon the vessel; popularly,
 the pulse is considered to  be confined to the
 wrist alone. The pulse or beat of an artery
 is felt simultaneously, or nearly so, with the
 beat of the heart, which takes place as each
 contraction  of that organ  sends  a wave of
 blood through the  arteries—the  elasticity
 and muscular  properties of those  tubi*? in-
 fluencing in a  considerable degree the ' cha 
P U L              431               PU M
racter" of the  pulse.—See Artery—Circula-
tion—Heart, Sec.
  The sympathetic connection of the central
organ of the circulation, and  indeed of the
circulating  system at large,  with changes
and states of the whole system, render the
pulse a most important guide in the inves-
tigation of those states and changes; it is,
however,  a guide which requires much edu-
cation  and no little  practical experience
fully  to take advantage of.  It may have ap-
peared to some, that throughout this work
generally, when different diseases have been
treated of, the state of the pulse  has been
comparatively  little noticed.  The previous
sentence affords the explanation,  which is,
that to feel a pulse properly, and  to gather
from  the feeling any real, definite,  trustwor-
thy  information,  requires  more  practical
knowledge than unprofessional persons  can
possess;  consequently, the author has pre-
ferred directing attention, in most instances,
to symptoms more palpable, more easily ap-
preciated, and  less likely  to  mislead  the
uninitiated.  If the frequency of  the beats
of the pulse was an unvarying indication of
the state of the system,  and if the know-
ledge as to frequency, or the  reverse, was
all that could be gathered from feeling it,
the case would be abundantly different; but
with  certain reservation  the  frequency  of
the pulse is, in many cases, a far less  im-
portant piece of information  to a medical
man than its rhythm or tone;  whether it be
full and  bounding or jerking, or soft, or
wiry, or compressible, feeble, or remittent,
or intermittent, all these and other varieties
of pulse convey impression to the mind of a
medical man;   but the ability to  receive
these impressions, and to form conclusions
from  them, is only the result of daily, almost
hourly practice.  It is  unnecessary to  say
more  to show how very slight and  imperfect
the information  must  be which  a casual
feeler of the pulse can gather from the ope-
ration.  At the same time, the author would
not discourage persons, such as the  clergy-
man or the intelligent emigrant, from endea-
vouring to gain some practical knowledge
respecting the  pulse:  but the above will
show  that useful  knowledge  must be at-
tained, either  assisted or  unassisted,  by
practical  attention and persevering avail-
ment  of opportunities.
  The average pulse of a healthy man in
the prime of life may be taken as beating
72 times in the minute; but from  this ave-
rage there is every possible variation, and
even in the same individual the pulse varies
greatly, according  to  the  period  of  the
twenty-four hours; according  to  the time
of meals; to the posture,  whether recum-
bent, in  which  it is slowest,  or  sitting  or
standing, in which it is  most frequent; it
varies  also according to physical exercise
or mental  emotion, and  also  according  to
external temperature.
  In some persons the pulse is always quick,
ranging at 90, or even more; in others it is
slow, perhaps does not exceed 40 beats in
the minute.   Age influences greatly the fre-
quency of the pulse.  The  following is the
table drawn up by M. Quetelet:—
                        Average of Pulsation!
     A£e                   per minute.
    Birth..............................  136
     5 years........................  88
    10—15...........................  78
    15—20 ...........................  69
    20—25 ...........................  69
    25—30 ...........................  71
    30—50...........................  70
  According to other observations, the pulse
in many children is  found  not to be more
frequent than it is in adults; as a general
rule, however, it is so.   It is, moreover, a
generally received opinion that the pulse  of
the aged is slower than that of the young:
the reverse is the fact.
  As a general  rule,  when the  system  at
large  is  in a state of excitement, feverish
or otherwise, the pulse is increased in fre-
quency and modified; in depressed states of
the system, unless  accompanied  with irri-
tability, the contrary takes place.  In affec-
tions of the brain, causing pressure on,  or
oppression of that organ, the pulse is usual-
ly slow.    If  a  particular portion  of the
body be inflamed, such as the hand or  foot,
the pulse in the artery going to the part is
increased in force, or in the  power of its
beat, but of course not in frequency, unless
the entire circulating system  is equally ex-
cited.
  Most persons are aware that the pulse is
distinguishable at the wrist, about an inch
above the wrist-joint of the thumb, the pul-
sating  artery lying by the side of the strong
tendon of a  muscle of the forearm.  The
pulse should be felt by the fore and middle
finger  together, [and not by the thumb.]
  Refer to Artery—Circulation—Heart, Sec.
  PUMPS—For water—when made of lead,
are apt  to prove  dangerous.—See Lead—
Water,  Sec.
  PUMP, STOMACH —Is  an instrument
made on  the principle of  the enema instru-
ment.—See Clyster, fig. xxxix.  It ought only
to be used by a medical man.
  PUMPKIN.—At one of the late meetings
of the Medical  Society  of Bordeaux, M.
Brunet communicated to  the society several 
PUN
432
P  U R
cases of tapeworm, where he had  suc-
ceeded  in causing  the  expulsion  of  the
parasite by means of a paste made of pump-
kin seeds, stating that he had been told of
the remedy by the captain of a ship.  Since
that period,  an  article  published in  the
journal Universel  of 1820  was discovered,
where  M.  Mongeny, a  physician  of  the
island  of  Cuba, says—"I used to  give to
patients  affected with  tapeworm   three
ounces of a paste made with fresh pumpkin
seeds, and  afterward six ounces of honey,
in three doses, the first  an hour after the
ingestion of the paste, and the others at the
same intervals.   Six or  seven hours  after-
ward,  the tapeworm  was generally  ex-
pelled:  and this* remedy has  succeeded in
cases which had  resisted all the means ge-
nerally employed.   The worm is ejected,
not in fragments, but twisted upon himself,
and where two parasites  had  existed, they
were wholly and simultaneously voided."*
[This article  has  been tried in the United
States  with most satisfactory  results, and
from its cheapness may be readily obtained
by any who are suffering in this way.]
  PUNCTURED WOUNDS.—See Wounds.
  PUPIL.—See Eye.
  PURGATIVES—Are medicinal substances
which  excite and accelerate the muscular
movements of the alimentary canal, and in-
crease the discharge therefrom.  For the
sake of convenience,  under  the  head  of
purgatives, aperients generally are treated
of.   These are divided into
  Lax atives—Purgatives—Dra stic  Cath ar-
tics.   A further  class  of  " hydragogue"
cathartics is also recognised.—See Hydra-
gogue.   Laxatives, which  gently  increase
the natural movements of the  bowels, may
be  arranged as  dietetic, mechanical,  and
medicinal.   Dietetic  laxatives are  chiefly
vegetables  and  fruits  of  various  kinds,
honey, treacle, preparations  of the grains,
cold water, malt liquors, bacon, &c. &c; but
many of these act mechanically also. Most
succulent vegetables and  fruits act upon the
bowels  by virtue of their peculiar nature,
but, undoubtedly, also by the mechanical
bulk of their refuse.  Of the mixed dietetic
and  mechanical laxatives, the farinacea or
grain substances are the  most important.
These  owe their property entirely  to the
presence, either whole or ground, of the ex-
ternal  covering or testa of the grain, as in
the case of bran-bread, or of Scotch oatmeal.
The  flour  of the  Egyptian lentil, or  Reva-
Ienta Arabica,- is almost medicinal  in  its
power of relaxing the bowels.  The seeded

      » Extracted from Lancet, July 10,1552.
fruits, such  as  currants, gooseberries, &o.
fall under the head of mixed dietetic  and
mechanical laxatives.
  The purely mechanical aperients are not
numerous.  Whole mustard seed, and  the
common  dried currant,  as it is often given
domestically,  are examples of the class.
  Clysters may be classed under the  head
either of purely mechanical or of medicinal
aperients, according to  their nature.—See
Clyster.   The  following  table includes the
principal aperient and purgative medicines
which may be used domestically:—
  I. Laxatives.
           Almond-oil.
           Cassia pulp.
           Cream  of tartar.
           Honey.
           Magnesia.
           Manna.
           Olive-oil.
           Phosphate of soda.
           Prunes.
           Sulphur.
           Tamarinds.
  II.  Purgatives.
           Aloes.
           Castor-oil.
           Epsom  salts.
           Glauber salts.
           Jalap.
                        (Blue pill.
                        Calomel.
                        Gray powder.
           Rhubarb.
           Rochelle salts.
           Senna.
   III. Cathartics—Drastic.
           Colocynth.
           Scammony.
  The two cathartics put down may be used
domestically—indeed,  the  first   is every
day used—in the  form   of the  compound
colocynth pill.   Croton-oil, elaterium, gam-
boge, are included in the drastic cathartics;
but, except under  peculiar circumstances,
ought only to  be administered by a medical
man.   For  details respecting the various
aperient agents above mentioned,  the reader
is referred to the individual articles.
  Purgative   or  aperient  medicines   are
unquestionably  much  more  generally had
recourse to, both by medical  men  and the
public, than  any  other  form  of remedial
agents; but while it is undoubted that  their
use is great, it is also certain that they are
and have been very greatly abused.   It is
intended to consider, first, the use of ape-
rients, and secondly, the abuse.  Under fuch
articles as  "Alimentary Canal,"  "Diges-
tion," &c. it has been  sufficiently explained 
PUR
433
PUR
how the food  mass, after undergoing  its
principal digestion in the stomach, is gra-
dually prupelled through the entire tract of
the bowels, and how, during this propulsion,
its nutrient constituents are absorbed from
it, the refuse  being left for discharge.   It
has also been  explained, that the discharge
from the bowels does not consist  simply of
the food refuse, but contains also various
secretions and excretions, thrown out  into
the bowels—from the general system—which
excretions can not be retained in the system
without injury to health.
  From these considerations, it must be  ob-
vious to all how great  the importance,  not
only that the  bowels should  be active as
regards the  excretions  into  them, but as
regards their own  discharge, both of these
excretions and of  the  food  refuse.  When
the bowels are inactive in  these respects,
the state is termed constipation, or costive-
ness.    As, under the latter term, the reader
will find the  evils which  result  from  this
condition, and also  its most frequent causes,
&c, sufficiently explicitly stated, it is un-
necessary to repeat the information here.
Under the same article  will be found an  ex-
planation of those  general remedies which
are most useful in  removing the condition;
and, indeed, when they prove sufficient,  are
certainly to be preferred to medicinal agents.
When they do not prove sufficient, either as
temporary or  permanent  means  of  relief,
the purgative  or aperient medicines must
be employed—under  the general rule, that
they should never be  used  stronger than
requisite.  By this it is not meant, that be-
cause manna,  or sulphur,  or  magnesia,  are
classed in the laxatives, they are  alwaj's,
when  possible, to be  substituted for  the
purgative  aloes, or castor-oil, or rhubarb,
or  senna: such a distinction could not be
observed without other and  greater coun-
ter-balancing inconveniences.  But the rule
should  be, that relief to the bowels is to be
afforded with as small an amount of purga-
tive actum as  possible,  unless that purga-
tive, or, in other words, lowering action, is
called for as a  part of the treatment, as it is
in persons of very full habit of body, &c.
  Where aperient medicines are either taken
or given  domestically,  there  is  often  too
little care in the selection.  Unless it be in
pregnancy, or in consequence of individual
experience, the idea seems  to prevail with
many   that one aperient is  as good  as
another.  This is far from being the case.
  Except in persons whose bowels are very
easily acted upon, or in such cases as those
v  here the aperient  is taken  rather  to give
additional action, than  to open the  bowels,
         2M
the "laxative" aperients are scarcely suffi-
cient  as general aperients.  Those classed
as purgatives, together with the cathartic,
colocynth, under the form of its  well-known
compound pill, are in daily use.
  There are few ailments in which increased
action of the bowels is called for, in which
one or other of the aperient remedies in the
list will not be applicable.  Aloes is valua-
ble for certainty of action on particular por-
tions of the bowels, for the small bulk of its
general  dose, for its tonic bitterness and con-
tinued effect even  after frequent repetition,
but must be used carefully in  pregnancy,
piles, and  other affections situated  about
the lower part  of the canal.  Castor-oil is
recommended  by  its  safety in almost  all
cases, by its certain, perfect action, and, like
aloes, by its not losing effect by repetition;
but unfortunately, it is too often the medi-
cine most disliked and sickened  at.   Epsom
salts  require  much  discretion  in  use, but
have  deservedly thrown Glauber salts  into
disuse.   Jalap  is  certain and active, but is
apt to gripe and to sicken, and its bulk is
an objection.  Mercurials alone, or followed
by  castor-oil or senna,  or combined  with
aloes, rhubarb, or colocynth, are most valu-
able,  but are  most  abused.   Rhubarb  is
mild, and with some persons effectual;  it is
also tonic, but is apt  to heat, and its bulk
and taste are  an objection, especially with
children.  Rochelle salt is similar to Epsom
salt in action, and is pleasanter.  Senna, the
medicine of the  nursery, is invaluable, and,
if properly prepared, is safe and certain.
  Colocynth, in its  well-known compound
pill, forms part of the most generally used
and useful  purgative in  costive habits.
Scammony is, in many of the affections of
children, especially  combined with a  mer-
curial, our most valuable purgative,-and is
recommended by the small bulk  of its dose.
—See articles on all the above mentioned-
  Purgation, however, is used,  not only as
a means of clearing  the bowels of their con-
tents, but also  as an agent for the  relief of
those organs, such as the liver, which are
closely  connected  with the bowels;'  and
further,  as a remedy calculated to relieve
distant  parts,  or  the  system   generally.
Thus, in many head affections, free purging
is one of our most  powerful remedies—in
congestion of the liver it is most serviceable ;
and in overfulness of the system at large, it
relieves greatly.  To the above facts nature
strongly points  in those cases in which sud-
den and striking relief often follows an at-
tack of spontaneous  purging or diarrhoea.
  The abuse of  aperient medicines owes its
origin,  probably, to  a variety  of causes.
28 
P U R
434
P  U R
Constipation, either alone, or as :i  concomi-
tant of disease, is so obvious and common a
symptom, and so often occasions distress, or
at least uncomfortable sensations, while  its
removal is generally so simply effected, and
often  so sensibly  felt as a relief, that  it
cannot be matter of  surprise if both doctor
and patient,  almost habitually, look to the
Action of the  bowels,  by purgative  medi-
cines, as  the requisite  preliminary  to  all
other treatment, and within certain  limits
they do right.  But the fatal facility  of the
treatment, assisted moreover by the power-
ful advocacy  which it has received in  years
gone  by, has  certainly produced a far too
general use of aperients  as purgatives ; not
simply in the treatment of acute disease,
but as a general rule of daily life.   If the
question be  put,  Which is the greater evil
of  the two, to have  the bowels habitually
confined;  or   habitually to take   aperient
medicines?  there  can be no  doubt,  if the
choice must lie between the two evils, that
the latter is the lesser one ; but  there are
few cases in  which the choice  is so circum-
scribed.  The bowels, probably, are confined;
but they are  so  because the  general con-
ditions   requisite  for their healthy  action
(see Costiveness)  are  neglected, and because
the aperient medicine is used as the readiest
substitute  for a  little trouble  and  perse-
verance.  Thus used, the aperient is abused,
and more or  less injury is inflicted  upon
the system, according to the  nature  of the
medicine, the frequency  of its use, and the
strength of  the  dose.   One  most general
effect of the abuse of aperients is the  weak-
ened digestive power of the stomach ; an-
other, the weakness of the  system at large ;
and a third, not unfrequently, is continued
irritation of some portion of the alimentary
canal.  The weakened digestion which fol-
lows  the abuse  of  aperients  may not  be
obvious  at  first;  indeed,  if  the  digestive
organs have been overloaded and oppressed,
instead of being weaker after an aperient,
they are actually more active, and this ap-
parent  increase of  activity is very  apt  to
lead to a too frequent renewal of the remedy,
and too often—trusting  in the remedy—to
a  continuance of  those habits of  excess
which caused the first disorder.  (See Indi-
gestion.)   The debility of the  system  which
follows the abuse of aperients is the natural
result of the digested food mass being hur-
ried  too rapidly through the bowels, to  ad-
mit of its nutrient portion being taken up
and conveyed into the system ;  debility is
also the result of the too frequent employ-
ment of purgatives, such  as the salines,
which  increase,  unnecessarily,   the dis-
charges—especially of  the  serous  portioj
of the  blood—into  the bowels.  Further,
the too frequent use of purgatives irritates
the bowels, by depriving the*in of their na-
tural protective mucus:  in this way ulcera-
tion may result.
  As  a  natural  consequence  of the food
mass, and of the secretions and excretions,
such as the bile, being hurried too  quickly
into and through the  bowels,  and  also of
the mucus  being carried off too abundantly,
the stools, under the continued use  of pur-
gatives,  assume  an  unhealthy character;
perhaps contain too  much  bile, &c, and in
consequence of this  unhealthy appearance,
and with a view to its  correction,  persons
are too often induced to continue the very
cause of its production,  and go on purging.
This is a very common case.
  In connection with the foregoing  article,
the reader is referred to Alimentary Canal—
Biliary  Disorder — Digestion — Indigestion —
Costiveness, Sec.
  PURGING  FLAX—The  Linum  catharti-
cum—deserves especial notice from the fact
of  its being  a plant commonly native to
England, and often  used as a domestic re-
medy, although not generally prescribed by
medical  men, not, indeed, as much  so as it
might be, for the report of  it is that of an
"excellent cathartic."   The purging flax is
a slender plant, about six or eight incite? in
height,  with smooth narrow leaves   placed
opposite upon the stem; it  blossoms about
the end of June, and the flowers, which are
small and  white, are "gracefully drooping
before expansion."   Every part of the plant
is bitter.   One drachm of the dry powdered
leaves, or two to three drachms of the fresh
plant, in the form of infusion, will, according
to Dr.Christison, act briskly upon the bowels,
without causing either sickness or griping.
  PURPURA—Popularly "thepurples"—ia
a disease in which the blood escapes from the
smaller or capillary vessels.  It is best known
from its outward manifestations on the skin,
on which account it is often, but erroneously,
classed as a skin disease, whereas it is truly"
a constitutional  affection, which, although
most  visibly manifest on  the skin, yet ex-
hibits its effects in various internal portions
of the body.   The attack of purpura  may
be sudden, or it may be preceded for a week
or  more by  symptoms of general   illness,
lassitude,  feebleness, &c.   Purpura, gene-
rally, first  shows itself on  the  legs, in the
form  of red or purple spots, of various sizes,
which do  not elevate the  skin, and do not
disappear on  pressure;  in  the course of a
few days, these spots become changed to a
brown or greenish yellow;  in fact, they g« 
PUR
435
PUT
 through the same changes in colour that we
 see in a bruise, in which, as in purpura, effu-
 sion of blood has taken place beneath the skin.
 The above  description applies to purpura
 perhaps  in  its mildest form.  When  more
 severe, the spots or blotches are spread over
 the body,  and blood is discharged from the
 mucous membranes  of  the nose, mouth,
 stomach, bowels, bladder, &c,  constituting
 a  most fatal affection,  which may  occur
 eitlier  alone, or  in  connection with other
 diseases,  such   as fever,  measles,  small-
 pox, &c.  Such  a  disease as purpura is of
 course not  one  for domestic management,
 and ought,  if possible, on its earliest ap-
 pearance, to be confided to proper medical
 care.  It may occur in the strong and ple-
 thoric ; in  which  case, of  course, lowering
 measures, perhaps bleeding, may be called
 for, or  at  least free  purging, with calomel
 and jalap, or calomel and colocynth.   The
 administration, two  or three times  a-day,
 of one or two drachms of Epsom  salts, dis-
 solved  in water,  each  dose being acidulated
 with fifteen  drops  of diluted sulphuric acid,
 would be very suitable treatment.
   Most frequently, purpura is a disease of
 debility,  and requires treatment  the  very
 reverse of lowering; quinine, in grain doses,
 three or four times  in the twenty-four hours,
 will  be useful, along  with  strong animal
 broths, wine, or  porter, and tonic remedial
 measures generally.   Turpentine, in  ten or
 fifteen drop  doses,  given three or four times
 in the twenty-four  hours, has proved an in-
 valuable remedy.   Having been found useful
 in different species of hemorrhage, the juice
 of the common nettle might, in places where
 other remedies are not procurable, prove of
 service.
   Where the tendency to purpura exists,
 with debility, means of strengthening should
 be  resorted  to,  which have been recom-
 mended under  article Debility.   In  every
 case, however, whether threatened or actual,
 a  medical man must be called without delay.
   PURULENT.—Consisting  of pus, or mat-
 ter.—See Pus.
   PUS, or  Mattkr—Is, or rather ought to
 be, a smooth, yellow, cream-like fluid; when
 warm it exhales a faint, sickly odour. Under
 the microscope, pus is seen to consist of gra-
 nules—somewhat larger than the globules
 of the blood—which float in  a transparent
 serous fluid.   The  above are the properties
 of healthy pus, which, however, may differ
 very greatly  from the  standard ; it may be
 thin, and serous, or flaky, as it is in a scro-
 fulous abscess ; it may be bloody, it may be
♦ptid, &c.   Pus is a consequence of inflam-
mation ;  its formation  is, in fact, the  " ter-
 mination" of that process by "suppuration,"
 (see Inflammation,) and may be  formed in
 various  situations  and textures.  It is the
 most general secretion from an ulcer. When
 contained in  a cavity  formed in the sub-
 stance of any of the bodily tissues, it con-
 stitutes an abscess.   It is a frequent conse-
 quence of inflammation, eitlier of mucous or
 of serous membranes, in  the  one case con-
 stituting a purulent discharge, in the other,
 a purulent effusion, such as takes place into
 the chest.  In some cases  it  is extremely
 difficult to distinguish the mucous, purulent,
 and muco-purulent discharges  from  mucous
 membranes,  from  one  another.   Less  im-
 portance is now attached to the distinction
 than formerly.
   Refer to Abscess—Inflammation— Ulceration.
   PUSTULES —Are  elevations  on,  and
 partly in the skin, which contain  matter.
 A pustule may commence as  such, when it
 is usually conical in shape, or it may com-
 mence as a vesicle, as in the cases of small-
 pox or cow-pox; the vesicle, in the first
 place, containing transparent lymph or fluid,
 and its contents afterward becoming puru-
 lent, constituting it a pustule.
   Refer to—Skin, Diseases of.
   PUTREFACTION, or Putrefactive Fer-
 mkntation—Is the peculiar chemical change
 undergone by many organized bodies after
 death.  The following extracts on this sub-
 ject from Liebig's " Letters on Chemistry"
 are full of interest and instruction:—" The
 proximate cause of  these changes,  which
 occur in  organized bodies  after  death, is
 the action of the oxygen of the air on many
 of their constituents.  This action only takes
 place when water, that is, moisture, is pre-
 sent,  and requires a certain  temperatiire.
 This  influence of  atmospheric  oxygen' is
 very distinctly  seen in fruits and other soft
 parts of  vegetables, when, by  an injury to
 their surface, the juice comes into  direct
 contact with the air. . When  an  apple  is
 bruised at one point,  a process of decompo-
 sition begins from the injured part; a brown
 spot appears, which increases  in a regular
 concentric circle,  till at last the whole apple
 becomes rotten, or is changed into a brown,
 soft, viscid mass."  " In like manner, a pro-
 cess of decomposition sets in,  after death,
 in the bodies of men and animals,  which
 begins in the  inside, in those parts, such
 as the lungs, which are in contact with  the
 air.  When  there are wounds, it  spreads
from  them,  and  in diseases from the dis-
eased part;  so  that,  in many  cases,  death
itself is  nothing  else  than the result of
a  decomposition  going on  in  an  inward
part ; with  the  disease,  of  which  it  i« 
PUT
436
p  n t
 *he proximate cause,  this process begins,
 nnd it continues after death.   The most re-
 markable of  these phenomena  is certainly
 this, that in  many cases, the  change  once
 begun in organic  matters, continues when,
 after  transient contact with the air, the at-
 mospheric oxygen is  entirely excluded."
 •• All these processes of decomposition which
 begin  in a part of  an organic substance,
 from  the application of an external cause,
 and ^vhich spread through the whole mass,
 with  or without the co-operation of  that
 cause, have  been called  the process of pu-
 trefaction."   "The number of  substances
 occurring in nature which are truly  pru-
 trescible—that is,  capable of putrefaction—
 is singularly small; but they are everywhere
 diffused, and form part of every organized
 being.   Before  all other  substances, this
 property of  putrescibility belongs to the
 highly complex  matters of the animal and
 vegetable kingdoms, which contain nitrogen
 and  sulphur;  such as  albumen,  fibrine,
 caseine, gelatine, and the like."  One of the
 most remarkable properties of putrescible
 substances is their power of  exciting fer-
 mentation in  bodies capable of  this change.
 —See Fermentation.
  •'The grand natural  process  of putrefac-
 tion, of  the  dissolution  of all  compounds
 formed  in living  organisms begins  imme-
 diately  after  death,  when  the manifold
 causes  no longer  act  under the influence
 of which  they  were produced.   The com-
 pounds  formed  in  the  bodies of animals
 and of plants undergo, in the air, and with
 the aid of moisture, a  series of changes,
 the last of which are the conversion of their
 carbon  into  carbonic acid, of their hydro-
 gen into water,  of their nitrogen into am-
 monia, of their sulphur into sulphuric acid.
 Thus  their elements resume the forms  in
 which they can again serve as food to a new
 generation of plants and  animals.  Those
 elements which had been  derived from the
 atmosphere  take  the  gaseous  form and
 return  to the  air ;  those which the  earth
had yielded return to the soil.   Death, fol-
lowed by the  dissolution  of the  dead  gene-
ration, is the source (medium ?) of life  for a
 new one.  The same atom of carbon, which
 as a constituent of a muscular fibre  in the
 heart of a man, assists to propel the  blood
 through  his  frame, was,  perhaps, a consti-
 tuent of the heart of one of his ancestors ;
 and any atom of nitrogen in our brain has,
 perhaps, been  a part  of the  brain of an
 Egyptian or  a negro.   As the intellect of
 the men of this generation draws the food
required for its development and culthation
 from  the products of the intellectual ac-
 tivity of former times, so may the constitu
 ents or elements of a former generation pass
 into and become pnrts of our own frames.
   " Finally, by a  knowledge  of the  causes
 of the origin  and  propagation of putrefac-
 tion in organic atoms, the question concern-
 ing  the  nature of  many contagions  and
 miasms becomes capable of  a simple solu-
 tion, and  may be reduced   to the follow-
 ing:—
   "Are there facts which prove that certain
 states of transformation or putrefaction  in
 a substance  are  likewise  propagated  to
 parts  or constituents  of  the living animal
 body; that by contact with  the putrescent
 matter the  same or a similar condition  is
 produced on  such parts as  that in  which
 the  particles of the  putrescent body are ?
 This question  must  be decidedly answered
 in the affirmative.
   " It is a fact that dead bodies in dissect-
 ing-rooms  frequently  pass into  a state of
 decomposition, which is communicated  to
 the blood in the living body.   The slightest
 cuts  with  the  scalpel used  in dissecting
 often cause a very dangerous and even fatal
 disease.    The  observation  of  Magendie,
 that putrid blood, brain, bile, or pus, when
 laid  on  flesh wounds, produce in animals
 vomiting, languor, and death, after a  longer
 or shorter  interval, has not  yet been  con-
 tradicted.
   " Further, it is a  fact, that the use of
 various articles of food, such as flesh, ham,
 sausages, if in a certain state of decomposi-
 tion, is followed in healthy persons by the
 most dangerous and even fatal symptoms.
   " These  facts prove that  animal matter,
 in a certain state of decomposition, is capa-
 ble of exciting a morbid action in the body
 of healthy individuals.  Now, since by the
 term products  of diseased action, nothing
 else can  be meant than parts or constituents
 of the living body, which are in a state of
 change in  form and  quality different from
 the normal one, it is evident that so long as
 this state continues, and the  change  is not
 completed,  the disease may be communi-
 cated to a  second or  third  individual, and
 so on.
   " Besides,  when  we  consider  that  all
' those substances  which  destroy  the com-
 municability, or arrest the propagation of
 contagions  and miasms, are  likewise such
 as  arrest  all processes of putrefaction  or
 fermentation : that  under the influence of
 empyreuraatic bodies, »uch as pyroligneous
 acid, which powerfully oppose putrefaction,
 the  diseased action in  malignant suppurat-
 ing  wounds  is entirely changed;  that in a
■number  of contagious diseases  especially 
P  U T                437               Q U A
 in  typhus,  ammonia,  free or combined,  is
 found in the expired  air, in  the liquid and
 solid  excreta—in  the  latter as ammonio-
 pltosphate of magnesia—it seems impossible
 any longer to  entertain a doubt as to the
 origin and propagation of many contagious
 diseases.
   " Finally, it is an observation universally
 made, and which may be regarded as  esta-
 blished, that the origin of epidemic diseases
 may often be referred to the  putrefaction of
 great masses of animal and  vegetable mat-
 ters ;  that miasmic diseases  are found epi-
 demic, where decomposition of organic sub-
 stances continually goes on  in marshy and
 damp districts.   These diseases also become
 epidemic,  under  the  same  circumstances,
 after inundations;  and also in places where
 a large number of persons are crowded to-
 gether with imperfect  ventilation,  as  in
 ships, in prisons, and in besieged fortresses.
 But in no case may we so securely reckon
 on the occurrence of epidemic  diseases as
 when a marshy surface  has  been  dried up
 by continued heat, or when extensive inun-
 dations are followed by intense heat."
   In connection with the above, the follow-
 ing instructive anecdote is  related in the
 appendix to  the publication from which the
 foregoing extracts  are taken: —
   " In order to  procure  a  roast for Easter,
 C----, in R----, desired his  family to  set  a
 snare for  a roebuck.   Accordingly, one of
 these poor animals was caught in the snare,
 which, as  its head and breast  had passed
 through, held it by the  hinder part of the
 body, the abdomen and pelvis being en-
 closed  in  the cord, so  that  it  must  have
 succumbed after a most agonizing  struggle
 It was found next day dead.
   "The master and mistress of the family
 eat  on Easter-day the  best part of the
 dainty; the servants had little;  the re-
 mainder was laid in vinegar, but not eaten.
   " On the same day, all in the family who
 had eaten of the venison observed a strik-
 ing dryness of  the mouth, oppression at the
 stomach, and nausea;  the features in all
 became anxious  and pale; all complained
 of oppression of the head,  giddiness, and
 great weariness of the limbs.  The master
 lost his sight for several  days, and in short
 there now began  a series  of remarkable
 symptoms, requiring in many ways  the
 assistance of a  medical man.   The husband
 was  only  restored  to  health in July, but
 the wife  never  recovered;  she  lingered
more   than two  years,  and  at  last  died
after severe sufferings.   The daughter, the
m.tn-servant, the maid, who had eaten little
of the  tortured  animal, were soon cured.
        2m2
The symptoms in  many respects recalled
those of  the  effects  of the  bite  of  rabid
animals, and of the sausage poison of Wir-
temburg."
   With  respect to that theory which regards
the putrefaction of  animal  matters as pro-
duced by  microscopic  animalculae,  Liebig
remarks—" To ascribe  putrefaction  to  the
presence  of animalculae is as irrational as
it would be to ascribe to the beetles, whose
food  is  derived from animal excreta, or to
the mites in cheese, the state of decomposi-
tion of  the excreta or of the cheese.  The
presence  of  animalculae,  which  are often
found in  prodigious numbers in putrefying
matters, cannot, in  itself,  be  considered
wonderful, since these  animals find  there
the  conditions of  their nutrition and  de-
velopment combined.  It  is  quite certain,
however, that in their presence  putrefaction
is exceedingly accelerated.   Their nutrition
presupposes the  consumption  of  particles
of the putrefying  body for their own  de-
velopment.  Its more rapid destruction must
be the necessary consequence."
   The extreme interest  and  importance
which surround the processes  of putrefac-
tion must be the apology for the length of
the above extracts on the subject from per-
haps the first living authority on these mat-
ters.  Whether we regard putrefaction in a
sanitary or hygienic point of view, as  the
originator  of   disease, when  favoured  by
man's ignorance or carelessness, or as the pro-
cess by  which  the material atoms of a gene-
ration which  has passed  away are  again
started  on their mission to fuftiish material
clothing for a  generation living  or to live,
our attention is alike  deserved.
   Refer to Fermentation, Sec.
   PYLORUS. — See Alimentary  Canal—
Stomach.
   PYRO LIGNEOUS ACID—Is acetic acid
obtained by the "  destructive  distillation"
of wood.
   Refer to Acetic Acid.
   PYROSIS.—See Water-brash.

  QUACK, QUACKERY, and QUACK ME-
DICINES.—The origin of the term quack is
doubtful;  it is  sometimes derived  from
"quack-salber," the German for quicksilver,
or mercury, which was first used by irregu-
lar practitioners.   However that  may  be,
the terms "quack"  and "quackery" are not
now confined to medical matters, but are
applied  generally to those  who pretend  to
exercise functions of which  they are  inca-
pable, and who support their  pretensions
with deceit, and generally  with  impudence
  History has proved, and facts of the pre 
QUA
                 {} V  A                4:

sent day testify, that of all the openings for
deception  and chicanery in connection with
the dealings of man with  man,  medicine
opens one of the widest.
  In former times, when even  the learned
entertained  most crude and erroneous ideas
of much of the structure, and of most of the
functions of the living body, and when the
mass of the  people were in the most perfect
ignorance on these points,—when, moreover,
superstition was rife,  when  charms and
king's touches were trusted to cure disease,
when  occult virtues, dependent  upon all
sorts of fancied and fanciful conditions and
circumstances,  were considered to be  active
or not according to the observance of these
conditions and circumstances,—when, it is
observed, these  things prevailed,  it cannot
perhaps be  matter of surprise  that people
believed the man who could lie  most glibly,
and who held out  the  most specious pro-
mises, in connection with that dearest pos-
session of man—dearest, at least, when lost
—his  health.   The most natural  thing for
ignorance and  superstition was  to believe
the tricked-out mystery.   But is it natural,
or, rather reasonable, that the foolish be-
lief in mysterious cures and quack panaceas
should still prevail  at the present day, and
that the most notorious quacks should amass
immense fortunes,  simply by  gulling  the
many foolish ?   Reasonable or not, the fact
is incontrovertible:  reasonable or not, it is
to be accounted for by  the almost perfect
ignorance  which still  prevails, even among
the most educated classes, of the structure and
functions of*their own  frames, of the re-
quirements  of their own constitutions, and
of the  true  principles  on which  the  latter
are to be preserved  in soundness and health,
or to be treated when afflicted with disease.
Moreover, the principles of health, in health,
also extend, or ought to  extend, to the ma-
nagement of illness when health is sought
to be restored.  These  principles  are  too
frequently dwelt upon in the various sani-
tary articles in  this work to require  reite-
ration  here, but, it is once more repeated,
they ought  to be part of the education of
all.  The diffusion of such knowledge will
and can put an end to quackery;  and yet
the diffusion of  such knowledge is dreaded
and condemned  even by some medical men,
who seek legal  enactments against the irre-
gular practitioner and  his practices,  in the
vain idea that these will prevent  the credu-
lous and  ignorant  from resorting to the
man who  lies most to  their ignorance,  or
flatters  their blind prejudices most unscru-
pulously.
  Quacks, generally, may be divided into
those who quack for  profit and those  win
are  merely  amateurs,— the latter  class  in
eluding the Lady Boumifuls and others, who,
not content  with using such simple means
of alleviating disease or  suffering  among
their neighbours  as can be safely employed,
must, without necessity, get  to handling such
edged-tools  as antimony, calomel, &c. &c.,
and with considerable vigour too, very often,
without  having  given  themselves   much
trouble to get any idea of  the proper mode
of, and  reasons  for the administration  of
what they prescribe.  Such practices cannot
be too strongly condemned.  When  such a
combination  of circumstances  occurs that
the immediate care of  a dangerous accident
or illness  devolves upon some intelligent or
responsible individual, in the absence of, or
at least  until the arrival of a medical man,
it  is  quite  admissible to  use even  active
measures, such as are often recommended
in the present work, if proper precaution be
observed; but this is very different  from
persons, without necessity, and for the mere
love of amateur quackery, taking upon them-
selves the management of cases of  serioug
disease.    " Without entering upon that dif-
ficult ground which   correct  professional
knowledge and educated judgment can alone
permit to  be safely trodden, there is a wide
and extensive field for exertion and for use-
fulness  open to  the unprofessional, in the
kindly offices of a true domestic medicine,
and in the timely help and solaee of a simple
household surgery."
  "But when it  is  remembered  how the
nicest judgment that  observation and expe-
rience can form, the most patient attention,
aided by practised ear and eye, by micro-
scope and test-tube,  are frequently neces-
sary to  enable the conscientious physician
to judge of his case before he can apply the
remedy, it is evident how great must be the
responsibility of  those who, in rashness or
ignorance, venture upon  the  treatment of
serious disease,  either in  their own persons
or in those of others :  incapable of judging
of its nature, still less capable are  they of
selecting the appropriate treatment.   There
is, however,  a vast difference  between the
management of real disease and of ordinary
ailment—between endeavouring to strike at
the root or  only to relieve the symptoms.
Any  unprofessional man, or woman either, in
England,  [or America,] who,  with  all  the
facility that  there  is for procuring skilled
advice, ventures to take the medical matiage-
mentof acaseof real illness, acts most unwar-
rantably.  Still less justifiable is interference
with  cases  upon which  a medical  man is
already in attendance.—See Advice, Medical. 
QUA
439
QUA
    The quacks, whose sole object is gain, are
 divisible into those who  sell some nostrum,
 and those who  profess  to investigate  and
 prescribe for diseases.
    The quack medicine, sold as such under
 the seal of government, [or of a patent, in
 the United States,] are of every variety.
 Some profess to cure every thing, and there-
 fore carry absurdity so plainly on the surface,
 that it is difficult to  imagine any persons
 being sufficiently credulous to employ them ;
 others are more circumscribed  in their pro-
 fessions, but yet, as far  as they go, are ad-
 vertised as infallibles.    One  instance  will
 demonstrate the danger of trusting to them.
 Under such articles as "Debility," &c. &c,
 it has been pointed out, that there is a false
 weakness,  to  be  distinguished from that
 which is really dependent on actual debility,
 both being accompanied with  languid de-
 pression.  For such a condition many quack
 pills and the like are  advertised—they re-
 lieve  " languor,  nervous depression, &c."
 Such  pills are  generally powerful  purga-
 tives, and by their strong action in this
 way, perhaps, relieve some individual suf-
 fering  under the languor of an oppressed
 system ;  he is delighted at the  change, and
 meeting his invalid friend, who is suffering
 from the real debility of  incipient consump-
 tion, or from some other disease, persuades
 him to try the wonderful pills—need it be
 said, with   how  great   probable,  perhaps
 irremediable injury.  It  would be easy to
 multiply instances—one is enough.
   Of the prescribing quacks,  some  are  so
 wonderfully skilful  as not to require  to see
 their patient;  these  include   the  " water
 doctors"—not  the  hydropathists,  but  the
 "casters" of the  urine—those who require
 merely to see the urine, and therefrom pro-
 nounce  the verdict of life or death, or send
 medicines accordingly.   The  chemical and
 microscopic examination  of the urine  is, in-
 deed, to the physician  a most valuable aid
 in  the  investigation of  disease,  when  taken
 in conjunction with the other symptoms of a
 case.  But  to imagine  that its inspection
 yields  any definite or trustworthy informa-
 tion to  the ignorant and illiterate "water
 caster," ignorant  alike  of the nature of the
 secretion  from which he  or she—for  there
 are female quacks of this  kind—professes to
 derive information, ignorant of the structure
 or functions  of the  animal body, is too ab-
 surd. In such c:ises—as,  indeed, in those of
 the prescribing quacks  generally—the sys-
 tem of fraud is supported by lying assertions
 and promises,  and  by working upon the
fears of the unfortunate dupes: this is espe-
cially the case in those who  profess the venereal
 department, and who cannot be too caiefullj
 shunned.   The most  shameful impositions
 are practised by this  description of quack,
 and the consequences  are very serious.  The
 conduct of newspaper publishers in giving
 currency to announcements connected with
 this obscene and disgusting phase of quack-
 cry is most reprehensible.   Some quack
 prescribers  follow  their  business  on  the
 strength, real or pretended, of having re-
 ceived the "receipts," as they are popularly
 called, of some predecessor, regular or irre-
 gular.  Even supposing such "receipts" were
 good for any thing, it would be difficult to
 prove that  their possession gave the faculty
 of applying them;  but the fact is, with the
 exception of a few general medicines, such
 as the  common aperient pills, every case of
 disease, and almost every constitution, re-
 quires  some modification  in  the  medicines
 prescribed, and the same  prescription is no
 more  applicable to three or four different
 individuals than the  same  coat would  be.
 Moreover, almost every case of illness calls
 for changes  and  modifications of  medicine,
 to meet the ever-changing symptoms which
 occur; but the quack  panacea ignores such
 distinction, and professes, by its wonderful
 property of curing at once,  to cut the Gordian
 knot—well if it does not do this by cutting
 the thread of life at the same time.
   As it is impossible  for  any man to treat
 disease with full  advantage unless he has
 acquired  by education a  sufficient amount
 of the  very varied  knowledge, both  theo-
 retical  and  practical, which  is  now  em-
 braced within the limits of medical science;
 so, every man who undertakes the treatment
 of disease as a practitioner, without such
 knowledge,  necessarily falls under the de-
 signation of a quack, because he pretends to
 that which he does not  possess—he deceives.
 It is true, many receive the necessary edu-
 cation,  and yet follow out irregular theories
 and modes of practice: if, in doing so, they
 do wrong, it is unfortunate ; but if the error
 is followed in sincerity, the follower cannot
 justly  be called a  quack.  On the ' other
 hand,  the  upholder of the most  orthodox
 medicine  may do so in a quackish manner,
 if,  in his practice,  he makes a display of
 methods, either of investigating or of treat-
 ing disease, which are  not  requisite.  Such
 things flourish because ignorance  abounds.
 As any system of  medical  practice may be
 converted into one of quackery, so may any
•medicinal agent, even  that which  is  safest
 when  properly used, become, in the  hands
 of the  unprincipled  empiric, an agent for
 evil.  In  fact, quack  medicines  generally
 are compounds of drugs which are regularly 
Q  U A               440               Q U  A
md daily prescribed by medical men.   It is
not in the  composition, but it is in the ap-
plication of the compound, that mischief is
done. If it be a matter of indifference, when
a purgative, an  anodyne, or  any other me-
dicine is required, what article is selected,
so that it belongs to the class ; or, if it mat-
ters not whether its peculiar action is suited
to the case and  constitution  of the patient
or not, or  if the same doses are suitable
to all, then may  quack compounds—each
professing  to  do  more  than another—be
permitted to go forth unchallenged on their
errands  of mischief  under  the  sign  and
seal  of government,  [as  in a patent medi-
cine.]   But, if  a medical adviser requires
to investigate his  patient's  case,  to weigh
in his own  mind  his constitution, circum-
stances, and tendencies,  and, finally, to se-
lect from the stores of his own  experience
and that of others, the remedy or remedies
best  adapted to him, it must be evident to
every reflecting  mind, either  that  these
latter necessities enjoined upon the man of
educated mind  and sense are a tissue of
deceptions  and  shams, or that  the whole
system of quack medicines must be founded
upon  fraud, and that it flourishes upon the
credulity which  believes  specious  lies, or
puts  trust  in the  easily obtained testimo-
nials of some weak-minded individuals, such
as are to be found in all ranks and classes.
  It  is  difficult  to account  for  the eager
credulity and secure indifference with which
persons,  otherwise sensible, swallow or use
what they  believe  to be  agents  capable of
acting powerfully upon  their own bodies,
while all they know of  these agents is  that
they  are put forth by  those  of whom  they
know nothing beyond the  advertisements
filled  with  assertions  so  impudent, or at-
tempts at  deception so palpable, that  the
wonder  is  they do  not  defeat   their  own
ends.  Few would be  inclined  to trust an
individual  whom they  had detected in  the
attempt to cheat them by offering a forged
check, with, perhaps, the precaution taken
to place the would-be  deceiver  out of  the
reach of the law by the  change of a letter
in a name;  and yet  people are daily gulled
by some such devices, eminent names, with
some  slight  alteration in spelling, being
made the attractions by which an  unprin-
cipled vendor seeks to puff  off  his wares.
Come from what authority it may, as soon
as a  medicine, or combination of medicines,
is held  forth as a "cure," irrespective ot
contingent circumstances, it becomes a quack
medicine;  in  other words,  it becomes a
source of danger to some, probably to many.
The  passion for gambling is a very widely
distributed one; and, ns men will risk thei.
fortunes and their liberty upon  the throw of      i
the dic>e, so  it can be only the same love of      ,
hazard that induces many of them  to risk      j
the possibility of injury against  the recovery
of some of those prizes of health which they     <
have thrown away time  back, but which are ,
now held  out as the tempting baits of the
speculator.
  Solomon's  Balm  of  Gilead  realized  a
handsome fortune for  its promulgator,  of
whom  the  following anecdote is  told:—    £j
Being asked how it was that  people  bought
his medicine so freely,  he replied, " Of ten
men who pass my door,  nine, at least as far
as medicine is  concerned, are fools; if you
will give  me the  nine  fools  for customers,
the regular practitioner may keep  the one
who is wise  in these matters."
  In advocating the doctrine that quackery
is only to be successfully combated by im-
parting to the people generally the informa-
tion necessary to enable them to see through
the deceptions of the charlatan, the author
does not  by any  means dissent from  the
suppression of  quackery by the strong arm
of the law,  at present,  as a means of pro-
tecting  the people  till  they can  protect
themselves.   But as  it must be long before
information is sufficiently diffused to effect
the end proposed,  the external  guard ought
to be substituted in the mean while, till the
dictates of educated intelligence are suffi-
cient  for the purpose.   Governments ought
to protect the  poor and ignorant in these
matters, instead of throwing the " patent"
protection over deleterious compounds which
destroy annually so many of the people.  A
case in  point  of  the  injurious  effects  of
quackery has  come  under the  author's no-
tice lately.   A labouring man,  suffering
from  obscure internal  disease, for which
he has been treated without  relief, both  in
private and in  the wards of a general hos-
pital, is induced by  the fair promises and
lying  opinions  of an itinerant  quack to re-
sort to him for  advice (?) given him gratis,
while the medicine  is paid  for at the rate
of five shillings a bottle, and paid for at the
time;  at  the same time the  poor man  is
applying for parish relief, and his family
in want.   He is to be cured in three weeks;
that is, he is to pay fifteen shillings, and  by
the time the quack has reaped that amount,
got together somehow, the patient may open
his eyes, if he likes,  to the fraud.
  Refer to Medicine, Practice of.
  QUARANTINE—Is derived from the Ita-
lian word signifying  forty; forty days hav-
ing been the usual space of time that per-
sons or goods coming from places in which 
QUA               441                R E A
 infectious diseases, or  diseases thought to
 be infectious  prevail, or that have been ex-
 posed to the influence  of any such  disease
 during a sojourn on board ship.  The qua-
 rantine  or isolation, is  either " performed"
 on board the vessel, which none are allowed
 to leave, or in a  building  called a  " laza-
 retto." set  apart  for the purpose, and cut
 off from all communication with the sur-
 rounding country.  There has of late pre-
 vailed  a strong feeling toward the  modifi-
 cation  of the laws of  quarantine.  The
 term of  isolation is often much less than
 the forty days.
   QUARTAN.—A term applied to an ague,
 the paroxysms of  which occur every fourth
 day.—See Ague.
   QUASSIA.—The quassia wood is obtained
 from a  tree,  native to Jamaica and other
 West India Islands.  It  is named the " quas-
 sia excelsa," from its height, which is often
 one hundred feet.  Quassia wood is usually
 sold in  the form  of chips  or raspings of a
 lightish yellow colour ;  it is intensely bitter,
 and forms  a  valuable tonic and stomachic
 remedy.  It is best given in infusion, made
 by soaking  two scruples  of the raspings in
 one pint of water for a couple of hours. The
 dose  is  one to one and a half fluid ounces
 twice  daily.  The  root  bark of  another
 species of quassia, or at  least  what was
 formerly ranked as a quassia, is also some-
 times used in medicine.
   QUICKENING.—See  Pregnancy.
   QUICKLIME —See Lime.
   QUICKSILVER.—See Mercury.
   QUINCE  SEEDS—When  boiled in water,
 yield a  mucilaginous decoction, which  is
 not, however, in any way superior to other
 more common preparations.  Two drachms
 of the seeds are ordered to  be boiled in two
 pints of water for ten minutes, and the de-
 coction strained.   [When boiled for half an
 hour, or when simply soaked, it forms what
 is termed " Bandoline," and is then used at
 the toilet to keep  the  hair smooth  and in
 place.]
   QUININE.—See Bark.
   QUINSY.—See Throat, Sore.
   QUOTIDIAN.— A  term  applied  to an
 ague, the paroxysms of which  occur daily.
 —See Ague.

  RABIES—As a  term, is  usually synony-
mous with hydrophobia, or canine madness.
—See Hydrophobia.
  RADISH — The  Raphanus  sativus, like
other vegetables which are eaten uncooked,
is not suitable  for persons of weak digestive
poAvers.                                   |
   RADIUS.—One of the bon<*s of the fore-
 arm.—See Forearm.
   RANUNCULUS.—The various  species of
 ranunculus, or "butter-cup," so common in
 Aiis  country,  are chiefly remarkable for.
 their acridity, as any one  may  prove whc
 will  chew a small portion  of one of the
 leaves.  Their action  is emetic,  and also
 when bruised and applied to the skin, irri-
 tating,  acting  like  a  mustard-plaster  or
 blister—a fact the knowledge of which might
 prove useful.   These plants completely lose
 their acridity by drying.
   RAISIN.—The dried  grape, in  which the
 mucilaginous and perhaps acid constituents
 of the fresh  fruit have been  converted into
 grape sugar in the process of desiccation.
 Raisins are used in various  medicinal pre-
 parations.  As an article  of diet they are
 unwholesome only if the tough, indigestible
 skins are eaten.  In the case of children,
 much disorder is frequently caused by the
 undigested skins  of raisins passing into the
 bowels, and lodging in the sacculi, or little
 pouches of the  larger intestines, where they
 cause much  irritation,  and  probably trou-
 blesome diarrhoea, which  is only  relieved
 when a dose  of castor-oil, or of some other
 aperient, clears out the offending accumu-
 lation.  Raisin-skins may thus  remain  in
 the bowels for weeks.
   RASH—Is a popular  term for eruptions
 on the  skin, more especially such  as scar-
 latina, nettle rash, &c, which  do not pre-
 sent either vesicles or pustules.
   RASPBERRY—The Rubus ida-us. is indi-
 genous to  England, [and the United States,]
 and grows wild in many situations,  especially
 in Scotland, amid the stony banks of streams.
 The raspberry is one of the most wholesome
 fruits we possess, either in its fresh state or
 preserved.  In the latter form it is a most
 grateful addition  to the sick-room comforts.
 In fever,  and feverish  diseases  generally,
 when the acid is not an  objection, the well-
 known raspberry  vinegar is  both  an agree-
 able and salutary beverage.   When the acid
 is inadmissible, a pleasant drink is made by
 mingling the  preserve or jam with water.
   REACTION—In medicine, is the  resist-
 ance of the  animal  system  to depressing
 causes—a resistance, however, which tends
 not only to restore to the ordinary level of
 action, but to go farther, and to  stimulate
 to action above that level;  thus, after the
 cold stage of fever, the reaction to  the hot
gives a skin, hotter  than  usual, a  pulse
quicker and  probably stronger than usual.
The  same  effect occurs in reaction after de-
pression from other causes,  such as aftej 
RE A
442
REC
accident.  In combating, therefore, especial-
ly by means of stimulants, the  depression
which in such cases at first seems almost to
threaten life, the after reaction must not be
lost sight of, and the means of relieving the
depression administered  with a sparing and
judicious hand.  When reaction can be pro-
cured by the natural powers or resilience
of the system, by external warmth, and  by
warm, comparatively  unstimulating fluids,
such as  tea, &c, it  is better effected than
by the use of more powerful  excitants.  In
some cases, however,  the  latter are  abso-
lutely necessary to preserve  life, and then
ammonia in  some form, but  especially as
sal-volatile,  alcoholic  stimuli,  such  as wine
and brandy, and the others, are all powerful
promoters of  reaction.  In some peculiar
cases, emetics of mustard, by rousing the
system,  greatly assist reaction.
  READING ALOUD—And speaking aloud
for a length of time are wholesome exercises
for the strong; but if  carried to excess, or
even if only practised moderately, may pro-
duce, in the predisposed, injury to the lungs,
spitting of blood, or affection of the throat.
—See Clergyman's Sore-throat.   The  modi-
fication  of the respiration and circulation
produced  by  continued loud  speaking  or
reading, is also apt to produce unpleasant
symptoms in those predisposed to apoplectic
or head affections.   The exercise of reading
aloud has been  recommended  as useful in
cases of hysteria and nervous disorders.
  RECREATION—Or the renovation of the
powers of body or mind, after  they  have
been exhausted by toil, is one of the highest
pleasures enjoyable  by  man; a  real plea-
sure, because  it can only be  purchased  by
those previous exertions, in the performance
of which, although they are exertions, man
feels that he is  fulfilling the  ends  of his
being.   Those who live in a constant round
of what  is  called pleasure, the idle, the
saunterers  after their work, do not  know
what true recreation is, cannot realize the
thorough enjoyment with  which the  man
who  works in  the  true sense of the" word,
who, "whatever his  hand findeth  to do,"
does it "with all his might," throws off his
toil,  and takes  to recreation in the same
hearty spirit  that he brings  to his  daily
effort, whatever that may be.
  Recreation is the enjoyment of man espe-
pecially, and the higher he  rises in the scale
of true  intellectual being^ the  more  tho-
roughly must he enjoy it—the  active plea-
surable excitement of both mind and  body,
in contradistinction to "rest," which is the
passive enjoyment of repose after exertion.
  The animal enjoys rest, but can scarce be
i said to ehjoy recreation ; tie man of physi-
I cal toil enjoys rest, and, if the mind be dull
j and untutored, finds his chief enjoyment, in
 the intervals  of labour, in rest, like the
 animal;  rest, which recruits the physical
 powers, while  the mind is comparatively va-
 cant.   But when the mind  is at all inclined
 to activity, after  the  rest  which follows
 action, comes the  desire for reaction, (for
 recreation,) an active state, more  useful in
 many respects than rest, because it is a state
 of stimulation, of wholesome excitation, if
 kept within proper  bounds.  Such a condi-
 tion of moderate pleasurable excitement of
 the mental and physical powers, which act
 and react on one another,  is highly condu-
 cive to health—is,  in fact,  a means of pre-
 serving  health,  to which man,  except  in a
 very  artificial state,  is  periodically,  almost
 instinctively impelled.
   The subject of recreation involves a great
 practical  truth.  Those who do not work
 cannot know recreation ;  without the action
 there can be no reaction, for the one follows
 the other as effect follows cause, and, when
 all is in order, as a necessary cause.
   Again, recreation must alternate with work,
 if the power of working  is to be  retained.
 If recreation cannot be enjoyed without work,
 neither can work be enjoyed or vigorously
 pursued without recreation.  But the  fact
 has been  greatly overlooked  in  this busy
 age, and work is pursued unceasingly, until
 either body or mind sink under the never-
 ending tension, or,  if they do endure, until
 the power of taking recreation is lost—until
 the mind becomes so immersed  in its daily
 engagements,  in its daily  routine, that it
 cannot divest itself of the trammels thrown
 around it.  The man becomes so bound down
 in the pursuit of money,  of power, of repu-
 tation, that he is a slave to  his own desires
 —he grudges every moment abstracted from
 the advancement of his darling cares—he
 cannot recreate.  Here is neither the  time
 nor place to point out how  far  this inordi-
 nate slaving is removed from the  true  ends
 of  man's being in this world, or  how little
 it is in accordance as a preparation for an-
 other.  It is a system but  little calculated
 to afford either continued health, or happi-
 ness, or usefulness, in man's daily life;  the
 physical  powers must eventually give way
 under it  if persevered  in, and  dyspepsia,
 miserable  hypochondriasis, paralysis,  and
 cerebral  disease be the  probable  conse-  •
 quences ; or, without the presence of  tan-
 gible disease,  the  power  of  exerting  the
 mind be lost   A man who  thus feeis  him-
 self enslaved by work, should, by an effort,
 break through the restraint—an effort itwil' 
R EC
443
RE C
  require, to cast off the morbid state of mind
  which is generally connected  with  the con-
  dition; but  the  effort must be made—and
  those  from whom it is  most required, are
  generally those  who most have  it in their
  power to avail themselves of the means of
  recreation to  the  utmost,—they  are our
  wealthy (but overtasked in mind and body)
  merchants, lawyers, men of business, and
 »in  some  cases  medical  men.  They think
  they cannot leave their posts without every
  thing  going wrong, without  risk  or  loss;
  risk of some rival taking up an investment,
  a cause, or a patient; and it may be so, but
  is the  chance of  such petty losses a reason
  for sacrificing health, and life, and real hap-
  piness too?  For that cannot be real happi-
  ness which is dependent for its continuance
  upon the same mill-horse round of actions.
  It is, therefore, repeated  that recreation is a
  duty which the man of real work owes to God,
  to society, to himself,  and to his family, and  it
  is a duty which he cannot altogether neglect,
  without risking the loss of both mental and
  bodily health.
   The kind of recreation in  which a man
  should  indulge  must of  course  depend
  greatly upon circumstances, but, generally
  speaking, a complete  change  of  scene and
  air is desirable, such as will break  in upon
  old trains  of thought, give new ideas, and
  afford  pleasurable  recollections,  when the
  active exertions of life «*re  again returned
  to.  It argues well both for the physical and
  mental elevation of the population at large,
 that the means of recreation, the cheap trips,
  the excursion trains, &c. are so abundantly
 taken advantage of, and are becoming yearly
 more common, for these  must be regarded
 as part of the great  sanitary movements of
 the  age, the means  of affording cheap and
 thorough recreation  to classes, who,  some
 years ago, scarcely dreamed of such a thing.
 It ought to be the duty of all, of every go-
 vernment, of every master, to give abundant
 facility for pure healthy-minded recreation
 to the people; to  do  so is true economy of
 that  real wealth,  social  and  political, the
 healthy  mind and healthy frame of every
 individual of the community.
   Recreation, reaction after toil, or in other
 words periodical  stimulation  of mind and
 body, in those who work, is so strongly in-
 Btinctive, that it will  be sought, and if not
 found in one way,  in  the  reading-room, the
 lecture, the concert,  the garden, or even in
 the cricket-ground, if  not afforded in the
fete  or  the  excursion, will be  procured in
the tap-room,  or in degrading and  vicious
pursuits.  [This sentiment is well worthy of
the serious consideration of the sons and ad-
 vocates of temperance in the United States.]
 To  sum  up,  the  stimulus  of  recreation is
 one of those  stimuli  necessary for the con-
 tinued healthy tone of both mind and body,
 it cannot be neglected without injury to
 both, but its gratification  ought to be di-
 rected into those channels which will pre-
 serve its utility, because they preserve it in
 order, in moderation, and in purity.
   Refer  to Exercise—Dancing — Pleasure—■
 Rest, Sec.
   RECTUM.—The rectum is the terminat-
 ing extremity of the large bowel which opens
 at the anus  or fundament.  It derives its
 name from its straight course  as compared
 with the  tortuosity of the other portions of
 the intestines.  It is about nine inches in
 length, lies in front  of the " sacrum," (see
 Pelvis,) and  expands into a dilatation just
 above the external opening, or  "anus," at
 which it is closed by a "sphincter"  muscle,
 which  retains the contents of  the  bowel,
 unless when, under the influence of the will,
 it permits their expulsion,  the  latter act
 being effected  by means  of the muscular
 fibres of  the gut itself, aided  by the down-
 ward pressure of the diaphragm and  other
 muscles of the abdominal boundaries.  The
 rectum is of course lined by a continuation
 of the mucous  membrane  which lines the
 intestines throughout.  The rectum  is  sub-
 ject  to various diseases,  which generally
 require efficient surgical assistauce for their
 safe and speedy cure.
   Infants  are occasionally born  with what
 is called " imperforation"  of  the rectum;
 that is, the gut, instead of being an open
 canal, is closed wholly or partially, either at
 the external opening  or higher up.   When
 ^•imperforation" of the rectum in an infant
 is either evident or is  suspected, from the
 non-passage of the natural  contents of the
 bowel  downward, from the belly becoming
 tense and full, and from vomiting the con-
 tents of the bowels, the child should  at once
 be seen by a surgeon, for it is possible that
 a simple operation, adopted without  loss of
 time, may rectify the evil and preserve life.
   Obstruction of  the  rectum,  painful or
 otherwise, may  occur either in adults or
 children,  in  consequence of  the presence
 either of hardened "faeces," in consider-
 able quantity, or  of  foreign bodies which
 have descended after  being  swallowed, and
 become fixed  in the  gut, just  above the
 lower  opening, or which, have been  intro-
 duced directly into the canal, either  by ac-
 cident or design.
  The dilatation of the rectum just above the
anal opening rather favours in some cases
the accumulation  of  the hardened  fsecaJ 
                  REC

 'ontents of  the  bowels,  especially  in  the
 aged—a condition which is  apt  to occasion
 much  suffering  and  inconvenience.  Such
 an accumulation generally requires  the aid
 of the surgeon, who removes it by  mecha-
 nical  means, such as scoops and such-like
 instruments; or  the  handle of  a spoon is
 sometimes used in the absence of the above.
 In proper hands the case is of course safe,
 but it would not be well for unprofessional
 persons to attempt such interference: much,
 however, may be  done by the persevering
 use of mild clysters, of about half a pint of
 fluid at a time, which will  first soften  and
 finally induce the  discharge of the mass.
 Foreign bodies lodged  in the rectum may
 produce distress simply from their  bulk, or
 they may produce much suffering by lace-
 rating the lining membrane by sharp edges
 or points, causing intense pain  on   any at-
 tempt being made to evacuate the  bowels.
 Children not unfrequently suffer in this way,
 from  the  stones  of  plums,  &c. which they
 have swallowed, and the author  has seen a
 case in which the greatest agony was appa-
 rently caused in a child, by the hard core
 of an apple becoming fixed  at the opening.
 In all such cases it is advisable to get pro-
 per advice at once;  but in  the  absence of
 this, clysters of tolerably thick  gruel may
 be used, or the finger well  greased  may be
 carefully introduced within  the  gut, to as-
 certain, if possible, the presence, and assist
 the removal of any small body within reach ;
 but no instrument can be safely used except
 by a medical man.
  Obstruction of the rectum  may  likewise
 be the result of disease  which causes nar-
 rowing or  " stricture" of its canal.  This
 disease, which generally occurs after middle
 life,  and which  may either be of a simple
 or of  a cancerous nature, is  thus described
 by Mr.  Syme, a high  authority on  the sub-
ject:—"The symptoms of simple stricture.
 are slow, painful, and imperfect evacuations
 of the bowels, the desire  to  empty  the rec-
 tum continuing after the most powerful  and
 prolonged  efforts  of  expulsion, the   dis-
 charge of fluid matters with great force, as
 if from  a squirt, the appearance of the solid
 evacuations in the form of slender cylinders,
 or small round masses, and the admixture
 of a large quantity of mucus, often  bloody,
 with the feculent excretions.  The  disease
 generally manifests itself very insidiously,
 and  before  long vis  usually accompanied
 with  a distended state  of the  abdomen,
 which  is owing  partly  to retention of the
 intestinal  contents, and partly  to   a tym-
 panitic  condition, induced by the irritation
 thus occasioned.   The desire to empty the
14               RE F

bowels  becomes at  length almost incessant,
and the frequent attempts which are  made
to do so, being seldom followed by any eva-
cuation, except of  fluids, there is a risk of
erroneously  supposing  that  the  patient
labours under diarrhuja, and, with this view,
of prescribing medicines which have  a ten-
dency to increase the distension of the intes-
tines."  It is only requisite to add, that when
such symptoms as the above show themselves,
there is but one course left—that of procur-
ing the best advice as soon as possible.
   Ulceration of the lining membrane of the
rectum, fissure at  the  anal opening, and
other diseases, especially the last  named,
which produce painful sensations, when the
bowels  are evacuated, can only be properly
investigated  and treated by a surgeon.
   Falling, or  "prolapsus" of  the bowel,
and piles, have already  been considered
under their proper articles.
   Fistula is  a  disease connected with the
rectum, which  often causes  much  incon-
venience.  It is the result of abscess, which
having  formed, and discharged at the side
of the gut, remains unhealed and unhealing,
and often  opens both externally  and into
the bowel, forming  as it were a side passage,
by which wind and fluids are apt to escape
along  with the discharge  peculiar to the
artificial  passage.   As  may  be imagined,
such a  state  of matters  gives  rise to much
annovance, and calls for speedy removal,
which can only be  procured with  certainty
by operative procedure on  the  part of a
surgeon.   The sooner, therefore, this is sub-
mitted  to the better, the bowels being  in the
mean while kept lax, and the disagreeables
of the  condition alleviated as much as pos-
sible.   Fistula is far more common in  males
than in females, and is often associated with
consumptive tendencies.
   REFRIGERANTS—In medicine, are re-
medies  employed to reduce the existing tem-
perature of the body, either locally  or ge-
nerally.  Internal  remedies,  such  as the
vegetable  acids, nitrate of potash,  or salt-
petre, &c, have been used tinder the name
of refrigerants, but it is difficult to trace to
them any  direct action.  Indirectly, they
probably act by reducing the force and fre-
quency of the  circulation.  The  best and
most direct  refrigerant is the obvious one,
cold itself, used through the medium of cold
air,  cold water, or  ice, and in  most  cases,
when the animal temperature is raised above
the natural standard, in  some of these form*
cold  is useful.  The late Dr. Currie, of
Liverpool, established the practice of  treat'
ing fever by the refrigerating action of cold,
used very boldlv, in the form of cold  water
4- 
                  REG.              4<

 dashed freely over  the patient,  and the
 practice was  at  one time considered most
 successful,  but  either  from  timidity, or
 some other cause, it has fallen into compa-
 rative disuse among  medical  men at the
 present time.
   Refer to  Cold—Ice, Sec.
   REGIMEN —Is  the  regulation of the
 habits of an individual with  reference to
 health.   Diet is properly  included under
 the term, but is generally spoken of  sepa-
 rately.  The proper regulation of  the regi-
 men of an  invalid  is  obviously a matter of
 great importance.  It includes the prescrip-
 tion of the hours, and kind of  employment,
 of exercise, or of amusement,  of the  times
 of meals, and of  sleep, of dress,  &c. &c.
 As the particulars of regimen are sufficiently
 entered into under the various  articles, it is
 superfluous to uotice them further  here.
   RELAXATION.—See  Recreation.
   REMITTENT FEVER.—See Fever.
   RENAL.—Appertaining to the kidney.
   RESINS—Are  vegetable  juices,  which
 are solid, are not soluble in water, but dis-
 solve in alcohol.  They are generally brittle,
 and more or less transparent.   The resins
 best known, and which are used in medicine,
 are left after the distillation of the essential
 oil of turpentine.  They vary in appearance,
 according to the mode in which the distilla-
 tion has  been conducted.   Resin  is  only
 used in medicinal practice, at present,  as an
 addition  to  plasters.   It enters into the
 composition  of  the  well-known basilicon
 ointment.
   Refer to Basilicon—Plaster, Sec.
   RESOLUTION.—The  term  is  used in
 medicine  to designate that  termination of
 the process of inflammation, by  which the
 affected part is left without obvious change
 of  structure, in other words, is  left in the
 same condition as it  was previous to be-
 coming inflamed.—See Inflammation.
  RESPIRATION.—Breathing, in its widest
 sense, is the process by  which  atmospheric
 air  is  brought into contact with the fluids
 existing in the interior of organized beings,
 whether vegetables or  animals.   In man, it
 is the  function by which atmospheric  air is
 introduced or drawn into the  lungs or re-
 spiratory  organs, and  again expelled, after
 its oxygen has been exchanged for  the car-
 bonic acid with which the venous  blood is
 loaded  as  it enters the  lungs.  Thus the
process of respiration in  man  comprises,
first, the act of drawing  in the air, 'or  " in-
spiration ;" and  secondly, that of expelling
the  air, or  " expiration."  As the reader
will find all  requisite information upon this
 vital  function under articles  Aeration —
        2N
 [5                RES

 Blood—Chest—Circulation—Lunja, Jec, it is
 unnecessary to repeat it he;e.
   RESPIRATORS—Are instruments used to
 protect the air  passages  from the  direct
 effect of the air, especially when it is cold.
 They are undoubtedly most valuable when
 used with proper discretion.   The first in-
 strument, probably, to which  the  name of
 respirator  was applied, was Jeffrey's well-
 known one, constructed upon the principle
 that the warm breath passing out  from the
 lungs should impart its heat to a number of
 small,  closely-set  wires,  this heat  being
 taken up at the next inspiration by the cold
 air, in its  passage through those wires to
 the lungs.   Jeffrey's respirators are made
 so as to protect the mouth alone, the nose
 alone,  or mouth  and nose  together.   There
 is  also a form of hand-respirator, intended
 for temporary use,  such  as when passing
 from room to  room, &c.   In many cases of
 chest affection, these instruments furnish a
 means of protection of the highest value,
 particularly for those who, suffering from
 delicacy of the lungs, cannot, by reason of
 their avocations, avoid exposure after night-
 fall,  or to  cold  or foggy air  of any kind.
 With  warm clothing, and  a  respirator, an
 invalid may almost defy climate, particularly
 as the instrument not only protects the air-
 passages  from the direct influence  of the
 cold, but seems  to assist in preserving the
 animal heat of the  body generally.  The nose
 respirator is principally intended to be worn
 during sleep, and enables persons who suffer
 from delicacy of  chest, to occupy,  during
 winter, bedrooms  much more freely venti-
 lated than  they could without its  assist-
 ance.
   The  chief objection urged against many
 respirators is, that they  keep  the  air of
 respiration in too artificial a state of warmth,
 and thus  render  the wearers peculiarly sus-
 ceptible on the slightest accidental exposure
 —in fact, render them so sensitive of cold as
 to be almost entirely dependent on the in-
 strument for comfort, and health,  and even
 for life.  Notwithstanding these objections,
 when as  full  protection  as  possible from
 cold  air is required, Jeffrey's respirator is
 the best instrument, care  being taken, of
 course, that it is not unnecessarily had re-
 course to.   When  a minor  degree of pro-
 tection only is required, it may be attained
 by some protective material worn across the
 mouth, which  acts upon the same principle
 as the respirator  above named.  A  hand-
 kerchief of silk or of woollen material is at
 once a  simple and  efficient respiratory pro-
 tector ; and various forms  of respirators,
I made of woven materials, may be  procured
4' 
                 R K S                4

at the shops. Some persons find respirators
o.' any  close  material  so  confining  as  to
cause difficulty  of breathing.    For such
cases,  open-knitted protectors of Shetland
wool are well adapted.  Vails of the same
material are made, which form an  additional
protection for females.
  Persons who are not very delicate, but
who yet  find it requisite to wear a respira-
tor, will often find it a relief, when walking,
to slip the instrument off the mouth when
they turn away from  the wind, or, in very
sheltered situations, readjusting it  when-
ever  they again meet the wind,  or pass into
a more exposed situation.
  REST.—Refer to Sleep.
  REST-HARROW.—This well-known and
common  weed  has some repute  as a remedy
in chronic rheumatism, and might safely  be
tried.  In the British,  and Foreign Review for
October, 184(1, it was stated, subsequently to
some other observations, that "It was not in-
variably successful, but it never did harm,
and cured many cases that had long resisted
other means."  The form of administration is
a concentrated  decoction of the fresh bark
with its roots, or of  the  roots  and  stems
dried, and a quart of  the decoction must  be
taken daily.  Its immediate effect is power-
fully diuretic.
  RESUSCITATION —The restoration  to
sensibility of persons apparently dead,  is
sufficiently treated of under  articles Car-
bonic Acid or Choke-damp—Cold—Drowning
—Hanging, Sec.
  RETE-MUCOSUM.—The  internal  layer
of the outer or scarf skin.—See Skin.
  RETINA.* —The  retina (fig. cviii. 1)  is
Fig. cviii.
the expanded sheet of nervous substance de-
rived from the optic nerve (2) which forms
the inner coat of the eye.  It is the essential
portion of the visual organ, the  mysterious
link  between  material  appearances  and
mental impressions, without which, or  in  a
diseased  state of which, all other  arrange-
ments  for vision, however perfect, must be
futile.  The eye  may seem as lustrous as

                 * See Eye.
6                R H E

ever, its  depths as clear, but if the retina
or its nerve tail, all is dark,
 " And knowledge from one entrance quite shut out."
  The retina (fig. cix.) does not extend quite
Fits. cix.
to the forepart of the interior of the eyeball,
but only as far as what is called the "ser-
rated line."  (4;) In front of  this serrated
line lie the ciliary foldings (5) of the coloured
coat of the eye, and  more anterior than
these the "iris," (1, 2,) the posterior view of
which as well as the pupil (3) is represented
in the drawing.
  Blindness from disease of the  retina con-
stitutes the disease  named amaurosis.—See
Amaurosis.
  In a living, or perfectly fresh eye,  the re-
tina is  transparent, but  soon after  death
acquires an opacity somewhat  resembling
that of ground glass.  The miuute structure
of this  portion of a wonderful organ is, in
itself, most wonderful and complex.
  RHEUMATISM.—Under  this  well-known
name are comprehended two  forms  of dis-
ease, differing greatly  from  each other—so
greatly, indeed, as to be distinguished even
by the unprofessional.   The acute form  of
rheumatism, frequently called " rheumatic
fever" by medical men, is popularly named
the "rheumatics,"  while the chronic form,
the "chronic rheumatism" of the physician,
is known  to the public as  simply  "rheu-
matism,"  or in vulgar parlance, as "the
rheumatiz."   " Muscular  rheumatism"  is
also included under the term rheumatism.
  Acute rheumatism, or rheumatic fever, is
characterized by symptoms  of high  inflam-
matory fever;  there is shivering, great heat
of skin, followed by profuse  sour-smelling
perspiration;  the pulse is  rapid  and full;
the tongue, covered with a white, creamy-
looking fur, is red at the tip and margins;
there is much  thirst,  and  the  appetite i«
deficient.   Delirium does not often  occui-
unless the heart becomes  involved.  Coin-
cident with the above  constitutional synip
toms, one or more  of  the  large joints, or 
R H  E               447               RUE
Bome of the tissues in the neighbourhood of
a joint, become exquisitely tender, swollen,
and inflamed, the skin over the affected part
turning red.  Whatever may be the part or
joint first affected in a case of acute rheu-
matism, it rarely becomes the fixed seat of
the  disease, which, before long, almost in-
variably transfers the site of  its manifesta-
tion to some  other joint, leaving the  one
previously affected entirely free,  or nearly
80.  This  shifting from one place to another
goes on during the whole period of the dis-
ease, and, indeed, constitutes its most cha-
racteristic and  well-marked  feature.  Few
diseases are  accompanied with more pain
and suffering than acute rheumatism, the
slighest  movement often causing  the  most
exquisite torture; the patient lying jn a state
of  helplessness  more or  less  complete, ac-
cording to the extent of the affection of the
joints.   A disease which, like acute rheu-
matism, can thus  shift its local indicationb'
from one part of the  body to another,  must
evidently be a constitutional one, and there
can be no question that it is a blood disease;
that is, that  it is  dependent on  a morbid
condition of the blood, or the circulation of
a poison generated in that fluid.   The near
resemblance in many of their circumstances
between gout and rheumatism renders it
probable that a similarity, at least of cause,
may be expected.  In  the former disease,
the blood  poison, the  " uric acid," not only
separates  itself spontaneously  under  the
form of chalk-stones, but it has been sepa-
rated from the  blood itself by Dr. Garrod.
That a superabundance  of peculiar acid,
probably lactic acid, does exist  in the sys-
tem during an attack of acute rheumatism
is  unquestionable.   So long as an  attack of
acute rheumatism confines itself to the j oints,
and to the parts in  their vicinity, it is a
disease devoid of danger. But, unfortunately,
in a very considerable  proportion of cases,
there is a tendency of the disease  to attack
some of the " fibrous" structures connected
with the heart, which resemble those fibrous
tissues, which, in the neighbourhood of the
joints, are the common seat of the disease.
This  inflammatory rheumatic  affection  of
the heart, included under the term carditis,
(see Carditis,) having already been suffi-
ciently entered into, does not require further
detail here. Suffice it to remark, that it is a
complication of an  attack  of rheumatic fever
which is always to be anxiously watched for,
and  its first appearance treated  with the
utmost activity.  It is more liable to occur
the younger the subject;  and. indeed, the
author has  reason  to believe, from a case
which  has come under his own notice, that
where  strong  hereditary predisposition  to
rheumatic affection exists, the  heart in a
child  may become  affected  rheumatically,
and the foundation laid of  future  organic
and incurable disease, without  any of the
usual   joint  affection  of rheumatic  fever
being  mixed up with the first attack, which
has probably been passed over as a feverish
cold. Probably, such cases are not common,
but their possibility should put parents, who
are aware  of  hereditary predisposition  to
acute  rheumatic  disease, upon their guard
as respects their children.  In considering
the causes of acute  rheumatism, the strong
predisposition  that exists in individuals and
families,  hereditarily,  is  most important;
for, in such persons,  extra  care is always
requisite: they  are liable to  become the
subjects of the disease from contingencies
which would leave others quite  unaffected.
This circumstance of hereditary predispo-
sition   to acute  rheumatic affection ought
always to be  considered by pareuts in  di-
recting or advising upon the  future destina-
tions of their children, who  ought never to
engage in any occupations  which may  in-
volve  much exposure  to  the vicissitudes  of
weather; for if they do, they almost certainly
become the victims  of rheumatic fever,  in-
volving long   and painful present  illness,
and in all probability  laying the foundation
of years of future suffering  and of half
usefulness from  heart disease.  Indeed,  so
serious .are  the  considerations involved  in
hereditary predisposition to acute rheumatic
disease, as to make it a  question whether
persons thus  predisposed would not find it
their best  plan to leave the changeable and
often damp climate of Britain, and make their
home  in one, such as that of Australia, free
from such objections; provided, of course,
that after the move,—occupations are not
engaged in,  which involve exposure.  The
question of hereditary predisposition to acute
rheumatism is one which  no  life-assurance
company should overlook.
  Of the direct causes of acute rheumatism,
there can be no question that cold and damp
combined  are  the most  usual—out of  all
proportion; consequently, the poor  and  ill -
clad are they who suffer most frequently
from the disease, although any person  ex-
posed  to such  influence is liable to be simi-
larly affected.   For the above reason, acute
rheumatic  affections   are most  prevalent
during cold, wet weather; they are, how-
ever,  by  no means uncommon  during  the
prevalence of  extreme heat.   This  circum-
stance is perhaps traceable to the fact, that
persons are apt to  have the  free action of
the skin, the  profuse  perspiration, checkei 
R II E               448               R H  E
by  incautious  exposure  in  hot  weather.
Whatever the cause,  the  diseose  prevails.
The author likewise believes he  has  traced
attacks of the affection in the predisposed
to unusual exertion, without any appreciable
check  having been given to the perspira-
tion.   The  disease  is  most generally met
with between the age of puberty and  the
fortieth year;  it is  more common  among j
males than females.
  The  treatment of  acute rheumatism is |
not either likely, or desirable, to be trusted
to unprofessional management, except under
peculiar circumstances.  The long continu- j
ance of the disease, its painful nature, and
above all the possibility, almost probability,
of so serious a complication as an affec-
tion of the heart arising during its progress,
all combine to render proper medical assist-
ance from the first highly desirable.
  When an individual  who has  either suf-
fered from an attack of acute  rheumatism, |
or is hereditarily predisposed to it, or indeed
when any one, after exposure likely to  pro-
duce an attack,  suspects the disease to be !
impending, the first effort should be  to  ex-
cite the free action of the skin.   If a warm
or vapour bath can be procured,  it is highly
desirable; if it  cannot, the best substitute
will be a well-warmed bed with hot bran
bags,  or  hot bottles, and the free use of
warm diluent drinks.   A draught composed
of half an ounce of spirit of mindererus, one
drachm of paregoric,  and fifteen drops of
ipecacuanha wine, in a wineglassful of wa-
ter, may  be given every four or  five  hours,
or a drachm of sweet spirit of nitre  may j
be substituted for the mindererus.  To  the
above draught, fifteen minims of liquor  po-
tassae,  or ten grains of the bicarbonate of
potash may be added with advantage.  Under
the above circumstances, any stimulant dia-
phoretic may be given  with benefit, even a
little gin, or other spirit, or wine, well di-
luted with hot  water;  these  stimuli being
used,  of  course, only at  first,  and while
fever is not yet preseut.
  When an attack of acute rheumatism  cha-
racterized by the symptoms detailed  at  the !
commencement  of this article  is unequi-
vocally established, if medical  assistance is
not immediately procurable,  the  patient I
must  be  kept in bed, moderately warm, the
thirst  quenched by the free use of  simple!
diluent drinks,  and  the  diet reduced  to a
very low  scale, any thing like alcoholic  sti-
muli, or animal preparations, being strictly
forbidden, except in the  case of very debi-
litated persons, when  animal broths, such
as beef-tea, may be permitted in moderation.
If fever runs high, tartar emetic, in from
an eighth to a fourth of a grain dose, may be
given every four, five, or six hours, and with
this, from six to ten drops of laudanum may
be combined, to alleviate the pain. This will,
however, under the circumstances, be better
effected by the use of from one grain to two
grains of  solid opium, given at  bedtime,
along with  five grains of  calomel, the  dose
being followed in  the morning by a purga-
tive, a black draught, or senna alone, or, in a
strong subject, senna combined with Epsom
salts.   The safest way of managing  the
opium will  be  to give a grain the first night,
and if that  does not procure sleep, gradually
to increase the dose.   If the mouth  becomes
affected by the calomel, it must of course
be discontinued.  Instead of simple opium,
Dover's powder,  in  doses of  from ten to
twenty grains, may be given, likewise com-
bined with  calomel, and followed in the same
manner by  the purgative.   The above mea-
sures might with safety be adopted, tinder
peculiar circumstances, in the absence of me-
dical assistance.  There are, however, many
other  modes  of  treatment—bleeding  was
formerly much employed—it has fallen into
comparative disuse;  at all events  it  could
only be had recourse  to legitimately by  a
medical man.  The treatment by large doses
of nitrate of potash, or saltpetre, has  hud
its advocates,  and  may be  tried: the  mode
of administration,  as  laid down  by Dr. Ba-
sham, is to dissolve two ounces  of the  salt-
petre in two quarts of water,  and to give
this  quantity  in the  course of the twenty-
four hours.  This  treatment, which is said
to be  very successful at  times, might be
available in the absence  at least of other
remedies; of course,  if symptoms indicative
of irritation of the stomach or bowels came
on, it would require to be abandoned.  More
recently the treatment of acute rheumatism
by lemon-juice, as introduced by Dr. Owen
Itees, has come into practice, and  seems in
many cases to answer extremely well: on
this  point the  author  can  speak favourably
from his own experience.   This treatment
has  the advantage of being perfectly  safe,
and  therefore, where the lemon-juice can be
procured, may, without danger,  be  pursued
in the absence of a medical man.  One table-
spoonful, or half an ounce  of lemon-juice,  is
to be given every four hours.   The "alka-
line  treatment" of acute rheumatism is fol-
lowed  by some, fifteen to thirty grains of bi-
carbonate of potash being given,  well diluted
in water, every four  hours.  Most persons
have heard of colchicum in connection with
the treatment of rheumatism, and in proper
hands, properly used, it is at certain  times
most valuable; but its employment requires 
RHE
449
RH E
too much discrimination to make it safely
usable, in this disease at least, by unprofes-
sional persons.  Many other modes of treat-
ing acute  rheumatism might be detailed,
but the foregoing are  sufficient; sufficient
at least as provisional means in the  hands
of an unprofessional person till the case is
seen by a  medical man, which it ought  to
be as  quickly as possible.  The  reader is
again referred to "Carditis" in connection
with this article. As regards the local treat-
ment of the  inflamed joints, little is to be
done  in a  disease which shifts its site  as
rapidly as  acute rheumatism ;  for even if it
can  be driven from one joint, it must,  as
long as the  poison  is  in  the constitution,
show itself  elsewhere,  it  may  be in the
heart. Above all things, leeching the joints,
unless  under  peculiar circumstances, of
which a medical man only can judge, is  to
be avoided.  Hot bran bags sometimes  give
relief,  but probably  the following  plan, laid
down by Dr.  Bentley Todd, will be the most
advantageous local method of treatment:—
When the joints are  much swollen and pain-
ful, much ease may  be given  by enveloping
them in a large quantity of the soft carded
cotton—" cotton wool"—over which  there
is wrapped completely a piece of oiled  silk.*
By this air-tight covering, the joints are
kept in a perfect vapour bath, and when it
is removed  after   twelve  or twenty-four
hours, the wool will be found saturated with
moisture which is strongly acid.   Dr. Todd
says,  this  treatment  affords  great relief,
supports and keeps the limb steady, and  at
the  same  time promotes  sweating.   It is
also serviceable in gout.
  There  are few diseases  so tantalizingly
tedious as acute rheumatism: it may disap-
pear quickly, possibly in a week, or it  may
extend its  visitation, ebbing  or flowing, to
ten,  twelve,  or  fifteen  weejjs, in spite of
treatment apparently the best directed; but
yet, provided the heart, the diaphragm, the
brain remain unaffected, it is free  from dan-
ger, and, generally speaking, does not leave
joints  which  have  been  severely affected
worse  than they  were before.  It is very
rarely the case that  matter forms  in conse-
quence of rheumatic inflammation.  It has
been said that there is a rheumatic predis-
position : not only does this show itself  in
a tendency to attacks of acute rheumatism
properly  so called, but it  tends to modify
any inflammatory action  in  the  body, as
for instance in the eye, when it gives  rise
to the  peculiar "rheumatic inflammation."
The  causes of  acute  rheumatism already
pointed out will suggest to  most persons
the precautions to be  adopted,  especially
when liability to the  disease  exists.   Cold
and  wet  are  particularly to  be guarded
against, and, after exposure, the preventive
measures  already laid down adopted.  Flan-
nel or woollen,  worn  next the skin, must
always be regarded as one of the chief pre-
ventives ;  it  should of  course be propor-
tioned in thickness to  the season and tem-
perature.   Some persons imagine that their
liability  to rheumatism, either  acute  or
chronic, is increased by flannel.  If it is, it
is probably because the wool keeps the skin
in too excited  a state, and,  by increasing
perspiration, increases the risk of suppres-
sion.  In such cases, woven silk, when it can
be afforded, is  useful, or spun cotton  may
be used in winter.  Many rheumatic patients
find their  chief protection in an under dress
of chamois leather.  At all events, perfectly
warm clothing and protection against  sup-
pressed perspiration is  essential in all such
cases.   Many of the  above  precautionary
measures  apply likewise to chronic rheuma-
tism.   Persons of full habit, liable to rheu-
matic  attacks, should eschew malt liquor
generally, should take animal food sparing-
ly, and avoid violent  exertions which  heat
the body.  Persons of  spare or feeble habit,
may  live better, and indeed require to keep
up the condition of the  body to as good a
pitch  as possible.
  By chronic rheumatism,  in the proper
sense, should be meant a disease  somewhat
resembling  the  acute  form,  accompanied
with but slight febrile derangement, if there
is fever at all, and affecting one or more  of
the joints, generally the smaller ones, which
continue for a greater or less length of time
swollen and tender, the inflammation either
subsiding without effect, or, after long con-
tinuance,   causing  permanent  thickening
around the joints, probably with permanent
distortion; the process  being more or less
accompanied with pain.  In  this form  of
rheumatism, instead of heat,  there is often
a sensation of cold around the affected parts.
The chronic nature of this disease must ge-
nerally place it under proper medical  con-
trol ; the chief  efforts of the unprofessional
must  be  to correct any slight deviations
from  the  general  health, to  protect the
affected parts especially from cold by means
of warm clothing, and to use friction, either
with simple oil, or by means  of  the soap
and opium liniment.   Much comfcit is not
only  derived from friction, but  if combined
with  proper exercise of  the joint  or joints,
it may do  much to  prevent  permanent de-
formity.   In  chronic  rheumatism, warmth
 * Sheet gutta-percha will do.
2N2 
RH E
450
It II  U
 of ciifliatt is  of much  importance,  and as
 much should be done toward the attainment
 of this as circumstances will permit.  Sir
 James Clark  recommends  Nice and Rome
 as the best European  climates, but these,
 of course, are the  resources  only  of the
 wealthy.  Australia, however, is open to the
 poorer classes.  Warm bathing,  especially
the  saline bath, such  as  is furnished by
 Bath or Buxton, or Ashby-de-la-Zouch, [or
 any  sea-shore,] is of the highest  service in
 cases of  chronic  rheumatism,  and  in  all
 cases of long standing, should, if possible,
 be had recourse to.  The charities connected
 with many of  the baths are available to the
 poor.
  Chronic rheumatism, properly so called,
 is such as above described; but the term
 rheumatism, or rheumatic pain, is also used
 to a great variety of anomalous pains, and
 from this has  arisen considerable confusion.
 The  best  marked of  these is  "muscular
 rheumatism," which affects chiefly the thick
 muscles,  such as those of the  shoulders,
 arms, neck, loins, &c.   This form of rheu-
 matism often  comes on suddenly, after ex-
 posure to a current of  cold air—sometimes
 after cold bathing; its chief characteristic
 is severe pain, when  the  affected  muscles
 are  thrown into  action.   This  muscular
 rheumatism seems to be a purely local affec-
 tion, and is generally  removable by purely
 local remedies.  Of these, the best is a large
 hot  bran poultice, or some other means of
 applying  heat and moisture,  applied over
 the affected part, for eight or twelve hours ;
 this  often at once cures—care must of course
 be taken, to protect the part to which the
 heat has been applied by a covering  of flan-
 nel.   After the hot application is removed,
 if the heat does not entirely cure, and even
 instead of it at times, the soap  and opium
 liniment,  either  alone  or  combined, with
 one-third turpentine added, may be  used
 with advantage; two or three teaspoonfuls
being well rubbed into  the part every six or
eight hours. In situations where other means
are  wanting,  counter-irritation,  by  means
of pieces  of metal dipped in boiling water,
and  applied to the skin, or by means of Dr.
Corrigan's hammer, (see Counter-Irritation,)
may be resorted to.  In rheumatism of the
thick muscles  about the shoulder, the  use
of the acupuncture  needles often removes
the affection in a strikingly rapid manner—
indeed, sometimes in a few minutes.
  Any notice of rheumatism at the present
day must  be imperfect, without some allu-
nion  to electric and galvanic agencies, gal-
vanic rings, electric chains,  &c.   That these
appliances are at times of apparent service
in cases of chronic rheumatism is undoubted,
and if such is the case, we are not justified
in  rejecting their  aid  because we cannot
exactly explain the why  and wherefore of
their action.  The effect of the acupuncture
needles, above alluded to,  in  curing mus-
cular, and also nervous rheumatism, such as
sciatica, is sometimes almost magical;  but,
how the simple introduction of a needle into
the substance of the body acts so  as almost
instantaneously to remove  a most  painful
affection, it is very difficult to say.  In using
electric  or galvanic appliances for  the use
of chronic rheumatism,  those  apparently
which keep up a slight but continued elec-
tric excitement, are most useful.  The electrio
chains of Pulvermacher seem well adapted
for this purpose.
   Refer to Acupuncture—Carditis—Gout, Sec.
   RHUBARB,  MEDICINAL —Rihbarii
Root.—Well known as this valuable medi-
cine is, there is yet considerable uncertainty
respecting which of the  many recognised
species of rheum, or rhubarb, yields the true
medicinal  drug.  A species known as the
Rheum palmatum,  is considered to  be the
most likely source of the  best rhubarb, but
it is  not improbable, that other species of
the  genus rheum yield much of the rhu-
barb root imported from the East;  and it is
certain that different species of rhubarb are
cultivated in  this country, and on the con-
tinent, both for  adulterating the  genuine
article, when in the form of powder, and for
simulating it  in substance,  being "dressed
up" in a manner similar to the real  root.
Dr. Royle  says,  "The  greater part of the
rhubarb of  commerce grows  in  Chinese
Tartary, and  is gathered in summer  from
plants six years old.   When dug up, it is
cleansed,  peeled, cut  into  pieces,  bored
through the centre, strung on a string, and
dried  in the siin."  A portion of this rhu-
barb goes to China, the remainder  passes
through Russia, and is known in this coun-
try as Russian or Turkey rhubarb.   When
genuine, this rhubarb  is alwaj's a superior
drug,  chiefly  on  account of the  care be-
stowed upon the examination of the sam-
ples, before they pass the Russian factory,
through  which they are transferred to the
European  markets. At  this  factory  the
inferior samples of the root are, or ought
to be rejected.  Russian or Turkey rhubarb
" varies in shape, being irregularly roundish
and  angular,  from the bark  having  been
shaved off with a knife;  some  pieces are
cylindrical, a  few  flatfish,  many of them
pierced with holes.   Externally smooth, of
a yellow colour; internally, tin; texture ia
rather dense; fracture  uneven  irregularly 
R H  U                451                RIB
marked  with white and  red veins, having
 a strong and  peculiar  slightly  aromatic
odour, a bitter, rather astringent taste, feels
gritty when chewed, and produces  a powder
of a bright yellow colour."*  The  grittiness
is owing to the presence of numerous crys-
tals of oxalate of lime, that salt being found
in the rhubarbs generally. Chinese, or East
Indian  rhubarb, is probably derived  from
the  same source as the  Russian, which  it
resembles in essentials, although  less uni-
formly good.  English  rhubarb is cultivated
chiefly near Banbury,  in Oxfordshire.   " It
it is the kind frequently sold by men dressed
up as Turks, as  genuine Turkey  rhubarb.
The pieces vary in  shape, some being  ovoid,
others cylindrical, smoothed externally, and
rubbed with a yellow  powder,  light, rather
spongy,  with a  reddish hue.  It  is rather
mucilaginous in  taste, and a little astrin-
gent.  Its odour is feeble, but unpleasant."
Few  medicines are more extensively used
than rhubarb—few are more  valuable or
safer.  The  most  characteristic action of
rhubarb is  that of a  mild, but  effectual
aperient, the action depending upon  the
amount  of  the dose;  it rarely gripes;  it
exerts,  moreover, a beneficial  tonic action
upon the stomach.  On account of its astrin-
gency, rhubarb is apt to leave a  tendency
to constipation, after its purgative effect is
over.
  Rhubarb  may be taken alone, as an ape-
rient, in doses of from ten to thirty grains,
either simply mingled with water, or made
into pills.   Some persons  habitually carry
a piece of the root in their pockets, and cut
off small fragments as they think them re-
quired.   Infusion of rhubarb is made, ac-
cording  to  the  London Pharmacopoeia, by
infusing  for two hours three  drachms of
the  sliced root  in  a pint of boiling water.
The preparation is  too weak for an efficient
aperient, but may be used as a stomachic.
  The compound  rhubarb pill, one of the
best forms of common  aperient we possess,
has been already considered.—See Pills.
  The compound  rhubarb powder is better
known as Gregory's Powder,  or Gregory's
Mixture.—See Gregory's Powder.   The tinc-
ture or compound tincture of rhubarb is an
extensively used and most valuable remedy,
chiefly as a stomachic  cordial and  anti-
spasmodic.   It ought rarely to  be  given as
an aperient,  on account of the large amount
of spirit which must necessarily be  taken
with it in this form  by most  persons ;  a
few  individuals,  however,  of weak habits,
whose bowels are very easily acted  upon,
* Boyle's Materia Medica.
 find it  beneficial,  not  only for its aperient
 action,  but for its subsequent  tonic and
 astringent powers.   Wrhen increased action
 is required in such cases, the tincture  of
 rhubarb and  aloes is a useful preparation.
 To make the " tincture of rhubarb :"—Take
 of rhubarb, sliced, two ounces and a half-
 saffron,  three  drachms — liquorice  root,
 bruised, six drachms—ginger, bruised, six
 drachms—proof spirit, two pints—macerate
 for a week and strain.
   For infants and children, rhubarb alone,
 or combined with  calomel or gray powder
 when requisite, forms a most excellent me-
 dicine;  the chief  objections   are the bulk
 and  taste, which render it sometimes diffi-
 cult to  administer.  It should be  remem-
 bered, that in persons who are taking rhu-
 barb, the urine acquires a deeper  colour
 from the  drug.   Rhubarb  is  sometimes
 thought  to be injurious to persons who suf-
 fer from head  affections, such as a tendency
 to apoplexy, or  epilepsy.  The fact is not
 confirmed.
  RHUBARB, GARDEN—Is too well known
 in its numerous varieties to require descrip-
 tion  : its agreeable acid depends on the pre-
 sence of the oxalic and malic acids, which
 it contains abundantly.  As  a cooling ar-
 ticle of  diet, it is wholesome for most per-
 sons; but some cannot take it without  suf-
 fering after  from  stomach  disorder,  and
 others, who have  any tendency to  certain
 urinary disorders,  must most strictly avoid
 it; indeed, if  garden rhubarb is  too freely
 indulged  in,  it  may give rise to urinary
 irritation.
  When  used  as food, garden rhubarb ex-
 erts  an aperient action  upon the  bowels.
 This is increased, if shortly after it has been
 eaten a moderate dose of magnesia be swal-
 lowed.
  Refer to Oxalic Acid.
  RIBS.—The ribs  are  the  curved bones
 which enclose  the chest (fig. ex.) and upper
 part of  the abdomen.  They  are  twelve  in
 number on each side.  Of these the first
 seven on  each side (fig. ex. 1, to  7) are di-
 rectly connected with the breast-bone  or
 "sternum," (fig. ex. 13.) and are called the
 true ribs: the  remaining  five  are called the
 false ribs—of  these the upper three are in-
 directly connected with the breast-bone, by
 means of  cartilages  attached  to  the carti-
 lage  of  the last two ribs; the lowest  two
 (fig.  ex. 11, 12) are  unconnected  with  the
 breast-bone, or other ribs in front, and are
 therefore  called floating ribs.  The "car-
 tilages" (fig. ex. 14, 14) by which the seven
 superior ribs are connected with the breast
bone, and by which the  three upper false 
R I  R
ribs are connected with the cartilage of the
last true  rib, are very elastic in early life.
As, however, age advances, they become less
so, and ultimately are converted into bone.
The posterior extremity, or head of the rib,
is attached to the spine (fig. cxi.) by means
                 Fi;.'. cxi.
of ligaments (fig. cxi. 1) which  admit of a
certain  amount of movement.   These liga-
ments are so strong  as  completely to resist
displacement of the bone by violence—frac-
ture, generally about the angle, taking place
instead  —See Fractures.   The ribs are like-
wise attached  in front  to the breast-bone,
by means of ligaments, and are  connected
to each  other by short  "intercostal"  mus-
;>■>                  R I 0

  cles, which act in the efforts both of inspira-
  tion and of expiration.
    RICE.—This well-known grain,  although
  far below most others of the class  in actual
  nutritive power—not yielding more  than 3
  or 4 per cent,  of plastic  nutriment—forms
  the  staple  article  of food to millions, iu
  warm climates, especially in Asia,  and is
  largely  used as an occasional article  of diet
  in this country, [and in many districts of the
  United  States.]   Its chief  constituent  ia
  starch,  of which it  contains  80  per cent.,
  and when  it is cooked in water,  it absorbs
  that fluid  so largely, as  to swell  to many
  times its  bulk  in the  dry state.   It  is un-
  questionable that  rice  is  well adapted as
  food to the inhabitants of those warm cli-
  mates  in which it  flourishes so luxuriantly,
  and that  its  unstimulating  nourishment
  must be conducive to  health, while at the
  same time its blandness to the palate and sto-
  mach can be corrected by the aromatic con-
  diments which  usually grow under  the same
  climate as that which  brings the  grain to
  perfection.  In  climates like that  of Eng-
  land, rice, probably, could  not form a staple
  article of food; but  as an addition to other
  food, it is of the  highest  value, and espe-
  cially to the food of  the young, in  the form
  of  puddings,  &c, care being  taken that  tht
  grain is thoroughly cooked, a point  not always
  attended to.  Nothing can be more  indigest-
  ible than  half-cooked  rice.  In puddings
  and the  like,  this is less likely  to occur
  than when the grain is dressed  as a vege-
  table, and required  to  present the distinct-
  ness of grain.
    The property of rice, in tending to con-
  fine the bowels, renders it a valuable adjunct
  to sick-cookery, when  such  an effect is re-
  quired.  In this case it is  most beneficial in
  the form of "ground rice," or of rice flour.
  In  cases  of diarrhoea,  or  of irritability of
  the  stomach or bowels, rice-water, that is,
  water prepared from rice, as barley-water
  is from barley, is very useful as a drink.  It
  may be flavoured  with lemon-peel, or any
  other condiment.    If  the case is  a  severe
  one, the solution  of a  teaspoonful of isin-
  glass or gelatine in  every  pint of the " wa-
  ter," is a useful addition.
     Arrack, a spirit used by the Orientals, is
  made from rice.
     Refer to Grains.
     RICKETS—Is  a   disease in  whicn  the
  bones  lose their  earthy constituents, and
  consequently their natural hardness, becom-
  ing soft like gristle, and somewhat brittle, so
  that they are not only easily bent, but easily
  broken.  The  term  rickets  is usually  ap-
  plied to this Boftening, when it occurs in 
R I C                453                R I N
childhood, but a similar disease also attacks
adults,  especially  females.   Rickets is a
constitutional disease, and is very generally
associated with  a  tendency to  scrofula,
either hereditary, or engendered by poor
living and unhealthy influences, such as de-
ficient ventilation and light,  impure damp
air,  and bad food.   Rickets may show itself
within the first few months after  birth,  but
is more generally perceived when the child
first  attempts to  walk, and the limbs give
way under the weight of  the body.  Coinci-
dent with, or rather preceding the evidence
of weakness in  the bones, the child's gene-
ral health is observably impaired ;  there is
languor and pallor, with  dingy complexion,
loss of flesh, tumidity of the belly, impaired
or fickle appetite, and unhealthy secretion
from the bowels.    In  fact, the child  pre-
sents the evidences of progressive scrofulous
disease.   Not unfrequently there is an ap-
proach to the cretin head and features.—
See  Cretin.   It  need scarcely be  said,  that
a child,  showing the symptoms  above  de-
tailed, cannot too  soon be placed under pro-
per  medical  attendance, for life  and future
well-being are at stake.   Every means  for
improving the constitution will be requisite.
If the situation  is  an unhealthy  one,  re
moval,  if possible, should be effected.  If
the child is still  at the breast, unless there
is positive evidence  that the milk is  of good
quality,  it should be weaned. Animal broths
will  probably be required even for infants—
certainly, along with animal food, for older
children.  Clothing  will  require attention
as regards its warmth, and tonic .and other
medicines, especially iron, must be requi-
site.   For a child  of a year  old, powders,
containing half a  grain of gray powder, and
three grains of  carbonate of iron in each,
are a very useful remedy, given twice a day
for some time.  The above are only general
directions, for such a disease  as  rickets
ought always to be under proper medical
care.  In the later stages, when the bones
are very soft, much care will be required in
moving,  to avoid inflicting either pain or in-
jury.   Very  many  children who  become
rickety, die,  but a certain  number recover,
and  though  perhaps with distorted limbs,
ret  become robust in health, the bones be-
coming quite firm  and strong, even more so
than those of other persons.
  Many  children,  without  becoming  the
subjects  of confirmed rickets, yet  exhibit
Lhe  tendency  in an enlarged state of  the
extremities  of the  long  bones,  especially
those of the  forearm, at  the wrist.  Such
an indication ought  never  to be neglected:
every possible means, by  change of air, by
diet, clothing, and medicine, should be used
to improve the child's general health.   The
powders above recommended will be useful,
or five drops of the tincture of  muriate of
iron may be given twice a day in water, the
bowels being regulated  by simple aperients,
and an occasional dose of gray powder.   To
resume,  it  must  be borne  in  mind  that
rickets  is a  disease of debility, and of an
enfeebled constitution,  which every means
must be  used to counteract.  The deficiency
of  earthy  matter in the bones, naturally
suggests the  use of lime, which may  be
given in the form of lime water, along with
milk.   The  use of  salt  by the  affected
children should be insisted on.
   Rickets  or  softening of  the bones in
adults, occurs, as might be expected, in the
debilitated, and in those of depraved consti-
tution.   It is most common in females,  and
the pregnant state seems to favour its esta-
blishment and  progress.  It has also been
thought  to be  dependent on  the gouty  and
rheumatic constitution.  The disease is often
preceded by severe pains in the limbs  and
bones, which  are apt  to be  considered as
rheumatic.
  As  in the case of children, rickets or bone-
softening in adults requires every means to
be  used  for invigorating the constitution,
but the proper remedies, and their applica-
tion, must  be regulated  by a medical man.
When a female  has at any period of life been
the subject of rickets, the fact may seriously
affect the capability of her becoming a  mo-
ther,  either with  safety to  her  own  life or
that of her child.  For as the bones of  the
pelvis (see  Pelvis) partake of the  general
softening, and yield underpressure, the exit
of the child into the world  may be rendered
impossible, or  nearly so.  The  fact should
not be lost sight of.  Refer to Scrofula, Sec.
  RIGOR—Is the sudden sensation of cold
accompanied with  shaking,  or, in  other
words, the  "shivering" which precedes  the
inflammatory stage of many acute diseases.
It is  probably a nervous  affection, for it
occurs likewise in many states of the body
in which there is neither fever  nor inflam-
mation.   It  is  a common  symptom of  the
presence of bile  on  the stomach.  It is  a
concomitant on the passage of gall-stone or
of gravel. It often occurs at the  commence-
ment of labour, and  may even be caused in
a slight  degree by  certain  sounds.—See
Shivering.
  RING-FIXED.—See  Finger.
  RINGWORM.—The  real nature  of  this
very troublesome affection  of the skin  has
been  the subject of much  dispute.   By
some  it has been classed  as essentially a 
RIN
454
RO S
  'pustular" disease, but the probably  cor-
 rect view is that which regards it as an af-
 fection of the hair, and of the hair follicles,
 and that when pustules do arise, they are
 the  product of  continued irritation.   The
 most usual  site of the disease is the scalp.
 but it is apt to appear on, or to extend to
 the forehead, the neck, the arms, and hands.
 Generally, the first indications  of the  pre-
 sence of ringworm are the falling or break-
 ing off of the hair, which leaves a bald (gene-
 rally circular) patch, and the itching which
 accompanies the disorder.  If examined at
 this  time, the patch will be found scurfy,
 slightly  red,  with the irregularly broken
 hairs  protruding.   If the  disease  be un-
 checked by treatment, it goes on extending.
 until at last it  involves  almost the entire
 scalp.   The hair, which is not detached, on
 the affected parts, becomes lighter  in colour,
 and  woolly in character.   If pustules form,
 the  discharge  from  them  dries  upon the
 surface  in the form  of scurfy scabs, or  in
 crusts.   That the  disease is highly conta-
 gious there can  be no question.  It is fre-
 quently, too, extended to different portions of
 the same head,  by combs, brushes, &c,  or
 by the nails, which children are apt to use
 freely on account of the itching.
  Few diseases give more  trouble  or vexa-
 tion  in the management than ringworm, for
 it often resists for months the best directed
 treatment, and that which succeeds admi-
 rably in one case  often fails to make any
 impression in another.  Frequently, power-
 ful stimulant applications are too  soon had
 recourse to when soothing measures, poul-
 tices,  &c,  would be  more  serviceable  in
 allaying irritation.  The safest treatment is
 to employ soothing means in the first place.
 and  gradually to have recourse to stimu-
 lants.   To enumerate the  various  applica-
 tions which  have been used with varying
 success in ringworm would be a very lengthy
 business.  The   late Dr.  A.  T.  Thomson
 says, in his work on  Diseases  of the Skin—
 " The  application which I  have found  most
 beneficial is  a solution of one  drachm of
 nitrate of silver in half an ounce  of dilute
 nitric acid.   The diseased  circles, after the
 scalp has been shaved, should be  pencilled
 over with the solution, and in ten  or fifteen
 minutes  afterward, the parts  should  be
 well  sponged, first with  tepid water,  and
 then covered with pledgets of lint dipped
 in cold water,  and the  evaporation dimi-
nished,  by covering  the wet lint with oiled
silk.   In India,  an  ointment  composed of
a drachm of powdered nut-galls, a  scruple
of sulphate of copper, and an ounce of simple
cerate  is said to prove most beneficial."
 Mr. Erasmus Wilson, nnother  high autho-
 rity in skin diseases, lays more stress  than
 many  others on the constitutional treatment
 in this affection.  He remarks—" Improper
 food is a frequent predisposing cause, and
 one of the  common causes  in schools.   I
 have seen it in children fed too exclusively
 on a vegetable diet."  For these  and simi-
 lar reasons he  advocates particular atten-
 tion to clothing,  ventilation, exercise, and
 to  the nutrition,  aided  by tonic medicines,
 such  as  iron,  bark, and  mineral acids.
 With  regard to  external  remedies, after
 irritation  has  been subdued, the same au-
 thor remarks—" An  ointment which I  have
 found  of  great service is one  composed of a
 drachm of sulphate of zinc to an  ounce of
 simple cerate."  Sulphate of zinc in lotion
 may  also be  used.   " It  is  beneficial to
 wash  the head  with  soap once a day, and
 when  dried  to anoint  it with pomatum:
 keeping the scalp  constantly moistened  with
 some  oleaginous  matter  is  an important
 adjunct to cure."   An application made by
 dissolving a drachm of powdered borax in
 an ounce  of vinegar, is said often to prove
 of  service.  The  tarry oil  which  distils
 from the  end of a piece of  coarse brown
 paper, when rolled up  in the form of  a
 match  and lighted,  is  said, if allowed to
 drop upon the  diseased  patch, to  effect a
 cure when other means  have  failed.   When
 ringworm  is present the hair should either
 be cut very short  or the  scalp shaved.  An
 oil-silk cap is frequently recommended to be
 worn, but one of linen is preferable, being less
 heating and exciting to the skin.   [Another
 kind of ringworm exists which is more simple,
 and is often cured by domestic treament.]
   ROASTING—Like broiling, is one of the
 most primitive  methods of cooking; in the
 latter  process, however, the surface of the
 meat is more  quickly  hardened, and the
 juices  and fat more effectually  retained.
 During roasting, the watery portions of the
 meat  evaporate,  and much  fat is  melted
 out; at the same time, the coagulation of the
 albumen,  the usual result of heat on animal
 food, takes place.   The loss of fat in roast-
 ing renders  meat thus cooked more diges-
 tible.   It  retains, moreover, the gelatine,
 which  is  greatly dissolved  out  in the pro-
 cess of boiling.   If,  however, the cooking
 is carried  too far—the meat  overdone—its
 nutritious properties are impaired.  On the
 other hand, if meat is underdone, although
 more nutritious, it is certainly less diges-
 tible.    " By  enveloping  small pieces  of
 flesh with  a covering of lard, the extraction
of the  sapid  constituents from the flesh by
its juices,  and the  evaporation of the watei, 
ROC
455
RUL
 which causes hardening are prevented, and
 the  surface  as well as the subjacent parts
 are  kept in the tender state which  is other-
 wise only found  in  the inner portion  of
 large masses of flesh."»
   Refer to Boiling—Broiling, Sec.
   ROCHELLE  SALT.—Tartrate  of soda
 and potash.—See.Potash.
   ROLLER.—See Bandages.
   ROOM.—See  Bedroom—Houses—Ven-
 tilation, &c.
   ROSE.—An old popular name for erysi-
 pelas.—See Erysipelas.
   ROSE-RASH.—See Skin, Diseases of.
 '  ROSE  PETALS, or Leaves.—The petals
 of the red rose are used in medicine, partly
 on account  of the colour they yield ;  but
 their most valuable preparation is the con-
 serve  made by beating up one part of the
 fresh  petals or  flower-leaves with  three
 parts  of  refined  sugar.  The  principal ap-
 plication  of the  conserve is the formation
 of pills, for which it is well  adapted, being
 less  apt  to harden  than other  materials
 used for this purpose.—See Pills.
   When the petals of the red rose are dried
 for  use,  the white  "claws"  at  one end
 should be cut off,  and the red portion dried
 as quickly as  may be, without too great
 heat being used.   The petals should then
 be sifted to remove -dust, &c, and packed
 in  vessels  closed  against light  and  air.
 " Dried rose-leaves" are used in the form
 of infusion, which may be made with three
 or four drachms of the leaves  to a pint  of
 boiling water.    The  infusion is  slightly
 astringent,  but its colour especially, com-
 bined as it usually is with diluted sulphuric
 or other mineral  acid, is  its  chief recom-
 mendation.
   ROSEMARY—Is chiefly used on  account
 of its fragrant volatile oil, which  is stimu-
 lant and  anti-spasmodic.  The oil may  be
 added to liniments as  a fragrant  stimulant
 addition to these  applications.   A spirit  of
 rosemary is made which may be used as an
 anti-spasmodic, in doses of thirty drops,  in
 water or on sugar.
   RUBEFACIENT.—An application which
 reddens the skin.  According to this defini-
 tion, a great variety of  agencies  must be
 included in the class.   When  the  irritant
 effect of any agent upon the skin  amounts
 to blistering, or  causes discharges of pus
 or matter, the action is said to be vesicant
 or suppurative.  All these agencies, there-
 fore,  are  included  under the one term,
counter-irritants,  the  rubefacient  action
being  the mildest of  the three,  and de-

          * Liebig's  Chemistry of I'iod.
 pendent, generally, upon the form and dura-
 tion  of  the  application;  as, for instance,
 heat, mustard, ammonia, or other excitant
 agents, may be  used so as to produce only
 the most transient redness, or may be made
 to cause  either blistering  or suppuration.
 The most commonly used rubefacients are—
     Ammonia, or hartshorn.
     Friction.
     Heat.
     Mustard.
     Spirit of wine.
     Turpentine, &c. &c.
   Refer to Counter-Irritation.
   RUE.—The Ruta  graveolens.   This plant
 is too well known to require  description.
 It is valuable, and much used  in domestic
 practice, on account of its powerfully stimu-
 lating volatile oil, which  is strongly anti-
 spasmodic.  Medical men certainly too much
 neglect rue as a medicinal  agent.   In accu-
 mulations of flatulence in the bowels, " tym-
 panitis," a strong  infusion of rue, given as
 an injection, is often of the highest service,
 and-second only to assafoetida: in worms—
 the thread worm—in the lower bowels, the
 infusion  of rue, also used  in  injection, is
 serviceable.  In suppressed menstruation,
 when stimulants are required, (see Menstru-
 ation,) the rue clyster  may prove of much
 use.   Rue is abused, when  given  as it fre-
 quently is, by nurses to new-born infants.
   RULE,  LIVING BY.—There are  few de-
 partments of practical medicine which have
 been carried out  to a more  mischievous
 extent of  refinement than that  which is
 noticed in  this article.    Mischievous,  be-
 cause an important principle has  been over-
 looked in  the prescription  or following oat
 of petty  detail.   That  principle  is,  that
 there is nothing more likely either to create
 or to keep up disorder in any of the organs
 of the body which usually act independently
 of the will than the continued and especial-
 ly anxious  attention directed to them while
 in active  operation.  It is unquestionable
 that in some diseases,   such  as  diabetes,
 dysentery, &c,  the strictest regulation  of
 diet  and regimen  is  absolutely  necessary;
 neither can it be doubted  that in most ail-
 ments, even in those of  a trivial character,
 some general regulations  as to  living  are
 required:  it is not  against such as these
 that  these remarks are directed, but against
 the absurd "living by rule," the worse than
 useless clockwork regulation of every action
 of daily life, eating, sleeping, walking, &c,
 which many dyspeptic  and hypochondriac
patients either adopt for themselves or are
advised into.  In such  cases, instead of a
wholesome varied  diet,  the nature of  the 
RU M
456
RU P
food is confined within  an unwholesomely
narrow compass  and  its amount, if  not
weighed physically, is  at least so mentally,
by  the trammelled invalid,  who  trembles
lest, inadvertently, half an ounoe more than
the prescribed quantity should find its way
into his stomach; and then, after his meal,
disturbs the digestive process by thinking
how it  is going on, and, by directing his at-
tention to  the sensations  of  his  stomach,
which  is petted and considered, and allowed
to choose its own work  and mode  of  work-
ing, till, of itself, it nauseates the uniformity
of  too  regulated a diet,  and sours even
to the tenderest of  mutton, and  the most
unexceptionable brown  bread.   At  last,
forcing its miserable possessor to the con-
clusion that he is yet over-taxing its powers,
the animal  diet is  perhaps eschewed,  and
farinaceous  foods of different kinds are re-
sorted  to  as more digestible by the " very
weak  stomach."   As  already remarked,
rules of life, and stringent ones  too, must
often be laid down  by medical  men for per-
sons labouring under serious disease—nor
can  they  be too strictly  attended  to;  but
these cases  are  abundantly different from
that numerous class of  nervous and  dys-
peptic complaints which  are  fostered by
the  too  close  attention to health, by  the
"living by  rule," the weighing and mea-
suring  and  considering  every morsel of
food, and every action of the body or mind.
As said under article " Indigestion," the  sto-
mach,  and  other organs too, must, in part
at least, be brought up  to  their work by
observation  of the rules of health generally;
the endeavour to bring the work down to
the organs is worse than useless.
  Refer to Indigestion.
  RUM.—This well-known spirit is distilled
from the products of the sugar-cane :  when
genuine it contains about 53 per cent, of
alcohol.  New rum  is  apt to contain lead,
dissolved off the leaden  worm  of  the still
in which it is made.  When this is  the case,
the rum  of course is  unwholesome, and
may give  rise to symptoms of colic;  but
after the liquor has  been permitted to stand
some time in casks of oak wood, it becomes
freed from the lead,  which forms  an inso-
luble compound with the tannin of the oak,
and falls to the bottom.   Rum is a favourite
domestic remedy in  cases of incipient cold.
It possesses, probably, no advantage over
other stimulants, and  in such cases, the  use
of an alcoholic stimulant at all may do harm.
  Refer to Colic—Lead, Sec.
  RUPTURE—By medical men called Her-
nia, is the  protrusion of some portion of
the  bowels,  or of the viscera usually con-
tained within  the  abdomen, through any
part of the " walls" of that cavity.  Unless
the  skin  is  wounded  from  without, the
rupture remains covered by it, and  by cer-   \
tain tissues  which lie  beneath  it  at the   '.
points where the  accident  usually  occurs,   j
these points  being at those portions of the
walls which  are  naturally thinner  and
weaker  than others, or at which there are
openings,  naturally,  for the  passage  of
blood-vessels, &c.
  The existence of  rupture  is  always  a
serious m.ttter, and on the first suspicion of  j
it, medical advice should at once be sought;   *
it  is, moreover, an  accident  much  more
common  than  is generally  imagined.  It
has  been  calculated that ten per cent, of
the population in England are the subjects
of rupture.
  It is  sufficient here  to notice the three
principal  kinds of rupture:  of these, one
occurs at the navel, two in the groin.   Rup-
ture at the navel is a very common accideut
soon after birth:  its nature  and manage-
ment have been fully entered into in article
"Children."   When  it  occurs in adults, it
is not unfrequently the  result of neglect in
early life, but it  may be  of recent origin:
in females it may be the result of pregnancy
and  child-bearing.  Rupture at or near the
navel is known by the presence of an elastic
or doughy swelling, which  is usually capa-
ble of being "reduced," pressed back  into
the  cavity of  the abdomen.   When  this
form of  rupture is discovered to exist,  a
truss should be applied without delay, under
the direction of a medical man.  The essen-
tial part of the truss is a pad made  to fit
over the site  of the  protrusion,  this pad
being kept in place by different contrivances
of springs, or of elastic belts, &c.—Fig. cxii.

                 Fig. cxii.
represents " Salmon  and Ody's"  truss for   J
the purpose—1  being the pad which is fit-
ted over the rupture ;—2 a  pad which  is
applied to the spine ;—3  the  steel Sjiring;  i 
                 RUP

 —and 4 the  strap which  helps  to  fix the
 apparatus.  The pads are  made  of  various
 materials,  sometimes  of  ivory,  sometimes
 of padded materials, and also of caoutchouc
 bags  inflated  with air,  &c.   [The  variety
 of trusses in the United States is.very great,
 Hull's,  Chase's,  &c.  being the more com-
 monly resorted  to;  but as  there is much
 quackery often  connected  with the popular
 treatment of hernia, the sufferers should be
 cautious whom they consult.]
  Rupture  in the groin in adults is of two
 kinds;  in one, the swelling first  appears
 above the  fold of the groin—in  the other,
 below it.   The former is most  common in
 males, the latter in females.   The affection
 is, however, much more common amid the
 former sex, the  calculation being, that four
 men are the subject of hernia for one  female.
 Rupture in the groin  also  occurs in infants
 —it is "congenital."
  It is found that rupture  prevails  most
 among  those  whose  occupations   involve
 strong  muscular efforts.    Rupture  may
 come on gradually, or suddenly during some
 violent exertion.  When  its  formation is
 gradual, it  is preceded by some  amount of
 pain  and fulness in  the part;  at last, or
 when  its  invasion  is sudden,  a  decided
 swelling generally shows itself more or less
 painful,  varying  in  size, and  elastic or
 somewhat  doughy  under the pressure  of
 the fingers;  the swelling  becoming tense
 and larger,  and as it were  pushed forward,
 when the person coughs  or sneezes,  and
 usually disappearing  during  lying down in
 Bleep.  It  is  proper,  however,  to  caution
 our  readers against  the  supposition that
 rupture  must always be accompanied with
 swelling.  Sometimes  the tact of the expe-
 rienced surgeon is insufficient satisfactorily
 to detect the  tumour, especially in  stout
 people, and he is forced to  base his treat-
 ment upon the general symptoms, when that
 accident which  constitutes the danger of
 rupture  occurs,  that  is, when rupture be-
 comes " strangulated," or  assumes  such a
 condition that it cannot be  returned into
 the abdomen, and is  so  tightly grasped at
 its  " neck," by  the  sides  of the  ring or
 opening  through  which it  is  protruded,
 that  the  natural functions of the part are
 interfered with.   A  rupture may   assume
 this  condition at any moment if it  be per-
 mitted, for want of  a truss,  to continue
 "down," as it is usually called, that  is, in a
protruded state.  When a rupture becomes
Btrangulated,  distressing  symptoms  very
quickly follow;  all motion  of the  bowels
downward is prevented, and, their  natural
movements  becoming  inverted,  their fecu-
         20
i7               RUP

 lent contents pass upward into the  stomacli
 and are rejected by vomiting; at the same
 time there is  severe pain, especially of a
 dragging character, from the back; and there
 is thirst and depression of the bodily powers.
 If the above state of matters be not speedily
 rectified, either by the return, of the bowel
 into the abdomen, or by a cutting operation,
 the  person speedily dies, generally in  con-
 sequence of the protruded  portion of bowel
 becoming mortified.
   It  is needless to remark that, upon the
 first  symptoms  of  strangulated   rupture
 showing themselves, efficient medical advice,
 should at once be sought.  Every minute is
 precious.   Until medical assistance arrives,
 however, some methods of relief may safely
 be tried.
   When a surgeon first sees a case of stran-
 gulated "hernia," or rupture, if it has  not
 been of so long continuance that  he  sus-
 pects the  possibility  of the bowel having
 become tender and liable  to be burst,  he
 makes  an  effort to return  the protruded
 bowel;  this effort, conducted in a peculiar
 manner, is technically named the "taxis"—
 it is in fact skilful manipulation.   The first
 step in the exertion of the taxis is to place
 the individual'in the position most favour-
 able  to the return of the bowel: this posi-
 tion is the horizontal one, with the shoulders
 half  raised, and the  legs and thighs bent
 upon the body,  so as to relax as  much as
 possible the walls of the abdomen, and  the
 rings through  which the  rupture passes,
 and by which it is so  tightly constricted.
 The above position having been assumed,
 the neck of the rupture, that is to say,  the
 portion of it next the  opening from which
 it protrudes, is to be compressed by the  fin-
 gers  of the left hand with moderate firm-
 ness, while the right hand is used as geutly
 as  consistent  with  the  requisite effort  to
 knead or mould, as it were, the protruded
 bowel through the opening.  At first, this
 process perhaps, seems to have little, if any
 effect, but if the rupture is returnable at all
 in this way, and if the taxis is properly made,
 after a time  a  perceptible  diminution  of
 the swelling  takes place, which goes on till
 at last  the rupture passes suddenly as it
 were back into the  abdomen—frequently
 with a gurgling  sound.
  Such is the process of reducing a rupture
 by means of the taxis:  it is one which, to
 perform well, requires both  skill and prac-
 tice : but it is one which may be safely tried
 for a short period by an unprofessional per-
 son, if medical aid is far distant in point of
 time.  Indeed it is a process which persons
 who  have  suffered  from rupture  for some
4i 
R U P
45$
RUP
 time not  unfrequently  perform for them-
 selves.   In a case of strangulated  rupture,
 if medical assistance is  quickly procurable,
 the  best  course  is, with the exception of
 laying a person in the horizontal  position,
 and the administration  of twenty  or thirty
 drops  of  laudanum, to  leave the  case en-
 tirely  alone,  and  to  avoid  handling the
 swelling; for this only places it in a more
 unfavourable condition  for  the manipula-
 tions of the surgeon.   When,  however, as
 Baid before,  medical aid is far distant, the
 taxis may be tried, but must  not be con-
 tinued  for more than twenty  minutes or
 half an hour.  In  almost all cases,  efforts
 are made by the  patient, or by  the persons
 around, to return the  rupture; it  is better
 thnt these should be made in an intelligent
 and  efficient manner.   If, by the  taxis
 simply, the  surgeon  does  not succeed in
 " reducing"  a  " strangulated  hernia,"  he
 probably  has  recourse  to  other  methods
 with a view of  assisting  it.   These  methods
 are such as either  assist the relaxation of
 the muscular parts  around the rupture, or
 such as tend to diminish the  size of the
 swelling.   To effect relaxation, the  surgeon
 may bleed, may give nauseating medicines,
 may administer  chloroform  or opium,  or
 put his patient in a warm bath till faintness
 comes  on, when -he again has  recourse to
the taxis   Many of the means had  recourse
 to by a medical  man, are of course quite
inadmissible for  the  unprofessional;  the
two  last-mentioned, however, they  may use
 carefully.  Opium given  so as to affect the
 system will sometimes  greatly facilitate the
reduction of an hernia;  for  this  purpose
 twenty drops of laudanum, or one grain of
solid opium  may be given to an adult, the
former every hour, the latter every hour and
a half, till three doses have been administer-
ed, taking care, of course, after the second
dose, that the  system does not seem too
powerfully affected.  The warm bath will
generally  produce  faintness  in less  than
half an hour.  During the condition an at-
tempt should be made to return the rup-
ture ; some  surgeons, however, object  to
the use of the warm bath.
  The chief means of facilitating the return
of a rupture, by reducing the  swelling, is
the application of cold.   For this,  the best
agent is  snow,  or pounded  ice, put  in  a
bladder,  which is laid upon the swelling.
If snow or ice are unavailable, cold may be
artificially produced, by  mingling five parts
of muriatic acid with eight parts of glauber
salt  in powder, or by mixing two parts of
oil of vitriol with two parts of water, al-
lowing the mixture to cool,  and then  min-
i gling with five parts of glauber sal;, or by
 mixing equal parts of muriate of ammonia
 and nitre (saltpetre)  in  water.   Cold may
 likewise be produced by the continued eva-
 poration  of ether dropped upon  a piece of
 lint laid over  the swelling,  or  the cold
 douche may be used with advantage.  Under
 the continued application of cold  for from
 half an hour to an hour  and a half, a rup-
 ture may possibly " pass up," without any
 manipulation at all: if it does not, however,
 manipulation should be tried.
   Such are the principal  means which may
 be resorted to by unprofessional persons, in
 the event of a case of strangulated rupture
 occurring at a distance from  medical aid.
 They are pointed out, not to induce any one
 to hazard one moment's  delay in procuring
 proper assistance,  but as a resource, when
 that  assistance is far distant,  and  when
 the suffering and  danger of this. serioua
 affection  render it advisable not to wait
 entirely  its arrival.   In a  case such  aa
 might occur, when a surgeon could  not be
 procured for many hours, it might be some
 days,  the author  thinks  the treatment by
 opium most calculated to relieve: it is,  at
 least, the most  likely  to afford  comfort  to
 the patient under  so fearful a contingency.
 If the stomach will not retain opium given
 by the mouth,  it  can of course  be  admi-
 nistered in clysters.
   It sometimes occurs  that purgative medi-
 cines are administered in  cases of rupture.
 This  should never be done.   They may
 greatly increase the distress of  the patient,
 and they afford very little chance of relief.
 Neither can any good, but only harm, result
 from  frequent efforts  to return  the rupture
 by manipulation after the first well-directed
 efforts have failed—neither is it  well to be
 too hasty in giving  purgative  medicines
 after a rupture which has been strangulated
 is reduced.   Very frequently the bowels act
 of themselves soon after; if they do not in
 the course  of a  few hours, a clyster, or a
 gentle dose of castor-oil,  or of rhubarb and
 magnesia, will be the most suitable aperients.
 The fact must be  kept in mind,  that after
 the existence of strangulated rupture, there
 is  always danger  of  inflammation of the
 bowels generally,  and that,  consequently,
 perfect quiet, and low diet for several days,
 is requisite.
   As soon as, from the symptoms as detailed
 in  the  first  part  of this article, any one
 suspects he is ruptured, however little, incon-
 venience he may suffer, not a day should elapse
 without medical advice being sent for.  Till
 this is  obtained, quiet in bed  is the safest
 plan.   Many a rupture has  been  strnngu- 
RUP
459
RUP
lated in a long walk to the doctor. The same
rules should be observed after the reduction
of a rupture which has  been strangulated.
Eyerj minute in the upright posture, passed
without the protection of a truss, is one of
peril.  If there is any necessary delay be-
fore a proper truss can be procured, a pa*d
composed  of  cloth, wrapped  round  some
firm material, and held in  its place  by  a
spica bandange, (fig. xvii., art. Bandage,) will
be of some service during  the confinement
to bed.   The  selection of a truss is  always
better  left to the judgment of a  medical
attendant.  Where price is  an object, the
old form of truss (fig.  cxiii.) may be used:

                 Fig. cxiii.
 it answers extremely well.   In some cases,
 however, a Salmon and Ody's truss, some-
 what similar to fig. cxii., but modified to fit
 the groin, is found more useful.   The pecu-
 liar feature of this truss is that the circular
 or oval pad  is  attached  to the spring by a
 ball and socket joint.   In some persons,
 owing to flatness of the back, it is difficult,
 almost impossible, to  make a spring truss
 fit  at all. For such and other difficult cases,
 the spiral  supporter* of  M.  Bourjeaurd
 (fig. cxiv.) may probably be found of use.
 There  are many advantages connected with
 this elastic  form  of truss, particularly  the
 extended support which it gives to the walls
 of  the abdomen, at those parts where they
 are  weakest  and most apt  to  give  way.
 This, it need scarce be observed, the simple
 steel springs  cannot do.  The use of  air
 pads is an additional comfort.  In the case
 of labouring men, and others, who perspire
 much,  the springs of the steel trusses are
 constantly breaking, in consequence of the
corrosion caused by the sweat.   The author
has  suggested  covering  the springs  with
sheet gutta-percha as  a preventive.   In a
few cases, it is  necessary to ,wear a truss
even during  the  night, for some time at
least, but generally it may  be  dispensed
with during the horizontal  posture,  being
Fig. cxiv.
 put on before getting out of bed.   It is im-
 portant that a truss fit well—otherwise it is
 of little actual  service, and is apt, to cause
 excoriations, &c.   It is also requisite  that
 the strength of the spring be  proportioned
 to the nature of the case.   Further, it is im-
 portant that the truss  should not be put on
 while any of the hernia is "down." When,
 as sometimes happens, a rupture is  " irredu-
 cible," that is,  cannot  be entirely  returned
 within the abdomen, a bag-truss  suited to
 the nature of the case is requisite.
   The causes of rupture are various. In one
 sense it may be said to be hereditary, that is,
 some individuals inherit a tendency to weak-
 ness about those parts which are the usual
 seat  of rupture.   The direct  causes  are
 such  as induce undue pressure by the walls
 of the abdomen upon its contained viscera:
 hence the disease  is most frequent among
 those who have to make strong exertions.
 Soldiers,  whose  belts compress the upper
 part of the abdomen, and  cavalry  soldiera
 who at certain times ride without stirrups,
 are not unfrequently the subjects of the dis-
 ease.  It is also brought on by hard riding,
 or by leaping in the hunting field.   Hence,
 those who are  in the least  liable, should*
 avoid all such causes; and those who wear a
 truss should bear in mind, that if the natural
 support has given  way, the artificial  may
 also.   It may become a  question with a rup-
 tured individual, how far the hazard of sea-
 sickness,  nnd the  consequent mechanical
 action of vomiting, is to  be incurred. Strict
 attention  to the state of the bowels is  im-
perative, by all who are the subjects of rup-
ture,  more especially as  nothing  is more
likely either to  cause or to  aggravate  the 
RYE
460
S A I
affection than the straining of constipation.
At the same time strong purgatives are not
advisable.  The danger of a rupture is not
in proportion to its  size.   When small and
recent, it is  more liable to become strangu-
lated.   Ruptures  may  of course  occur  in
both groins of the same  person.   In this
case a double truss  is requisite.
  When rupture in the groin occurs in in-
fants, it is usually of considerable size, de-
scending into the  scrotum, and becoming
very tense whenever the child cries.  In the
early periods of life, spring trusses cannot
very well be worn  : those made of elastic
material will answer best: frequently no truss
is used.  Strict attention to the bowels, and
bathing the loins of the child every morning
in cold salt water, will do much to prevent
the  disorder  getting worse, and will some-
times effect a cure.
  RYE.—This hardy  grain possesses a nu-
tritive power about equal to that of barley.
It has slight aperient properties.  The chief
point of interest connected with this  grain
is the peculiar diseased or fungus growth
(the ergot of rye) which is apt to be  deve-
loped upon the seed.—See Ergot.

  SACCHARINE—Of the nature of sugar.
—See Sugar.
  SACRUM, or 08 Sacrum—Is the bone  of
the  pelvis, which fits in like  a wedge be-
tween the two irregular lateral bones;  upon
it the spine  rests.—See Pelvis.   The bone
derives its name from having been formerly
offered in sacrifices, whence it  was consi-
dered sacred.
  SAVINE.—See Juniper.
  SAFFRON—Is  procured from  the  blue
autumn-flowering crocus, which is cultivated
extensively for the  sake of the  drug,  both
in this  country and in France, Spain, &c.
                 Fig. cxv.
In the centre of each crocus-flower rises the
" style," which terminates in three wedge-
shaped, notched divisions, (fig. cxv.,) which
are  called  "stigmata" — these  stigmata,
with a portion of the upper part of the style,
constitute saffron,  being  clipped  off when
fully 'leveloped, and dried carefully. Saffron
■ s  sol' either in the form  of  "hay saffron"
or of " cake saffron," the former being com
posed of the loose dried stigmata—the latter,
of these  parts beaten into a cake, before
they are quite dry.  In  Eastern countries,
saffron is still largely used medicinally; in
this, except as a colouring matter, it is little
employed.   It is stimulant and anti-spas-
modic.   [In  the United  States it is  often
employed as  a domestic remedy  in measles
and  similar complaints,  when the eruption
is "not  out  sufficiently;" but it often in-
creases the fever, and does harm. It is better
to trust  to nature, till  medical  advice can
be  obtained.]  Saffron is liable  to much
adulteration.
  SAGE—Like other  plants  which contain
essential oil, is stimulant and carminative.
It is a good deal used domestically in the
form of  " tea,"  or  infusion, especially as  a
gargle, combined with vinegar.
  SAGO.—This well-known dietetic article
is the produce  of various  species  of the
palm-tree,  being obtained from the cellular
substance contained within the stems of that
tribe of plants.  The stem is split, the cel-
lular substance scooped out,  and stirred up
with water to separate the fecula or starchy
matter, which, while suspended in the water,
is passed through  a sieve, then allowed to
subside, and, being dried, forms  the  " sago-
meal" of commerce.  This sago-meal,  after
having been  made into a paste with water,
" granulated," and again dried,  constitutes
the sago of the shops—common  or " brown
sago," or white or  pearl sago, according to
the mode of preparing.  Sago is nearly pure
starch, and closely resembles arrow-root—
for which it is a frequent and cheap substi-
tute—in composition.   The remarks male
upon the nutritive properties and dietetic
uses of arrow-root apply equally to sago:
the chief difference is in the former being
the more agreeable preparation  of the two,
and requiring a  somewhat different mode of
cooking.—See Cookery—Starch.
  SAINT ANTHONY'S FIRE.—A popular
name for erysipelas.—See Erysipelas.
  SAINT VITUS'S DANCE—Known to me-*
dical men  by the name of "chorea," is  a
disease strongly indicative of nervous dis-
order ; its  precise nature,  however,  is  at
present obscure.   Probably it may be  occa-
sioned by direct causes, that is, by causes
seated in the great centree of the nervous
system, or by indirect causes, which act by
" reflex action," (see Nervous System,) in the
same way that teething in infants  produces
convulsion;  that  is  to say, irritation in
some portion of the body, as in  the bowels,
may, in  the  first  place, give rise to  func-
tional  irritation of the  brain  and spiial 
S AI
461
SAL
 chord, which irritation, acting as if its ori-
 ginal  seat  was  in these great centres, is
 "reflected"  on the body generally, or,  at
 least, upon some  portion of it, causing the
 irregular muscular movements of  the dis-
 order in question.   St. Vitus's dance is, for
 the most part, a disease of youth, occurring
 before puberty, and usually disappearing at
 that period  of life, if it has coutiaued  so
 long.  It is  more  common in girls than in
 boys, in the  proportion of three to one.  It
 may,  however, continue  into  adult  life.
 It rarely proves fatal; indeed, in those sub-
 jects of the disease who have died during
 its existence, it has been a question whether
 death has not been the  result of other co-
 existing maladies.
   The most manifest symptom of St. Vitus's
 dance is continued involuntary  actions of
 the voluntary muscles,  to a greater or less
 degree—the  extent of the muscles affected,
 and the  intensity of their affection,  varying
 with the severity of the disease.   The move-
 ments,  however,  generally  cease  entirely
 during sleep, and  in all cases certainly are
 diminished.   The ordinary voluntary move-
 ments are still  capable of being performed
 after a fashion; that is, in  an unsteady,
 uncertain, and somewhat grotesque manner.
 It seems as  if,  after the voluntary impulse
 had been communicated to them, an addi-
 tional  involuntary  one  interfered to throw
 the  limb or  other  part out of  the usual
 steady movement.
   The disease generally commences  with
 twitching about the face or neck,  or in a
 particular limb, gradually extending to one
 side of the body, or to  the whole body, as
 the case may be. Pain is seldom complained
 of, but it does sometimes occur in the head.
 The appetite  may remain quite  good, but
 the bowels are possibly confined,  and their
 secretions  unhealthy.   To  this  depraved
 state of the bowels, or to constipation, or
 to the presence of worms,  the  disease  is
 often traceable.   In females it is not unfre-
 quently connected with  the menstrual func-
 tion, especially if it be delayed, or imperfect.
 The  irritation of the coming of the second
 teeth has been  assigned as a cause;  and
 there is  no doubt that imitation, especially
 among females,  may  spread the  disease,
 which is most general, as might be expected,
 in persons of a nervous tendency; and it  is
 said, those with dark hair and eyes are more
 liable to  it  than  those of a blonde  com-
 plexion.   The duration of the attack varies
from ten days or a fortnight, to months; but
having once existed, it  is, up to the age of
Duberty at least, apt to recur, or  to be re-
excited,                                   i
         202
   As regards the treatment of chorea, the
 best plan is as soon as possible to submit
 the case to  a proper medical examination,
 for, as already explained, it may be depend-
 ent merely on some casual irritation, which
 skill will  at once detect and remedy.  The
 disease, moreover, is one devoid of danger,
 and as there can be no question that many
 cases of it will get well without any treat-
 ment at all, it evidently  is better without
 active unprofessional interference.
   Dr. Watson says that when pain in the
 head exists, he finds benefit from the mode-
 rate abstraction of blood by leeches; and if
 persistent pain does exist, the application of
 four or five  leeches might be had recourse
 to, if the individual is of full, florid habit.
 In any case, no harm, but almost  certain
 benefit will result from acting on the bowels
 freely—more  moderately, of course,  in  a
 weak  subject  than  in  a  strong one.  For
 this purpose, the  compound  colocynth pill
 simply, or combined for two or three doses
 in  succession with calomel or blue pill, will
 be of  service,  or the blue pill and black
 draught, or the compound decoction of aloes
 draught  may be given.   After  the  bowels
 have been well cleared,  if the  subject of the
 disease be weak and pallid, iron will be re-
 quired.  In the disease in question,  the red
 carbonate of iron, as given by Dr. Elliotson,
 has been  found extremely useful  in large
 doses,  from  a drachm upward,  given twice
 or three times a day; other preparations of
 iron,  however, may be given, or  quinine.
 The author has found the oxide of  zinc  of
 much service, but these are remedies which
 ought  to  be  given under medical sanction.
 The shower-bath is often serviceable in St.
 Vitus's dance,  but  for  some  individuals
 the shock is too powerful, and seems rather
 to increase the disease; for such, the douche
 down the spine may be substituted.  In all
 cases  attention to the general  health is re-
 quired.  Good  diet, exercise, change of air,
 and attention to the hours of  sleep,  and  to
 free ventilation of sleeping rooms,  are all
 circumstances  to be kept  in  mind in such
 cases.
  Refer to Convulsion—Nervous System, Sec.
  SALADS—Generally, being composed of
 raw vegetables, are unsuited to persons of
 weak  digestion.  When,  however,  the sto-
 mach  is capable  of digesting  them, the
 general effect on the system appears to be
 beneficial, particularly  in  salads  derived
 from the tribe of the cruciferous plants,  to
 which  the water-cress,  radish, mustard-
 cress, scurvy-grass, &c.  &c. belong.
  Many persons with whom raw vegetables,
such as salads, cucumbers, &c, invariably 
SAL
4<
S A L
 disagree, if  eaten  "undressed," find the
 addition  of  the ordinary salad or  "Flo-
 rence" oil,  correct  the tendency.  In this
 country, some individuals have a prejudice
 against the use of oil.  It is difficult to see
 why it should extend to  the beautiful pre-
 paration in question.
   SALEP—Is prepared  from  the bulbs of
 the Orchis maseula.   It is imported chiefly
 from  the Levant, but some is brought from
 India.  It consists of a peculiar kind of gum,
 termed bassorin  and fecula.   It  is  more
 nutritive  than  either arrow-root or  sago,
 and consequently is better  adapted for the
 convalescent  than for the sick.   It is pre-
 pared by dissolving the powdered salep  in
 hot water, with assiduous stirring, and add-
 ing to the solution sugar  and milk.*
   SALICINE—Is a " peculiar bitter crystal-
 lizable principle," obtained from the bark
 of the willow  or  of  the  poplar.  In  some
 respects it resembles quinine, and has been
 brought forward  as a cheap substitute for
 that  expensive medicine, especially in the
 treatment of  ague,  neuralgia,  &c.   That
 Balicine  is a most excellent  tonic remedy
 there is no  doubt, and it is one, moreover,
 which is  applicable to cases in which qui-
 nine is inadmissible, the former remedy be-
 ing less likely to heat or to cause headache.
 In  such cases, however,  as ague or neural-
 gia,  it does  not  seem to exert  the  same
 powerful  curative effect,  although it  might
 well be used, either in its prepared form, or
 in the form of an infusion of the willow bark
 itself, in  the  absence of  quinine or of cin-
 chona bark.  The dose of salicine as a tonic,
 is from one to two grains, given as a powder
 or dissolved in water, or if  a  stimulant be
 required, dissolved in a little sherry.   For
 neuralgia it should be given  in  the  same
 doses as quinine.
   SALINES — Or salts,  are  distinguished
 from  other bodies by their general proper-
 ties of incombustibility, aptness for combi-
 nation, and a peculiar taste generally known
 as a saline taste.  Salines are  better  illus-
 trated by their many well-known examples,
 Buch  as common  salt, potash,  soda, Epsom
 salts, &c, than by any description.
   SALIVA —Or  spittle, the  fluid  which
*moistens  the  mouth, is secreted by glands
 disposed around that cavity.  These glands
 are three on each side.   The principal, or
 parotid gland, (see Parotid,) is situated be-
 neath the angle of the lower jaw, the  sali-
 vary  fluid secreted by it being  conveyed
 into the mouth  by a  duct which opens be-
 tween the gum of the  upper jaw and the
* Thomson's Sick-Room.
cheek, opposite the second double tooth.  A
second  salivary gland lies  deep below  the
tongue, its duct opening by the side of  the
bridle, or tie of the tongue, just behind  the
corresponding front "Incisor" tooth of  the
lower jaw.  Where the duct opens there is
a perceptible  eminence,  from  which, when
some individuals gape, a small jet of saliva
is apt to be projected at least a foot beyond
the mouth;  this  is caused  by the muscles
exerted  in  gaping compressing the gland
and its  duct.  The third salivary gland,  the
"sub-lingual,"  lies partly  just below  the
•duct of the  last mentioned, its  small ducts
conveying the saliva into the mouth  close to
the other.   As, therefore, these glands are
situated on each  side of the mouth, there
are six  salivary glands in all.   The saliva,
or  spittle, for the supply  of  which such
ample provision is made, contains about one
per  cent, only of solid matter, which con-
sists partly of  animal constituents,  and
partly of saline.   The  saline constituents
are similar  to those contained in the blood,
with the addition  of a peculiar salt, a sul-
phocyanide.   The animal  principle, known
by the  name of  " ptyalin," resembles in
action  the  vegetable principle "diastase,"
in possessing the power of converting the
starchy constituents of the food into saccha-
rine aliment.—See Digestion.  When food is
not  being taken, the  secretion  of saliva is
very greatly diminished,  and in sleep seems
to  be   almost suspended  altogether;  no
sooner,  however, is the appeasement of hun-
ger  by  food commenced—and indeed pre-
vious to the food being taken—than the flow
of saliva begins, the secretion continuing to
be poured out as long as the meal continues.
The amount of saliva secreted in the period
of four  and twenty  hours,  has been esti-
mated at from fifteen  to twenty ounces; but
it is very difficult to ascertain the  precise
quantity,  and probably it varies.
   The importance and the functions of the
saliva in the process of digestion have been
variously estimated by different observers.
Its action upon starchy matter has been
already noticed.   The experiments of Dr.
Wright, of Birmingham, detailed in his valu-
able papers on the saliva, tend to show that
its alkaline properties are necessary to  the
perfect  fulfilment of the digestive  process
generally.  Dr.  Wright observed, that after
a full meal, the saliva became more strongly
alkaline, and that if,  instead of swallowing
this alkaline  saliva,  he spat  it out, there
was manifestation " of abundance of acidity,
with much pain at the stomach;" but that
if he neutralized  the  acid  on the stomach
by a dose of carbonate of soda, the alkuline 
SAL
463
SAL
condition of the  saliva quickly diminished,
as  if, being  no longer required, the  alka-
linity was withdrawn.  The saliva, however,
is not constantly alkaline—it is frequently
acid, especially during fasting; the acidity
has been attributed to  the mucus of the
mouth, with which the secretion is  necessa-
rily intermingled.   Dr. Wright performed
a variety of experiments with the  view of
determining  the  influence of the  saliva in
the digestive process.  From  these experi-
ments he formed the following conclusions :
   " That saliva has  the power of modifying,
and to a certain extent of digesting vegeta-
ble and animal substances.
   " That it  has  a  more powerful  action
upon vegetable than upon animal matters.
   " That acids or alkalies, added to saliva,
diminish or destroy  its digestive properties.
   " That the presence of saliva in the sto-
mach is essential to  healthy digestion."
   Of course  the saliva performs other func-
tions beyond the simple assistance  of diges-
tion ; it facilitates especially all the move-
ments  connected  with  mastication  and
Bpeech.   The  " tartar" which accumulates
about the teeth is a mixture  of the earthy
salts and animal matter contained in the
saliva.
   The influence of the mind upon the secre-
tion of saliva is  very considerable: the po-
pular saying  of  the "mouth  watering," at
the sight of tempting food, is an illustration
of its increase from this cause: its diminu-
tion under the influence of painful  emotion,
such as  fear,  is well ascertained, and  in-
deed, in  some Eastern countries, is practi-
cally acted  upon as a means of detecting
crime.  If a crime,  such  as a theft, is com-
mitted, and  a number of  persons, such as a
staff of servants,  are generally suspected,
the whole of the  suspected are placed toge-
ther and caused to chew and  then  spit out
a handful of  rice, in the  presence of the ex-
aminer : it is said that such is the feeling in
these countries with  regard to  the test, that
the fear of the real criminal diminishes the
6ecretion of his saliva to so great an extent,
that the portion of rice chewed by him re-
mains comparatively  unmoistened.  There
is a peculiar affection of the salivary secre-
tion, to which  some dyspeptic persons are
liable, which  the  author has never  seen de-
scribed in any medical work, and which he
believes is generally confounded with pyrosis
or water-brash ; it consists of the rapid flow
of  a quantity of limpid  saliva   into the
mouth, or from it, in a stream, if permitted,
accompanied  with a sense of  constriction
about the jaws ;  the flow continues for a
minute or two at a  time.  It  is generally
preceded by symptoms of  indigestion, uf
heartburn,  or of irritation  in  the stomach.
It is in fact a  symptom of indigestion, and
an instance of "reflex" action, (see  Nervous
System—Indigestion,) or of irritation in  the
stomach  acting  upon  the salivary  glands,
which seem to be peculiarly susceptible to
irritation  from  such causes.    The above
remarks  upon the  uses of  the saliva may
explain, in some measure,  the  disordered
digestion from which  many smokers,  who
waste this  fluid, suffer.  Indigestion  is  a
very common malady in America, and may
in  part  be occasioned by  the well-known
habit of "spitting," peculiar to the country.
[Except  among  the tobacco-chewers,  this
habit is not common in the United States,
though otherwise represented by superficial
tourists.]
  SALIVATION—Is the excessive secretion
of saliva from any cause.   The term is best
known in connection with mercurial saliva-
tion.—See  Mercury.  Salivation  may, how-
ever, arise  from  other causes.  A course of
iodine medicines may occasion it, and nitric
acid has the same effect; it  also  arises from
constitutional  causes.   Salivation,  that is,
simple increase of the  flow of  saliva, is  not
an unfrequent concomitant of the first stages
of pregnancy.
  Refer to  Indigestion.
  SALMON—Like  the other  oily fishes, is
less digestible than white fish  generally for
persons of  weak stomach.    Like other arti-
cles of food, too, which contain oil, it is  apt
to prove highly injurious if  eaten in a state
of decomposition.   Indeed,  death has been
the result of a meal of pickled  salmon which
had become somewhat  decomposed.
  SAL-PRUNELLE—Is saltpetre which has
been fused by heat and cast in a mould, ge
nerally of  a globular form.  The prepara-
tion is used by  some  persons in incipient
sore-throat with advantage ; the ball of the
salt being  allowed to dissolve gradually in
the mouth.
  SALT.—The term  salt is applicable  to
saline matters generally, (see Salines;) in
this article, however, it is regarded in its
conventional acceptation of "common salt,"
as used in daily  life.  Common salt  is  a
compound of soda and muriatic acid, or in
another  view, of chlorine and sodium and
water.   It  is therefore either a  muriate of
soda, or a  chloride of sodium with water.
Indeed,  common  salt  is one  great source
whence the soda of commerce,  now so cheap
and  so "extensively used, is obtained.—See
Chlorine—Soda, Sec.
  Common  salt is most generally procured
either from the salt mines,  such as those of 
S A L
404
SAX
Cheshire, from saline springs, such ns exist
in America, or in Germany, or from sea-
water;  in the two latter cases by evapora-
tion.    However  obtained  in the first in-
stance,  salt generally requires to be puri-
fied  from  other  saline  ingredients,  with
which it is usually mingled, and which par-
ticularly interfere with its keeping proper-
ties, causing it  to become moist.  Of late
years the  finer  descriptions of salt  have
become  so cheap that the coarser kinds are
scarcely seen.
  As regards the use of salt as a condiment,
or as an addition to food by man, there can
be no doubt as to its beneficial  effects; in-
deed, the desire for salt seems almost to be
instinctive, as a necessary for health.   In
countries at a distance from the sea,and where
from  the absence of saline  springs salt is
difficult  to procure—as in  the  interior  of
Africa—-it is most highly prized as a neces-
sary of life.  Many travellers  have described
a temporary deprivation of salt  as  one  of
their greatest hardships ; and, to descend to
the lower creation, the way in which  the
salt springs or "licks" in  America are fre-
quented by the wild animals, is evidence of
instinctive desire ; and indeed the eager de-
vouring of salt by, and consequent improve-
ment of condition among domestic animals,
sufficiently testify, if not  the- absolute  ne-
cessity for, at least the great benefit arising
from the admixture of salt with food.  Salt
unquestionably  assists and  renders more
perfect  the process of digestion: moreover,
it forms one of the constituents of the blood
and  of the body generally.   If salt be de-
nied, the digestion is weakened;  the general
tone and nourishment  of the body  are im-
paired, and it is observed that  worms  are
more likely to be generated in the intestines.
Salt, therefore, ought to be an addition  to
the foou of all, and attention should be paid
to children in this respect; they should be
made to eat a certain proportion of salt with"
their food—their greater liability to be in-
fested by worms than adults being an addi-
tional reason.
  It is,  however, a very different thing  to
eat salt  with food, and to live upon meat or
fish which  has been salted.  In  the latter
case it is well ascertained that certain che-
mical effects are exerted upon the meat and
its nutrient constituents by the  salt, which
modify considerably the nutriment afforded
to the body.—See Preserved Provisions.   In-
deed, the effects of a continued diet of salted
meat are most injurious.—See Scurvy.  The
exclusive and  continued use of salted provi-
sions is  here alluded to, not their moderate
occasional  employment.   Salt may  almost
be regarded as medicinal in some cases of
convalescence,  in  which the craving fir it
becomes intense.  It should be allowed.   It
appears to act as a tonic.   From one to two
ounces  of  salt, dissolved  in  half  a  pint of
water,  forms  a good  and not unfrequent
domestic emetic.  It may, however, purge
instead of  causing vomiting.   It is  used in
the form of olyster to destroy worms.   The
occasional  use  of  salt in the treatment of
typhus  fever, and  of cholera, &c. does not
require  notice  here.   Externally,  salt is
used in solution, generally as in sea or cold
salt-water  bathing, in which  cases it seems
to exert a tonic effect.  Warm saline bathing
is efficacious  in  rheumatism.   For local
bathing after injuries, such as sprains, &c,
the  salt-water  douche is well  adapted to
give strength.   For the above  purposes, a
pound of salt  dissolved in three gallons of
water  is a good  average strength.  The
"brandy and  salt" application, so much in
vogue  some years ago, is of the  same  use
as any other  stimulant application.  Suit
is widely  distributed throughout  nature,
forming a  constituent  of  the  animal and
vegetable kingdoms.
  Refer to  Preserved Provisions—Sea, Sec.
  SALT-MEAT.— See  Salt — Preserved
Provisions, &c.
  SALTPETRE.—See Potash, Nitrate—
Sal-Prunelle.
  SALT OF  TARTAR.—A purified  sub-
carbonate of potash.—See Potash.
  SAMPHIRE.—This  plant, which  grows
on rocks close to the sea, is used as a pickle,
and is about as wholesome as pickles gene-
rally.—See Pickle.
  SANATORIUM—Is an  institution for the
promotion  and  preservation of health,  in
contradistinction to an  hospital, which is
devoted to  the cure of disease.   The sana-
torium  is at present but  little known,  or
brought into use,  although probably it will
become more so.  The hospital  for conva-
lescents  must be regarded as a sanatorium
of the most useful description;  and at  the
present time a sanatorium for  consumptive
patients is  about being  established at Tor-
quay,  in connection with the  Bromptoo
hospital for consumption.   The  author,
however, is not aware that these are on tht
plan suggested in this  article, the nearest
resemblance to which is the covered  square
of one of the London hospitals.   The bene-
ficial effects of winter residence in a warm
climate, in  some cases of disease, have been
too well proved  in numberless  individual
instances to  admit  of  doubt  that  such  a
change  is not, in  the cases adapted for it,
in the  highest  degree  serviceable.  At the 
SAN
465
SAN
 Bame  time,  there  cannot be a doubt that
 change of climate, as it  is usually resorted
 to,  has been  much  abused, and  that  in
 numerous instances  uncalled-for  sacrifices,
 not only of  a  pecuniary  nature, but of the
 strongest  feelings  and  affections of  the
 human heart,  are made to give  a beloved
 invalid  the  change  of climate  considered
 necessary for  the  restoration of  health, or
 for the preservation of life.  Not only doubt,
 but certain conviction, exists in many minds,
 that numerous cases which formerly would
 have been sent abroad should now, and will
 now, be kept amid home comforts and home
 affections, to live or to die.  But it must be
 matter of thankfulness, that, when the hope
 —too often  the  delusive  one—of that last
 resource of  " climate" is, to say the  least,
 weakened, another and a better one is likely
 to open up, one which involves neither sever-
 ance from home  nor friends, and one which
 may be  made  the  resource  of the indigent
 as well as of the rich.  The resource is the
 glass-covered sanatorium—the acres of plea-
 sure and of exercise-ground—under a climate
 which may be rendered  more certain and
 genial than any open to the winds of heaven,
 which may be accessible to the delicate, and
 to the invalids,  during a winter  season  in
 England.  The various arrangements under
 which a glass-covered  sanatorium may be
 made  available  are  very palpable.   With
 such a building as the new crystal palace at
 Sydenham, it  might be possible to connect
 the villas of the wealthy, in which invalids,
 though resident in the houses, and mingling
 in the  society of their own families  and
 friends, might  yet enjoy the free but genial
 atmosphere and  extensive grounds of the
 magnificent  erection.  But,  even without
 the magnificence, wide  extension, and con-
 sequent expense  of such  a fabric, it would
 be very  possible to  enclose  glass-covered
 spaces of one, two,  or more acres in extent,
 into  which  the  windows  of some  of the
 apartments of adjoining houses might open,
 apartments to  be occupied by the invalids,
 while the rest  of the house, for  a family
 generally, has  the ordinary aspects and ar-
 rangements.  Or, under another construc-
 tion, detached  houses,  or sets of houses,
 might be connected by covered glass or other
 passages with  the  general  glass-protected
 garden, or promenade, or climate, as it may
 be named.  The varied  arrangements  of
 which  glass  structures, for  the benefit of
consumptive and other invalids in this coun-
try, are capable,  need not be  entered into
here.   The possibility of such structures is
certain, not  less so,  perhaps, the fact of
their wide adoption in years to come;  but, j
 amid the various plans for glass structures
 in the vicinity of our large  towns, for the
 purposes of  pleasure  or instruction, the
 author has  regretted  to  see  little  or no
 notice taken  of their important availabili-
 ties as regards health.  Their capability Oi
 supplying a great want and of serving as
 an antidote to  our comparatively rigorous
 climate  should  be  remembered  on  occa-
 sions which so  often present the apparent
 necessity for the young  and  the delicate
 seeking  a home,  and too often  finding  a
 grave, in a foreign climate, exposed as they
 then are  to  the  depressing, and  therefore
 necessarily injurious influence which  sever-
 ance from home scenes, home comforts, so-
 ciety and home  affections,  cannot fail to
 produce in a greater or lesser degree.
   It would be possible to dilate greatly upon
 the advantages offered by the glass sanato-
 rium ; but, perhaps, enough has been  said
 for the purpose.
   SANITARY, or Sanatory—Regulations
 and observances are daily  acquiring more
 importance, both in a public and in a private
 point  of  view.   The " Commissions"  and
 " Reports"  commanded and issued by the
 government [in England,] and the numerous
 publications which are appearing upon the
 subject,  attest the  growing interest;  but
 much, very much, yet remains  to be  done;
 the movement is  as yet in its infancy;  and
 if its growth and  development  do not pro-
 gress more vigorously than  they  have yet
 done, not this generation only, but the next,
 will be in their  graves  before sanitary im-
 provement has gained any approach to  ma-
 turity.  The fact  is, although  the interest
 on the subject is increasing, it is as  yet
 confined   to but  a few.  There are  a  few
 honoured names  among the aristocracy as-
 sociated  with the principles of  sanitary
 reformation, and  many of the medical.pro-
 fession, and a few of the more intelligent
 middle classes, have given it their hearty
 aid ; but the great mass of our citizens heed
 it not, and  are indeed profoundly ignorant
 of the subject.
   The  principles of sanitation  ought  to be
 made part of all modern  education;  there
 are no situations of life in  which they would
not be useful, in  some they would be invalu-
able.   A more extensive acquaintance with
them, on  the part of the  clergy especially,
would greatly add to their means of useful-
ness in their visits amid the poorer classes.
A step in this direction has lately been  taken
in the  delivery, before the theological stu-
dents of  King's  College,  of  an  admirable
course of  lectures  upon "hygiene," by Dr
Guy—an addition to the  ordinary routine 
S A R
46(3
S C A
of education which cannot  be  too highly
estimated.  In fact,  before long, no educated
man, in any position of life, especially if he
has, either by courtesy or by appointment,
influence or command amid his fellows,  can
with propriety be ignorant on these subjects.
Attention to the principles and  practice of
sanitary observances and regulations, in-
cluded under the  single  word "hygiene,"
is  so  constantly enforced  in  the present
work, that  further  notice  here would  be
superfluous.  The  articles more  especially
devoted to sanitary matters, to which refer-
ence should be made, are—
  Acclimation—Air—Bed  and  Bedroom—
Chimney—Climate — Clothing—Cold—Con-
tagion — Damp—Diseases—Drainage—Edu-
cation—Exercise—Food—Graveyards—Heat
—Houses—Life—Light—Putrefaction—Re-
creation—Skin—Sleep—Temperance—Town
— Training — Ventilation — Walls — Water,
&c.
  SARDONIC SMILE, or Grin—Is  a  pe-
culiar characteristic expression of counte-
nance, which occurs in some diseases.  The
corners  of the mouth are  retracted and the
teeth exposed.
  SARSAPARILLA—Is the root of a tribe
of creeping plants,  natives of Central Ame-
rica and of  Northern South America.  The
drug is brought to  this country in the form
of the roots, tied up in bundles, which  are
distinguished  by  various  characteristics,
according to the place from whence they are
imported. These roots are cut up into chips
for retail selling.   Medical men are greatly
divided  in opinion, not only as regards  the
medicinal properties of sarsaparilla, but  as
to whether it possesses any medicinal pro-
perties of value at all: while some contend
that if the  root itself has medicinal power,
this is destroyed by the usual modes of pre-
paration.   However the truth may be, sar-
saparilla is not a medicine likely to be used
domestically, that  is, without medical pre-
scription ; and when it is employed, it will
be most  efficaciously so, as  sold in some of
the usual prepared forms  of extract, infu-
sion, decoction, &c.   The decoction is  or-
dered to be made  by digesting five ounces
of sarsaparilla chips in four pints of water,
kept just below boiling, for two hours;  the
chips are then to be taken out, bruised, re-
placed, the whole boiled down to two pints,
and then squeezed and strained.   The dose
of this  preparation is from  two  to four
ounces.
  SAUSAGES—Generally speaking, are in-
digestible as an article  of diet,  but they
chiefly demand  notice here  from the  liabi-
lity, especially of some of the German forms
of the preparation, to  undergo a  peculiai
kind of decay, by which they are  rendered
highly poisonous; indeed, the thing goes by
the name of the "sausage poison."  Many
hundred  deaths have  occurred  from  this
cause in  Germany.   The sausages in ques-
tion are generally made of liver, blood, with
fat, &c, salted, and spiced,  and  smoked,
and, if properly prepared, keep well, and are
wholesome for months.   If badly prepared,
they undergo the  poisonous  putrefaction,
which is  probably analogous to  that which
takes place in some  descriptions of cheese,
in bacon, salmon, and other oily articles of
diet.  The symptoms of poisoning from sau-
sages are not very quickly developed; they
are similar to  those described under the
article Putrefaction.
  Refer to Putrefaction.
  SCABIES—The itch.—See  Itch.
  SCALD.—See Burn.
  SCALD-HEAD.—See Scalp.
  SCALP.—The skin of the head is tolera-
bly thick and  firm,  and is connected to the
parts  immediately  subjacent by  a rather
loose cellular  tissue.  These circumstances
often give a peculiar character to the effects
of violence and  to wounds of  the head, for
the skin  being firm, and the cellular tissue
being easily torn, large portions of the scalp
are occasionally separated  in flaps, either
entirely  or partially.  When,  as the result
of violent  accident,  a  portion of  scalp is
separated, the best  thing  that can  be done
by a bystander  is to replace the  parts as
nearly in their proper position as  possible,
provided grit or dirt have not been forced
into the  wound.  This  will require a little
care, for the skin is apt, from  its own elas-
ticity,  to curl  up.   If the  wound  has  got
dirt in it, and if it is  possible  to  procure
surgical  aid in  the  course  of a few hours,
the best plan will be to  rest content with a
superficial cleansing of the wound and adja-
cent parts, and  then simply to lay the  de-
tached portion somewhat in its proper posi-
tion, and to place over all a cloth wet with
tepid water, till  the arrival of the  surgeon,
who will  cleanse the wound  in the  most ef-
fectual manner—a  matter of some import-
ance.  If, however, surgical assistance is far
distant,  some one  should endeavour, cart-
fully, to free the wound of foreign matter,
by means of washing with a soft sponge,
and also by picking out small portions of
gravel, or the like, if these  are present, bj
means  of forceps  or tweezers.   After  the
wound has been cleansed, the detached scalp
must be  fitted as closely as possible in its
proper position; and if the hair around the
wound has not  been already clipped close 
S C A                467               S C A
 off, this should now be done: in addition, it
 will be requisite in most cases to have the
 scalp perfectly clean  for  some distance
 around.   To retain the detached portion of
 scalp in its place, if it be large, two or more
 stitches, according to the size of the wound,
 may possibly be required, (see Wounds,) in
 addition to plaster.  If the wound be  small,
 strips of plaster laid evenly, so as to hold
 the edges together,  will probably be suffi-
 cient ; but in any case, in order that these
 may retain their  hold, the hair must be
 shaved clean  off.   After  the plasters  are
 applied, a piece  of lint,  double, and  wet
 with simple soft water, is to  be laid over the
 wound, and over this, to retain all in  place,
 a bandage of some kind.  A handkerchief,.
 applied as  represented in  fig. xi.,  article
 Bandage, will  generally answer every pur-
 pose, or a cap  may be made to fit close upon
 the head; indeed,  the cap or the  handker-
 chief  are better than any regular  bandage,
 and are generally more accessible.   After
 the wound has  been thus  dressed, the per-
 son who has suffered from  it should, whe-
 ther feeling ill or not, go to  bed,  keep per-
 fectly quiet  on low diet, especially avoiding
 stimulants for some days, and, if of full habit
 of body, take a dose of common purgative me-
 dicine.  A few hours after the dressing, the
 wound will probably feel hot and dry,  but
 these symptoms must be kept down by the
 use of cold water, used so as to soak through
 the dressings without removing them.  In
 the course of two or three days,  according
 to  circumstances, the wound may again be
 dressed. — See Dressing.    Simple incised
 wounds of the  scalp are to be treated in a
 manner similar to the above, but of course
 they are less troublesome when the scalp is
 not detached.  Some persons, condemn  the
 use of stitches and plasters  entirely in  the
 treatment of wounds of the scalp, and prefer
 the use of pads, adapted, by bandage and
 otherwise,  to retain a flap in its place; it is
 doubtful whether this method could be  ap-
 plied by a non-professional person, at least
 with sufficient  accuracy.    Bleeding from
 wounds in  the scalp is often profuse,  espe-
 cially if an arterial branch has been divided;
 it may, however, generally  be  stopped by
 the use of cold, or by pressure.  Even  when
 a very large portion of scalp has been de-
 tached, it is  often marvellous how quickly
 and completely it  becomes reunited to the
 other parts;  at other times, however, por-
 tions of the skin die, leaving a granulating
wound to  heal  like other wounds of the
same kind.    One chief danger to be appre-
hended  after wounds of the scalp—inde-
pendent of the  violence to the brain which I
 is  often a concomitant of  such accidents—
 is the occurrence  of erysipelas, which may
 set in, spread over the head, cause extensive
 formation of matter  under the  skin, and
 perhaps  destroy the patient.   Such a case
 must, of course,  be treated  as erysipelas
 from any other cause; but if a medical man
 has not before seen the patient, he ought to
 do so now without delay; it may require all
 his skill to save life.
   The scalp is often the seat of "encysted"
 tumours, which are at times conspicuous on
 the heads of aged people; they are perfectly
 harmless and painless if they do not inter-
 fere  with the wearing of the usual head
 covering.  If desired by the possessor, their
 removal is simple.  Soft fluctuating tumours
 beneath the scalp of infants are sometimes
 met with immediately after birth: they  ge-
 nerally disappear shortly, but it is better
 they  should be examined by a medical man.
   The scalp is the  seat of different forms
 of  eruption, or of skin disease, especially in
 children.   It would  be quite  superfluous
 and useless, as far as the non-professional
 are concerned, to  attempt to enter  into the
 differences between these, although some of
 them differ greatly, or to  give  the various
 modifications  of treatment: general  obser-
 vations are all that can be offered with any
 advantage.   The first great object in erup-
 tions of  the  scalp is  to  get  them  under
 treatment as early as possible; the next, to
 observe the strictest cleanliness.  The variety
 and the obstinacy  of the disease in question
 is' a reason for placing them under proper
 medical  treatment  as  early  as  possible.
 When this cannot be done quickly, the first
 step  should be to examine the head tho-
 roughly, that  no affected spot be undisco-
 vered ; the next to clip the hair moderately
 short, and around the affected parts per-
 fectly close.   If the eruption is extensive, it
 is better to cut the hair close off altogether
 at once.   The hair having been removed  by
 clipping, in preference to shaving, washing"
 with good brown soap, with warm soft water,
 night and mor-ning, is a process which will
 cure  many a scalp  eruption,  especially
 among those classes in whom deficient clean-
 liness is often the cause of the  evil.   When
 this does not suffice, an ointment made with
 ten grains of the  red  oxide of mercury to
 the ounce of lard,  smeared slightly over the
 affected part, is often of much service.   As
long,  however, as there are any scabs  or
 incrustations on the head, there is  no use
applying either this ointment  or any other
 application; these, therefore, should be re-
moved in the first  place by poulticing.   In
some kinds of scalp eruptions, such as scald- 
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468
PU L
 heat?, alkaline washes are often of service.
 Dr.  Bennett, of Edinburgh, recommends in
 some forms of that disease a lotion, com-
 posed  of two drachms of subcarbonate of
 soda to the pint and a half of water, to be
 applied  to the affected parts by means of
 lint soaked in it, and covered with oiled silk.
 Very many applications for eruptions on the
 scalp are and have been used;  but if a dis-
 ease of the kind does not yield to the simple
 measures  above detailed,  a  medical man
 should  see the case.  Moreover, in  some
 forms of scalp eruption, it is scarcely desir-
 able that the eruption should  be done away
 with, at least quickly, or  without the con-
 stitution being acted upon by  medicine; for
 it may happen that, after the disappearance
 or cure of a scalp eruption, a child will be-
 come the subject of convulsions, or of other
 affections of  the brain.
   In all cases of  tendency to eruption on
 the  scalp, the diet should be attended to,
 salted meats  forbidden, and, in those of full
 habit,  the allowance of  animal food cur-
 tailed, and milk and farinaceous diet sub-
 stituted, more or less according to  circum-
 stances; on the other hand, in the weak and
 delicate, it may be requisite to improve the
 diet both in nourishment and stimulation.
   In strong children, three grains  of gray
 powder, given at  bedtime, and followed in
 the  morning  by a dose of senna  or other
 aperient, will often be useful.  In more deli-
 cate children, half a  grain of gray powder
 with two or three grains of carbonate of
 iron, given twice  a day for a week or ten
 days at a time, is a useful remedy.   In all
 such cases, however, proper medical attend-
 ance is the best and safest plan.
   When there is eruption on the scalp, the
 glands of the neck are liable to become en-
 larged and painful.
   Refer to Erysipelas—Skull—Wounds.
   SCAMMONY.—This drug, which belongs
,to the class of purgatives called cathartics,
4s obtained from a species  of convolvulus, a
 native of  the countries of the Levant.  It
 is one  of our  most valuable medicines, but,
 from its high price, one of the most adulte-
 rated drugs in use.   Indeed, the scammony
 generally met with does not  contain above
 fifty per cent, of the pure drug, and the
 doses are generally regulated according to
 this;  consequently,  if pure, or, as  it is
 called,  "virgin," scammony was generally
 attainable, the  doses would  not be  above
 half what they now are.   Scammony is
 generally met with in the form of a grayish
 mass,  or  gray  powder;  the  adulterations
 are  chiefly chalk, flour, &c. Scammony acts
 as an efficient purgative  without griping,
and is not liable, if properly given, to pro-
duce violent effects ; its  certainty of action
is  however increased by combination  with
other purgatives ; on this account it  forma
a valuable addition to the compound  colo-
cynth pill.  For children, when free purging
is  required, scammony is remarkably well
adapted, combined with small doses of calo-
mel  or  gray powder; moreover,  its  small
bulk of dose, and the comparative absence
of nauseousness, fit it for such administra-
tion.  For a child of  four years of age, four
grains of ordinary scammony alone, or one
grain and a half  of calomel, or three grains
of gray powder, with three grains of scam-
mony, will prove a certain and active  pur-
gative.   Scammony  alone  may be  given
rubbed up with milk  in the form  of emul-
sion.
  SCARF-SKIN, or Epidermis, or Cuticle.
—See Skin.
  SCARIFICATIONS—Are deep scratches,
or superficial cuts, made  generally upon the
skin, or  upon a  mucous  membrane.   The
chief use of scarifications is  to give exit to
blood or serum, from parts  in which there
is  an improper  accumulation  of either of
these fluids.   The scarification of the gums
in  children  is not, as is often supposed,  to
assist the passage of the tooth, but to re-
lieve the tension  and inflammation of the
gum by allowing the  escape  of blood  from
the overloaded vessels and tissue.  Scarifi-
cations of other  parts act in a similar way.
  Refer to Children.
  SCARLATINA and SCARLET  FEVER—
Are both designations for one and the  same
disease,  although an  idea  prevails popu-
larly  that  the  former  is the name  of a
milder and less dangerous affection than the
latter.
  Scarlet fever belongs to the class of erup-
tive fevers, and  is characterized by symp-
toms so  well marked that it can scarcely be
mistaken for any other disease, even by un-
professional  persons.   Generally, the first
symptom complained of, in  the  incipient
stage of  scarlet fever, is  sore-throat, either
accompanied, or  quickly succeeded by the
usual symptoms  of a feverish  attack, shiver-
ing,  headache,  loss  of  appetite, perhaps
vomiting, followed by heat of skin, quick
pulse and  thirst.  The  eruption  appears
early, on the second day  after  the  first
symptoms of indisposition.   It first shows
itself in  the form of minute  red points on
the chest and arms, especially  about the
elbows,  the  points becoming  more nume-
rous, till they form one  diffused surface  of
a tolerably  bright scarlet eruption, whicL
extends  to  the  neck, face,  and abdomen, 
SC A
469
SC  A
 and  body generally.   On  the  second day,
 when the eruption is  appearing, the  symp-
 toms of  general fever, and  especially the
 beat of skin, continue unabated, the  throat
 is more inflamed,  and the tongue assumes
 the appearance characteristic of this disease.
 It is probably covered with a white creamy-
 looking fur, through  which the " papillae"
 on its forepart, about the tip especially,
 project like red points.  This appearance
 may continue, but in  many  cases  the fur
 comes off, as it  were, in patches at a time,
 and  ultimately  leaves  the  tongue preter-
 naturally clean  and red,  covered with the
 elongated papillae, in  some cases almost
 like  a pile upon it.  The eruption in scarlet
 fever generally looks  more patchy upon the
 extremities  than  it  does  upon the trunk.
 In a moderately favourable case of scarlet
 fever, the eruption begins to fade between
 the  third and  fourth  day from its appear-
 ance, and with it the feverish symptoms, and
 other general symptoms of the disease, such
 as  sore-throat, &c.  The patient of course
 is left weakened, but with moderate  care,
 convalescence is for the most part  speedy.
 The  chief care  is required until  the des-
 quamation of the cuticle, or peeling, is com-
 pleted.  During this period also the power
 of  communicating the disease by contagion
 appears to be retained.
   Although   favourable cases  of  narlet
 fever pass  through  the course nearly  as
 described  above, there are much  severer
 forms of the  disease.   The  feverish symp-
 toms from the first may have a high inflam-
 matory form ; or the reverse may give evi-
 dence of an extreme condition of bodily
 depression,  with tendency to malignant dis-
 ease, and to a putrescent or typhoid condi-
 tion.   In such cases the eruption is tardy,
 and, when it does appear, patchy, and dusky
 in colour, the swelling of the throat is great,
 and if they can be  seen,  the tonsils are
 evidently ulcerated,  the breath  offensive,
 the tongue  swollen, and swallowing  diffi-
 cult, if not impossible.  Offensive discharges
 take  plaee from  the nose, and at the  same
 time there is evident extreme depression of
 the  constitutional  powers, with  delirium.
 Between the comparatively mild form first
 described, so mild indeed at times as scarcely
 to constitute  a perceptible  disease, and the
 malignant, scarlatina is met with in every
 degree of severity.  As a general rule, the
 severity or mildness of the attacks of scarlet
 fever  depend greatly upon the  type of the
prevailing epidemic, which at one time may
be so favourable that  almost  every  case
does  well, while  at  another the greatest
fatality attends it, and sorrowing parents
        2P
 see their children  carried off one after an-
 other with fearful rapidity.
   The great variation in the severity of the
 attacks  of  scarlet fever must render the
 variation in the  treatment equally great.
 When the form of the prevailing epidemic
 is extremely mild,  little if any treatment  is
 required, and  many cases get none at all,
 not even confinement to the house,  and cer-
 tainly not to bed.   This is not well, even for
 the sake of others; and should the weather
 be ungenial, or should cold be taken, a mild
 affection may  be  at  once converted into a
 dangerous  disease.   A  moderately smart
 attack of scarlet fever requires, certainly,
 confinement to bed, in as well ventilated a
 room  as possible, kept at an average tem-
 perature of 60° Fahr.; the  diet should be
 kept  low, and  consist of milk,  farinaceous
 articles, &c, and  the thirst may  be freely
 indulged with  diluent drinks.  The patient
 must  not  be  covered  with   bedclothes,
 which will  keep  up  feverish heat.   If the
 heat  of  skin is great, and  indeed  in most
 cases  of this disease, sponging the  surface
 of the body with tepid water, with or with-
 out the  addition of a little vinegar,  is at
 once most beneficial and grateful to the pa-
 tient.  A gentle aperient should be repeated
 once or twice in the course of the disease, a
 tablespoonful  of castor-oil,  a dose  of mag-
 nesia and rhubarb, or from a half to a whole
 seidlitz  powder,  may be required; or  in
 fuller  habits,  or  where fever runs  high, a
 more active purgative still,  of calomel and
 scammony,  or  in an adult,  calomel  or blue
 pill, and colocynth.
   The common effervescing soda-powders
 are often liked, and  may be permitted in
 moderation  to  all; but more  freely (and
 indeed the  salines generally) to persons of
 full habit.   From five to ten grains (accord-
 ing to age) of chlorate  of potash, given
 every six or eight  hours, in a little sugar
 and water, is one of  the  most appropriate
 cooling salines  in this disease.
  If  the feverish  symptoms run  high,  of
 course the lowering  and  cooling  remedies
 must  be more  actively enforced.   In most
 cases much relief  is  afforded to the throat
 by the frequent use of warm gargles, made
 either with simple gruel, or  with gruel with
 one or two tablespoonfuls  of vinegar to each
 half-pint.   Externally, hot  bran poultices
 frequently renewed, are also of much ser-
 vice to the throat.   When the throat is very
 much swollen, leeches may be requisite, but
 so much caution is called for in the abstrac-
 tion of blood in scarlet fever,  that this should
only be done under  medical sanction.  Greal
enlargement of the  glands around  the jaw 
S C  A
47U
S C A
and in the  neck must always be  regarded
seriously.   When  a case  of scarlet fever
presents symptoms  of malignancy, every
method of supporting the strength by wine,
broths, &c. must be used, nnd the prepara-
tions of chlorine employed both internally,
and  as washes and gargles, to the nose,
mouth, tonsils,  &c.   The chlorate of potash
in from five to ten grain doses, must be given
every three or four  hours ;  or muriatic acid
in five drop  doses in  sweetened  water.
Two drachms  of  the solution  of  chloride
of soda, in the half-pint of water, will make
a  convenient   wash, to be used  with  a
syringe, if  the  child or person is unable to
gargle.
  Although the above directions are given
for circumstances which might render them
useful, it is not with the idea that  any one
in their senses would have recourse to them
if medical aid could in any way be procured.
The fearful rapidity of a fatal case of malig-
nant scarlet fever  calls for the  most ener-
getic exertion of the highest skill, which is
too often of no  avail.   After the eruption
has faded, the person may sit up, and gra-
dually return to fuller diet, such as pudding,
broth,  fish, &c., the bowels being kept free,
but not purged, and close  attention given
to the  state of the urine as  to quantity  and
appearance.  At this stage, too,  much com-
fort and benefit will  accrue  from the use of
two or three warm  baths.   These  relieve
greatly the discomfort arising from the harsh
and dry state of the peeling skin, and, what
is more important, encourage  and keep
active  its ordinary perspiratory functions,
which  are apt to be impaired or impeded,
and thus to give rise to one of the most se-
rious  incidents connected with the  disease
in question, that is, to a dropsical condition
connected  with a  disordered state of the
kidneys.   The  occurrence  ol dropsy after
scarlet fever is always  a  serious  matter,
and the possibility of it a cogent argument
for guarding  against  all  those influences
which, by interfering with  the perspiratory
functions  of the (for the  time)  morbidly
susceptible skin, tend  to  induce it.  It is
observed that  the attacks of dropsy after
scarlet fever are by no means in  accordance
with the severity of the attack itself,  and
this  is supposed to be  because those who
have had only a mild attack are more care-
less as to  after exposure  than  those who
have  suffered a severe one.  However this
may be, it  is certain that  many, who have
passed safely through the disease itself, fall
victims tc the subsequent dropsy, purely as
the result of carelessness on their own part
or on that of others.   The attacks of dropsy
are most likely to occur from the end of the
first fortnight to the end of the fourth w ?ek
after the decline of the eruption. Its symp-
toms  are generally  those  of  languor  and
oppression, with  headache, and it may be
vomiting, the swelling coming on  simulta-
neously.   Usually, the  face (especially the
eyelids) is first affected, and the  dropsical
swelling  may go  no further, but generally
the feet  and  legs, the hands,  arms,  chest,
&c. become filled.   Concomitant with these
symptoms, the urine is scanty, high coloured,
or "smoky" in tinge.   It  presents,  more-
over, peculiar chemical changes.
  Little has hitherto been said about medi-
cal attendance in a case of scarlet fever.
Although mild cases may be, and every day
are, carried safely through with simple nurs-
ing, the  attack, if it be  at all  a smart one,
ought to be attended to by a medical man; if
it  is severe,  his presence  is indispensable,
equally so",  whatever  the  case may  have
been,  if   the  least symptoms  of the  after
dropsy show  themselves.   Should  this  last
contingency occur, warm baths ought to be
used to restore, if possible, the functions of
the skin,  hot  bran  poultices applied to the
body,  and if there is pain about the kidneys,
blood   taken  by leeches or cupping.   The
bowels should be  well  cleared, or rather
purged,  by  the calomel and  rhubarb, or
calomel and  colocynth pill, or better still,
by calomel and compound  powder of jalap.
At  the same  time a draught consisting of a
drachm of nitrous ether, half  an  ounce of
spirit of mindererus, and ten or fifteen drops ,
of ipecacuanha wine, in a wineglassful of
water, may be given every four  or five hours.
These  measures ought to  be sufficient till
medical assistance is procured ; if, as some-
times  occurs, convulsions or delirium come
on, they are to be treated as directed in .the
articles on those disorders.   Besides dropsy,
scarlet fever is liable to be followed  by other
affections, particularly in those of  weak or
scrofulous constitution.   If the affection of
the throat has extended to the ears by the
Eustachian tubes, the structure  of the organs
of hearing may be materially damaged, and
deafness,  total or  partial, be  the result.
Frequently, runnings from the external ears,
from  the nose or eyes, continue  for long
after  the subsidence of scarlet fever,  and
if  the attack  has been a severe one, a per-
manent state of impaired health may be the
consequence.  Of course, if a patient, after
an  attack of scarlet fever, remains weak,
tonic  medicines, quinine or iron, with wine
and good nourishment,  will be required—
also warm clothing.
   The question of contagion in scarlet feror 
SCA                471                 SCI
 is an important one.  Few diseases perhaps
 are more  eminently contagious, and few
 retain  the power of propagation longer;
 indeed, it is difficult to say when this totally
 ceases, at least for some weeks.  Probably,
 when the peeling  stage is complete, the risk
 of contagion is gone, or  nearly  so.   The
 fomites (see Fomites) from scarlet fever are
 very persistent, and unless the rooms which
 have been occupied by patients, and indeed
 every thing which has been about them, are
 very freely cleansed, aired, or fumigated,
 there is always some risk for a considerable
 time.   The power of belladonna, in acting
 as  a prophylactic, that is,  in protecting in-
 dividuals against the contagion of scarlet
 fever, has  been much discussed.   It has
 been used extensively in Germany, and also
 in  this  country, and with apparent success;
 indeed, the author believes he has found it
 efficient for the purpose;  at all events, the
 evidence  is  sufficient to make it  worth a
 trial during the prevalence of a very severe
 or  malignant  form of scarlet  fever.—See
 Belladonna.  Scarlet fever is generally a
 disease of childhood, and  is usually passed
 through once in a lifetime;  but adults  who
 have escaped  it in early life, are liable to
 be  affected.  Second attacks are rare.   Al-
 though, however, those around persons suf-
 fering from searlet fever may not have the
 disease, they are very liable to suffer  from
 sore-throat, often  in a severe form.  It is a
 serious thing  for women  to be exposed to
 the contagion  of  scarlet fever soon  after
 child-birth; every means, therefore, should
 be  used to guard against  such a contin-
 gency.
  Scarlet fever has  sometimes been  con-
 founded with measles ;  a comparison of the
 described symptoms of the two diseases will
 point out the complete difference.
  SCAPULA—TfiE Shoulder Blade.—See
 Shoulder.
  SCHOOL.—It too often  happens that in
 consequence either of ignorance or of care-
 lessness, the health of young people suffers
 irretrievable injury during the years of in-
 struction.  In day-schools the chief source
 of injury is from deficient ventilation.   The
 consequences of this, and the remedies, are
 sufficiently entered into under such articles
 as  Air  and Atmosphere—Bedroom.— Ventila-
 tion, Sec, and  require no  further comment
 here.  Suffice it to remark, that the effect
 of breathing an atmosphere deteriorated by
 the carbonic acid exhaled from the lungs of
 a number of children into  a small or badly
 ventilated room, must be to produce drow-
«iness  and  languor,  and  consequently to
 eutralize in some degree  the exertions of
the teacher.  [In the United States, the pu-
pils sometimes suffer from being retained in
the school for too long a period consecutively.
The old hours of nine to twelve, and two to
five o'clock, are, in the opinion of many me-
dical men, preferable to the long session from
nine to  two o'clock,  as this exhausts many
children.]
  In  boarding-schools,  the  health  of the
children is of course subject to those general
conditions and laws  of  health which are
commented  on in  the various  sanitary ar-
ticles ; and parents would do well to assure
themselves that due attention is paid  to
these, ere they commit the daily life of their
children to influences over which they have
no control.  It is  to be hoped that there
are few seminaries for the  young,  in this
country, in  which  actual deficiency of food
occurs; but it is possible, that in the selec-
tion and preparation of the food, there may
be defects, which  to strong-constitutioned
children are of comparatively little moment,
but which are of the greatest importance to
the delicate.  The  point should not be over-
looked.  It is impossible in the limited space
of this work to enter into particulars, but
the reader is referred to the various articles
on Food—Digestion—and  the  principles of
Nutriment.   Equally  important with quan-
tity and quality of food  is the permission
of sufficient time for  meals, not only for the
mere eating, but for  rest after them, before
school-work is resumed.   The author is in-
duced to notice this point especially,  from
having recently had  his attention drawn to
the regulations of a large  educational insti-
tution, in  which the time allowed for meals
is so short that the  meal itself must  be a
scramble,  independent of the  injury which
may result from the resumption of  head-
work  immediately after taking food.—See
Digestion and Indigestion.  It does seem  to
be the case with some, that  in seeking to
cultivate the mind they destroy the  body,
forget how dependent the  activity of the in-
strument  they seek to form  is  upon the
well-being of its material clothing.  There
are many other points connected with school-
hygienics  which are  important, but, as be-
fore said,  they fall under the heads of sani-
tary information generally, as already given
in other parts of this  work, and which space
forbids to  be reiterated.
  Refer  to Air, Sec.—Bedroom—Education
— Ventilation, Sec. SfC.
  SCIATICA—Is neuralgia or nervous rheu-
matism, affecting  the great  or  " sciatic"
nerve of the lower extremity.   This  nerve,
the largest  in the body,  passes down the
back of the thigh to  the ham,  a little above 
SC  I
•471!
SCR
 which it divides into two main branches.
 The nerve sometimes becomes  the  seat of
 severe neuralgic pain, felt down its entire
 course, or perhaps in the hip only, or some-
 times in the foot and ankle only : the pain
 comes on in paroxysms,  and is generally
 increased by exercise; in some cases press-
 ure upon the course of  the nerve  causes
 pain.
  Sciatica  is often attended with so much
 suffering, that it affects the general health
 to a  considerable degree; moreover,  it is
 frequently most difficult to get rid of.   For
 these reasons,  the  case  should be under
 medical superintendence.  Leeches and cup-
 ping,  in the first instance, down the course
 of the nerve, especially in plethoric  sub-
 jects, followed   by blisters, are useful; or
 heat and moisture may be used with  advan-
 tage, in the form of  the bran  poultice, fol-
lowed  twice  or three times  a  day by  an
 embrocation  composed of one part of tur-
pentine and  two of soap and opium  lini-
ment.
  A couple of drachms of this  should  be
rubbed in for ten minutes at  a  time.  The
 bowels being cleared  by a purgative, if there
 is no tendency  to fever,  drachm doses of
 carbonate of  iron, given three times in the
 twenty-four hours, often cures quickly ;  or
 turpentine, in doses of fifteen drops, given
in milk, three times a day, may be tried;  or
quinine,  in   two-grain  doses, every eight
hours.   There is considerable uncertainty
in the effect of remedies in sciatica, even in
skilful hands.  In obstinate cases the author
has found much benefit from the use of the
warm saline baths, such as those of  Moira,
or of Ashby-de-la-Zouch.   Acupuncture is
often of service in this disease, and is,  per-
haps,  not so much  had  recourse to as it
might. In all cases of sciatica, perfect rest
 of the  limb is essential.   Again, it  is  re-
peated,  the obstinacy of  the  disease,  the
uncertainty of remedies, and the possibility
 of its  being  symptomatic of  irritation in
 the kidney, make it the safer and wiser  plan
 to have the case treated by a medical  man
 at once.
  Refer to Neuralgia.
  SCIRRHUS—A form of cancer character-
 ized  by its peculiar hardness in the inci-
 pient stage of the disease.—See  Cancer.
  SCLEROTIC—The outer thick coat  of
 the globe of the eye.—See Eye.
  SCREAMING—Of infants, if  continued,
 and if increased on particular  movements
 of the body, should not be neglected.   In-
 termittent screaming may be  indicative of
 painful affection of the  chest  or abdomen,
 which  incites the child to scream; while,
on  the  other  hand, the aggravation of the
pain thus induced compels^ it again to de-
sist, thus giving the intermittent character.
Screaming of  children during, or on  awak-
ing from sleep, may arise from the irrita-
tion of  teething, or of worms, &c, or from
indigestible matters in the bowels; for these
causes the suitable remedies are to be used,
as directed  in the proper places.   Scream-
ing in sleep may be simply a bad habit, un-
traceable to any cause, or may be attributa-
ble to dreams, or excitement of mind pro-
duced  by fright during the  day, excited
accidentally, or by design, by foolish nurses.
Lastly,  screaming may arise from incipient
disease  of the brain.  If  the affection  be
persistent, its cause should be investigated
by a medical  man.   It is said that in some
cases of screaming  a small dose of bella-
donna given to a child at bedtime is  useful
as a preventive.  The author  has no expe-
rience of the remedy.
  SCROFULA — Is the name rather of a
constitutional   tendency, or   " diathesis,"
than of a disease,  although cases of a scro-
fulous  disease alone  do occur  where  the
tendency is strong.   That many persons
may be  tainted with scrofula,  and neverthe-
less be free from those external signs which
are usually considered  to indicate  the ten-
dency, is unquestionable ;  but, generally,
if the scrofulous  diathesis  is at all strongly
marked, its  evidences are sufficiently appa-
rent, and often  strikingly so.    The follow-
ing description of the signs of scrofula, by
Dr.  Phillips, one of the  highest authorities
on the subject, is peculiarly truthful:—"In
the  form of the body there is  usually ob-
servable a want of muscular  development;
but even this  is  often  absent.   There  is
often  an appearance  of  plumpness and
roundness, which is the result not  of mus-
cular  development, but simply of an infil-
trated condition of the cellular tissue, and
which rapidly disappears  under  fatiguing
exercise, privation, or disease.  Commonly,
there is a general  paleness and coldness of
the  surface  of the body, which is owing to
a feeble circulating  apparatus;  but in  a
large  number  of cases,  that  paleness does
not extend to the face.  The  colour of the
hair is very  variable,  but for the most part
it inclines to  a dark tint.  Of nearly nine
thousand scrofulous  children examined,  a
little  over thirty-two per cent, had light
hair and eyes.   The abdomen is commonly
tumid—discharges from the nose, the eye,
and the ear are  common—the tongue has
commonly  a  dirty  whitish  coating;  the
tonsils are  usually enlarged, ana  they are
often so  tumid as to impress a disagreeable 
SCR                473                 S C R
and  frequently  husky  character  upon the
voice, and to cause snoring when the patient
is asleep.   The  stomach  and  bowels are
frequently disordered, and  digestion is ill
performed.   Sometimes the evacuations are
clay-coloured, very offensive, and of varying
consistency,  at others having a  redundancy
of bile.   The skin, though often dry and
hard,  is often the seat of  a considerable
greasy exhalation; sometimes it is found to
be fetid and  sour.   The scalp and other
parts of the cutaneous integument are often
the seat of eruptive affections.  The absence
of  vascular   and  muscular  energy  often
causes the child  to sit and  lie about much,
and  indisposes him to  enter into  the ener-
getic games  of his playfellows.  As  to the
intellectual  development claimed for scro-
fulous  persons,  that is usually wanting.
That many scrofulous children present that
character is  quite true ; but the result of
very careful  observation," says Dr. Phillips,
" has convinced me that the  overwhelming
majority are without those superior intel-
lectual qualities which  have been pointed
out as their  ordinary characters."   More-
over, if the intellectual  powers are  forced,
as too  often happens, "and  the nervous and
intellectual systems have the vital  actions
concentrated  on  them  too  intensely, the
sufferer loses flesh, the general health lan-
guishes, and  the intellectual  faculties may
give way, destroyed by  an opposite but not
less  sure  method than  that  which  breaks
down the poor man's child."
  As noticed  above,  the very common idea
that scrofula is usually associated with light
hair and complexion  is far  from being cor-
rect,  the  larger proportion  of scrofulous
subjects  have dark hair and eyes,  with  a
dingy  complexion;  and  some  are  ruddy,
and  to  the common observer I«.>jk robust;
others with delicate skin, inclined to freckle,
have red hair.
  Of the causes  of scrufula  there  can be
no doubt  that hereditary predisposition is
the  cause  above  all  others.    The  fact is
beyond dispute, and  there  are few families
in this kingdom who have not, indirectly at
least, practical connection with the fact. It
is to be observed, however,  that the  predis-
position is strengthened, if a parent adds
to the taint an acquired state of bad  health,
or if in a father the bodily  powers are im-
paired  by age. Probably the  reverse holds
good, that whatever conduces to health and
vigour,  even  in  parents tainted with scro-
fula, tends to improve  the  constitution of
offspring  as   regards  the  predisposition.
Further, it is undoubted,  that  whatever
hereditary  tendencies children may possess
         2 p2
they are greatly retarded  or  strengthened
by  the external  conditions to which such
children  are  exposed.   If the  climate  in
which they  reeide  is dry  and bracing, if
they are  so placed that healthy habitations,
good  clothing,  and nourishing  food  are
provided for  them, and especially if their
parents and  guardians  are  awake to  the
importance of these things, of being on the
watch for any tendency to  failing health or
to disease, the  chances  of health and  life
are far greater thau they are for children of
even originally better constitution, who are
exposed to a damp cold climate, and to the
unhealthy influences  attendant  upon  the
circumstance of poverty. These, in fact, of
themselves, especially cold, damp, and pri-
vation of food, particularly if accompanied
with depression of mind, may even engen-
der scrofula in a constitution comparatively
untainted by it.  It ought always to be an
object  in those predisposed  to scrofulous
disease,  to  maintain the  highest possible
condition of health.
  In children, the glands, (those of the neck,
chest, and belly,) are the most usual seat of
scrofulous  disease, though few if any other
of the tissues are free  from the liability.
In adults, the lungs most  generally suffer.
Whatever disease  affects a scrofulous per-
son, whether it be, like enlargement of the
glands, distinctly traceable to  the scrofula
itself, or some other ailment, it is apt to be
modified  in its course  and appearances by
the existing  tendency.  Purely scrofulous
inflammation is slow in it progress, and un-
attended in any marked degree by the usual
phenomena  of inflammation.   When  sup-
puration ensues, the matter is not " healthy
pus," but  more  like  whey  or serum.   If
ulceration  results, it  is indolent, and  the
discharge is  also  of  the  thin  whey-like
character.   The  formation of tubercles or
of tubercular matter is  another character-
istic of scrofula.   These bodies, so common
in the lungs, may also occur throughout the
body:  consisting  of  cheesy-looking  sub-
stance, they excite inflammation  and form-
ation  of  matter in the  adjacent  parts of
the tissue in  which  they are deposited.
When this occurs in the lungs, the tubercles
become as it were softened  down in the sur-
rounding matter, and the fluid  or semifluid
mass is discharged by cough.
  Under  the head  of causes, sufficient  has
been said to indicate the general course to
be followed when a tendency to scrofula ex-
ists ; when the disease actually breaks out,
the same measures  must be continued,  and
new ones of a more direct medicinal charac
ter adopted. These, to be thoroughly carried 
SCR
474
S C U
out, require the superintendence of a medical
man.   Iodine  in  its  various preparations,
especially that of the iodide of iron, also
iron itself, with tonics generally,  and above
all the use  of  codliver-oil, are the principal
remedies; and change of air, when  obtain-
able, to the sea, or  to a  dry bracing air, is
always advisable.   Season, as might be ex-
pected,  exerts considerable  influence over
the scrofulous constitution ; the early spring
months  being the most  unfavourable.   In
some countries there is considerable import-
ance attached  to the contagiousness of scro-
fula.  It cannot be considered contagious in
the ordinary acceptation  of the word, but it
must  be always  advisable,  especially for
those  predisposed to the disease, to avoid
close contact with the affected.   The scro-
fulous is often spoken of as the "strumous
diathesis."
  SCURF.—See Dandruff.
  SCURVY.—This  disease, so  well  known
and so fatal in times  past to voyagers  and
others, has, within the last few years, been
again brought prominently into  notice, in
consequeuce of its prevalence in England
during the year 1847, when, in consequence
of the failure  of  the  potato  crop, numbers
of the population  were compelled to do alto-
gether without a vegetable  substitute.  It
is requisite here to explain, that  what is
meant by scurvy in this article, is a very dif-
ferent disease  from  that meant in the popu-
lar acceptation of the term, which is  applied
to undefined cutaneous disorders, especially
of a scaly character.  The error has proba-
bly arisen from the dry scurfy appearance
of the skin, which often  precedes an attack
of the real scurvy.  True scurvy is a severe
disease, unquestionably owing to deteriora-
tion of the blood, as a result of inappropri-
ate nourishment,  especially of nourishment
unvaried by the admixture of fresh  vegeta-
bles,  milk,  &c.   Scurvy commences  with
languor and signs of general debility,  and
great depression of  spirits, the gums be-
come  swollen and  spongy,  red  or  purple
looking, project  over the teeth,  and bleed
easily;  this tendency to the exudation of
blood extending to the various mucous sur-
faces  within the  body,  in bad cases,  and
showing itself in the discoloured patches of
effused blood beneath the skin.   The lower
extremities become first stiff, then  swollen
and hard, the  skin  being as it were glued
down to the  parts beneath, and  covered
more or less with brownish or purple patches.
If the  case  goes on unchecked, blood is
passed from the various outiets of the body,
and  the patient  sinks.   Fortunately, for
this formidable malady we possess the well-
known  and almost certain cure  of  lemon
juice;  but although this is the most strik-
ingly speedy and most  certain curative
agent, it  is by no means  the  only one:  at
the  deprivation of fresh  vegetables  or  of
milk seems to be one chief cause  of the dis-
ease, so a return to the use of these articles
appears to be an antidote; and, in this way,
potatoes  and vegetables  generally, without
medicine  at  all, are often sufficient to cure.
Indeed, in the epidemic  of scurvy which
prevailed in 1840, in the General Prison at
Perth, the cases which occurred were cured,
and the further progress of the disease ar-
rested,  by the addition  of milk, and in some
cases meat, to the usual dietary; malt liquor
is likewise found  useful in diminishing the
tendency  to, and in arresting the progresi
of scurvy.
   Of course, in a bad case of  scurvy, when
lemon-juice is procurable it should be used;
half a pint may be given in the day, alone
or diluted.  Until lately, the  opinion has
prevailed that the curative powers of lemon-
juice in scurvy depended upon its acid, and
that the  good  effects  of other vegetables
arose from their  containing  that or other
similar acids:  the researches of Dr. Garrod,
however,  have thrown doubt upon this, and
apparently go to  prove that the  beneficial
influence  is  rather due to the potash which
exists  in  combination with the acid. This
view is supported by the fact, that citric
acid—the acid of the  lemon—when used
alone,  does  not  cure scurvy.  Should  the
potash  view  of the question prove correct,
it will afford an important, cheap, and  ge-
nerally available remedy for this severe and
often fatal affection.   [Dr. Hammond, Sur-
geon, United States Army, has reported  12
cases of scurvy cured by the salts  of potash,
thus confirming the views of Dr. Garrod. The
"cream of tartar," bitartrate of potash, an-
swers very well, and so also does the carbon-
ate. ] Although, however, it is certain that the
disease in question depends for its develop-
ment upon the deficiency of certain articles,
or constituents of food, it is no less  certain
that its  attack is greatly favoured  by the
deficiency of sanitary regulations  generally,
and that  those who are subjected  to confine-
ment, as  in a prison, or on board ship, espe-
cially  if  ventilation  and other  necessary
arrangements are neglected, will much more
quickly become the subjects of scurvy, than
those who are not exposed to the same de-
pressing  influences, even  if the food be the
same.   Salt  provisions  alone  will not pro-
duce scurvy, unless other conditions favout
i the disease.   Males  are more liable to it
I than females. 
SC Y
475
SEA
   SCYBAL^E—Are hard lumps—generally
 black-looking—of feculent matter.
   SEA.—The effects of the sea upon health
 have to be considered under the two aspects
 of exposure  to  "sea-air,"  and of  "sea-
 bathing."  That  exposure to the air of the
 sea, especially  in the case of persons unac-
 customed to it,  exerts a stimulant and tonic
 effect cannot be  doubted.   The freshness
 and, in summer, comparative coolness of the
 air in the vicinity of the sea contributes to
 this ;  and its impregnation with saline par-
 ticles,  the  chlorides   especially, probably
 adds to its tonic properties.   Moreover, the
 average temperature of sea-coast places is
 more  equable  than of  those  inland, being
 generally warmer  in  winter.   Although,
 however, the general  character of  sea-air,
 and  its  effects upon  health,  in different
 places are similar, it varies greatly, accord-
 ing  to locality,  as to particular influences :
 thus,  at Torquay the  relaxing  air is  the
 opposite of the stimulating atmosphere  of
 Brighton, which again is very different from
 Hastings.  These differences, it is true,  de-
 pend  more upon  land  influences, such  as
 formation of coast, the vicinity of hills, &c,
 than upon  the sea  itself,  but  still they
 modify the effect of the latter so greatly as
 to make them a serious consideration when
 residence, either temporary or permanent, is
 chosen with  reference  to health.   Under
 any circumstances, it is considered as a ge-
 neral  rule that  invalids derive more benefit
 from sea air,  at a little distance—quarter
 of a mile—from  the  water,  than they do
 close to it.
   Refer to Climate.
   SEA-BATHING—When  properly employ-
 ed, is  a stimulant, in the first instance  to
 the skin, and further to the body generally.
 The  stimulant action upon the skin, indeed,
 even proceeds so far as to cause eruptions,
 somewhat resembling  scarlatina.  In  some
 cases the smarting from these eruptions is
 so severe, after each  immersion, that the
 practice has to be discontinued, at least for
 a time.
  The abstraction of caloric from the body,
 in consequence  of bathing in  sea-water,
 certainly appears to be less than it is from
 bathing  in  fresh.   The effects,  however,
 from bathing in the sea must vary, as the
 proportion of the  saline»constituents varies
 considerably in  different localities.   "The
 average  quantity of saline matter is three
 per cent, which consists of chloride of soda,
 or common  salt—sulphate of magnesia, or
Epsom salt—sulphate  of soda, or Glauber
salt; also muriate of magnesia and of lime,
 with  salts of iodine  and  bromine."  The
 above constituents are uniform  as  to pre-
 sence, but  are  so  unequal as to quantity
 that, "in  the Baltic, a pint of water con-
 tains scarcely two scruples of  salt;  on the
 coasts of Great Britain  it contains more
 than half an ounce;  in the Mediterranean
 much  more, and in some parts under the
 Line, the quantity amounts to more than
 two ounces."  " From the beginning of'July
 the temperature of the sea is constantly on
 the increase, and during  the month of Au-
 gust it  is  at  the  highest, remaining  the
 same with very  little alteration till Septem-
 ber, when the temperature again becomes
 less.  The minimum temperature of the sea,
 for each day, is in the morning before ten
 o'clock, its  maximum  from twelve  to five.
 Other  circumstances  being the  same, the
 temperature of  sea-water is observed to be
 higher  in  proportion to  the proximity  of
 continents and  islands."*  Moreover,  the
 temperature of the sea on a line of coast is
 modified by the  construction of the  shore;
 if this be rocky,  rapidly deepening, the tem-
 perature of the ,sea during summer will be
 lower than it is on a flatter shore, where the
 advancing tide travels over an extent  of sand
 warmed by the sun, and vice versa in  winter.
   Persons  who  are  unaccustomed  to sea-
 bathing, may sometimes  find it  of  service
 to take two  or three tepid sea-baths before
 going to the open sea.   There  is, however,
 no necessity, as  some suppose,  for a course
 of medicine beforehand, unless the  indivi-
 dual is decidedly out of  health, and  then
 sea-bathing should not be  engaged in before
 consultation with a medical man, who may
 give medicine for the existing ailment; but
 certainly, persons in  good health have  no
 occasion for preparatory medicine.   Indivi-
 duals who are very plethoric, who are  the
 subjects of any organic disease,  or who have
 any tendency to fulness about the head, also
 aged persons, should not bathe  without me-
 dical sanction.
   If a person is in a state  of body to  benefit
by bathing,  and  if the good effects are not
counteracted by  too long  immersion  in the
water,  the bath  should be followed by reac-
tion, which conveys a sensation  of increased
strength  and spirits, a glow of warmth  on
the skin, and increased appetite.  If, on the
other hand, the reaction is tardy, if the skin
continues  cold and  blue-looking,  if the fin-
gers and toes become what is called "dead,"
if  there is bodily and mental depression,
with languor and sleepiness, it is certain
the bathing does not agree, from some cause
or other.—Refer to Bath.   When cold sea-
* Lee's Baths of England. 
S K A
476
SE R
 bathing does not agree,  or  is too depress-
 ing,  the  tepid  sea-bath  is  often of much
 Bervice, and does not relax like fresh-water
 tepid bathing.
   Sea-water, as might be expected from its
 saline constituents, acts as a purgative.  The
 usual dose is half a pint, repeated  once or
 twice according  to effect.  It may be gone
 on with with  less risk of depressing conse-
 quences than arises from the use of saline
 aperients generally; indeed, it exerts a tonic
 influence.   In worms, both when taken by
 the mouth and used as an enema, sea-water
 is often useful.   " Sea-water has been  fre-
 quently taken in habitual costiveness, par-
 ticularly by those of full habit who lead a
 sedentary life.  In this instance its stimu-
 lant properties are as useful as its purgative
 qualities.  When it is to be  given to chil-
 dren, they are easily persuaded to take the
 dose if its nauseous taste be  covered with a
 little port wine.  It is  a  curious fact, that
 by the continued employment of sea-water
 as a purgative, although for a short  time it
 produces emaciation, yet its secondary effect
 is to promote obesity."
   "It is  not easy to account for the  fact,
 that no artificial  mixture  of the component
 parts of sea-water  produce a compound of
 powers equal to the natural."  "Although
 sea-water cannot be regarded as a purgative
 of much power, yet in some constitutions it
 operates when no other cathartic will take
 effect."  " When it fails to purge, which it
 does  in some habits, it produces fever of a
 low kind, accompanied with purple spots on
 the skin."*
   SEA-SICKNESS.—See Sickness.
   SEASONS—The influence  exerted by the
 changes of the seasons upon man's  health
 and life has been  considerably  elucidated
 by the researches of different observers, and
 by the statistical returns of this and other
 countries.  But it is a subject so much mixed
 up with coincident  influences and circum-
 stances, that accurate results  are with diffi-
 culty  attainable,  as,  for instance,  while
 according  to  the  returns of mortality  in
 England,  the winter months  present  the
 greatest average of death,—according to the
 researches of Casper and  Quetelet, summer
 is  the most fatal  season  in  Stockholm, in
 Montpelier, and  in  Berlin,  and probably
throughout  Central  Germany.  These dif-
ferences  perhaps depend on  local  causes.
Along with this uncertainty, however, there
are certain general rules of climate connect-
ed with the seasons, which are well ascer-
tained; such, for instance, as the greater
 prevalence of inflammatory attacks, and .'
 disorders  of the respiratory organs during
 winter and spring; the frequent occurrence
 of apoplexy during frost,  and  the epidemic
 of biliary  disorder toward the  close of sum-
 mer nnd autumn, after the  high temperature
 has permitted the accumulation of carbona-
 ceous compounds in  the system.  The in-
 fluence of season  is  of course  much  less
 felt by the young, the robust,  the well-fed,
 clothed, and  housed,  than  by those who are
 exposed to the reverse circumstances.   "At
 no period of  life is the influence of the  sea-
 sons on mortality more perceptible than in
 old age; and  at no age less than between
 twenty and twenty-five,  when  the physical
 man, fully developed,  enjoys the. plentitude
 of power."*   Of course, much  is to be done
 by care, in guarding against the influences
 of climate consequent upon season, both in
 old and young.
   Refer to Clothing—Cold—Heat, Sec.
   SEASONING.—See  Acclimation.
   SEBACEOUS—Glands  or  Folliclbs-
 Are glands situated in the skin, which  se-
 crete an  unctuous matter; they are most
 common on the face and about  the nose. In
 many persons, especially in those who  live
 in towns where  there is much smoke, the
 orifices of these glands become black, con-
 stituting what  are called " black-heads."
 When these are  squeezed,  the "sebaceous"
 matter is expelled in a worm-like form,  and
 with the black-head at the extremity, from
 its resemblance to a worm, has actually been
 taken for such.  The sebaceous  matter itself
 is not indeed a worm,  but it has within  the
 last few years been discovered by Dr. Simon,
 of Berlin, that it is the seat or " habitat" in
 many persons—according  to Mr. Erasmus
 Wilson, in all—of  a  minute parasitic ani-
 mal.  According to Mr. Wilson, the animal
 varies from the T^-j to the  5'$ of an inch in
 length.   There  are usually two, but often
more, in the small mass of sebaceous matter
 squeezed out of a follicle.   Even in the most
 healthy-looking skins they are said to exist,
 not causing irritation  unless by accumula
 tion in undue numbers.
  When irritation takes place in a sebaceous
follicle, it causes the inflammation and form-
 ation of matter which  constitute a common
pimple.  The  formation of black-heads is
best prevented by bathing with warm water,
 and  then rubbing the surface  well with a
towel; frequently, however, the tendency is
 connected  with  disorder of the  digestive
 organs, which requires rectification.
  Refer to Skin.
• Thomson's Materia Medica.                         * Quetelet, On Man. 
SEC
477
SEN
   SECALE CORNUTUM—See Ergot.
   SECONDARY.—See Primary.
   SECRETION.—This term, as usually ap-
 plied  either to vegetables or animals, signi-
 fies the separation  of a specific  substance
 from  the  ordinary  fluids of  the  organized
 body.  In  the stricter acceptation, it is more
 applicable to such processes  in animals as
 the secretion of  the saliva,  gastric juice,
 &c.
   SECUNDINES.—The after-birth and mem-
 branes cast off after the birth of the child.
 —See After-birth—Child-bed.
   SEDATIVES—Are medicines  which  de-
 press the activity and sensibility of the nerv-
 ous system, without causing previous  ex-
 citement ;  in this they differ from narcotics.
 There  has been  considerable diversity of
 opinion respecting the action of sedatives,
 and as to what agents truly belong  to  the
 class.  Prussic  acid is usually cited as a
 characteristic example.
   Refer to Narcotics.
   SEDENTARY.—The  observations made
 under  such  articles  as Exercise — Motor
 Change, Sec. Sec, render  comment upon  the
 effects of sedentary  habits superfluous.
   SEIDLITZ. — The waters  of  this well-
 known Bohemian spa  owe  their aperient
 activity to the presence of Epsom salts, or
 sulphate of  magnesia, one hundred  grains
 of which are said to be contained in every
 pint  of water.   It  also  contains  lime in
 small proportion.  These qualities are very
 different from those  which distinguish  the
 commonly  used Seidlitz powders.
   SEIDLITZ  POWDERS. —These consist
 essentially of two drachms of Rochelle salt,
 mingled with forty grains of carbonate of
 soda in the one paper, and thirty-five grains
 of tartaric acid  in  the other, usually  the
 white paper.  Seidlitz powders possess  the
 advantages  and   disadvantages  of  saline
 aperients  generally,  except  that  they  are
 pleasanter than most.
   Refer to Effervescing—Purgatives—Salines,
 $*■
   SELTZER-WATER — Is  chiefly  distin-
 guished  by the  large amount of carbonic
 acid it contains, in combination with alka-
 line carbonates, such as those of soda, mag-
 nesia,  and lime;  it  also  contains common
 salt.  It is useful in  some forms of dyspep-
 sia, gravel, &c. &c.   It cannot, however,
 be used  habitually, as  it is  by some who
 are in good  health,  with any apparent  ad-
 vantage.
  SEMOLA and SEMOLINA—Both belong
to  the  class of farinaceous preparations.
The former, as made by  Mr.  Bullock, con-
sists principally of the gluten of wheat, free
 from the starchy constituent of the grain,
 Its  nutritive  power, therefore, that is,  its
 capability of yielding  the  plastic  elements
 of nutrition, (see Grains,) must be  consider-
 ably greater than that of the simple grain.
 Indeed, it must  in  some  degree  approach
 animal food  in nourishing power.  Semola
 may be mixed with  soap, or prepared like
 sago, &c.  Semolina,  also  called  manna
 croup, a preparation of  a Russian grain, is
 less used now than formerly, but forms a
 light nourishment, prepared and  used like
 sago.
   SENDING for the DOCTOR.—Under the
 head of Advice, Medical,  a few observations
 applicable to the present  subject have al-
 ready been offered : a few more may be ser-
 viceable.   In large towns, where  distances
 are short and medicines procurable in every
 street, it  is generally  of less  consequence
 for a medical  man to  be strictly  informed
 of the nature of any case  of emergency to
 which he is summoned, than it is  in  the
 country.   In the latter, if  the case is at all
 an urgent one, or if it is  an accident, the
 message  should  always be  either clearly
 given to an intelligent messenger, or sent by
 note, which is the safer plan, giving such
 an idea of the nature of the case as may
 serve to  guide  the  practitioner in taking
 with him  remedies or  instruments, the im-
 mediate   employment  of which  may save
 much inconvenience to  all  parties—much
 suffering  to  the  patient, perhaps life.  A
 medical man cannot, of course, at all times,
 even from the plainest  message, form a cor-
 rect idea  of the case he  is  to meet, but he
 may in  many.  When  a case is one of acci-
 dent  or  emergency, of  course any  hour,
 night or day, is the  same;  and if medical
 attendance is required, it  should  be so  at
 once; in  other cases,  however,  much  con-
 venience to all parties may be secured by
 messages   properly timed.   Some persons
 have a habit of putting off  till evening send-
 ing for a medical man.   This, when  it can be
 avoided, is neither just  to themselves nor
 to their medical attendant; they get a man,
 jaded perhaps with a day's work, and with
 his energies less alert than  in  the  morning,
 and  they  also perhaps Bubject him to un-
 necessary fatigue, which a timely morning
 message might have saved.  Of course, cases
 of illness which have appeared slight in the
 morning, may, by becoming much more ag-
 gravated in the lapse  of a few hours, and
 especially toward  night, call  for  that  at-
 tendance which before seemed unnecessary;
 these are not what are  meant, but, in ordi-
nary cases, it ought to be  a  rule  to  let a
medical  man have the message as early as 
S E N
478
S E N
possible in the forenoon.  It not only enables
him  to arrange his  own business better—
and, when he  is busy, the question of ar-
rangement is  no slight consideration—but
it renders it probable that his patient will
be earlier visited.  Again, when a message is
sent, care should be taken that there is no exag-
geration.
  A  portion  of  the  above advice may pro-
bably surprise some  persons,  but every me-
dical man who has been in general practice,
must have experienced its want, not so much
among the wealthier classes  as among the
poor; above all, the  subject last alluded to,
that of sending exaggerated messages, re-
quires notice.   The message  that a  person
is "dying," or "killed,"  even in cases of
comparatively slight, though sudden illness,
or of an accident, is  an extremely common
one in the country.   And although when  a
practitioner has  been deceived by such calls
time after time, he  gets more  wary, and
takes them for what  they are worth, it may
occur that the repeated " cry of wolf" will,
in some instance, cause him unintentionally
to overlook a case, by turning a careless ear
to the call which has so often before proved
untrue.   Certain it is,  that such is the real
explanation of some of those cases of ap-
parent neglect of the poor by medical men,
which now and then  come before the public.
The  general  readiness of the members of
the  medical profession to attend to the poor,
either by engagement or gratuitously, when
such attendance is  really requisite, might
save them from some of the censure, public
or private, with  which they are occasionally
visited for such omissions, by those  who
know little of the trials  and vexations to
which they are subjected.
  It is not meant to  say, that whenever an
exaggerated message is brought, it is a wil-
ful misrepresentation.  In many cases, some
relative or bystander, without waiting to as-
certain the real  state of matters,  starts off
in a fright to  the  surgeon; in  other in-
stances, however, among  the ignorant, the
system  is  one  of deliberate forethought,
under the idea that  the  medical  man will
make greater haste in attending to  his pa-
tient.  It has been shown how, in the  long
run, this defeats its own end, and does mis-
chief as well.  Lastly, some persons send for
the  doctor by irregular  channels, through
third or fourth parties, or by leaving  mes-
sages at houses,  &c.; this is  always uncer-
tain, and often, by the message being forgot,
inflicts disappointment.   If a medical  man
is really required, send for him direct,  soon
in the day if possible, and, if there  is any
distance to be traversed,  by note, giving  a
clenr  account of the case to  which he is
summoned.
  SENNA.—This most  useful  purgative is
the leaf or rather leaves of different species
of cassia.   It is a very old medicine, haviug
been used by the Arabians.   Senna grows   ,
abundantly in Northern  Africa, from whence
large supplies are obtained ; it as also culti-
vated in India, and  a considerable amount
exported thence.  The most familiar desig-
nations of senna are Alexandrian, Tripoli,
ond East Indian senna; other varieties  are
known in commerce, but not commonly in
this country.
  Alexandrian senna has the highest  gene-
ral reputation:  It  is brought chiefly from
Nubia  and Upper Egypt.  As imported, its
long lance-shaped leaves are  mingled with
pods, flowers, leaf-stalks, &c, of the plants,
with the broad leaves of another description
of senna, and with the leaves of a plant which
is not a senna at all.  The latter  adultera-
tion, which  is always  introduced into this
description  of senna to some extent, and
sometimes largely,  goes  by the  name of
argel.   This leaf may be known  from  the
true senna  by its being thicker  and more
fleshy-looking, by the absence of the  pro-
minent veins  of the true leaf, and  by the
regularity of the leaf, which, it will be seen,
differs from that of the senna, one side of
which  is  more prolonged down the midrib
than the  other.   The  " picked  senna" of
the shops is chiefly the Alexandrian senna,
from  which the impurities, broken leaves,
&c. have been removed.
  Tripoli senna  closely resembles the nbove,
but, probably from  more careless gathering
and packing, the leaves are  more broken,
and the admixture of impurities greater.
It is cheaper than the picked senna; but if
the impurities are  not very abundant, the
mere fact of the leaves being broken up, if
they appear to be properly dried, does  not
militate against  the perfect efficiency of the
drug;  indeed, it is  as good as the other.
  Some varieties of East India senna, such
as the Bombay,  are of but low value, owing
to being badly prepared;  there is one kind,
however,  the  "  Tinnivelly senna," which is
described by Dr.  Royle  as   "well  grown
and carefully picked ; the leaflets of a fine,
rather lively green  colour; thin,  but large,
being from one to two inches in length,  and
lance-shaped."   This  kind  is now  highly
esteemed,  and  is  rapidly  displacing  the
other sorts in many places.   " It is mild in
operation, certain as a purgative, and ope-
rates without griping."
  Sonna,  as a  purgative, is safe, certain,
and  convenient, and  deservedly holds  a 
SEN
479
SEX
 high  place  among domestic  remedies.   It
 is a pure aperient, does not depress  or de-
 bilitate, and  is admissible  in  most forms
 of  disease,   and   at  all   times  of life.
 Senna is often accused  of griping,  but this
 effect generally results from faulty prepara-
 tion, or from the admixture of the Argel leaf
 above alluded to.   Senna is generally given
 infused; if time permits, the infusion may
 be  made with cold water,  which, in the
 course of  a  night, will fully  extract the
 purgative  principles of the leaf.   When
 quicker preparation is necessary, the infu-
 sion  may  be made with  hot  water, like
 common tea, but should never be boiled; the
 higher the temperature employed in pre-
 paring the senna  infusion, the  more likely
 is it to gripe.   Formerly, an idea prevailed
 that  the griping  properties of  senna de-
 pended on the presence  of  the  leaf-stalks.
 It is erroneous.  Additions, such as ginger,
 caraway, &c, are  frequently made  to senna
 to prevent griping, and saccharine matters
 are often added for the same purpose.  The
 inconvenience is better rectified by  atten-
 tion in preparing; and no addition  covers
 the  slight nauseous taste  of the  drug  so
 effectually as a small  portion  of  common
 black  tea  infused along with  it,  with  or
 without the addition of a  little milk and
 sugar.  Besides infusion, senna is  given in
 the form of confection, and  of  syrup ; but
 none of these  preparations  are  so  actively
 certain as the infusion, and  may  disorder
 the stomach.
  The common combination of Epsom salts
 with  senna infusion,  or, as  it is called,
 black  draught, forms a very active purga-
 tive,  but is only  suitable for  the strong.
 The average dose of senna  is a quarter of
 an  ounce,  infused in  rather less  than  a
 breakfastcupful  of water;  this will make
 a teacupful of infusion, and be a  suitable
 dose for a child ten years of age.   Confec-
 tion of senna, the  old "lenitive  electuary,"
 agrees well with some  persons,  as an habi-
 tual aperient,  particularly if they are liable
 to piles.  The dose is two drachms or tea-
 spoonfuls.  [The fluid extract of senna is
 far preferable  to the old form of infusion.
 It may be taken in doses varying from ten
 drops to a teaspoonful, and in this dose will
 be equal to a teacupful of the infusion.]
  SENSATION  and  SENSIBILITY.—See
 Nerves and Nervous System.
  Refer to Pain.
  SERUM.—The serum is  the watery por-
 tion of the  blood,  which remains after the
clot is separated in the process of coagula-
tion or  clotting.   The  "water"  thrown out
in a blister is the most familiar example
of serum.   While the blood circulates in
the living  body, it consists of the globule
(see  Blood) floating  in the  " liquor san-
guinis," or fluid  of  the  blood, which is
serum  holding  the "fibrin" in  solution.
When blood is withdrawn from  the  body,
and   allowed to  repose,  this  fibrin  sepa-
rates, and in the act, entangling the glo-
bule, forms the red clot, the serum remain-
ing as yellowish-looking fluid.  In this state
the  serum still  holds in  solution " albu-
men" and earthy salts;  if it be exposed
to heat, the  albumen  is  separated by co-
agulation.—See Albumen.   The remaining
watery fluid still contains  the salts of pot-
ash, soda,  lime,  and iron, which exist in all
healthy blood.
  SETON.—A  seton  is  usually formed by
means of a portion of a skeiu of silk, passed
under the true skin, so that it excites sup-
puration ;  it is in fact an issue.  The sur-
geon  forms a  seton by pinching up a fold
of the skin in which he intends establishing
it; he then passes the  silk  through the base
of the fold by means of a "seton needle,"
made  for  the purpose,  or by cutting the
skin with a knife, and using a probe to pass
the silk.  Caoutchouc, and other tapes, are
used  for setons  as well  as  silk.  In  a few
days  after a seton  has been introduced,
there is usually a free discharge of thick
matter.  A seton,  to be at all tolerable, re-
quires the strictest cleanliness, and  ought
to be  dressed twice a day, with fresh linen,
spread with a simple cerate, the silk  being
moved from side to side at each dressing,
so as  to keep up the irritation ; if this does
not seem to be  sufficient, it will  be  neces-
sar}'  to smear the silk from time to  time
with some  Spanish fly, or savine ointment.
When the  silk  becomes hard and  stiff  it
must  be changed,  by attaching the  fresh
silk to the old, and drawing  it into  the
wound.
  SEWER.—See Drainage.
  SEX.—With  regard  to  the  question of
sex, in connection with childbirth, there can
be little doubt that a pregnancy in which
the  child is male  is like to be more  pro-
longed than one in which it is a female.
  As  regards the relative  number of the
sexes born, the averages for Europe give
106 boys  for  every 100 girls   Further,
according to researches  made both in this
country and in Germany, "on the influence
of the age of parents on the male and fe-
male  births,  it  is  found that in general
when  the mother  is older  than the father,
fewer boys than  girls  are  born;  the  same
is the case  where the parents are of equal
ages ;  but the  more the father's age  ex- 
80
S II I
                 S H A                4!

ceeds that of the mother's, so is the ratio
of boys greater "*
  The nearer the sexes approach  puberty,
the greater is the consideration  required
for the different  tendencies of constitution,
and after that period the peculiar differ-
ences, of the female at least, require  con-
stant  consideration.   As a  general rule,
females require  medicine in smaller doses
than men.
  SHAMPOOING—Is a  system  of mecha-
nical  manipulation of various parts of the
body, for the cure of disease.   In rheumatic
affections,  sprains, &c,  it  is said to  be
useful.  The practice is  much followed in
the East.
  SHARE-BONE.—The  anterior  portions
of the "ossa innominata."—See Pelvis.
  SHELL-FISH—Generally,  are  indigest-
ible, and some, such as the common mussel,
are at times even  poisonous.  The poison-
ous effects of mussels have been attributed
to the  presence  of copper, and  in some
instances this metal  has been detected in
the fish which have  caused symptoms of
poisoning;   in other  cases,  however,  che-
mistry could afford no clue to the cause of
the catastrophe.   "It is probable that there
is an  animal poison present."   The symp-
toms  produced  by mussel  poisoning  are
described by  Dr.  Taylor,  as uneasiness,
and sense of weight at the  pit  of the  sto-
mach,  numbness of  the extremities,  heat
and constriction in the mouth and  throat,
thirst, cramp's;  or with swelling  of  the
eyelids, heat and itching of  the skin, with
nettle-rash  eruption; also  vomiting  and
diarrhoea,  with  colic.   Emetics,  followed
by sal-volatile,  or  stimulants, would  be
appropriate treatment.
  Refer to Crab—Oysters, Sec
  SHERRY—One  of the dry strong wines,
contains,  as  imported  into  this  country,
rather more than 19 per cent, of alcohol.
It is free from the astringency of port wine,
and generally agrees better with persons of
weak digestive powers.  To be good, it ought
to be  free from acid, or nearly so.
  SHINGLES—Is  a  disease of  the  skin,
known to medical men as herpes.  It con-
sists  of  groups  of vesicles  situated  upon
inflamed patches of skin.  The "breaking
out"  upon  the lips, nose, &c, which occurs
after  a cold, is an eruption similar in kind
to that of  shingles.   Shingles is usually
situated  near the  waist, surrounding one-
half of the trunk of the body, like a zone
or belt: it  may, however, extend in other
directions  over  the trunk, and, but rarely
* Quetelet, On Man.
 on  the limbs, it is  always situated on one
 side, and  that, generally,  the right.  The
 eruption of  shingles is generally preceded
 by  symptoms of general  indisposition, nnd
 especially  by severe darting  pain  in  the
 parts where  it is about to appear.  At first
 red patches  show themselves  at  the extre-
 mities of the site  of the future eruption,
 and gradually become  more  numerous till
 they form  a  line—upon these  patches shin-
 ing points form, which  gradually enlarge
 into vesicles, a  little under the size of small
 peas, these vessels containing  a clear fluid,
 which gradually becomes opaque.  At length,
 in the course of eight or  ten days, the vesi-
 cles burst,  discharge,  and dry off  in the
 form of scabs,  or it may be,  in very weak
 subjects, leaves sores or  ulcerations.  The
 belief was formerly entertained among phy-
 sicians,  and still retains its  hold  of the  i
 popular mind,  that if the belt of the erup-
 tion of shingles was continued  round the
 body,  so as to meet, the disease proved fatal,
 This is perfectly erroneous.  In itself, shin-
 gles is a disease devoid of danger, but requires
 investigation, on account of its frequently
 being sympathetic of constitutional disorder
 and disease.   On this account, although the
 eruption  itself  may subside under  the use
 of simple remedies, a case of shingles should
 be  examined by a medical man.
   When the disease occurs in the young and
 plethoric,  the diet must  be reduced to one
 of  milk and  farinaceous substances,  and all
 sources of heat  or excitement avoided.  Five
 grains of  blue pill at night, followed by
 senna, black draught, or Seidlitz  powder in
 the morning, may be repeated once or twice;
 and, in the course of the  disease, if there is
 muoh fever,  five grains each of the  carbon-
 ate and nitrate of potash may be taken
 twice or three times a day, dissolved  in half
 a tumblerful of water;  or the proportion
 of carbonate of potash may be doubled, and
 a teaspoonful of lemon-juice   used to form
 an effervescing draught.   The painful itch-
 ing of shingles, often causes much distress.
 It  may sometimes  be  allayed by  simplj
 keeping the eruption covered with  a cloth
 soaked in  tepid water, or by using the com-
 mon lead  lotion in the same way.   Pencil-
 ling  the shingly eruption with a  strong
 solution of  lunar caustic, as  recommended
 in  erysipelas, is found to relieve the severe
 pain.
   When shingles occurs in the  aged and
 debilitated,  instead of the diet  being re-
 duced, it requires, perhaps, to be improved;
 at  all events, the system must be sustained
 with nourishing broths,  and   probably with
I wine,  along with  quinine  and  medicinal 
SH I
481
S H 0
tonics, the bowels being regulated, but not
purged.   In such cases, however, a medical
man  must be in attendance.  Care should
always be taken that the vesicles of shingles
are not  forcibly burst, as by lying  upon
them ; if they are,  troublesome  ulceration
may follow.  Herpes is not contagious.  As
above mentioned,  it is generally owing to
constitutional  disorder, which a  medical
man  only can discover and rectify.   Its
occurrence  has been  at  times apparently
traceable to violent mental emotion, such as
anger.   In some cases the tendency appears
to be hereditary.
   SHIP.—At all  times,  but especially at
present,  when so many hundreds and  thou-
sands are emigrating  from England, it is
to be regretted that stricter supervision is
not maintained over vessels,  in which, for
the time being, those who have taken their
passage  in them, are  utterly powerless, or
nearly so, as regards abuses, and are obliged
to submit to whatever arrangement, or, too
often, want of arrangement, there exists on
board.   Space  forbids  the subject   to be
entered  into  here  as  it deserves;  it has
been  ably treated   in a recent number of
" Household Words."  The reader is further
referred  to the article " Emigration,"  in the
present work, as containing a few hints on
the subject.   It  is  reiterated,  those who
contemplate embarking on board ship for a
long voyage should  assure themselves well,
not only that the vessel is right in a nautical
sense of  the word, but that she is arranged
and fitted in such a  manner that they need
not fear that health  will be injured or sacri-
ficed during the transit.  While these sheets
are going  through   the press,  attention is
drawn in some of the public prints to the
injurious  results  from a  description  of
" patent  fuel," which is carried on board
some  vessels.   The  matter should not  be
forgotten.
  In addition to the ordinary provisions, the
following is a list of  the supply of " medical
comforts" which emigrant vessels are bound
to be  provided with for every hundred adult
passengers.
 56 lbs. of oatmeal.
 20 lbs. of West India arrow-root.
 40 lbs. of Scotch barley.
100 lbs. of sago.
 20 lbs. of tapioca.
 30 lbs. of preserved boiled beef, in  1 -lb.
      tins.
 20 lbs. of preserved boiled mutton, in 1-lb.
      tins.
400 pints of lemon-juice, in wickered  stone
      bottles, of five gallons each,
300 lbs. of sugar.
       2 0                               31
  24 bottles of port wine.
  12 bottles of sherry wine.
   6 bottles of gin.
  66 gallons of approved stout, including at
       least six dozen in bottles, the rest in
       9-gallort casks.
   5 gallons of brandy.
  15 gallons of vinegar.
  12 dozen pints of preserved milk.
   2 cwt. of marine soap.
   The above  medical comforts to be issued
 at the discretion  of the surgeon, whether
 for the sick,  or to  preserve health.
   Women,  who may be nursing, may have
 a pint of brown stout each day, if  ordered
 by the  surgeon,  and the surgeon is to make
 liberal  use of the preserved milk, for keep-
 ing up the  health of  the younger children.
   SHIVERING—As  a  symptom of illness,
 is the sensation as of cold, which all must
 have  experienced  at the commencement of
 even  a  slight cold  or  ailment.  When it
 amounts to actual  shaking of the limbs and
 chattering  of the  teeth, it  is called  rigor.
 The  cause  of the  sensation of shivering is
 probably from the  nervous system.
   Shivering,  or rigor, is a  symptom  which
 frequently  accompanies the  formation  of
 pus or matter within the body, in the course
 of inflammatory disease.
   SHOCK—In medical  language, is the de-
 pressing impression  imparted to the nerv-
 ous system, and through it to the constitu-
 tion  generally, as  a  consequence of severe
 pain or injury.  The extent of the shock, its
 duration, and even its fatality, often depends
 more  upon  the part or organ through  which
 it is received, than  upon the actual extent
 of the living  body injured,  or the pain suf-
 fered.   Thus, a comparatively slight blow
 over the region of the heart, upon the pit of
 the stomach, or on the neck, in all  which
 situations nerves are collected in numerous
 interlacements, is apt to be  followed by im-
 mediate, and it may be, fatal shock.  The
 depression  of the  system  which follows a
 blow  on the  head  is of  a  similar nature.
 Again, injuries which involve large portions
 of the  body in destruction,  which  cause
 severe pain,  or much effusion of blood, are
 all followed  by shock.   This ist or  rather
 was, one of the principal hazards of severe
 surgical operations;  was, for the introduc-
 tion of chloroform, and  of other anaesthetic
 agents,  has in a measure done away with
 this  hazard,  and in  doing so must already
have  saved  numbers  of  lives—numbers
which would  far outweigh the few instances
of death which have been  attributable  to
the use of these most merciful alleviators
of human suffering. 
S II 0               48:
S H 0
  WIren an  individual suffers a shock from
any of  the  causes above enumerated, he
may die at  once, as sometimes occurs from
a blow on the pit of the stomach : life, as it
were,  is simply extinguished.  But  if  the
shock is not of  this immediately fatal kind,
the person becomes pale, perhaps falls to the
ground, and, it may be, vomits—conscious-
ness is partly or entirely suspended, and
the action of the heart suppressed, till it is
all but imperceptible.  This  state of shock
may be  recovered from in a few minutes, or
it may continue for many hours,  and termi-
nate either in recovery or death, its duration
depending on  contingent causes, often on
the fact whether there has been  much effu-
sion of blood or not, along with  the  injury.
In some cases of shock, in which severe pain
has been  suffered in  the first instance, it
appears as if the intense suffering had  an-
nulled the sensations of the nervous system,
the sufferer undergoing even the most severe
operations apparently without feeling.  This
is  always a most fatal symptom.  The im-
mediate treatment of a person who has suf-
fered  a shock  is similar  to that   recom-
mended in cases of fainting, and of concus-
sion of the brain, with the same  precaution
as to the use of stimulants.  When the state
of shock continues, stimulants by the mouth,
although required to be gone  on with, must
not be too strongly pressed ; it is impossible
to  lay down any  rule beyond that of cau-
tious administration.  Ammonia in different
forms, the ethers, and the most readily pro-
curable alcoholic stimuli must be  employed;
but along with these should be joined the
stimulation  of  heated" fluids, of  stimulant
clysters, and of heat applied externally ;  the
latter, especially, is most useful on account
of the  continued coldness of the  surface,
and especially of the extremities,  which ac-
companies such cases.  Above all, any inju-
dicious interference or movement during the
first state of  shock  must be avoided, as
likely to extinguish  whatever remains of
struggling vitality may be left. The absurd,
almost murderous practice which formerly
pretailed, of surgeons, whenever called to
a case of accident, bleeding the patient, has
already been alluded to.—See Blood.  What-
ever is  requisite to be done  for  the treat-
ment of the injuries of a person  in  a state
of shock, should,  if possible,  be delayed till
at least some effort has  been made  by the
use of  stimulants to  rouse from the state
of depression.  In alluding to  the shock sus-
tained by the wounded on  the field  of bat-
tle, Mr. Hennen, in  his Military Surgery,
remarks, "Many lives might be saved,  and
the patients placed in a more  favourable
condition  for undergoing primary opera.
tions, by the early administration of a small
quantity of wine."
  Refer to Pain.
  SHORT-SIGHT.—See Vision.
  SHOULDER.—The shoulder, in  addition
to the muscles and other soft parts, by which
it is surrounded, is made up specially of the
three bones,  the shoulder-blade, or "sca-
pula," (fig. cxvi. 1,) the "clavicle,"  or collar
bone, (2,)  and the "humerus," or arm bone,
(see Humerus,)  the round  head of which (6)
fits to the cup (5) of the shoulder-blade (see
Skeleton) to form  the shoulder-joint.—See
also Ligament.  The upper ribs (4) may also
be considered as entering into the  forma-
tion of the shoulder region generally.  The
whole  formation  and adaptations of this
most important part of the body are singu-
larly beautiful, made  so as to give the most
extensive motion, and yet that fixedness and
steadiness  of  action,  by which those most
perfect agents—the human arm and hand
—of that  most wonderful  instrument—the
human  mind—are  so  specially adapted  to
fulfil the ends of the  Creator  of each.   By
means  of the collar bone (2) bearing at the
one extremity on the breast bone (3) and  at
the other upon a projection of the shoulder-
blade,  the  shoulders are kept  extended  or
" squared."   It  is this  squaring  of the^
shoulders which causes the chest to  appeal
broader at the superior than at the inferior
portion, whereas, in itself, the cavity of the
chest is conical, the narrowest part above.—
See Chest.  The comparatively loose attach-
ment of the  great body of  the shoulder-
blade to the trunk admits of much freedom
of motion,  while the fullest extent of move-
ment is secured to the arm  itself by the
nature of the  shallow ball-and-socket joint,
formed by the head of the arm bone, (6) and
the shallow cup of the blade bone,  (5.)  The
shallowness of the cup, however, which is
requisite to admit of this free movement. 
                  SI A

renders the head of the arm bone, in  some
degree, liable  to  displacement  or disloca-
tion more frequently than other bones of
the body.
  Refer to Dislocation—Fracture—Clavicle—
Ligament—Skeleton—Axilla, Src
  SIALAGOGUES—Are medicines which in-
crease the flow of the saliva, when they are
chewed, such  as horse-radish, ginger, &c.
They are rarely prescribed.
  SICKNESS.—See Vomiting.
  SICKNESS, SEA.—The  primary cause of
the distressing  affection,   sea-sickness, has
been a good deal disputed, but its depend-
ence upon peculiar affection of  the brain,
by the motion of the vessel, seems now very
generally admitted.   It has  been imagined
that the effect upon the brain was conveyed
through the medium of the eye, and caused
by the apparent movement of the objects of
sight;  as, however, blind people suffer from
sea-sickness, the affection must be excitable
by other means than the  above.   Possibly,
as has been suggested, it partly results from
disturbance of certain portions of the brain,
which  have for their function the preserva-
tion of the equilibrium of  the body.  That,
however, sight is  in some  degree accessory
to the excitement of nausea is evident from
the fact  that  some persons experience the
sensation  simply from objects appearing to
move before them, as they do from a ship
moved by the  waves, or,  indeed,  in  some
cases by the mere appearance of a waving
pattern upon  a wall-paper.   The  affection
is more  readily caused  by  long heaving
waves, than by a  short  rough  sea.  The
best preventives of sea-sickness seem  to be
the horizontal posture, as near the centre
of the vessel,  and  therefore the centre of
motion, as possible—that  is, where the mo-
tion is  least.    Exposure  to  the open air
renders the liability less.    Stimulants, com-
bined with sedatives, certainly  appear to
have considerable  effect  in preventing or
alleviating the affection.   A pill, composed
of four grains of cayenne  pepper, with two
or three  of extract of henbane,  taken  at
intervals,  may be found  useful.    Creasote
is also  an  excellent antidote.—See Creasote.
Some persons  find themselves less liable to
sea-sickness if they take food freely—with
others  the reverse is the  case;  the effect
probably depends  upon the state of the di-
gestive powers of the stomach,  temporary
or permanent.   If these are vigorous, the
excitement of  digesting food acts probably
as a  counter-agent  to the cause of the
nausea.   Sea-sickness, of  itself,  is rarely
injurious,  but  it should be  a subject of con-
sideration with persons who are liable (or
13                 S IL

likely to be) to head-affection, who are the
subjects of rupture, prolapsus, &c, how far
they  should incur  the  risk of these being
aggravated  by the  mechanical  action  of
vomiting.  Some  who  do  not  suffer  from
sickness while on  the  water,  experience
nausea and other uncomfortable sensations
after landing—an effect, doubtless, due to a
partial  disturbance of the digestive organs,
and probably to  biliary disorder.  One or
two doses of compound colocynth, or com-
pound  rhubarb pill, will generally remove
the inconvenience.
   SIDE — Pain  in the  Side.—This very
common affection arises from a great variety
of causes.   If situated high up,  in the re-
gion  of the  chest, it may be occasioned by
inflammatory affection of the  lungs, but in
this case will be accompanied with more or
less fever, and other symptoms  indicative
of the disorder.—See Lungs.  It  may, how-
ever, be caused in  the  same situation by a
kind  of rheumatism  or neuralgia of the
muscles connected  with the ribs.  In this
form  there is not, generally, fever, and the
usual signs of affection of the  lungs are
absent;  the pain, moreover, is much more
liable to aggravation by pressure externally,
and by slight movement, than that of inflam-
mation of the lungs.  The affection requires,
chiefly, the local treatment of rheumatism ;
bran-poultice, and  anodyne and  turpentine
liniment.  The above pains may,  of course,
occur on either side of  the chest.  Pain on
the right side, lower down, may be  owing
to affection of the liver, (see Liver;) on the
left side to affection of the spleen.—See ^46-
domen—Spleen.   Pain on the left  side, how-
ever, often occurs as a sympathetic affection,
sometimes of the heart or lungs, in  either
sex.  It is most  common in females,  and  is
then  very often  sympathetic of disorder,
functional or otherwise, of the womb.  Any
person  becoming the subject of continued
pain  in the side, should have the cause in-
vestigated by a medical man.
   SIGHT.—See Vision.
   SILK.—Some persons who, from irrita-
bility of the skin, cannot wear woollen ma-
terial next  it, find a woven silk texture a
good  substitute.
   SILVER.—The only  preparation of this
metal much  used  in the  practice of me-
dicine  is the nitrate  of  silver,  or  lunar
caustic, and this  principally as an external
application; it is, however, given internally
by medical men.   For convenient use as  a
caustic, nitrate of silver is cast in the form
of small cylindrical  sticks, which are carried
generally in  silver, or  silver-gilt holders;
the best having  a •'quill" .of  the  metal
II 
S I N
484
S K E
called  palladium,  to hold  the  caustic, it
being found that in  time the nitrate of sil-
ver acts chemically upon the metallic silver
of the holder.   Cheaper holders of  glass,
gutta-percha, &c,  are made.   When nitrate
of silver, in the  least  degree  moistened,
touches the body, it acts  as a corrosive, and
on the skin leaves  a deep brownish or black
stain, which is only  removed, as the outer
skin is worn off and renewed in course of
time;  or, if it  is applied early, by hydrio-
date of  potash.   If, however, the caustic
be rubbed on the skin it will probably cause
blistering.   The modes of  using nitrate of
silver  being  pointed out  in  the different
articles,  such  as  Erysipelas,  Whitlow, &c.
&c,  it is unnecessary to  repeat  them here.
Oxyde of silver  has lately been  brought
prominently before the  medical public by
Sir James Eyre; as a remedy in some forms
of stomach  affection and  of menorrhagia
the author has  found it useful.   It is not a
remedy for domestic administration.
  SINAPISM.—A mus-
tard-plaster or poultice.
—See  Mustard—Counter-
irritation.
  SINGING—Is open to
the  same objections, to
the  delicate-chested, as
reading aloud, to the re-
marks  on   which  the
reader is referred.
  SINKING.—The sensation of  "sinking"
at the  pit of the stomach, is a nervous one,
generally connected  with disordered  diges-
tion,  and  often with  overloaded  bowels.
Persons  are too apt to have recourse to
stimuli for its  removal,  which would often
be better effected by the use of an aperient,
and  by regulation of the digestive organs.—
See Indiyestion.
  SINUS—In anatomy, is  a depression, or
oavity, or covered tract.  The  large veins
within the skull, which  are partly formed
by  depressions in  the  bone,  are  named
sinuses.   In surgery, a sinus is a canal, the
result  of disease,  leading  from a diseased
part.
  SKELETON, HUMAN.—The human ske-
leton is that wonderful frame-work of bone,
which  gives support to, and to  which are
attached the various soft parts of, the body.
It cannot truly be said that a skeleton is a
beautiful object, in the usual sense  of the
term beauty.   But  the term beautiful is
well applicable to  the adaptation of the va-
rious parts to one  another, and to the man-
ner  in which they subserve the object of
their existence.  When, moreover, the con-
nection  of  the different  portions > of the
skeleton by  means  of the ligaments, and
the action, and mode of action simple and
combined,  of the  various muscles  of the
machine at large, are considered ;  when we
regard the protection given by the bones to
important  parts  contained within the ca-
vities, and to the blood-vessels in the limbs;
the strength, and yet comparative lightness
of the whole fabric; and lastly, the powers
of reparation after injury, the word beau-
tiful, in another sense, is that which really

                 Fig. cxvil.
expresses the admirable perfection of the
structure.
  The  entire skeleton consists of two hun-
dred and forty-six different bones.  As the
descriptions of the most important of these
are given in the separate articles, it is un-
necessary to do  more  here than  to poinJ 
S K I
485
SKI
them out by name on the figure, (cxvii.) on
the preceding page.
  1. The skull, or face bones, including the
       lower jaw.
  2. The spine, composed of the vertebrae,
       which supports the head, and  rests
       on the pelvis.
  3. The collar  bones, or clavicles. — See
       Shoulder.
  4. The ribs.
  5. The breast bone, or sternum.
  6. The shoulder blade, or scapula.
  7. The arm bone, or humerus.
  8. The forearm  bones, or radius and  ulna.
  9. The wrist bones—eight in number, also
       called the  carpal bones.
10. The hand, and finger  bones, also called
       the meta-carpal bones.
11. The pelvis, or pelvic bones.
12. The thigh bone,  or femur.
13. The knee cap, or patella.
14. The leg bones.  The  larger, the tibia.
15. The smaller,  the fibula.
16. The tarsal bones, seven in number.
17. The foot and toe bones,  also called the
       meta-tarsal bones.
   The bones above mentioned do not nearly
make  up the number of  two hundred and
forty-six.   To do this,  must be added the
small  bones of the  ear,  the teeth, a de-
tached bone, the  " hyoid," situated near the
base of the tongue, and sundry  of what are
called  sesamoid  bones,  which are found
regularly in the tendons of certain muscles,
such as those of  the thumb.
   SKIN.—No less wonderful than the  bony
frame-work of the human body, which we
have just considered, is the covering of that
body,  the  skin,  which,  while it  protects,
and  retains in  place  the various parts,
serves, also, most important purposes in the
animal economy.
   The skin consists of two distinct  forma-
tions, the "epidermis" or cuticle, or scarf
or outer  skin,  (figs,  cxviii. 1, cxix. 1,)
and the "derma."   "Cutis," or true  skin,
(fig.  cxviii. 2.) The  skin is continuous with
the mucous membranes at the openings of
the various cavities, such as  the  mouth,
nose, &c, its epidermis corresponding to the
epithelium  of the membranes.
  The  epidermis is a thin, semi-transparent
membrane, which is  extended over the sur-
face of the true  skin of the  body.  Appa-
rently, it is without structure,  and  indeed
was long considered to be  simply an  exuda-
tion which  became hardened by exposure to
the air.  It is now known to consist of re-
gular series or layers of cells,  (fig. cxix. 1.)
The outermost layers of these cells, which
are exposed to general contact,  and to the
        2q2
Fig. cxix.
Fig. cxx.
influence of the atmosphere, are compara-
tively  hard,  and  are flattened  as  repre-
sented, becoming less  flat,  and  softer, in-
ward,  (fig.  cxix. 1,)  as the  surface  of the
true skin is approached, at which point the
cells are quite soft and granular.  This soft
layer of the epidermis used formerly to be
regarded as a  distinct portion of the skin
structure, under the name of "rete muco-
sum."  The intermixture, in this layer, of
"pigment  cells," that is, cells  containing
colouring-matter, gives the varied  hues to
the skin of different races, as most strongly
exemplified in the negro; and the appear-
ance of freckles originates from the same
cause.  On the surface of  the epidermis,
the flattened  cells lie over one another, as
represented, (fig.  cxx. 2,)—the  outermost
becoming   continually detached  and worn
off.   When these  detached scales  are re-
tained, as  by the hair, or by the clothing,
they constitute what is called scurf or dan-
druff.  The epidermis is,  as  all are  aware,
insensible.   It varies considerably in thick-
ness on different  parts of the body,  even
at birth, being  much thicker on those, such
as the heel, back, &c, which naturally re-
quire greater  protection.   It, however, be-
comes  immensely thickened on  any portion
of the body which is subject to continual
pressure or friction.   Of this, the hand of
every workman  is  an example.  The  ap-
pearance of the skin, as are all aware, varies
according to age, from the soft skin of the
infant, or of the bloom of youth, to the flac-
cidity and  wrinkles of age.   Constitution 
S KI
486
S K I
 also, exerts much influence over the appear-
 ance of the skin.—See Complexion.
   The " cutis vera," or " derma," or true
 skin, which lies underneath the cuticle, (fig.
 cxviii. 2,) is much thicker than the latter.
 It consists chiefly of areolar tissue, that is, of
 interlacing fibres, which inclose the blood ves-
 sels (3), nerves, &c. which make up the sub-
 stance of the covering.  The true skin, being
 abundantly supplied both with blood-vessels
 and nerves, is extremely sensitive, so much
 so indeed as to require the protection of  the
 cuticle as a necessity.  All are aware of  the
 painful sensibility of the  true skin,  when
 the outer skin  has  been abraded.  At  its
 surface,  where  it  is in contact with  the
 cuticles,  the true'skin is elevated into  little
 eminences,  or "papillte  ;" these are  most
 manifestly  developed, on the pulpy extremi-
 ties of the fingers, and on other places where
 sensation is acute, each papilla being  re-
 ceived into a corresponding hollow in  the
 soft granular layer of the epidermis.
   The deeper layer of the true skin is  com-
 posed  of interlacing fibres, already  men-
 tioned, and  with these  are mingled  elastic
 fibres, and a peculiar form of muscular fibre,
 the latter being  evidenced  in  action by  the
 occurrence of what is popularly called goose-
 skin.   The  deeper layer of the skin inter-
 nally rests  upon the  cellular tissue, fat, &c.
 beneath.
   Were  the skin  required simply for  an
 elastic, sensitive, and complete  covering to
 the body, the structures already mentioned
 might have been sufficient; but it has other
 functions equally important to perform,  for
 which provision is made over its wide ex-
 tent of surface.   The most important per-
 haps of  these functions  is the discharge
 of the  perspiration which is  going on con-
 tinually.   The perspiration is  not, as might
 be  thought,  a  simple  exudation of  fluid
 through the skin, but is  a regular secretion
 and excretion from the blood, by means of
 innumerable small glands (figs, cxviii.  4, 4,
 and cxix. 2) which are situated in the  deep
 layers  of the  true skin.  These " sudipa-
rous" or  sweat-glands  are  composed,  as
represented, of  a rounded extremity formed
by the convolutions of the tube, which opens
 to the  surface  by  means of  a spiral  duct
 about a quarter of  an inch long.   This duct,
in many  situations,  makes its exit on the
surface of the cuticle, obliquely, (fig. cxix.
 2.) in such a manner that it has, as it were,
a valvular covering:  it does not pierce the
cuticle, but this latter  membrane is  con-
tinued  down into* it  as a lining.  In addi-
tion to these perspiration glands, the  skin
is  furnished with another set  of excreting
 agents, which closely resemble  the  above,
 but  which are named the "sebaceous," or
 oil-glands, (fig. cxviii. 5, 5.)—See Sebaceous.
 The office of these glands  is to  separate
 certain matters from the blood,  and to ex-
 crete them in the  form of an oily matter
 from the skin, which oil or grease, although
 it is doubless an excretion, serves also to
 lubricate  the skin, and to preserve it from
 cracking  from dryness;  on this  account,
 probably,  the  sebaceous  glands  are  more
 abundant in the skins  of natives of warm
 climates,  to  shield them from the drying
 effect of the heat.   The sebaceous glands
 have been  already alluded  to  under the
 article  sebaceous;  they  are often lobular
 in structure,  frequently communicate with
 one another by a common duct, nnd in such
 situations  as the scalp, one or two of them
 open into  each hair follicle, (fig. cxviii. 6.)
 As already mentioned, the skin, in  addition
 to the  above,  contains  blood-vessels and
 nerves abundantly ; it also contains absorb-
 ent vessels.  The number of sebaceous and
 sweat  glands,  particularly of the latter, is
 almost innumerable, and  some curious cal-
 culations have been made respecting them,
 by  Mr. Erasmus  Wilson,  the well-known
 writer upon the skin,  who says, " I counted
 the perspiratory  pores on the  palm  of the
 hand,  and found 3528 in a  square  inch.
 Now, each  of these pores being the aperture
 of a little  tube about a quarter of an inch
 long, it follows,  that in  a  square inch of
 skin on the palm  of the hand there exists a
 length of tube equal to 882 inches, or 73$
 feet."  "To obtain an estimate of the length
 of the tube of the  perspiratory  system of
 the whole  surface  of the body,  2800 may
 be taken as a fair average of the number of
 pores in a square inch, and  700, conse-
 quently, of the number of inches in length.
 Now, the number of square  inches of sur-
 face  in a man of ordinary height hnd bulk
 is  2500; the number of pores  therefore,
 7,000,000, and the number of inches of per-
 spiratory tube 1,750,000,  that  is  145,833
 feet, or 48,600 yards, or nearly twenty-eight
 miles."
   From the above exposition of the perspi-
 ratory system, the reader will be prepared
 to learn  that the  skin  is often the  most
 abundant  excretor  of fluid  in  the  body,
 exceeding in this, except under  particular
 circumstances,  even the  kidney,  and also
 the lungs.  According to the mo.-t generally
 trusted  experiments,  it  is found that the
 average amount  of watery  fluid  exhaltd
 from  the  lungs  and skin  of  the  human
 body in twenty-four hours, at an ordinary
| temperature,  is about fifty-four  ounces, of 
SK I
487
SK I
  which amount, thirty three ounces  are  at-
  tributable to the skin, the remaining twenty-
  one  to the  lungs.  This excretion of fluid
  is capable,  however,  of being  largely  in-
  creased,  and it is an  ascertained fact that
  a  stout man undergoing strong  muscular
  exertion, under high  temperature, has, in
  an hour, lost as much as five pounds weight.
  The  perspiration thus  depends greatly upon
  the external temperature of the atmosphere;
  it is, however, considerably influenced  by
  conditions  of  bodily  health.   Under ordi-
  nary circumstances, perspiration takes place
  insensibly, that is,  in  the form of vapour,
  which, passing off into the air as it is thrown
  out,  gives no palpable  indication  of its pre-
  sence ; if, however, it  is confined, as by  an
  inverted  glass, on the skin, a deposition of
  moisture at once occurs upon the glass.
  When the perspiration is so rapidly thrown
  out that it  cannot be at once  evaporated
  from the surface,  it takes the form of sen-
  sible perspiration, or sweat,  in greater  or
  less  abundance.   It is evident,  that when
  the external air is greatly laden with moist-
  ure,  the perspiration will  be  much  less
  quickly evaporated, and consequently much
  sooner evidenced  than under the  reverse
  circumstances.  Moreover, • as the kidneys
  alternate in some measure  with the skin,
  in the excretion of fluid, influences which
 increase the one must diminish the  other,
 as in hot countries the cutaneous  moist-
 ure is much  increased and the flow of urine
 lessened.
   There is no doubt that the evaporation  of
 the perspiration is one great means of keep-
 ing the  temperature  of  the body down  to
 its proper level  under exposure to  heat;
 indeed, this is the  secret by which persons
 have  been able to endure, without injury,
 the heat  of  an  oven of sufficient intensity
 to  cook meat.   It is not, however, a mere
 exudation of simple water which takes place
 in  perspiration: the mixed  fluid which  is
 thrown out  from  both the sweat and the
 oil glands, contains  a  considerable amount
 of free acid—lactic acid—and of salts, car-
 bonates of soda, lime,  and ammonia, mu-
 riatic acid, &c.   To these must be  added
 carbonic acid and nitrogen, which have also
 been proved to be excretions from the skin.
 According to Andral,  the sweat is always
 acid,  the sebaceous  secretion alkaline, the
 predominance of one  or  other  giving  the
 characteristic chemical  reaction.
  Simple  reasoning might be  enough  to
convince  that the extensive perspiratory
apparatus spread  over so large  an extent
of skin, and in  such active operation, must
•ubserve some very important offices in the
 animal  economy.  Moreover, the injunout
 effects of which all are aware, as the conse-
 quences of having this secretion suddenly
 interfered with, prove, that these offices are
 intimately connected with the health of the
 system generally; and, lastly, direct experi-
 ments have added to the proof.  The experi-
 ments alluded to are those of M. Fourcault,
 who demonstrated that if  the transpiration
 of the skin of living animals was prevented
 by  means of* a coating  of varnish,  they
 speedily either died in  a  state  resembling
 suffocation, or became the subjects of inter-
 nal congestions of blood,  especially of the
 liver.   In  addition  to its  excretory func-
 tions,  the skin is endowed  with the reverse,
 becoming at times a medium for absorption
 of fluids, gases, or other substances into the
 system.   The  fact of gases being absorbed
 by the  skin, adds to the importance  of the
 body being surrounded by pure air;  in fact,
 by some it is  thought  that noxious effluvia,
 malaria, &c. are more readily absorbed into
 the constitution  through  the   skin  than
 through the  lungs.   If the body  be  im-
 mersed for  some  time in  a tepid bath, it
 gains weight by absorption of water, and if
 thirst  has existed it  is relieved.  Certain
 medicines, again, such as mercury, Spanish
 flies, rhubarb, &c,  affect  the constitution
 through the  skin.  Probably, as suggested
 by Dr. Combe, even  matter which has been
 once cast out  by the skin may be reabsorbed
 by it, and cause disease.
   Enough, perhaps, has now been said  to
 demonstrate to all of what  immense import-
 ance the functions of the skin  are to the
 animal system; to show, that while this most
 perfect structure fulfils  the  palpable office
 of a protector and coverer of the entire  sys-
 tem, it constitutes one  of the  great channels
 by which used-up  and therefore  noxious
 matters are cast out from the blood—a chan-
 nel, too, which cannot be interfered with
 without  its internal coadjutors, the liver,
 the bowels, the kidneys, the lungs,  one or
 all of them suffering.
  Again, if it is reflected that every moment
 of our lives this exudation  through the skin
 is going on, that while the  watery fluid es-
 capes,  it leaves  the  solids,  the  salts,  the
 acid, the grease behind, mingled with  the
 scales and scurf of the epidermis, and, added
 to  this, the dust, &c, which must adhere to
 the skin, it will give some little idea of what
 there is to remove from the skin to keep  it
 commonly clean—still more to keep it in that
 state of healthy activity and freedom which
is requisite for health.
  The  " appendages" of the skin are  th«
hair, nails, &o. 
S K 1
48*
S K I
  Refer to Ablution — Absorption — Hair —
Nails.
  SKIN, DISEASES OF.—The diseases and
disorders to which an organ—as it may be
called—like the skin is liable,  must neces-
sarily be numerous.  It is exposed, not only
to many influences from without, to  atmo-
spheric vicissitudes, to the effects of neglect
and dirt, of contagion  and accident, but  it
U also liable to influences from within, aris-
ing from those internal organs with  which
it is so intimately connected, both sympa-
thetically and in function, and  it is excited
by altered conditions of the blood, for which
it"performs such important offices.
  Very various  classifications of skin  dis-
eases have been made by different authori-
ties on the subject, with the  view of  facili-
tating their distinction  from one  another,
and their treatment. In the following slight
Bketch, the author has adopted  the divisions
best calculated to  give a clear  general  idea
of the subject; to attempt  more  would be
quite at variance with the character of this
work.
  The exanthemata, or eruptive fevers, in-
clude measles, scarlet fever, small-pox, cow-
pox, and chicken-pox,  some of the most im-
portant affections  connected  with  the skin,
which have already been noticed under their
separate articles.  Many other eruptive dis-
eases  are  accompanied  with febrile  symp-
toms, but  not of  such marked peculiarity
and uniformity as those which characterize
the above.  Some  authors, however, include
in the  class  of  eruptive fevers, erysipelas
and erythema—nettle-rash and rose-rash.
   Nettle-rash cannot  be better  described
than as an eruption which closely resembles
nettle-stings,  both in appearance and.in the
Bensations it gives rise to.   When acute, it
is generally accompanied with more  or less
fever.  The nettle-rash, in almost all cases,
arises from disorder of the digestive organs,
caused either by indigestible food, or  in
some  persons by  particular kinds of food.
 Kernels or seeds, such as  almond,  peach,
&c, which contain prussic acid seem espe-
cially apt to cause nettle-rash, and in some
individuals even the pips of an apple  have
been known to produce the disorder.   Fish,
particularly shell-fish, or mushrooms, also
 bring it on;  also  certain medicines, such as
 turpentine;  teething,  hurry  and  agitation
 of mind in adults, and other irritations, also
 give  rise to nettle-rash.   The  generally
 known causes of this  affection indicate the
 remedy—the removal  from the alimentary
 canal of  offending matters.   If  there is a
 tendency  to  sickness, and if the eruption
 appears  soon after  a  meal,  an emetic  is
the appropriate  remedy;  but whether this
is  administered  or  not, nn aperient should
be given.  As acid in the bowels often ac-
companies the condition, a dose of magne-
sia with  rhubarb is very suitable, or  some
other antacid may be had recourse to, and,
afterward,  castor-oil.   External  remedies
are  comparatively  of little  service in the
acute forms of nettle-rash.   A lotion  com-
posed of carbonate of ammonia and sugar of
lead, of each one drachm, in half a pint of
distilled or rose-water, will give relief.   Dr.
Watson recommends  flour dusted over the
surface.   If  nettle-rash takes  a chronic
form, that  is, continues,  and keeps recur-
ring, after the use of such mild aperients as
recommended above, and after regulation of
the diet,  the case should be seen by a medi-
cal man.
   Rose-rash  occurs both in children and
adults, in the form of rose-red patches of
various sizes, somewhat resembling measles
in many cases, but of a redder  hue.   The
disease is generally accompanied with some
slight  constitutional  disorder or fever, but
the  symptoms  differ from those which ac-
company measles.  It is devoid of danger,
and generally subsides after the adminis-
tration of a simple  aperient.   If either rose-
rash or nettle-rash are thought to be con-
nected with teething, the gums should be
scarified.
   A class of skin diseases is  called "papu-
lar."  They consist essentially of the eleva-
tion of minute  "papulae,"  or points, upon
the surface. To this class of diseases belongs
the "red gum" of  infants; also, two  other
diseases, named lichen and  prurigo, which
are  both extremely  troublesome, from the
intense itching with which they are accom-
panied,  and the obstinacy  with which  at
times  they resist treatment.  The affection
named prickly heat, described in a former
article, is a species of lichen; and a  some-
what  similar  affection  occurs in  England
in hot summers.  The general directions  as
to diet, &c. given in the above article, may
be useful when  the affection occurs.   Tepid
baths, with or without the addition of  vine-
gar, or sponging with water, to each pint of
which a drachm  of diluted sulphuric acid
has been added, may be tried as a tempo-
rary relief  to the itching.
   The vesicular class of skin diseases (see
 Vesicle)  includes chicken-pox  and cow-pox,
 which also  may  be classed with eruptive
 fevers; also shingles and similar "herpetic"
 eruptions.—See Shingles.  One of the vesi-
 cular eruptive diseases, "eczema," "crusta
 lactea," has its frequent site upon the scalp
 and face.—See Scalp.  The tJass of " pustu- 
SKI                489                S K U
lar" eruptions (see  Pustule) also comprises
various  scalp diseases.  In  many of  the
affections of this class, however, the pustu-
lar eruptions extend over various portions
of the body.
  The class of "bullae" are characterized
by  the development of "blebs,"  or %mall
blisters, which resemble those occasioned by
a scald, or by the use of a common blister.
This form of skin disease is generally asso-
ciated with great debility of constitution.
  The "scaly" diseases of  the  skin  are
many  of them  extremely obstinate,  and
sometimes resist every  form  of treatment.
Of  these, "lepra" is characterized by ele-
vated, scaly, circular patches, distributed in
greater or less number over the skin.  It is a
disease totally distinct from the "leprosy"
of  the Jews and other ancient nations.  Tu-
bercular diseases of the skin are equally dif-
ficult to get rid of.   Stains, mother-marks,
or  " naevi,"  freckles,  &c.  are all  included
in the category of skin affections;  they are
noticed under other  articles.
  No description could  possibly enable an
unprofessional person to  distinguish, one
chronic skin disease  from another, nor would
it answer any good purpose if the knowledge
could be imparted.   These affections are, in
a majority of instances, indicative of some
peculiar disordered condition  of the  blood,
or  of  the digestive  processes,  primary  or
secondary, which require the strictest inves-
tigation of a medical man, and, probably,  a
long continued course of treatment—even
under  the best directed remedial measures,
they often  prove intractable.  Very many
chronic skin  diseases  are  connected with
debility,  and, of  course, when such  is the
case, tonic remedies  are useful; a smaller
proportion are owing to a plethoric state of
the constitution; some appear  hereditary,
and others are connected with the  venereal
taint.  Whatever the case be, however, those
who suffer  may be assured that their  best
course will  be at once  to  put themselves
under  proper medical advice, and, if they
can, under the advice of a practitioner  who
has made the skin a department of special
study.   Above all things, let sufferers be-
ware of quack ointments, lotions, and the
like; they may inflict upon themselves irre-
parable injury.  In  the event of any delay
occurring before advice is procured, if the
system is full and inclined to fever, low diet
is advisable, and one or two  gentle mercu-
rials, followedby a saline aperient, may be
taken  with  advantage.  If  the  system be
debilitated, while all sources  of heat  and
irritation are avoided, nourishing diet should
be taken, and the bowels regulated.  AVhen
I milk diet agrees, it is very suitable in many
i chronic skin affections, and there are few in
 which tepid bathing does  harm;  it clears
 the skin  of  any irritating  matter, while it
 soothes; it is, at all  events,  generally agree-
 able to the feelings of the patient.  Another
 reason for the enforcement  of tepid bathing
 is the fact that, although  as stated  above,
 very  many,  perhaps the majority of  skin
 diseases are connected with constitutional
 disorder,  some are almost entirely due, and
 others much aggravated by inattention to
 cleanliness, among certain classes.—See ^46-
 lution—Skin.
   It has  been stated that  the  majority of
 skin diseases are of constitutional origin,
 and such is the  case;  some, however, are
 not so. . Itch, probably, is simply due to the
 presence  of  the  insect; and  the  form of
 skin disease—eczema—from which  grocers,
 bakers, and others  suffer,  from handling
 flour, sugar,  &c, is undoubtedly local.  The
 last-mentioned cases will generally get well
 if the hands are protected from the irritating
 substance, and  soothed by tepid  bathing.
 If the eruption is obstinate, the  ointment of
 red oxyde of mercury, ten grains to  the
 ounce of lard, is of service.
   SKULL.—The skull  (fig. cxxi.)  contains
 the brain, and  forms  the  support of  the
                  Fig. cxxi.
                     4
features, and organs of the special  senses
It is composed of twenty-two separate bones;
of these, eight are devoted  to the cranium
or brain-case alone:  the remaining fourteen
are the bones of  the  face.   These bones,
with the exception  of  the lower jaw, are
united by  means of joinings, named "su-
tures."   In one form of suture, the margin! 
SKU                490                S K V
of  the  different  bones  are,  as it were,
toothed, (fig. cxxi. 1,2,) the toothed edge of
one fitting into the indentations of another.
At fig. cxxi. 1, is seen such a suture, which
forms the junction between the "frontal,"
or forehead  bone, and one  of the two "pa-
rietal" bones,  which  principally form  the
arched vertex or "crown" of the skull.   At
fig. cxxi. 3,  where the parietal  is joined to
the "temporal," or temple-bone, the suture
is different, being formed by the thin  margin
of the latter bone overlapping the similarly
formed edge of the  former; where these
bones overlap, their edges are roughened, so
as to give greater adherence.   In another
form of suture, the adjoining edges of the
bones are simply roughened.  In fact, the
form of the  bones of the skull individually,
their junction,  and the shape of the whole
case,  is   constructed  with  reference  to
strength  and lightness at the  same time;
indeed, so strong is the arch of the  vertex,
or crown of the head, (fig. cxxi. 4.)  formed
by the  parietal and  frontal  bones,  that in
falls on the head, instead of this portion of
the skull giving way, it is not uncommon to
find that the fracture, if it occurs, is in the
opposite portion of  the skull, where it is
supported by the spine.  When  the skull is
sawn through transversely, about its mid-
dle, it presents the oval form, represented,
(fig. exxii.,)  and if the brain be removed, the
Fig. exxii.
interior portion of the  skull,  or floor, on
which the brain rests, is seen as in the cut,
consisting of (1.) anterior, ('.',) middle,  and
(3) posterior depressions or J'fossae:"  the
anterior and rriddle being adapted to receive
portions  of  the larger brain or cerebrum  ;
the posterior  being the receptacle  of  the
lesser  brain or cerebellum, on the  top of
which  the posterior  portion  of the large
brain  is  situated.—See  Brain.   The large
opening (4)  in)  the  base  of the ekull gives
passage to the spinal cord or marrow. There
are a  number  of smaller  openings in the
base of  the skull for  the  transmission of
nerves and for  the possuge  of blood-vessels.
Within the  prominent  portion  of bone (•">)
is contained the internal  auditory appa-
ratus.—See Ear.  The  interior surfaces of
the skull are variously grooved and marked,
more particularly for the accommodation of
the blood-vessels, especially the large veins
connected with  the head circulation.  The
bones of the skull do  not each consist of one
solid piece of bone, but  of an inner and outer
"table" or  plate  of dense  bone,  separated
by a lighter and more cellular portion, which
is called  the "diploe'."—See Diploe.  The
depressions  and hollows of the outer table
do not entirely correspond with  those of the
inner.
  The frontal  or forehead  bone,  (fig. cxxi.
5,) a bone of the cranium or  brain-case, is
also a  bone  of the face,  entering largely into
the formation  of the  eye-sockets,  (6, 6.)
These  conical  cavities  (see Eye)  are made
up by  the combination  of other bones, such
as the  cheek-bone, (fig. cxxi. 7,) the upper
jaw-bone, (8,)  &c.  At  fig. cxxi.  9, is seen
the hollow for  the nostrils, divided  in the
centre.—See Nose.   The  lower  jaw-bone
(fig. cxxi. 10,)  (fig. exxiii.) of the figure re-
presented, is joined to the skull by means of
the rounded heads, (fig. exxiii. 1,  1,) which
Fig. exxiii
 fit into corresponding hollows in the skull.
 This is a specimen of the hinge-joint.   The
 shape of the lower jaw varies greatly during
 the different periods of life.   It also differs
 considerably  in different  races  of human
 beings, exhibiting, as well as the upper jaw,
 a tendency to  become  more  projecting as
 the descent is made in the scale of civil-
 ization.  The variations which are observed
 in the forms and in the relative proportions
 of the  different regions of smlls  belonging
 to various tribes of the  human family, is a
I study of the greatest interest.   The'bone* 
SLE
491
SLE
of the  skull and  face  arc closely covered,
like other bones,  by a  membrane or " peri-
osteum," in this  case  called the "pericra-
nium."   The scalp is  connected with the
skull by means of a loose, easily torn, cellu-
lar tissue.—See Scalp.
  Refer to  Brain—Fractures.
  SLEEP.—The explanation of the actual
physiological  condition  which  constitutes
this periodical phenomenon of life, has  often
been attempted, but the essential nature of
the condition  remains unexplained.   The
external  phenomena manifested during the
state of  sleep  are familiar,  and, in  some
measure, those that take place within the
body during the state are known, but there
the knowledge stops.
  Sleep  may  be  defined as  that state of
natural unconsciousness, in which the vo-
luntary powers are in  a  condition of insen-
sibility, while  the involuntary functions of
nutrition, secretion, &c.  are going on, in-
creased,  diminished, or  unaltered,  accord-
ing to circumstances.   The cause  of the
sensorial inactivity of the voluntary system,
and of the apparent disconnection  of the
mind with outward things, and, as it appears
to us on awaking from sleep, disconnection
with thought generally, has  been variously
explained.   A kind  of congestion of blood
in the head, caused by the compression of
the veins in the neck  by certain muscles,
has been suggested.  The most general  idea,
however, is, that  sleep is the  consequence
of exhaustion  of the usual  nervous stimu-
lant in the  services of  the waking hours, or
of exhaustion  of  this,  along  with waste of
the tissues generally.   As put by Liebig,
" Since in  different individuals, according
to the  amount  of force  consumed  in   pro-
ducing voluntary mechanical effects, unequal
quantities of living tissue are wasted, there
must occur in every individual, unless the
phenomena of  motion are to  cease entirely,
a condition in which all  voluntary  motions
are completely  checked, in  which, there-
fore, these occasion no waste.  This condition
is called sleep."  Dr. Carpenter advances
the same idea  somewhat in  a similar  man-
ner, saying, "  The occasional suspension of
sensorial activity is requisite for the repa-
ration of the destructive  effects of that acti-
vity; so  that,'  however  unfavourable  may
be the  external  circumstances, sleep will
supervene as a necessary result of exhaus-
tion, when  this has been carried very far."
That exhaustion  is  one, perhaps  the one
great condition of sleep,  is unquestionable ;
hut that it is not the only  condition  is no
less true, unless, indeed, the statement of
Liebig  be adopted unreservedly, that wine,
narcotics, and other sleep-inducing agents
produce a state of artificial exhaustion, by
putting a stop to the regular changes  of
matter, especially its  union with oxygen,
which  is  constantly  going on within  the
body.  Moreover,  there is a state of over-
exhaustion both of mind  and  body, which
tends to keep off sleep, rather than to induce
it. Further, there is a most undoubted con-
nection between the periodical revolution of
the twenty-four hours which constitute our
day, and  the periodical requirements and
renovations of sleep.
  It is observed by  Dr.  Whewell,  in  his
Bridgewater  Treatise, that " man in all na-
tions and ages has  taken  his principal rest
once in twenty-four hours, and  the  regu-
larity of this practice  seems most suitable
to his  health, though  the  duration  of the
time allotted to repose is extremely different
in different cases.   So  far as we can  judge,
this period is of a length  beneficial  to  the
human frame independently of the effect of
external  agents.   In the  voyages recently
made into high northern  latitudes, when
the sun did  not rise for three  months, the
crews of the ships were  made to  adhere
with the utmost punctuality to the habit of
retiring to  rest at  nine,  and rising at a
quarter before six;  and they enjoyed, under
circumstances apparently the  most trying,
a  state of  health  quite remarkable.  This
shows, that according to the common con-
stitution of  such men, the  cycle of twenty-
four hours  is very commodious, though
not imposed upon  them  by external cir-
stances.   No one  can maintain  with «ny
plausibility  that the period may be length-
ened or  shortened without limit.  We may
be tolerably certain that  a constantly re-
curring period of  forty-eight  hours would
be too long for one day of employment, and
one period of sleep, with our present facul-
ties; and  all whose  bodies and minds  are
tolerably  active will  probably agree, that
independently of habit, a  perpetual  alter-
nation of  eight hours  up  and four in bed,
would  employ  the  human powers less  ad-
vantageously than  alternations of sixteen
and eight."
   " The succession of  exertion and  repose
in the muscular system, of excited and dor-
mant sensibility in the nervous, appears to
be fundamentally connected with the nerv-
ous  and  muscular  powers, whatever  the
nature of  these may be.
   " The necessity of these alternations is
one of the measures of the intensity of thpse
vital energies;  and it  would seem that we
cannot, without assuming the human poweri
to be altered, suppose the intervals of tran- 
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49ii
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quillity which  they require,  to be  much
changed."
  The amount of  sleep  necessary for  an
individual  depends  greatly  upon  time  of
life, upon natural constitution, or upon ac-
quired habits.  The infant, it is well known,
spends most of its  early days in sleep.   In
adult life the hours of repose are  reduced
to  the  moderate  average  of  from six to
eight hours, while in advanced life, that is
before the period of decrepitude,  the amount
of  sleep is  still  further diminished.  By
Liebig this is reduced to a regular calcula-
tion.   After  giving the calculation, as com-
puted  in mechanics, of the force available
for  mechanical purposes in an adult man in
a certain period, he says,  "By the restora-
tion of the original weight of his body, the
man collects again a sum  of force which
allows him, next day, to  produce, without
exhaustion,  the same amount of  mechanical
effeots.  This supply of force is furnished
in a seven hours' sleep," provided, of course,
sufficient nutriment has been given during
the  waking  hours, from which the repara-
tive powers can draw their  supply of new
material.   Further, if the man exhaust, use
more out of  his system than can  be restored
or repaid duriug  the seven hours, or what-
ever other  amount of sleep  he  may take,
his  strength must diminish.  Practically,
therefore, sleep is a periodical natural con-
dition, in which the voluntary of exhausting
powers, both of body and mind, being  at
rest, the involuntary or reparative powers
have, or ought  to  have, time for restoring
the  material of the living body, which has
beeu used up during the  hours  of wakeful
activity.  Such being the case, it is evidently
most important, not  only that a supply of
sleep adequate to the  reparative  require-
ment of the system should be procured, but
that the benefit derived from the sleep should
not  be impaired by contingencies likely to
interfere with the processes  which are ac-
tively carried on during the state of uncon-
sciousness.   These  processes—devoted  to
the  repair of the structures —must evidently
be more connected with the secondary  assi-
milation of nutriment, that is, with changes
in the nutriment  after it has entered the
blood,  than  with  the primary assimilation
in the stomach.  This, probably, is  one rea-
son  why nourishment is usually  more bene-
ficially taken some hours before the ordinary
nights rest: it permits the  result of the
digestion of  the meal, not  only to enter the
circulation, but to be ready for the processes
of reparation which take place  during re-
pose.   It would almost appear  as if these
reparative processes were  carried on at the
 expense of others, which are more nctiv«
 during waking hours; for. during sleep, the
 respiration is diminished in frequency, the
 pulse is slower, nnd the action ot the brain, as
 observed in Blumenbach's case, diminished.
 At the  same time the  temperature sinks,
 and the nervous  power  is  evidently dimi-
 nished, and with it the power of resistance to
 morbific influences,  such as malaria.   In-
 deed,  as observed elsewhere in  this work,
 this diminished condition of nervous power
 is not recovered for some time after waking,
 and by  the weak not until food has been
 taken.—See Breakfast—Early  Rising,  See.
 The  perspiration, for obvious  causes,  is
 generally increased during  sleep.
   The amount of sleep required by different
 individuals varies greatly; as already stated,
 the  infant requires  most, sleeping at least
 twenty hours out  of the  twenty-four.  The
 hours of sleep  which are requisite diminish
 up to adult maturity, when from six to eight
 hours is the average requirement during
 the most active periods of life.   There are,
 indeed, instances  of persons who could do
 well with  a much smaller average of sleep
 —four, three, two hours, or even less; but
 these are exceptional instances, and the in-
 dividuals have generally been  persons of
 strong constitutional powers.   The  exten-
 sion of the hours  of sleep beyond the term
 of eight, or at least nine hours, is generally
 the  result of habitual indulgence.   More-
 over, when sleep is thus taken excessively,
 more is required, or thought to be required,
 on account of the debility which arises from
 consequent excessive  action of  the skin.
 Women,  as a general rule, require rather
 longer sleep than  men:  and it  is said  that
 tall and  bulky people do so, more than those
 who are the reverse.
   Many  of the  external conditions requisite
 for sound  and healthy  sleep having been
 noticed  under  " Bed" and   " Bedroom," it
 is unnecessary  to repeat them here.  It  may
 be added, that  no portion of clothing which
 tends, either in the way of  wristband or of
 neck fastening, to confine in the least de-
 gree, should be worn.    Especial attention
 should \>e directed, especially in the case of
 children, to the injurious effects of sleeping
 with  mouth or head covered over with the
 bedclothes.  The practice is a common but
 most hurtful one.
,  Some persons, Napoleon for instance, have
 appeared  to possess the power  of falling
 asleep  almost  momentarily—of  as it were
 putting themselves to sleep ; and the faculty
 has  been quoted  to prove that-sleep was an
 active state rather  than a passive one.  It
 would rather prove  that the mind  has so 
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493
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far power over the body as to restrain the
tendency  to  sleep until it can  be conve-
niently indulged in, and that as soon as the
powers of body and  mind  are surrendered
to its influence, it at  once  takes  possession
of them.  The power  of  certain  external
agencies, (soothing sounds in particular,) in
inducing sleep, are well known, and may be
taken advantage of.
  In the above remarks, sleep has been con-
sidered as a natural,  healthy process, either
the result of exhaustion, nervous or general,
or the  consequence  of a periodical condi-
tion of  the body.   It has been regarded.as
a process tending to health,  to recruit the
exhausted powers of  body and mind.  But
sleep is often not a natural process ; it may
be occasioned by excessive  use of alcohol,
or by narcotic drugs,  by the action of  heat,
or by the depression of extreme cold; it
may result from  overfulness  of  blood,  or
from deterioration of  the vital fluid—in the
latter case, generally, it is probable, by the
accumulation of  carbonaceous  materials,
consequent  upon  imperfect   aeration  of
blood in the lungs, or its imperfect purifica-
tion in  the  liver.—See  Biliary  Disorder.
Again,  heavy, very heavy sleep,  is  a  com-
mon accompaniment of chlorotic or anaemic
conditions of the  system.—See Anoemia.  In
such cases, although the powers of the  body
are in some  degree recruited  by the sleep,
it  is not followed by the same fee'ings of
health as the natural  sleep of  the  properly,
but not over-fed—well-exercised,  but not
exhausted—worker of either mind or body,
provided the worker of the mind neglect not
the physical exercise.
  Sleeplessness arises from various causes.
It  is often a distressing concomitant of old
age, (see Age,) but mental causes, anxieties,
excitements, distresses, most frequently give
rise to  it, and especially intellectual exer-
tion of the mind  late in the  evening, and
just before retiring to  rest.  Want of due
physical exercise also occasions  sleepless-
ness ;  it is  the result  of dietetic errors—
either eating  heavy  meals too late in the
evening, or retiring to rest without sufficient
nourishment; and especially is it caused by
strong tea or coffee taken at a  late hour—in
some people,  at any hour.—See Tea. If any
of the  above  causes of habitual  sleepless-
ness  are suspected to be the origin of the
evil, the most effectual  mode  of correction
is of course  to remove  the cause; but ex-
cept under the sanction of  a medical  man,
who can discriminate  how far sleeplessness
is dependent on disease, or likely  to impair
the constitution, artificial, that is medicinal,!
modes of procuring sleep should  never be
        2 R
resorted to.   Early rising, moderate atten-
tion to diet, and  moderate exhaustion of
both body and mind  by exertion, ought to
be  the means tried to bring back the soft
restorer.   Sometimes, the mere  alteration
in the hour of a  meal, a biscuit  before re-
tiring  to  bed, instead  of  going with  an
empty stomach, or some apparently trifling
alterations in habits,  is all that is requisite
as a corrective.   Continued sleeplessness is
a symptom of delirium tremens;  it is  too,
the  forerunner  and  concomitant of some
forms of insanity.  In both these phases it
requires to  be  dealt with  by a  medical
man.
  Disturbed sleep is almost a constant attend-
ant upon disorder of the digestive organs,
either  as exhibited in  mere restlessness, or
unpleasant dreams, or in the more aggra-
vated form of nightmare, which is generally
considered to depend upon impeded respira-
tion and circulation within the chest, caus-
ing those disagreeable sensations  connected
with the condition, of which all must at
times have been conscious.   It is probable
that the  uncomfortable  sensation  in  the
chest,  in  the first place, gives rise to the
" suggestive dream."—See Dreams.  Night-
mare, if of frequent occurrence, may depend
on disease connected with the heart or cir-
culation; but more usually it is  the result
of causes much more easily removable,  such
as indulgence in  heavy  suppers,  or excess
of food  generally—in fact, of indigestion.
Disturbed sleep in children is very common,
taking either, the form of moaning or rest-
lessness, with grating of the teeth, or talk-
ing ; of awaking suddenly, frightened  and
screaming;  or of getting out of  bed, when
it becomes somnambulism, or sleep-walking.
The  excitability of the nervous  system in
children renders  them liable  to be thus af-
fected by even slight disorders of the bowels,
and especially by worms, &c.;  in such cases,
therefore, it  is always  right  to make  sure
that nothing offends  in this way, by clear-
ing out  the canal by  means of a smart
purge ; calomel and scammony is probably
the best.  If the  affection does not seem to
depend on disorder of the bowels, so much
as upon general excitability,  every thing in
the way of  mental excitement which can in-
crease  this, must be avoided ; cold bathing
of the  head  every morning,  and the  cold
douche to the back should be used, and the
nervous  system  tired  before bedtime by
active but not exhausting exercise.
  Somnambulism, or  sleeping-walking, in
adults, belongs to the  class  of mental, or
rather  psychological  phenomena,  not yef
generally understood;  it evidently resem- 
                 SLU               4!

bles, if it is not identical with, the mesme-
ric  condition of which some,  and generally
the same class  of persons,  are  susceptible.
Where  a  tendency  to  sleep-walking does
exist,  it is perhaps  scarcely requisite  to
remark that  every  means of guarding the
person  so unfortunately affected, from ac-
cident, should be had recourse to.
  Night is the natural season for rest; but
in warm climates, a day sleep, both in man
and animals, seem  beneficial.   In  temper-
ate  climates, after  the age of childhood, it
is not an advisable  custom.   After  any un-
usual fatigue, however, a short sleep before
—not after—dinner, is  often very  service-
able.
  Refer to Breakfast—Dreams—Early Ris-
ing—Night, Sec.
  SLOUGH.—A slough is  a dead  portion
of  tissue cast off  from a  living animal
body.
  SMALL-POX.—This dreaded disease be-
longs, like measles and scarlet fever, to the
class  of eruptive  fevers.  It is,  too, like
these diseases,  characterized  by its  own
special  constitutional symptoms from the
commencement, independent  of  the  erup-
tion which stamps its character.
  Small-pox commences with shivering and
languor, followed by heat, thirst, and head-
ache:  so  far,  these  symptoms mark the
beginning of most other severe febrile affec-
tions ;  but added to them, in the disease  in
question, there is  usually either  pain  or
great oppression at  the pit of the stomach,
and  not unfrequently vomiting;  there  is
severe pain  in the back or loins, and  in
children not uncommonly, and more rarely in
adults, convulsions.   On the third day after
the  Betting  in of  the above  symptoms,
usually toward evening, minute red spots,
Bomewhat resembling flea-bites, show them-
selves on the  forehead, the  neck, the wrists
and  arms, the chest and  abdomen,  and
finally on the  extremities;  this,  at  least, is
the course of the eruption, but  it does not
reach the lower extremities till at least the
fourth diy.   If the eruption on the parts
first mentioned is discovered over night, by
morning it is much more distinct, and the
spots are much more numerous than  they
first appeared to be;  they are, too, slightly
and conically elevated—are,  in  fact, " pa-
pular; from  this they continue  enlarging;
on  the third day  after their  appearance
they evidently  contain a little fluid on their
summits,  which gradually  increases  in
quantity, giving either a globular form  to
the spot, or  an umbilicated  or  wheel-like
form, resembling that which is seen in cow-
pox,  the  centre of the vesicle or pustule
14                 S M A

being  depressed, tied  down as it were, in
the centre.   Toward the fifth  or  sixth day
of the eruption,  this peculiarity of  form
disappears,  the  pustules  become  real pus-
tules, and contain  pus or matter.  About the
seventh or eighth  day of the eruption they
begin to "crust,"  that is to break, allowing
their contents to escape, and then to harden
into  a  crust or scale.  At this period of the
disease,  that  of " maturation," the eighth
day  of the  eruption,  the eleventh  of the
disease,  what is called the  secondary fever
comes  on; the febrile symptoms, which had
more or  less abated  after the eruption ap-
peared, become  again aggravated, and con-
tinue so for a few days.   At length, if the
case has progressed  favourably, toward the
end of the third week from the first showing
of the eruption, some of the scabs begin to
separate and fall off, leaving either a pit or
a stain of a  deep red colour.
  Such are  the  most prominent character-
istics of small-pox, as  they show themselves
upon the face to  the eyes  of an  observer.
The  progress of the eruption  on  the  body
generally must be reckoned as twenty-four
hours, and even more on  the  lower limbs,
later than the face.  Much of the severity
and danger  of the small-pox depends  upon
the amount  of the eruption : whether it is
what  is called  "discrete," that  is,  each
separate spot distinct from  another;  "con-
fluent,"  when the spots  all run  into one
another, forming one mass  of eruption ; or
" semi-confluent," a medium between the two
former.  There  is of course  every degree
of severity.   It  need  scarcely be  added,
that the regular confluent  small-pox is the
most dangerous disease.  As a general rule,
the eruption of small-pox is thickest on the
face,  and its variety, confluent or not, is
generally reckoned from its amount in the
above  situation.    The   skin  surrounding
each pustule is inflamed  or  swollen,  this
inflammation  and swelling being  of course
more severe according to the severity of the
eruption; in consequence of it, the features
are swollen  and disfigured, and the eyelids
closed.  The eyes partake of the inflamma-
tion of the  skin,  and  are  apt  to  be much
affected, discharge of matter taking place
from  beneath the  eyelids.  The  nostrils,
mouth, and throat are usually more or less
affected  with small-pox pustules;  indeed,
one of the most serious dangers apt  to arise
in the course of  small-pox,  is the  throat
affection, and any signs  of  impeded breath-
ing are always to  be most anxiously watched
and cared for.  Unless the attack of small-
pox is extremely modified, as by previous
vaccination, the pustules on the face almost 
S M A               495               S M A
 all  run through their regular course  as
 above described.  In many cases, however,
 they do not do so on the body, but on  the
 eighth day, that is, when those on the face
 are discharging their contents, those on the
 trunk and lower limbs begin to "go back,"
 as it is called, or wither up, without  the
 formation  or discharge of matter.
   When an attack of small-pox comes on
 with great severity, and when the constitu-
 tional powers are, as it were, overwhelmed,
 a person may sink early in the disease, but
 more  generally the chief danger is  about
 the time of the secondary fever, either from
 the affection of the constitution, or from that
 of the throat and from impeded respiration.
 Small-pox may show itself in an extremely
 mild form, there not  being  more than a
 dozen spots—if so many—on the body alto-
 gether.  This generally occurs when the dis-
 ease is modified by previous vaccination, or
 has been  introduced into  the system  by
 inoculation.
   In the early stages, small-pox  may be
 confounded with  other eruptive diseases,
 especially  with measles,  which disease its
 eruption in the first stage somewhat resem-
 bles.  This mistake,  however, can scarcely
 occur if the distinct characters of the con-
 stitutional symptoms  of  the  diseases  are
 kept in  view;  when the eruption  has ad-
 vanced a little way there can be no con-
 fusion.
   It need scarcely be said,  that  an attack
 of small-pox, of even ordinary severity, is
 not for unprofessional management.   If the
 disease be prevailing, and if an  individual
 exhibits   the   symptoms above  detailed,
 small-pox may fairly be suspected.
   The appetite,  probably,  is  totally gone
 from the first;  but in such cases, food  of
 the lightest kind only must be taken, and
 cooling drinks  (nothing is better than  the
 ordinary effervescing powders) may be  al-
 lowed freely;  or Seidlitz  powders, to keep
 the bowels  lax, without purging;  or castor-
 oil, or other mild aperients, must be  given
 if required.   But,  although the bowels
 should be kept  easy throughout the disease,
 when the eruption is coming  out  all  at-
 tempts at purging should  be dropped, cool-
 ing saline  medicines being  continued.   If
 the  surface is very hot and dry, sponging
 with tepid  water is useful and agreeable.
 When the secondary fever comes on, it may
 be requisite both to act more freely on  the
 bowels by means of the aperients alrea'dy
 mentioned,  or by senna,  or Epsom  salts,
 well diluted, or some of the aperient pills,.
while at the same time the distressing rest-
 iftsaness requires opium,  twenty drops  of
 sedative  solution,  or  five-and-twenty of
 laudanum at bedtime.  In  some cases, if
 signs of sinking come on, with weak pulse,
 tardy eruptions,  and pustules not filling,
 all  lowering measures  are  to be  avoided,
 and  good broths, wine,  wine-whey, &c. ad-
 ministered, as the case  may require.   The
 principles of treatment  are,  in the onset of
 the  disease  to moderate febrile  action, and
 through it, the eruption,  by cooling ape-
 rients ; when the eruption  is coming out,
 to interfere but little beyond  keeping the
 bowels  easy, regulating the  diet according
 to the  strength;  and, again, in  the stage
 of secondary fever, to purge  moderately.
   If much swelling and distress  about the
 throat  should result in the course of the
 disease, leeches  ought  to  be applied, in
 number proportioned to  the age and consti-
 tution of the  patient.  This  treatment em-
 ployed  in a case  far distant from medical
 aid might save life.
   In any case small-pox is a fearful disease,
 and  should  be  under medical care when
 possible;  circumstances,  however,  may
 occur in  which  the above  directions will
 prove useful.  The  disfigurement which is
 apt to result  in consequence of the marks
 left upon the face  by small-pox is an addi-
 tional aggravation.   Various methods for
 its  prevention are resorted to.   The light,
 being supposed  to exert some influence on
 the progress of the pustule, is often exclud-
 ed from the room, and as the eyes are apt
 to be sensitive, the expedient  is  good  in
 more ways than one.  Opening each sepa-
 rate pustule with the point of a lancet, and
 touching the interior with a pointed  stick
 of lunar caustic, has been found of use. In
 France, a  mercurial—the  Vigo-plaster, is
 used, being  put  like a mask  over the face;
 but it may cause heat and  unpleasant sen-
 sations in the head, and, therefore, a better
 application is the  common mercurial oint-
 ment thickened with starch powder, smeared
 over the face on the second or third day of
 the eruption,  and  allowed   to remain till
 the scabs separate.   It  is generally some
 months  before  the  stains  of even  a  mild
 attack of small-pox disappear..   Small-pox
 is highly contagious, and may even be com-
 municated by the  dead  body.  The attack
 generally comes  on  about  ten  or  twelve
 days after exposure  to contagion.   As all,
 perhaps, are aware, until the discovery of
 vaccination  by Jenner, the   system of in-
 oculating  small-pox,  as introduced  into
 England from Turkey,  by   Lady  Wortley
 Montague,   was   generally   followed,  and
 certainly was a great boon.   It substituted,
in almost in every case,  a mild form of thv 
                 SM E

disease, for, to say the least, one of uncer-
tain severity;  and,  moreover,  the disease
was imparted to a constitution which had,
by preparation, been placed in a favourable
condition  for its reception, and for its de-
velopment in  a  mild  form.  To  counter-
balance,  however, these advantages, there
was the serious consideration that, although
a case of  inoculated  small-pox  might  in
itself be a trifling affection, devoid of dan-
ger, it was capable of originating the dis-
ease in another person, in its most virulent
form.  This drawback, Jenner's discovery
removed,  and,  vaccination  has,  therefore,
rightly, taken  the place  of inoculation;
and  government has rightly put  it  out  of
the power of foolish people  to do  mischief,
by  imposing  a  heavy penalty  upon the
practice of inoculation for small-pox.
  The question of the relative values of cow-
pox, or vaccination, and inpculated small-
pox, having been alluded to in the article
on the  former, need not be repeated here.
  Refer to Cow-pox.
  SMELL.—See Nose.
  SMOTHERING.—See Suffocation.
  SNEEZING—Is  a  convulsive   or  spas-
modic effort, the result of reflex action, ori-
ginating in irritation of the lining membrane
of the  nostril, by which air is forcibly sent
through the passage so  as to expel any cause
of irritation.  Sneezing is  one of the first
symptoms of cold, of influenza, of measles,
and of diseases which involve the air-pas-
Bages.   Continued sneezing is a spasmodic
affection, said to be relieved by emetics.
  SNUFF—Habitually taken, is  injurious,
and a  common  cause  of dyspepsia.   As a
counter-irritant, in  some forms of headache,
snuff proves serviceable.—See Tobacco.
  SNUFFLES.—A name sometimes given to
the catarrhal affections of infants.
  SOAP—Is a compound of fat  or oil with
alkali, which is usually soda.  Tallow and
Other cheap fats are used for the commoner
soaps,  and yellow soap has about a fourth
part of resin and palm-oil  in its  composi-
tion.   It is the resin which makes  it irritat-
ing to some skins.   Windsor soap has the
addition of olive-oil. For soft soaps, potash
is used instead of soda, the medicinal soft
Boap being composed  of potash  and pure
olive-oil.  Soap of any kind is an antidote
in  poisoning  by the  mineral  acids, and
might  be  used in the  absence   of  better
remedies.
  Refer to Castile Soap—Plaster,  Sec
  SODA. — This well-known  and  exten-
sively  used alkali  is now manufactured
almost entirely from common i alt, which  is
a muriate of soda.—See Salt.   Soda is best
6               SOD

known  in  the form of  its carbonates, 01
subcarbonate  and bicarbonate—the fornrsr
being largely  used domestically, the latter
medicinally and  for  some domestic pur-
poses.   The subcarbonate of  soda, or as it
is commonly  known,  " soda,"  being more
irritant, and not  so pleasant as the bicar-
bonate, the latter  is generally employed in
medicine, its antacid properties being simi-
lar to those of potash, but rather weaker.
It is usually  sold  in the form  of white
powder.
   Bicarbonate of  soda is  largely used for
making  the  common  " effervescing  soda
powder."—See Effervescing.  Many dyspeptio
persons  take  it habitually, as  an  antacid.
The habitual use of soda internally, even in
cpmparatively small quantity,  cannot be too
strongly condemned.   It undoubtedly exerts
a most debilitating effect upon the stomach,
and also upon  the system  at  large.  Many
persons  injure themselves by its use. The
usual dose, as an antacid, is from  ten to
twenty  grains in solution.
   Soda-Water—Properly so cnjled, is water
containing about twenty grains of bicarbon-
ate of soda to the half-pint,  and  strongly
impregnated with  carbonic acid gas, but a
good  deal is made without  the  addition  of
soda at all.  When used simply as a drink,
this  omission  is  unimportant,  but  not so
when it  is required as  an antacid.   As a
drink  in  febrile  diseases, soda-water is
often beneficial, and  much  relished, but
should not be given in too great quantities
at once, otherwise the gas  may cause inju-
rious and uncomfortable  distension.—See
Effervescing.   When  a  bottle  of soda-water
has  been opened  and recorked in a sick-
room, it should be  well corked, secured by
lying, and  inverted in  a jug of cold water.
In this way the gas is  preserved ; but if the
tying  over is  neglected,  it very probably
occurs  that the gas, especially  if the situa-
tion is a warm one, forces  out the cork, arid
the bottle out of the jug at the same time,
spilling the fluid, and, what is worse, making
a sudden noise that may  startle, and thus
seriously injure, an invalid.
   Milk  and soda-water  is thus  made:—
" Heat  nearly  to  boiling  a  teacupful  of
milk, and dissolve in it a teaspoonful of  re-
fined sugar, put it into a large tumbler, and
pour over  it two-thirds of  a bottle of soda-
water.   This  is an excellent mode of taking
milk when the stomach is charged with acid,
and consequently is apt to feel oppressed
by milk alone."*
   Chloride of Soda—Is the  " disinfecting
* Thomson'* Sick-Room.
4S 
SOL                 497               SOB
 liquor of Labarraque."   It  is used medi-
 cinally by medical men for disinfecting pur-
 poses.  There are  better preparations.—
 See Chlorine.
   Phosphate of Soda—Or  tasteless  salt,
 is a mild aperient, which possesses  the ad-
 vantage of having so little taste that it can
 be given in soup.  The dose is half an ounce.
   Sulphate  of  Soda—Or  Glauber  salt,
 for a  long time the commonest aperient in
 use, but has been displaced by Epsom salt,
 which much  resembles  it  in  action.  The
 dose of Glauber salt is  from  half an ounce
 to an  ounce,  dissolved in water.  The addi-
 tion of a few drops of dilute  sulphuric acid
 diminishes the nauseous bitterness.
   Refer  to  Borax — Rochelle  Salt — Salt,
 Common.
   SOLANUM.—See Dulcamara.
   SOLUTION—Is the disappearance of  a
 solid  body in a liquid menstruum or solvent.
 The  colour of the liquid may be changed,
 but if perfect solution has taken place its
 transparency is  unaltered.   The solubility
 of bodies, such as salts of various kind, in
 liquids, varies greatly.  Generally it is in-
 creased by heat, but  not always.   The mi-
 nute  state of division in which a body ex-
 ists when in  solution,  renders this form
 especially favourable for the development
 of medicinal  action.
   SOMNAMBULISM.—See Sleep.
   SORE-THRO AT — Quinsy. — Sore-throat
 is not only  a concomitant of other affec-
 tions, such as scarlet-fever, but  is  one  of
 the most  frequent effects  of common cold.
 Some  persons are  peculiarly liable to  it.
 One of the simplest  forms of throat affec-
 tion from cold is relaxation  of the  uvula.
 —See Palate.  Perhaps  on waking  in  the
 morning, the  sensation is experienced  of
 there  being something in  the  throat which
 requires to be coughed  up, and, along with
 this,   tickling  cough, from the uvula irri-
 tating the top of the windpipe.  The condi-
 tion is easily discovered  by means of  a
 looking-glass, the uvula appearing  longer
 than usual.  Frequently the affection passes
 off in  the course of a few hours.  If it does
 not, the use  of an  astringent gargle (see
 Gargle) will remove it.
  Sore-throat may be simply inflammation
 of the mucous membrane of  the  throat;
 there  is an uncomfortable feeling  of  rough-
 ness or rawness about the fauces and tonsils,
 with   some pain  in  swallowing,  probably
 accompanied  with constitutional symptoms
 of cold, shivering, &c.  This form of sore-
 hroat may pass away in the course of a day
or two without  going further, or  it  may
spread by extension into the  air-passages,
       2r 2                             3:
causing cough and catarrhal symptoms.  It
is this form of the affection which is often
quickly relieved by the use of the sal-pru-
nelle balls, one or two being  allowed  gra-
dually to  dissolve  in the  mouth.   It  is
generally best treated  as a common  cold
(see  Cold) with  the  addition of hot  bran
poultices up the angles of the jaws, and the
use of hot gargles of simple warm water or
gruel.  This treatment is better than the
mustard  plaster and hartshorn and oil, re-
sorted to by some.  These, however, may be
advantageously used at a later stage.  An-
other and highly dangerous sore-throat, of
an erysipelatous character, [called "Black-
tongue"]  sometimes prevails,  and requires
the most active measures of the medical men;
the most  effectual treatment  consisting in
pencilling the whole of the inflamed throat,
either with the solid lunar caustic or  with
the  solution.—See  Erysipelas.   The great
danger from this form of sore-throat is its
extension to the larynx and  air-passages,
when it most frequently proves fatal.
  Another serious form  of sore-throat in
children, ending in croup, is described under
the article on the latter disease.
  In  quinsy,  the inflammatory  action  is
deeper than in the  above-mentioned forms
of the disease,  and  affects the  substance
of the tonsils and surrounding tissues, it
usually ends in  the  formation of abscess.
Quinsy is  sometimes  a  most distressing
disease, the swelling caused both  by the in-
flammation and by the matter preventing
the swallowing even of fluids, which, when
the  attempt is made, instead of passing
down, regurgitate into the nose.  In  bad
cases the breathing is  impeded,  and when
this occurs the case must always be regarded
seriously.  The feeling attendant  on quinsy
is rather one of extreme distress than  of
acute pain, except when the attempt  to
swallow is made,  at which time the pain is
often greatly complained of as shooting up
to the ears.    In  some  cases  the swelling
extends down the neck, and completely under
the jaws, affecting the tongue and the  sali-
vary glands.   When this occurs, the flow of
saliva is generally profuse, and in all oases
there is  formation of much stringy mucus
about the tonsils.  The voice  is  thick and
husky, the tongue very  much  furred, and
the breath  offensive.   Along  with  these
local  symptoms  of quinsy, there  is always
more  or  less  fever,  and if  the  disease
be  long   continued,  considerable depres-
sion  from the deprivation of nourishment.
The  treatment of quinsy in  the first in-
stance is like that of  common cold.  If the
symptoms are severe, and if the person has 
SO K
498
SPA
suffered  from the disease previously, from
four to fix leeches may be placed under the
jaws  in  the  commencement of the attack,
bran  poultices, hot  gargles,  and  steaming
being used, with active  purging at first.
If the patient can  swallow it, medicine in
the effervescing  form  always gives relief,
by clearing the mouth and throat.  Nothing
answers better than  the common soda effer-
vescing powder,  with the addition of six or
eight  grains  of nitre, in full habits ;  or of
a teaspoonful of nitrous ether in weak con-
stitutions, in  each dose.  The above mea-
sures  may be continued until the matter, if
it forms,  discharges.   When this occurs, the
distress, which has perhaps been  great,  dis-
appears  at once, and  convalescence,  gene-
rally  rapid,  commences.   The  discharged
matter, which is usually offensive, may flow
out in a perceptible  gush, and be spat from
the mouth, or  it may be  unnoticed,  and
ooze away, passing  down the throat.   The
hot poultices and  gargles should be con-
tinued to the throat  for twelve or eighteen
hours after the discharge of the matter; after
that time an  acid or astringent gargle  will
generally be most   serviceable  and grate-
ful, and  the  poultices may be replaced by
flannel, and perhaps by stimulant liniments.
At this period, too,  the patient, unless very
much reduced,  should be tolerably freely
purged.  At  the same time good nourish-
ment, broths, and,  if requisite,  wine  being
permitted.
  Blisters  are sometimes used  in quinsy;
at the very commencement they may be use-
ful—but  the author prefers the poultice.  It
is said that powdeied guaiac, given in half-
drachm doses ever}'  six hours, at the com-
mencement of quinsy,  will frequently  cut
Bhort  the disease.
  A person who has  suffered from, or is
subject to quinsy, should, after an attack
has passed off, use every means of strength-
ening the throat; by this the attacks may
be greatly prevented.   Any  of  the astrin-
gent  gargles  may be used after quinsy,  but
none  perhaps answers better, or is  more
accessible  to the poor, than the decoction
of oak-bark.   This  ought to be used  night
and morning for some weeks, and when its
use is dropped,  the person  should acquire
the habit of gargling  the throat with cold
water at  the above times, as a regular prac-
tice, and at the same time should, habitually,
lave freely with  cold water, on salt water at
first at least, all around the throat.  In  this
way a tendency to  quinsy may  be greatly
overcome.  Further,  all unnecessary muf-
fling,  either by fur  or  otherwise, about  the
neck, should be avoided, for there  is  no
more fertile source of sore-throat.—See Fur
Doubtless many cases of simple sore-throat
may be well mannged domestically: but the
contingencies  of  erysipelatous or croupy
sore-throat, or of quinsy, which  may sutio-
cute, must not be lost sight of.  The attend-
ance of a medical man gives the only chance
for life in such cases.
  Refer to Croup—Throat, Sec.
  SOUND.—A surgical instrument for ex-
ploring cavities within the body.
  SOUND.—See Deafness.
  SOUND.—See Ausuvltation.
  SOUP.—See Broth—Bekf, &c.
  SPASM—Is  painful contraction of  the
involuntary muscular fibres,  in  contradis-
tinction to cramp.—See Cramp.   There is
cramp in the legs, spasm in the stomach or
bowels, in the latter case constituting colic.
Spasm of the stomach, owing to the presence
ot indigestible substances, is not unfrequent.
lt is characterized by sudden agonizing pain
in the region of the  stomach, which, like
other spasmodic pain,  is relieved by press-
ure ;  there may  be attempts  at vomiting,
and perhaps eructation of wind.  The seve-
rity of the pain, in this form of spasm, makes
speedy relief  important, and  for this  the
general remedies noticed under Colic should
be resorted to; in addition, if  the presence
of irritating matters in the stomach is sus-
pected, an emetic should be given at once,
and after  it has acted, or in place of it, if it
is not given, an antacid, magnesia, or soda,
or potash, in  combination with a stimulant,
sal-volatile or brandy,  and   also opium.
Five  grains of rhubarb, five  of  alkali, a
teaspoonful of sal-volatile, and from ten to
fifteen or  twenty  drops of laudanum, will
form a dose, which may be repeated  every
quarter or half hour, or at  longer intervals,
as requisite.   These measures may be  fol-
lowed outv and  give great relief before »
medical  man  can be  procured, which  he
ought to be, if the attack does not yield at
once,  for it is possible that other disorders
may be mixed up with it.  After the imme-
diate  attack has passed away,  the digestive
functions  will require attention.—See In-
digestion.
  Spasm  in the  bowels has  already  been
considered under  article "Colic."  Spasm
of the heart  is  included  under "Angina
Pectoris."  Spasm of the urinary passages
may occur as the  result of gravel or urinary
irritation.  In all cases of  spasm, it should
be remembered that heat is one of tb<5 best,
ami certaiuly is the  safest remedy.
  Refer to Colic—Cramp—Urine. &c.
  SPASMODIC DISEASES.—See Lo k-Ia*
—St. Vitus's Dance, &c. &c. 
SPA
499
SPI
   SPATULA—Is a blunt, flexible knife, used
 by the apothecary, and in the various  me-
 dicinal manipulations.  It is usually made
 of iron, but bone spatulas are also used for
 substances  that  act  chemically on iron.
 The most convenient size of spatula for a
 domestic chest is one with the  blade about
 three and a half inches and the handle three
 inches in length.
   SPECIFIC—Is  a term  applied  to a  me-
 dicine which is known from  experience to
 cure  a particular disease or set  of symp-
 toms, the action by which it does so being
 unexplained.  Thus, quinine  is specific in
 ague and other periodic diseases—specific,
 at least, within certain  limits; that is, it
 is generally successful, though  not  always
 bo.  This applies to other so-called specifics.
   SPECTACLES.—See Vision.
   SPECULUM.—A surgical mirror, adapted
 to assist  the examination of  internal parts
 of t*te body.
   SPEECH.—Distinctness of speech, or ar-
 ticulation, is so intimately connected with
 the full  command and free  movement of
 the  tongue, that indistinctness is often a
 valuable  leading  symptom in the investi-
 gation of disease, especially of a nervous
 character.   The "thick" articulation of the
 drunkard is an  instance of the  affection
 of the tongue from  nervous  disorder;  the
 Bame thing  occurs in  paralysis and other
 diseases  of  the brain; in some cases,  the
 articulation  of  particular letters  being in-
 terfered with, such  as " d"  being  substi-
 tuted for "1."
   Stammering in the speech  cannot be said
 to be a disease, being rather a functional
 disorder; this is evident from the fact, that,
 under certain  circumstances, an  habitual
 stammerer  does  not  stammer,  and  that
 cases have occurred in which most invete-
 rate stammering has  been completely cured
 —as history tells us in the case of Demos-
 thenes—by the exertion of the will.  More-
 over, stammering is  often  caused  either by
 imitation in children or  by nervousness in
 both children and adults.  This nervousness
 is often the  result of debility, and of weak
 constitution—a fact which  should not be lost
 sight of, for, if such be the case, every means
 .if strengthening should be used.—See Chil-
 dren, Sec   At the same time,  while the ge-
 neral health is sustained, much may be done
 by checking  children,  and  making them
 speak at all times slowly.  Much pains with
 children,  and much perseverance  and self-
command in  adults, is required in the efforts
to overcome the  defect  in  question,  but
there is the encouragement that  it has been I
effected.  When  it can  be  done,  a child
should be placed under the care of a person
experienced in the moral  and  intellectual
training of children thus afflicted.  Surgical
operations on the  tonsils  and  uvula have
been  proposed,  even by high  authorities,
and practised  largely for the cure of stam-
mering, but they have never  met with  the
cordial support of the profession. Articula-
tion is sometimes indistinct from the tongue
being "tied,"  that is, too much confined in
its motions by its natural  bridle, or "frae-
num."—See Tongue. When this is discovered
in early life it is very easily rectified.—See
Children.
  SPERMACETI—Is a species  of concrete
oil found  in the  head of the  sperm whale.
Its appearance is sufficiently well known.  It
was formerly used internally on account of
its supposed healing properties, and, accord-
ing to this idea, the "spermaceti-draught"
was a favourite lying-in-room remedy.  Sper-
maceti is  now used only as an  addition to
ointments.—See Ointment.
  SPHINCTER  MUSCLES —Are  muscles
the office of which is to close the apertures
round which their fibres run, usually in  a
circle.
  SPINACH.—This well-known vegetable is
one of the most wholesome we possess, and
less liable than most others to disagree. The
leaves of cither the common beet-root or of
the mangel wurzel, when cooked like spi-
nach, form  a  substitute in some respects
even superior  to the former vegetable.
  SPICES.—See individual articles, Cinna-
mon—Pepper, &c.
  SPINE, or  Spinal, or  Vertebral Co-
lumn—Is  a chain  of twenty-four  bones,
called  the "vertebrae,"  (see  Skeleton,)  so
beautifully  contrived  and  fitted to each
other that, while  they permit  the most  ex-
tensive  motion of the trunk  of the  body,
they at  the same time preserve it  (in man
at least) firm and erect, and guard the spinal
cord  or marrow (see Nerves) against all but
the most violent injury.   The spinal cord,
thus guarded, is enclosed in the spinal canal,
which is  continued through the vertebral
chain,  from the  head  downward,  to and
into the " sacrum" bone of the pelvis.  The
twenty-four vertebrae  are divided by anato-
mists  into seven  "cervical" or  neck verte-
brae,  twelve "dorsal"  or back vertebrae, and
five "lumbar" or loin vertebras; the verte-
brae belonging to  these divisions being dis-
tinguished by marks peculiar to  each, while
at the same time all the bones have certain
characters in  common.   All the vertebrae,
except the single one next  the  head, have 
S PI
500
SP1
what is called their body, (figs, cxxiv. cxxv.
and cxxvi. 1 ;) on the bodies rests the main
weight of the parts above them:  they are
Fig. cxxiv.
    1
Fig. cxxvi.
also extensively subservient to the motions
of the spine.  The bodies form the inner por-
tion of the spinal column.—See Chest—Ske-
leton.  Attached to the body, one on each side,
are "laminae," or projections, (figs, cxxiv.
cxxv. 2,) which serve to enclose the canal (fig.
cxxiv. 7) of the spinal  cord;  from the junc-
tion of these laminae proceeds what is called
the "spine" of the vertebrae, (figs, cxxiv.
cxxv. 3, 3.)  These "spinousprocesses" pro-
jecting backward give the peculiar character
of the spinal  column, when  examined in a
living,  and especially a thin person.  In ad-
dition to the  parts  above named,  there are
what are called the "transverse processes,"
(tigs, cxxiv. cxxvi. 4,4.)   These processes are
chiefly concerned in affording attachments
to the muscles, and, in the dorsal  vertebrte,
in giving firmness and support to the ribs.
—See  Ribs.  There are  various other dis-
tinctions common to the vertebrae which it is
unnecessary to enter into here.  The bodies
of the vertebra?  are  separated from  each
other by what are called "inter-vertebral
cartilages,"  (fig. cxxvi.  5.)   These carti-
lages  are  endowed  with remarkable  elas-
ticity,  yielding  with every  motion  of the
body, and breaking the effect of the  shocks,
which must have been communicated to the
brain with every step, had the spinal  column
been all bone.  Moreover, the variations in
thickness of  this component of the spinal
column contribute greatly to mould  its dif-
ferent curves.
  In addition to being fitted  to one another
in a most  beautiful manner, the  vertebras
are firmly  braced together  by a  serieB of
ligaments of various kinds,  which  permit,
but yet restrain motion.   One of these liga-
ments  is shown (fig. cxxvi.  6)  which  runs
down the bodies of the vertebrae externally;
a similar ligament runs down the interior of
the spinal canal, and there are others.—See
Ribs, fig. cxi. 2.
  The two upper cervical or  neck  vertebra,
which are more especially concerned in sup-
porting the head, are peculiar.  The upper-
most one, named the " atlas," from its of-
fice, is little more than a ring of bone with
two lateral joint surfaces on  which the head
moves in the performance of bowing motions.
The second vertebre, called  the  axis,  (fig.
cxxv.,)  has, in addition to (1,) the ordinary
body of a vertebre, a tooth-like process or
projection, (fig. cxxv. 7,) which, projecting
upward, rests within the bony ring of the
first vertebre, and is kept in position  by  a
strong "transverse"  ligament, which, run-
ning across from one side of  the ring of the
first vertebre to the opposite,  crosses the
tooth-like process of the  second vertebre, as
at the dotted line—8.  By this arrangement,
as a moment's reflection  will show, the  side
to side motion of the head is  secured, which,
in combination with the  bowing motion ex-
ercised on the first or atlas vertebre,  permits
of that perfect capability of  movement  with
which an all-wise Creator  has endowed the
noblest part  of  man.   Should  the above
transverse  ligament  be  broken  by  any
chance, or by violence, as sometimes occurs
in hanging, the tooth-like process, thus Bet
at liberty,  presses  forward upon  the spinal
cord, and instantaneously extinguism-s life 
SPI
501
SPI
Tt is the danger of this occurrence  which
the author adverts to in the article on " Lift-
ing Children."
  The seventh or lowest cervical vertebre is
remarkable for being more prominent than
the others, and is by this easily recognisable
in  the  living  body.  The  dorsal vertebrae
support the ribs;  their  spinous processes
(fig. cxxiv.  3)  overlap one  another like the
tiles  of a house,  (see Ribs, fig. cxi.,)  while
the  spines  of  the neck and loin vertebrae
project  outward.   The  "lumbar" or loin
vertebrae (fig.  cxxvi.) are the strongest in
the body; the  lowest of them rests upon the
sacrum  bone,  (see Pelvis,) and, indeed, this
bone is evidently  a  series  of vertebrae con-
solidated to fulfil the functions of their po-
sition.
  The spinal  column  constructed as  above
described is not  straight, but  has various
natural curves. The principal of these  is one
outward, which  increases the capacity of
the chest, and one inward  at the small  of
the back, which  assists in  maintaining the
equilibrium of the  body, and also  in sup-
porting the contents of the  abdomen.—See
Chest, fig. xxxiv.   The  canal which   runs
through the entire spine is continuous with
the cavity of the skull by the opening in the
base of  the head, (see Skull,) and the  mem-
branes and nerve substance of the spinal
cord are, through the above opening, con-
tinuous with the brain and its membranes,
—See Nervous System.  The equilibrium of
the spine, and therefore  of  the  body  gene-
rally, and  the motions of  the trunk,  are
effected by means  of the various muscles
attached in a longitudinal direction, chiefly
to the posterior portions of the vertebrae.
  Diseases and Injuries of the  Spine.—
The spine is liable to be the seat of a  pecu-
liar malformation at  birth.   This  consists
in the deficiency of the posterior portions of
a certain number of the vertebrae, generally
those of the loins, by which the membranes
lining the interior  of  the spinal canal are
left uncovered,  except by  the skin, both
membranes and skin being distended  into a
livid-looking semi-transparent bag contain-
ing fluid. This peculiar malformation gene-
rally ends fatally, but  not  so invariably as
to  justify  the child being left  to its fate
without an  attempt to save it.  This attempt
can only be made by the surgeon, and will
probably consist of cautious evacuations, at
intervals, of the fluid contained in the bag,
pressure being at the  same time employed.
Natural cure  is  said to  have  occurred in
consequence of the fluid being  allowed to
escape through an ulcerated opening.   Con-
cussion of the spinal cord is not unfrequent,
as a consequence of heavy falls on the feet;
especially on  the heels, or of direct blows
on the back.   The usual symptoms are de-
pression of the system, with loss  of sensa-
tion and power of motion of the lower por-
tions of the body, which either passes off in
the course of a few days, or remains per-
manently,  perhaps  passing  into  disease.
Occasionally, very acute pain in the  lower
limbs comes on.  In cases of concussion of
the spinal cord, the power of evacuating the
urine is sometimes lost, in  which case the
use of the catheter will have to be resorted
to by the surgeon, whose speedy presence is
requisite in every case of  the  accident in
question.   The best thing that can be done
until aid is procured, is to place the patient
as carefully as possible  in  the most easy
position, and to  keep  him  perfectly  quiet.
Any symptoms of inflammation  following
such an injury will require the usual treat-
ment of leeches, fomentations,  poultices,
&c, the bowels being acted  on by purga-
tives given by the mouth or in clysters, &c.
In patients confined  to bed after injuries of
the spine, bed-sores are  particularly to be
guarded against; moreover, if sensation be
much impaired, and the  case be neglected, a
sore may make considerable progress before
it is discovered.  Even  if a  case of injury
of the spine does well, it is apt to be tedious,
and the lost  powers are very slowly re-
gained. Friction repeated frequently, warm
saline bathing,  the douche, and gentle exer-
cise of the  limbs, are  the  most beneficial
remedies.   Displacement  of vertebrae  can
rarely take place without extreme violence,
and, even then, fracture generally accom-
panies the  accident, except in the case of
the upper vertebrae of the neck, alluded to
in the last article.  Displacement is accom-
panied to a greater or less extent by injury
to  the  spinal  cord, and  consequently  by
paralysis of the parts below: if the injury
is high up, instant, or at least speedy death
being the result.  In the event of an indivi-
dual surviving, for a longer or shorter time,
such an accident, all that others can do, till
proper  assistance is procured, will  be to
place the person in an easy posture, to admi-
nister stimuli with due  caution, and to en-
deavour to preserve  the proper heat of the
paralyzed parts by friction and warm  appli-
cations, bearing in mind the cautions given
under article "Paralysis."
  The spine  is liable  to various diseases,
such as inflammation, apoplexy of the cord,
softening, &c, the latter being not an unfre-
quent concomitant of epilepsy.  Pain in the
part, and disorders of the functions of sen-
sation and motion, and convulsive twitching, 
S PI
502
S PI
ore the most usual symptoms.  It is not pos-
sible, that beyond temporary soothing mea-
sures,  such as bran poultices, &c, unpro-
fessional interference in such cases can be
usefully employed.  In cases of severe pain,
however,  opiates may  be cautiously given
till a medical man sees the case.   In some
forms of fever, and of lock-jaw, the spine is
affected.    Functional  disorder,  and what
is  called " irritation of the  spine," are ex-
tremely common, especially  in females,  and
are often at the root of the obstinate palpi-
tations, and many of the nervous  and hys-
terical derangements of  the sex.   In  such
cases,  if the back  be  carefully examined,
a tender spot may  generally  be discovered
Bomewhere  in  the upper part of the spine,
and  often,  when there is  more   than  one
tender spot, lower  down.   In these situa-
tions, the spine may be simply  tender on
pressure,  or pressure  may  cause pain  to
radiate as it were from the point, round the
body,  or, in severe cases,  may  bring  on
hysterical symptoms at once,  and fainting.
Such cases are frequently overlooked.  They
are generally connected with debility of con-
stitution, and require the well directed treat-
ment of a medical attendant. The  useof the
tepid or cold douche down the spine, followed
by friction with a rough towel or flesh-brush,
does much  to  relieve  in  such cases, often
more than counter-irritation.  The general
health requires attention,  and, generally,
tonics, quinine and iron, are called  for.
Exercise must be regular, but not carried
to fatigue, which is injurious.   In severe
cases, repeated small blisters are sometimes
useful.
  Curvature of the spine is  far from being
uncommon.   It  is  of  three varieties—the
angular curvature,  lateral  curvature,  and
curvature backward.   The  first   of these,
angular  curvature,  is caused by disease
(caries) of the bodies of  some of  the verte-
brae themselves, which, permitting the bone
to yield under the weight of the body, causes
angular distortion at the seat of  the affec-
tion.   This disease, being sometimes at first
accompanied with little pain,  may be over-
looked.  It  usually  occurs in  children,  and
in young people of delicate, and especially
of scrofulous,  constitution.  Matter forms in
connection with the diseased bone, and gra-
vitating  downward, shows itself as abscess
lower  down, perhaps in  the loins or groin.
The  first  symptoms of this  disease may be
the child  wincing or crying out from  sud-
den pain  in some movement  of the spine.
If allowed to go on unchecked, very great
deformity ensues, and the constitution is at
(ength worn  out.  The  great essential of
treatment in this form of curvnture, is rest,
in such a position as will take  the  pressure
off the  diseased  bones ;  this being best ef-
fected by the use of the  inclined plane, the
patient lying either  on  the back  or  face;
but this,  and the local  and constitutional
treatment,  can only be  properly conducted
under medical superintendence.
   Lateral curvature is not, like the above,
the result of disease, but is the mechanical
effect of repeated and continual malposition
of the body.  It  is the form of spinal  curv-
ature from which nurse-girls  who are put
at too early an age to carry heavy  children
frequently suffer.  It is also the  affection met
with among the pupils of injudiciously con-
ducted  female schools.   It of course is most
liable to occur in weakly subjects  but may
take place in any young  person who is com-
pelled,  habitually, to  maintain the  body,
even  without additional weight, in one po-
sition  for  any length of time,  (see Educa-
tion,) and especially if compelled to support
a  weight  on,  or  to make undue  exertion
with,  any one side of  the  body.  The first
thing, generally,  which attracts attention in
this form of curvature, is the appearance of
the shoulder, which assumes the prominence
popularly known  as "growingout;" that is,
it  evinces the displacement from its symme-
trical position, which it, in common with
the ribs, experiences from the  curvature of
the spine.    If the incipient curvature  be
neglected, as a matter of necessity for the
support of  the head  in an upright  posture,
a  second curvature takes place in a direc-
tion opposite to the first, giving the  spine
the curves  laterally in the form indicated,
(fig. exxvii.,) and distorting the body as re-
presented.   The  causes  of the above  com-
mon deformity which have been pointed out,
naturally indicate  that  the first   step to-
ward  cure must  be the removal of  the pro-
ducing cause. If  a weight has been carried,
if  exertion made,  if injudicious school ma-
nagement,  such as too  long-continued sit-
ting or standing upright, has occasioned the
deformity, it must be put a stop to at once.
Such  a course, with general tonic measures,
rest of the body for a considerable portion
of the day,  equal exercise of  the  muscles
connected with the tipper extremities, and
cold or tepid salt  douche, with regular gene-
ral exercise, will  probably remove the tend-
ency  to curvature in  incipient cases.  If,
however, deformity has made any progress,
other and probably mechanic 1 means will
be  required for  its   removal,  which can
only  be properly  employed under  medical
direction.
   The curvature  of the  spine  from  before 
SPI
503
S PR
Fig. cxxvii.
 backward occurs in weakly children, and
 constitutes the "stoop," or round-shoulder
 of the young.   It is usually connected with
 general debility of constitution,  which re-
 quires  to be  corrected  by the  ordinary
 means; the  local  deformity being relieved
 by the horizontal posture, by the  moderate
 use of "a back-board" when the patient is
 of sufficient age, and by the douche, fric-
 tion, &c.
  Refer to Education, Sec.
  SPIRITS, LOW.—See Hypochondriasis
 —Indigestion.
  SPIRITS. —See Stimulants—Brandt-
 Gin, &c.
  SPITTING  of  BLOOD.—See  Hemor-
 rhage—Lungs, &c.
  SPLEEN,  or  MILT—Is a body of vari-
 able size, which  is  situated in the left hypo-
 chondriac region. — See  Abdomen.   It  is
 somewhat of a spongy texture, and is capa-
 ble of containing blood  so largely that its
 office  in the economy (which  even now is
 not yet clearly made out) has been supposed
 to be that of a blood reservoir.  Recent in-
 vestigations  point  to its close  connection
 with the condition  of the  blood corpuscles.
 The spleen  is  liable to  become  greatly
 enlarged in  cases of continued ague.—See
 Ague—[Ague-Cake.]
  SPLINT.—See Fractures.
  SPONGE.—This well-known production
 of the animal  kingdom  is chiefly brought
 from Turkey.  The great uses of sponge in
 medical,  and  especially  surgical  matters,
 need not be dwelt on  here.  Suffice it to
 remark, that sponge selected for such pur-
poses should be free from  the gritty parti-
   cles which are often present in considerabl*
   quantity in inferior sponges.  Burnt sponge
   was formerly the best remedy in cases of
   "bronchocele."  It is now known that its
   power of removing that disease  depended
   on the presence  of iodine.—See Iodine—
   Bronchocele, Sec.
     SPONGIO-PILINE.—See Poultice.
     SPORADIC DISEASES.—Diseases which
   show  themselves  in  individual  cases, in
   contradistinction to epidemic and contagious
   diseases.
     SPRAIN, or  STRAIN.—This painful in-
  jury is the result of forcible overstretching
   of the ligaments (see Ligaments) of a joint.
   In their natural state, the ligaments are but
   slightly sensitive,  but when  overstretched
   they are acutely so. There are few, perhaps,
   who have not, in a greater or less degree,
   experienced the sickening pain of a sprained
   wrist or ankle, the two joints which are most
   frequently the seat of the injury ;  their lia-
   bility arisingfromtheirimmobility,compared
I  with such a joint as the shoulder, which is
r more liable to dislocation. Asprainisattend-
1 ed with pain, which, perhaps,  causes faint-
- ness or vomiting. When this passes off, it is
r found  that the joint cannot be employed as
I usual, every attempt renewing  the suffering.
; Shortly afterward swelling conies on, follow-
3 ed by the heat and pain of inflammation.  An
- injury of this kind, it need  hardly be said,
  should not be slighted; for,  should it be so,
  in some constitutions it may lay the founda-
3 tion of irremediable disease. Few, perhaps,
  have either the power or the will to neglect
- a strain at first,  but very many are inclined
  to rebel  against the rest and confinement
- necessary for its perfect cure,  which ought
  to be effected before the joint is brought into
-  active  use.   When  a sprain has occurred,
- complete rest is  the first necessity, accom-
3 panied by the soothing influences  of  fo-
- mentation and poultice, well and thoroughly
i made use of, from the very first—the early
3 employment of the remedies doing much to
1 alleviate the suffering. When,  in the course
- of a few hours, inflammatory signs appear,
l six,  eight, or  ten leeches may be applied
. around the joint with advantage, and if the
r patient is of at all full habit, a few doses of
; purgative medicine  should  be given.   To
  allay the pain, six or eight grains of Dover's
  powder, with a couple of grains of calomel,
1 may be given at night, and followed  in  the
t morning  by a  Seidlitz  powder,  or some
i other purgative.   After the joint has been
, soothed for  some days by rest, with poul
i tices and fomentations, it will be advisable
■ to  change these applications for a bandage,
  which  is  to be kept wet with  tepid water, 
SPR
504
SQU
lightly applied to the injured part, which, if
agreeable to the feelings of the patient, may
be  enveloped  in  some warm  material.   In
uuch injuries, regulation of the temperature,
the employment of heat or cold in the treat-
ment,  is always  best  ruled by the feelings
of the patient.   In some few cases, even
from the beginning, cold lotions, such as the
lead or the spirit lotion, &c, are found most
soothing, and  then  it  is right to use them,
at least  as long as they prove agreeable;
but more frequently warmth, with moisture,
is preferred and preferable.  The bandage at
first applied lightly, may gradually be used
to exert  more pressure, and  to give more
support, and the  tepid applications may be
exchanged for old ones.  As soon as  it can
be  borne, friction night and morning, with
the soap liniment or soap and  opium lini-
ment, will be found agreeable and  service-
able.   Lastly, instead  of  the  morning rub-
bing, the cold-water douche  (the pump  is
a common and very  good  form)  must be
used to give strength and  tone.  For the
latter  purpose salt-water or sea-water  is
perhaps preferable to  fresh.   Whichever is
employed, it ought to be continued till the
joint aches slightly, the after reaction being
promoted  by  rubbing  well with a  towel.
It is repeated, too great caution cannot  be
used in bringing  a joint, which has been
sprained, into  use, and  especially if the sub-
ject of the accident is  at all of a scrofulous
habit.  Although the treatment of a sprain
is perhaps neither difficult nor complicated,
the discrimination  of  the accident in the
first instance  is  sometimes  by no  means
easy even  to  a surgeon ;  for when  much
swelling  has supervened, and when  every
slight  movement is torture  to a patient,
there is much difficulty in coming to a de-
cision  respecting the  exact  nature of the
injury,  and  in deciding  whether  or  not
the sprain is complicated with more or less
fracture or displacement.   On this account
it is desirable  that these accidents should be
early examined by a medical man ;  for it is
too late,  after weeks of poulticing, nnd
bandaging, and rubbing, *to  find  out that
the so-called sprain  is a fracture  or dislo-
cation.  The swelling  of a sprain is  some-
times colourless,  but more  generally it is
coloured  from  the  effusion of blood  under
the skin.   As  this is gradually absorbed in
the process of cure,  the variation from
" black and blue ' to greenish and to yellow,
&o. takes place.
  SPRUCE-BEER—Is  a  drink  made from
molasses or sugar  fermented  in  water, and
qualified by the extract from the spruce-fir;
the saccharine matter,  in fact, answering to
the mnlt, nnd the spruce extract to the hop of
common  beer.   Spruce-beer, when brisk in
bottle, is  not unpleasant, and  is highly es-
teemed among some of the Northern nations
ns a preventive of scurvy and other diseases.
It probably owes  any active properties to
the presence of turpentine.
   SQUILL.—This drug  is  the produce of
the Scilla or  Squilla  maritima;  the bulb,
which weighs generally  from one to three
or four pounds, being the part used.   It is
chiefly brought from the  shores of the Medi-
terranean.
   Squill is  met with  in the shops in the
form  of  yellowish, white, semi-transparent
pieces, made by slicing the bulb, and then
drying  the  slices.   While  perfectly dry,
squill should be brittle, but from the readi-
ness with which it attracts moisture, it is
very often met with not quite dry, and rather
tough.
   Squill is popularly  known and used  as
an expectorant medicine, and when properly
employed it  is invaluable;  too often it is
improperly  given, and  does  mischief.  It
also acts as  a diuretic, and may cause sick-
ness or purging, in large doses.  As an ex-
pectorant, squill is irritant  and stimulant;
it is therefore   inadmissible  when any thing
like inflammatory  action  or  active irritation
is going on in  the bronchi or air passages;
in such cases it aggravates cough, instead
of relieving.   As  an expectorant, squill is
most  serviceable in cases of chronic  bron-
chitis, especially in the aged ; but indeed in
all cases when the phlegm or mucus is tough,
viscid, and  separates  with difficulty from
the air-passages,  causing long and  severe
paroxysms of  cough  before it can be ex-
pelled.   Squill  is most advantageously com-
bined with opium; the latter drug does not
seem  to  impair its expectorant properties,
while it modifies  its tendency to irritate.
From one to two drachms of paregoric, with
twenty drops of tincture of squills, in a wine-
glassful of water, forms a most excellent
cough draught  for night; to which, if there
is much debility, there may be added  one
drachm of sal-volatile.  For diuretic pur«
poses, squill is most generally given in pow-
der, in from one to  three grain doses,  and
usually in combination.  It is  not adapted
for domestic use with  this view.
   Squill-vinegar is a  frequently used pre-
paration,  made by macerating two and  a
half ounces of sliced squill-root in a pint of
distilled  vinegar for a week.  After  strain-
ing and squeezing, an  ounce and a half of
proof spirit is added to insure keeping, and
the whole is filtered.   The syrup of squills
is made by  dissolving  three  and a half 
SQU
505
ST A
pounds of refined sugar  in  a pint of squill
vinegar, by the aid of gentle heat.   Its dose
is from  one  to  two drachms.  Squill  in
powder is better purchased ready prepared;
it requires to be very carefully  secured in a
well-stopped bottle, and to be kept in a dry
place ; otherwise it quickly becomes useless
from damp.  The common squill pill is often
used, but  in  many cases  irritates and in-
creases  cough instead of relieving.   The
author has found  the expectorant  pill, for
which a prescription is given under article
"Pill,"  much more generally useful.   In
dropsy of the abdomen, a  liniment composed
of two parts of soap-liniment, and one part
of tincture of squills, rubbed into the  skin
to the extent of two drachms, twice or thrice
in1 the twenty-four hours, is said to be ser-
viceable.
  Refer to Expectorants.
  SQUINT.—This  unpleasant defect, when
permanent, arises from contraction or per-
manent shortening of one of the "straight"
muscles of  the  eyeball. —  See Eye.   The
squint may be congenital, or at least  may
appear very shortly after birth.  In many in-
stances, however, it dates  from teething,
especially if that phase  of  infant life has
been accompanied with any tendency to con-
vulsions ;  it may also arise  from irritation
in the intestines, caused either by worms  or
by indigestible food.   Indeed, in some chil-
dren, the  first and  invariable  symptom  of
their becoming disordered is the occurrence
of squinting.   In some cases squinting ap-
pears simply to be the result of bad habits.
Squinting comes on in some of the stages,
especially  the  latter  ones, of disease of the
brain, such as acute  water in the head.
  If squinting in a child is suspected  to
arise from  irritation  in the  stomach  or
bowels, or from any  cause, such as that of
teething, the primary occasion of the dis-
order is of course to be  removed as far as
possible.   When no such origin is assignable,
and when  the defect, whether temporary or
permanent, appears to be  the result of habit.
the best corrective,  probably,  is to  cover
over the unaffected eye for a certain period
every day, so  that the child in using the
other shall be compelled  by an exertion, if
it possibly can be done, to direct it into the
proper axis of vision,  from which, in the
case of a  squint, it  is thrown  out.  When
squinting  remains as a permanent defect,
the only effectual remedy is the operation
which some years ago was so much in vogue,
and  so indiscriminately  performed.   This
operation consists simply in cutting through
the  muscle,  the  contracted condition  of
which occasions the squint.  No sooner is
        2»S
it perfectly  divided, than,  in  a successful
case, the  other  muscles at  once draw the
eye to, and retain it in, the right direction
—the divided muscle in the course of a short
time  contracting  adhesion to the  eyeball
farther  back than its original  attachment,
and  so  restoring and maintaining the ba-
lance of action.  The operation is in  itself a
trifling  one,  but is   not  successful  in all
cases; in some it has happened  that the
muscle antagonistic  to the  one divided in
the operation acts  too  strongly, drawing
the eye as much in one direction as  it  had
before inclined to the other; other cases,
although apparently  cured  for a time, are
again apt to relapse to their former condi-
tion.  Still, even with these drawbacks, the
operation  relieves  many from an unsightly
and  annoying defect, and as it  always re-
quires the aid of a surgeon for its perform-
ance, he must decide as  to the probability
of its affording prospect of permanent cure.
Squinting is  generally  inward toward the
nose, being caused by contraction of the in-
ternal straight muscle ;  it may, however, be
either outward or upward, if  the correspond-
ing muscles are affected.
  Refer to Vision.
  STAB.—See Wounds.
  STAMMERING.—See Speech.
  STARCH.—See Fecula.
  STARVATION. — Deprivation  of  food,
either total  or  partial.   Under  article
" Food" it has been pointed out that nou-
rishment is, or ought to have reference in its
composition  to two distinct  ends—the  nou-
rishment of the bodily tissues, and the main-
tenance of animal  temperature; moreover,
in the above and other articles—" Debility,"
&c.—it has been shown, that to the latter—
the  support  of the heat  of the body—all
other considerations must give way; for that,
fuel  must be found,  and  if it  be not fur-
nished by periodical  supplies of food, it will
be taken from the component tissues of the
body as long  as these are capable of  afford-
ing  it.  Every inspiration  of the starving
man  imparts to his blood the oxygen which
is to be hurried to  the consumption of his
wasted  and momentarily wasting tissues;
every expiration gives out the carbonic acid
and vapour, the smoke of the furnace  within,
which, like a steamer at sea run short of
coal, is forced to consume its internal frame-
work, in the effort to carry the hull to the
haven of  safety.  The animal temperature
must be  maintained, or the  person dies;
hour by hour, tissue after tissue is used up
for  this  end, (see Animal Heat, Sec.,)  and
hour by hour the slow wasting of  starva-
tion  goes on, till either relief comes in thf 
ST  A
506
S T A
 shape of nourishment,  or  the last  avail-
 able  tissues have  been exhausted, and the
 person dies, chiefly of cold.  The fat, in the
 above process,  goe«  first—its  oxygen  and
 hydrogen furnish the readiest fuel, the most
 easily burned material; the muscles next
 yield and become  soft and  wasted,  the
 nervous  system falls before the pressure of
 necessity, and  with it mental power; deli-
 rium ensues, and  the vital power of  resist-
 ing the ordinary processes of decay is lost.
  A little consideration of the above  will
 show that the  process of starvation must
 be modified by various contingent circum-
 stances, more particularly the  condition of
 the body as regards fat, &c.  This internal
 supply of fuel, so to speak—were the  simple
 chemical  changes incurred in  maintaining
 heat only to be  considered—would make the
 fattest man the best resistant to, and longest
 liver  under  circumstances  of starvation.
 This, however,  will scarcely hold good, for
 there seems to be a power  of endurance in
 the constitution (in the nervous system—
 of some) apparently a less susceptibility in
 the tissues to give  way, that enables them
 to withstand a  greater extent  of privation
 than those who, according to the chemical
 theory alone, ought  to last  the longest.
 Again,  external  temperature   influences
 greatly the effects  of privation of food upon
 man.   As shown under article " Cold" and
 elsewhere, a man exposed to low temperature
requires food, not only more abundantly, but
 of a  more nutrient character,  to preserve
 him in health, than an individual surrounded
 by and breathing  a warm atmosphere.  It
 follows, therefore,  that a man  exposed to
 cold, breathing a cold air, and especially if
 ill-clad, will be much more quickly starved
 to death  than  under the  reverse circum-
 stances.  The above observations, especially
if taken in connection with the  articles re-
ferr*>d to, must  make it clear that starvation
ip in  fact, the chemical union  of the com-
ponent particles of the tissues  of the ani-
mal body with the oxygen of the atmosphere
 carried through that body by the blood, and
 that the process is accelerated  by whatever
 increases the amount of oxygen taken in by
 the lungs, whether  it be cold,  which gives
 a greater amount of oxygen in  a given vo-
 lume  of the atmosphere, or exercise,  which
 increases the rapidity  of.the   respiratory
 process, and at the same time the consump-
 tion  of the muscular particles  in the per-
 formance of motion.—See Motor Change.
  Happily, cases of starvation  from  actual
 inability  to procure food are not frequent
 in this country; but medical men often wit-
 ness an approach to a state of starvation in
the progress of diseases, of fever especially,
when patients lie for a great length of time
without t iking food. In such cases it occurs,
that at list the patient is actually in dan-
ger of perishing from  starvation, or  rather
from cold;  the  animal temperature  begins
to sink in  consequence of the  fuel  tissues
of the  frame  being all used  up.   Much,
indeed, may be  done to ward off this condi-
tion  by the employment of  strong broths,
and  of gelatinous materials, which,  by en-
tering the blood, furnish materials for heat-
ing,  and so protect the tissues.  But, after
a certain point, these are insufficient, and
nothing  but alcohol will  do;  nothing but
spirit, with its ready  combustible carbon
and hydrogen, will give a  chance of  life to
"him  who  is  ready to  perish" from the
starvation of disease.
  Starvation has  to be  viewed  as  it takes
place under total  deprivation  of food, and
as it occurs under  an inadequate supply.
In the first of  these, "there  is  pain  at the
stomach, relieved  by pressure,  the counte-
nance is pale and  cadaverous, the eyes wild
and  glistening,  the  breath hot,  the  mouth
parched and dry,  and  the  strength is pros-
trated.   After  a  time  the body exhales a
foetid odour, the mucous membranes  at the
outlets  inflame, and life closes  in  delirium
or convulsions."*
  In that gradual starvation produced by
deficiency of food,  the symptoms seem to be
chiefly referable to depression of the nervous
system, both  the  ordinary  sensations and
mental  powers  being  in  some  respects
blunted, although  at the same time nervous
irritability is  present, and perhaps mental
disorder.  Dr. B.  Holland, who has written
on the subject, thus  describes the condition
resulting from continued deficiency of food:
"The  state is  indicated by a  sallow and
dingy appearance of the  skin,  a  soft and
flabby feeling of the  flesh, more or less ema-
ciation, general  debility, feebleness  of the
circulation,  and  swelling of the ankles.  The
stomach becomes  disordered, the  appetite
defective, the digestion impaired. The imli-*
vidual feels  languid  and desponding, is soon
fatigued, incapable of exertion, and  has an
irresistible disposition to  fall asleep, from
which he is  apt  to wake suddenly and in a
fright.  The body is easily chilled, breath-
lessness  and  palpitation  are  experienced
after  slight  exertion, attacks of giddiness,
noise in the ears, and transient blindness
are common, and there  is a peculiar forlorn
and  dejected aspect of countenance  which
is very characteristic."   The above  symp-
Taylor's Juritprudenct. 
ST A
507
STI
 toms in  a  severe form  occur in  those who
 are so unfortunately placed as actually to
 want bread; in a minor form they are met
 with in  those  who for  some reason accus-
 tom themselves to  take too  little  nourish-
 ment, either as regards quantity or quality.
   When total  deprivation of food has ex-
 tended even  to  twenty-four hours—when
 partial deprivation has gone so  far as  to
 produce pain at $he  stomach,  and marked
 debility—return to  a proper  supply of nou-
 rishing food  must be  very gradual.  The
 stomach and its sources of nervous  stimula-
 tion partake of the general depression, and
 are no more fit for much exertion than the
 rest of the body; consequently,  food must
 be given in small  quantity,  and  in such  a
 form as will most easily enter  the  circula-
 tion, such as good broths along with a small
 proportion of alcoholic stimulant,  very care-
 fully given, and warmed.  When partial starv-
 ation or continued deficiency  of food has
 been in operation for some time, it lays the
 individual  open to  the  attack  of epidemic
 and endemic disease,  and, indeed, seems  to
 be the exciting cause of disease, as observed
 in  the  "Irish fever,"  which followed the
 famine.
   STAYS.—See Education.
   STEAM.—See Heat—Inhalation—Poul-
 tice, &c.
   STEEL.—See Iron
   STERNUM.—The breast-bone  to which
 the collar-bones and ribs are  attached ante-
 riorly.—See Chest—Ribs, Sec.  It consists of
 three separate pieces.
   STERTOR, or Stertorous Breathing—
 Is very similar to snoring, lt occurs in apo-
 plexy, and  on the approach  of death from
 other diseases.
   STETHOSCOPE.—See Auscultation.
   STEWING—Which is  the slow cooking of
 food by heat which  does not reach t.e boil-
 ing point, renders  meat peculiarly digest-
 ible;  and,  moreover,  as  the juice of the
 meat, or gravy, is most usually eaten with
 the meat, the whole nutriment is preserved.
 Stewing may, of course, be  rendered inju-
 rious to  some invalids  by the  addition of
 much fatty matter, or  by that of vegetables.
  STICKING PLASTER—Also called  Ad-
 hesive or Diachylon  Plaster.—See Dress-
 ing—Plaster, Sec.
  STIFF-JOINT.—See Anchylosis.
  STILL-BORN.— See  Child bed— Chil-
dren, &c.
  STIMULANTS,  GENERAL.  — See  Ex-
citement and Excitants.
  STIMULANTS,  ALCOHOLIC—Temper-
ance  and  Total Abstinence—Intemper-
ance
   Alcoholic stimulants are classed  as  fer-
 mented and distilled.  The  principal  fer-
 mented liquors  in use in this  country  are
 grape wines—domestic or home-made wines
 —liquors  from the fermented juice  of  the
 apple or pear, cider and perry; and malt li-
 quors from various grains, principally barley.
 To these might be added many more made and
 used  among different nations, according to
 the materials within their reach.  Distilled
 liquors  are not less  numerous than  the
 fermented, for man in every quarter of the
 globe has  taxed  his ingenuity, and generally
 with  success,  to find  the means for their
 manufacture.   The  distilled liquors most
 commonly used  in  England  are brandy,
 whisky, gin, and rum, or preparations from
 these : but, like the fermented liquors, many
 other alcoholic  products of distillation  are
 used  in different countries,  according  aav
 their natural  products offer  facilities  for?
 their formation.   Distilled liquors contain a
 much larger proportion of alcohol than those
 which are simply fermented;  indeed, alco-
 hol and water make up their constitution,
 the  peculiar  flavour  of  each  depending
 chiefly on  the essential oils, or  ethers,  de-
 rived from  the materials  from which they
 are distilled.  As the special characters of
 the various  alcoholic liquors in use are  en-
 tered into  under their separate articles,  the
 following  observations are directed  to  the
 action of   alcoholic  stimulants, generally,
 upon man, and to their employment by him—
 their "use and abuse."  Pure alcohol itself
 (see Alcohol) is ranked among the narcotico-
 acrid poisons.  If a large quantity of strong
 spirit, or  of alcohol, be quickly taken into
 the stomach, it may cause immediate  death ;
 indeed, many deaths from this cause  are on
 record,  and are frequently noticed  in  the
 public prints,  as the  result of  foolish  at-
 tempts to  drink a large  amount of  strong
 liquor in a  given time.  If, in  such  cases,
 death does  not   immediately  ensue, total
 insensibility generally supervenes, lasting
 for a longer or  shorter time, either  termi-
 nating in recovery, or passing into apoplec-
 tic stupor.   In these cases of poisoning,  the
 alcohol undoubtedly acts in the first instance
 by giving  a shock to  the nervous system
 through the stomach, similar to that  which
is  produced by  a blow on the  pit  of  the
 stomach,  or by  a draught of  cold  water
taken by a  person in a state  of heat and
exhaustion.   And, secondly,  it  acts upon
the system  generally, and  especially upon
the brain,  in consequence of its  absorption
into the circulation.  When this  absorption
occurs, it produces the phenomena observed
in  aggravated intoxication.  To  the'articl* 
STI
508
S Tl
 " Intoxication" the reader  is referred for
 further information. There  otin be no ques-
 tion that in the form  above stated, of con-
 centrated or of pure aloohol, this agent acts
 as a poison ; but  to deduce from this, as is
 frequently done, the assumption that under
 all forms, and in  any dilutions or combina-
 tions, alcohol is a poison, is  so illogical that
 it scarce deserves refutation.
  The effect  of  a moderate quantity  of
 diluted  spirit, or of wine or malt liquor, is
 very different from that of poisonous irri-
 tant doses of alcohol—as  different as the
 scorching flame is from gentle heat.   When
 a moderate quantity  of diluted alcoholic
 fluid, such as wine or malt  liquor, is swal-
 lowed by a person in health, there generally
 ensues a feeling of warmth  in and around
 the  stomach,  which  is gradually  diffused
  «rer the whole body, and is accompanied
  itha slight increase of muscular and nerv-
 ous  energy, the functions  generally  being
 more actively  performed, and the mental
 power increased.   Such may be called the
 salutary effects of a moderate quantity of
 the stimulant.  If the bounds of moderation
 be passed,  the stimulation is increased, the
 pulse quickened,  the cheek flushed,  and the
 mind excited in excess: if  the quantity of
 stimulant  is  still  further  increased,  " a
 degree of  torpor is induced,  both mental
 and bodily ; perception is blunted, there is
 a general languor, giddiness, and obscurity
 of vision, incoherence of ideas, and incapa-
bility of  exercising volition ; the  person is
 " drunk," and either sinks  into a state of
 somnolence—half sleep, half stupor—or, by
 becoming sick  and vomiting,  recovers hh
 senses quickly, sometimes  at once.   The
 amount of stimulation caused by alcoholic
 fluids varies, of  course, according  to the
strength  of the dose, but also in some de-
 gree according to the  habits of  the indivi-
dual : for there is  no question that those who
habitually  drink  strong wines or  spirits,
 derive little if any stimulation  from the
weaker  alcoholic  drinks;  moreover,  some
conditions of the system modify greatly the
stimulant power  of alcohol.   In spasm,  in
fainting,  in depressed  states of the system,
from fever or other such  causes,  persons
 often take, with scarcely perceptible effect,
 doses of wine or spirit which at other times
 would put them in a state of intense intoxi-
cation.  Although,  however, habit  enables
individuals to consume alcoholic drinks  in
greater quantity,  and  of greater strength,
it by no means follows that  this  is done
 with impunity; if excess is habitually in-
dulged in, the mucous membrane  of the J
(tomach becomes  diseased; ae  the effect  of
 a continued low state of inflammation, and
 even the other coats of the  organ undergo
 changes of structure and indurations, which
 occasionally degenerate into  cancer;  at the
 same time the muscular and nervous sys-
 tems, and  the secreting organs generally,
 especially the liver and kidneys, are apt to
 suffer seriously.
  There can  be no doubt that most of the
 effects of  alcoholic excitement, intoxication
 and stupefaction,  depend  upon  absorption
 of the fluid into the  blood, this having been
 found to take place very  rapidly;  that is
 to say,  the  alcohol  passes as alcohol into
 the blood, and circulates as  alcohol  in the
 vital fluid till it is got  rid of by the usual
 processes of chemical change and of excre-
 tion.    During this  oitoulation, the  most
 evident effects of alcohol are exerted in the
 nervous system ; nor can this be matter of
 surprise, considering that after death from
 drinking  spirit—gin—largely,  there has
 been found  within  the  brain  "a quantity
 of limpid  fluid distinctly impregnated with
 gin, both to the sense  of smell and  taste,
 and even to  the  test  of inflammability."
 Moreover, there appears to be some special
 relation existing between the nerve tissues
 and alcohol.
  With  regard to the effect of alcohol upon
 the blood, it  is unnecessary here to detail
 the various observations which have  been
 made.   One thing, however,  appears to be
 well confirmed, which is, that the  effect of
 intermixture of  alcohol tends to  keep up a
 venous  condition  (see  Aeration—Blood)  of
 the circulating fluid  for  a considerable time.
 According to Dr. Prout,  after taking alcohol
the excretion  of  carbonic  acid  from  the
lungs is at first diminished; languor, yawn-
ing, and drowsiness  being the consequence.
There can be no doubt that the above effect
of alcohol is in great measure owing to the
elements of the  spirit combining with oxy-
gen in  the body, and that its carbon and
hydrogen  are  given  ofl* ultimately as car-
bonic acid and water.   " The oxygen, which
has accomplished  this  change must have
been taken from the arterial  blood; for we
know of no channel, save the circulation of
the blood, by  which oxygen  can penetrate
into the interior of the body."   " The oxy-
gen thus abstracted  from the arterial blood
to combine  with the elements  of alcohol,
would,  under   other circumstances,  have
combined  with the atoms  of the muscular
and other tissues,  giving  rise to develop-
ment of muscular force;  consequently, in
this way,  muscular power is rather dimi-
nished;  there is languor.   This statement
may seem at  variance with a  former one, 
S T I                509                 S T 1
 that alcoholic stimulants  give  rise to in-
 creased muscular energy.   Both statements
 are true—it  is  circumstances only which
 alter the effects.  This is proved by practi-
 cal experience, thus:—If an individual in
 good health, making active exertion in the
 open air, especially if it be  cold, or  if he
 be perspiring freely in warm  air, consumes
 a moderate quantity of alcoholic  fluid, he
 experiences the excitant effect; that is to
 say, the  special  stimulation of the alcohol
 upon the nervous  system  is experienced;
 but the activity of both the respiratory and
 circulating  systems, and the consequent in-
 creased  supply of oxygen  throughout  the
 body generally,  counteract  the chemical
 effect of the spirit elements on the blood—
 they do not permit the venous state above
 alluded  to  to be  formed.   On  the other
 hand,  if a person keeping  quiet in  the
 house,  especially if the air  be  warm, and
 ventilation deficient, takes but a small pro-
 portion of alcoholic fluid, how quickly does
 he become  languid,  sleepy,  and unfit  for
 exertion, either mental or bodily!   In this
 case, even  without  alcohol,  the  circum-
 stances  were  such as  to  favour carbonic
 accumulation   in  the  blood,  and  with  it
 muscular inactivity and mental  hebetude;
 it is, therefore, much more likely that these
 symptoms will occur when the alcoholic in-
 fluence  is added.  A clear understanding
 of the foregoing remarks will explain much
 of the usual effects of alcoholic fluid,  ob-
 served  either in one's own  person, or in
 that of others.   It is only necessary to keep
 in mind, that  the first  effects are  those of
 special  excitement of  the  nervous system,
 giving increased  activity through that sys-
 tem to  every  function of the living body;
 but  that  this  special excitement is apt to
 be interfered with by the chemical effect  ex-
 erted by the elements of the  spirit on  the
 blood as above described, more or less,  ac-
 cording as  circumstances facilitate or not
 the  introduction  of oxygen into the  vital
 fluid, and its  transmission  throughout  the
 frame.  Here  attention may be drawn, as it
 has  in other articles in this  work, to the
 importance of this substitution of the alco-
 holic elements for those of the  bodily tissues
 in exhausted states of the frame, as in fever,
 &c, (see Starvation,) the animal temperature
 being maintained by the artificial  " alcoholic
 fuel," so to speak, when the ordinary tissues
 are exhausted.
  The less palpable effects exerted  by alco-
jiol upon  men who work out of doors,  than
upon those whose employment is of a more
confining nature, probably influences in some
degree the statistics of its consumption, and
          2  s 2
 for this reason Dr. Guy states, "that  men
 who work out of doors are more  nddicted
 to  drinking  than  men who are  employed
 within  doors."   If the palpable general
 effects are not so great in  the former as in
 the latter, it,  however, by  no  means holds
 good  that excess may not  give rise to an
 equal amount of local injury to the digestive
 and other organs.
  The effect of  alcoholic  fluids upon the
 digestive  organs  and their functions  has
 been  the  subject  of much  discussion  and
 observation.   In  the  case  of  St. Martin,
 (see Digestion,) Dr. Beaumont observed  that
 even under the stimulation of ordinary food,
 but  in  greatly increased intensity if extra
 stimuli were taken, "the colour of the lining
 membrane of the  stomach changed from a
 pale pink to a deep red."  The actual effects
 of alcohol upon the digestive functions pro-.
 bably vary according  to the amount  and
 strength of the fluid taken, and upon the
 habits of  the individual.  That immoderate
 closes of strong wine or spirit interfere with
 digestion is, perhaps, correct; but  that the
 moderate   employment of  alcoholic  beve-
 rages with their meals  is requisite to enable
 many persons to digest their food properly,
 is perfectly certain, and in accordance with
 the experience of  medical men generally.—
 See Digestion.  The requirement may not,
 perhaps, be  that of a person  in  the  full
 vigour of  health,  and placed in healthy cir-
 cumstances ;  it is, however, one which we
 find closely linked with the every-day life
 and constitution of a large  number of per-
 sons in  this civilized,  artificial  community
 of Britain: such  being the case, it is folly
 to ignore its existence.
  At  the  same time, although the  admissi-
 bility, and in many cases the necessity,  of a
 moderate  allowance of alcoholic beverage,
 is contended  for  as necessary to perfect
 digestion  under the circumstances named,
 it ought never to  be forgot  that the immo-
 derate use, the abuse of these stimuli exerts
 the  most  serious  effects upon organs with
 which they come so immediately in  contact.
 —the effects,  moreover, being  aggravated
 rather by the concentration  of the  spirit in
 the  fluid usually drunk, than by its  gross
 amount.   Ardent  spirits* drunk regularly
 to excess,  exemplify the baneful influence
most strikingly; the most usual consequences
being, as  already mentioned, a  low degree
 of inflammation of  the  stomach, followed
by thickening of its coats, and great impair-
ment of its digestive power ;  and along with
these, frequently,  hemorrhage  from  the
bowels.   The close connection  of the liver
with the stomach, both in situation,  func- 
ST1
510
ST I
tion, and vascular communicition,  renders j
it liable to be  affected equally with  the
latter organ, and, in fact, the liver-affection
of drunkards, the "gin-drinker's liver," (see
Liver,)  is matter  of  popular information.
This affection, moreover, is liable to be in-
creased by a  warm  climate, and  a most
remarkable  diminution in  the  occurrence
and fatality of liver complaints  among  the
troops in India, has been  proved, statistic-
ally, to follow the abridgment of  the allow-
ance of spirits.  Again, disease of the kid-
neys is a frequent consequence of the abuse
of alcoholic fluids, and with the  kidneys
the urinary organs are usually implicated.
The lungs, the  heart, the arterial system
generally, are  not exempt  from the evil
influence.   Sir James Clark remarks, "that
the abuse of spirituous liquors  among  the
lower classes in this  country is  productive
of tuberculous  disease (consumption) to an
extent far beyond what is usually imagined,"
and that not only is the tainted constitution
acquired by the individual,  but  that it is
transmitted with great certainty to the off-
spring.  Not only, however,  is the physical
effect transmitted, but the mental and moral
taint  are so likewise;  too often  there is an
inborn love  of  intemperance, which, if in-
dulged, adds  immensely  increased power
to the  physical  evil—the  drunken  child
of a  drunken  parent  is  generally much
the shortest lived of  the  two.   Moreover,
the child of a drunkard is very  apt to be
deficient in intellect,  and not improbably
idiotic.
  If the abuse of alcoholic liquors is injuri-
ous to the body, equally so is it to  the ma-
nifestations  and  tendencies  of  the mind.
Passing over the milder forms of excitement,
we find, under the influence of excess, that
faculty which  keeps the will subordinate to
the judgment weakened,  or  for the time
destroyed;  there  is  produced,  in  fact,  a
state of temporary insanity;  and  so close is
the rosemblance that, as   remarked by an
esteemed writer,*  there is simulated "the
raving delirium, the maudlin  sensibility and
groundless apprehensions of the melancholic,
the bloodthirstiness of the homicidal,  the
cunning desperation of the suicidal maniac ;
the prostration of the moral  feelings;  the
inflation of the  mind with delusions as  to
dignity, wealth, and knowledge ; and finally,
in the  last state  of  intoxication  may be
noticed the gradual disappearance of every
manifestation  of reason,  until the vacant
gaze and drivelling smile  have for  the mo-
ment  stamped  upon  the  countenance  the
* Dr. Robinson.
 fearful inanity of idiocy.   Since,  then,  a
 single  dose of an intoxicating  substance
 possesses the power of temporarily disorder-
 ing the intellect, perverting the moral senti-
 ments, nnd even  wholly suppressing  the
 operations of the mind, it is not wonderful
 that the continued use of such agents should
 frequently  induce  permanent  mental  de-
 rangement.  Continuance in that habit may
 occasion  this effect either directly or indi-
 rectly.  We possess no data by which to
 estimate  its  influence  in  predisposing  to
 insanity : we can, however, readily conceive
 that  it must  be very  considerable.  It is
 found that the minds of persons who have
 once laboured  under an attack  of mania,
 are ever afterward  more liable to excite-
 ment, and less capable  of preserving their
 equilibrium while  exposed  to disturbing
 influences,  than  those  which  have  never
 deviated from a healthy state. We have seen
 that  each  fit  of  intoxication is, in  fact,  a
 temporary attack of insanity.  We notice in
 every-day life  how frequently the intellects
 of habitual drunkards   become impaired;
 and,  knowing these things,  we cannot avoid
 the conclusion,  that  an excessive use  of
 intoxicating substances  will in time so en-
 feeble the mind as to render it incapable of
 bearing ordinary  sources  of disturbance,
 and thus  act  as a powerful predisposing
 cause of insanity."            r
   Dr. Joseph Williams  gives the following
 table as the proportion of cases of insanity
 caused by the  "abuse of spirits," admitted
 into various asylums :—
                          Total   Proportion
                          lulmis-  cnused hy in-
                          sions.   tempuranro
   Charenton...................   855 ......  184
   Bicetre and Snlpetriere.. 2012 ......  414
   Bordeaux....................   150......  20
   Turin,  18:10-31............   158 ......  17
   Turin,  1831-36............   300 ......  76
   Card .........................   209 ......    4
   United States..............   551  ......  14b'
   Palermo.....................   189 ......    9
   Caen..........................    t,0 ......  IG
   Dundee......................    II ......    4
   M. Parchappe..............   107 ......  4G
   M. Bottex...................   288......  54

                          5049 ......  940

   Dr. Robinson has drawn up a table, show-
 ing the proportion which intemperance bears
 to other causes of  insanity,  as  exhibited in
 the returns from  ninety-eight  asylums in
 England  and  Wales.   From  the table we
 find that intemperance  constitutes the im-
I mediate cause  of one seventh  of the cases
 contained  in  the  English  asylums.   Dr. 
ST I
511
S T I
Robinson, however,  considers  the  propor-
tion estimated much below the real amount,
which is marked by various  contingent  cir-
cumstances.  Accordingly another table is
given, drawn up from the returns of twenty-
five asylums.   From the second table we
learn  that one-fourth of the  cases of in-
sanity admitted are referred to intemperance
alone, and to it in conjunction with vice  and
Bensuality, nearly one-third.   It is further
remarked, that many of those cases entered
in the tables as unknown might be added to
the list.
   Were it needful, much additional evidence
on this point might be adduced.
   There is no  doubt, when habits of intem-
perance have reached a certain point, that
the unfortunate victim becomes partly in-
sane, at least so much so as to  become affected
with the  species of monomania to which
the term dipsomania has been applied.   Sir
Alexander Morrison describes it as a morbid
craving for  drink, which generally  occurs
at intervals, in which persons are seized
with an irresistible  propensity to drink to
excess, although conscious  at  the time of
their misconduct, but are unable to control
themselves.  Change of scene, confinement,
&c, effect a cure, but  relapses are very
likely to occur.
   In the  endeavour, however, to correct,
either the s.tate of dipsomania or to reform a
drinker, care must be taken  that the brain
be not affected, and mania  or  fatuity pro-
duced by  too  sudden a withdrawal  of  the
accustomed  stimulus.  Andral  relates  the
case of a man who,  being  thrown into prison
for theft, became, in the course of a fort-
night, perfectly delirious, and was only re-
stored  to  sanity by the  physician  allowing
him a  small proportion of  brandy daily.
The above might be regarded  as a case of
delirium  tremens;  but  the  boundary  line
between the latter disease and insanity is so
little defined, that it is difficult to say where
the one ends, or where the other begins.
   It is under the temporary insane excite-
ment produced by the abuse  of alcoholic li-
quor, whether purposely or accidentally, that
a large proportion of the petty, and many of
the most  fearful, crimes  are perpetrated by
man.   M. Quetelet,  in his chapter on  the
"Development of the propensity to crime,"
assigns to the excessive use of  intoxicating
drinks  the increase of crimes against pro-
perty  and person  in certain provinces of
France.   But we need not go  out of England
to find evidences of the effect of the insane
excitement of drink in stimulating to crime;
every newspaper, every prison  report, tells
the same  tale.   But, perhaps, the most con-
clusive evidence on this subject (indeed. w»
need no other) is the collection of opinions
expressed by many of our eminent judges
on this head,  who have publicly from  the
bench declared,  as their deliberate opinion,
individually, that drinking alone gave ori-
gin to by far the largest proportion of crimes
that  came before them for trial—crimes
from  which  the perpetrator would have
shrunk, but from the short-lived insanity
of intoxication.
  In considering the  effect of alcoholic sti-
muli upon the system, due  attention must
always be given to the form  in which they
are taken.  It is certain that ardent spirits
—which, it may be remarked, should never
be taken but as medicine-"—will exert a much
more irritating effect upon the nervous sys-
tem,  both  locally in the stomach  and  at
lr.rge, than  the fermented  liquors.  It is
well  ascertained that a certain amount of
wine exerts less intoxicating effect than the
spirit in the  same quantity of wine would
do, were  it separated  by  distillation  and
then diluted with water; and moreover, that
" different wines, although  containing  the
same  absolute proportion of spirit, will be
found to vary very considerably in their in-
toxicating powers."
  There is no doubt  that the lighter wines
of the  continent, those  which contain  no
more  spirit than is  yielded  by  the simple
fermentation  of the  grape-juice,  are  quite
the most wholesome, and that  the action
upon  the  system of  those  stronger wines,
such as port and sherry, to which spirit has
been added, must, in some degree, resemble
the action of  distilled or ardent spirits.   At
least  it has been proved that spirit artifi-
cially added to a wine is not united with it
in the same manner as the spirit  formed in
it by  the  natural process of fermentation,
which does not  yield above eight per cent.
In considering  the  action  of  the various
kinds of  wine,  however, the influence  of
habit must not  be lost sight of; for many
who are accustomed to the flse of the strong,
dry wines cannot change to the lighter and
more  acescent kinds, such as the hocks, &c,
without risk of inducing disordered diges-
tion, a tendency to gravel, and other similar
complaints, which, however,  does not  pre-
vail among those who regularly make use of
these wines.  The  brisk sparkling wines
affect the nervous system so rapidly,  con-
sidering their small amount of spirit, that
their  effects have been in part attributed to
the carbonic acid rising in the stomach,  and
carrying with  it a  portion  of the alcohol
into more intimate contact with the nerves
of that organ.  Home-made wines are  apt 
S T I                 512                 S T  I
to disagree  with  many persons,  in  conse-
quence  of the amount of sugar they often
contain, or from the presence of lactic and
other acids.   Many of the remarks on wine
apply also to the malt liquors, to the articles
on which the reader is referred for further
information.—See  Ale—Porter.   Attention
has hitherto been confined to the actions of
alcohol, and of its various preparations,  on
the system, without  reference to external
circumstances: and at the same time occa-
sion has been taken to advert to the serious
physical aud mental evils which  inevitably
result from the abuse of the agent.  It will
now be pointed  out  under what external
conditions  and circumstances,  and under
what  peculiar conditions of mind  and body
the use of alcoholic stimulants is either ser-
viceable or necessary.
  If the question  be asked,  whether alco-
holic liquors form  a  necessary part of the
sustenance of healthy men generally, it must
be answered certainly not. That they are not
necessary  is proved, not only by the history
of many nations, both ancient and modern,
but by  the  results of the  total abstinence
movement:  numbers are well and active
both is mind and body, who never touch  an
alcoholic fluid.  But what is a rule  for some,
or even for many,  is by no means universal,
and  the experience of medical men gene-
rally, including those whose names  stand
highest at the present time—and  they, it is
presumed, are the  most proper judges of the
case—goes to prove that there are  numbers,
under  the present artificial  positions and
modes of life, in this country at least, who
cannot eschew the use of alcoholic stimuli
without the  risk, or rather the certainty,  of
detriment to health.   Probably  there  are
few medical men who cannot  reckon among
their  patients (the  author  certainly can)
individuals who have seriously injured them-
selves  by  the unadvised  adoption of, and
rigid  adherence  to  total  abstinence prin-
ciples.  In such cases, the nervous system,
the digestive organs, and bodily and mental
vigour,  gradually  become  weakened, and
there is often great depression of spirits.  It
may be said that persons who require alco-
holic stimulants to maintain their digestive
and other powers, are not in a proper healthy
condition, anil possibly they  are  not.  But
tbey are in  the  state of numbers in this
country at the present time—a state fostered
by circumstances,  by the debilitating effects
of the deficient sanitary arrangements of our
large cities, by the wear and tear  of mental
anxiety and overwork, and by  the struggle
in the perpetual buttle of life, in which most
are engaged in the throng of  competition.
 These influences and others, including per-
 haps deficient natural  constitution,  reu 1,-r
 the moderate employment of alcoholic sti-
 mulants  absolutely requisite  for  the pre-
 servation  of the energies  on  which  their
i livelihood and usefulness depend.  The re-
 quirement may be artificial, but we cannot
 change  the circumstances;  at least, not
 quickly; and  until  they are changed, it is
 folly, and worse than folly, to refuse a bene-
 ficent provision.   There can be no  question
 (indeed it has been proved) that the depress.
 ing influence of deficient sanitary arrange-
 ments are among the most powerful  incen-
 tives to  intemperance amid the workmen of
 our large towns, who, unfortunately, instead
 of wholesome moderation, too often indulge
 in excesses, especially in the use of spirits,
 which  entail  upon  them  many  diseases.
 Better is it, certainly, that  a man  should
 risk health, even if that should sutler by
 his becoming a total abstainer, rather than
 ruin both  body and soul  by intemperance.
 But better still, that he should  be exposed
 to neither risk, by being placed beyond the
 influences  of depression,  and  within the
 influence  of  those natural  stimuli  (see
 Excitement)  which  our Creator has  made
 necessary to our healthful existence  in this
 world.
    There are  accidental circumstances  in
 which all may at times be placed, in which
 the question arises  whether  the assistance
 of  alcoholic stimulation  may be had re-
 course to with benefit  or  not.   Exhaustion
 by long exertion  in extreme of heat  is one
 of these—the skin, acting powerfully, dis-
 charges immense quantities of fluid, which
 must be compensated for.  As long  as the
 energies remain unimpaired, the compensa-
 tion should  be  made  by  unstimulating
 drinks; by these the  strength is  in every
 way better preserved; but when  the ener-
 gies Aug, if  exertion  must still  be made,  a
 small quantity of diluted alcoholic  stimulant
 may be  taken with  advantage.  Under con-
 tinued exposure to the  effects of intense
 cold, especially  if  symptoms  of  torpidity
 supervene, the use of  undiluted spirit may
 save, and has saved, muny a life.   In such
 cases,  however, the  caution  must  not  be
I forgotten, that the  spirit should not be bad
 recourse to early,  nnd not, if possible, till
 it is used  to stimulate to the 'ast effort to
 gain the place of safety.   [Neither  should
 it be taken in such quantity as is likely to
 inebriate.]   Other cases occur,  in  which
 persons are compelled by circumstances to
 make continued exertions, involving loss of
| the usual rejt.  In these,  after a time, tho
I moderate use of the  stimulant  i«  highly 
ST1
§13
ST1
beneficial; [but hot  coffee, when it can be
obtained, will answer better.   On  board
Bhip,  when  all  hands are overworked, hot
coffee is far preferable in its  effects  to the
"grog" usually given.]
  The necessity for the use of alcoholic
stimuli, under the various external circum-
stances which tend  to  depress or exhaust
the bodily powers, is, of course, immensely
modified  by the constitution, hereditary or
acquired, of the  individual.   Some  indi-
viduals there  are, who from  birth upward
are always below par, who  have no power
of endurance.   Such persons generally re-
quire stimulants habitually, to enable  them
to keep up to life's duties at  all; still  more
do  they do  so when  exposed  to  conditions
of depression or exhaustion.
  The above have been considered irrespec-
tive of those cases in which long habit has
rendered the use of  alcoholic stimulants an
acquired necessity, especially if excess has
debilitated  the  constitution.  There  are,
undoubtedly,  many  individuals  of  strong
constitution and nervous power, who can at
once lay aside the use of these stimulants
without inconvenience; but there are others
who quickly become depressed.   This is
especially the case if other depressing effects,
such as an accident  and its necessary pains
and confinement, are in operation.    Such
cases,  in hospital  practice,  are very  com-
mon ; the continued  allowance of the  alco-
holic stimulant is necessary, not only for the
reparation of the  accident, such as a  frac-
ture, but  even for the continuance of the
functions of life.
  The question of the propriety and benefit
of alcoholic  stimulation in the treatment of
certain phases of disease, is one which it is
matter of surprise could ever  be  mooted in
the face of the approval and enunciation of
the highest authorities, past and present, in
practical medicine—ignorance alone  could
ever have raised the  doubt.   As the use of
alcoholic  stimuli is noticed under the heads
of the various diseases, it is unnecessary to
enter upon its  consideration again.
  Few subjects, perhaps, included in the
present work, are more important than that
which has just been discussed, briefly of
necessity, but much too briefly to do it jus-
tice.  The evils of intemperance in England
[as  well  as  in the United  States] are  so
deplorable, that every man who wishes well
to his kind or to his country must earnestly
desire to  see them checked.   And when it
is looked upon as a matter of temporary bene-
fit and expediency, must regard the total ab-
stinence movement as one fraught with im-
mense  benefit  to numbers.   At  tho  same
 time, medical  men, especially, are  aware
 that its uncompromising  dogmas  are thei
 source of evil as well as good;  evil,  not  to
 individuals only, but to the  community ge-
 nerally, by turning the  attention  from the
 great incentives to  the abuse of alcoholic
 stimuli, the depressing influences to which
 all classes  of the community are exposed,
 by deficient sanitary arrangements,  by the
 exhausting effects of competition in the vo-
 cations of life,  and  by  the  great  absence
 of provision for, and  relish of, the  harm-
 less excitements.  Excitement of some kind
 is necessary,  and if men,  uneducated, or
 partly educated, have not the natural stimuli
 of the light and  air of heaven, and proper
 relaxation  afforded  them—if they have no
 mental  stimulus presented  to  them as a
 change after the physical  toils of the day,
 no object of interest with which to fill the
 vacuity of the mind,  and no attraction, save
 that of a squalid home, most surely will they,
 in  numberless  instanpes,  when they  can,
 seek the artificial stimulus of alcohol,  and
 the comfortable fire and comparative  clean-
 liness of the tap-room.
  STINGS  of  Bees, Wasps, Hornets, &c.
 —Are  punctured, and  at the  same time
 poisoned  wounds, the  intense  pain being
 caused  by the  acrid poisonous fluid, which
 is pressed through the tube of the  sting at
 the moment it is inserted in  the skin.   The
 poison is  contained in a bag at the base of
 the sting, and  the latter is barbed on one
 side.   After the first  acute  pain of a sting
 subsides,  a severe  tingling  smarting  re-
 mains, and  the part begins  to swelL  The
 amount of swelling varies  greatly in differ-
 ent persons.  In some it is trifling, in others
 it is very great, and  in a few individuals  it
 extends over the entire body, while at the
 same time there is much sick faintness,  Sec,
 requiring the  administration of sal-volatilo
 and other stimulants.  If the sting has been
 inflicted  about the throat,  the swelling has
 been known to prove  fatal.   The domestic
 local applications to stings are very  nume-
 rous.   Oibis frequently applied, and gives
 relief; but alkaline  preparations  certainly
 appear to be most serviceable. The popular
 remedy of  the " blue-bag" is probably use-
 ful for this reason.  Soda is also employed:
 but ammonia or  hartshorn (the weaker so-
lution) is the best form of alkaline  applica-
 tion, and  it may be  used alone  or  mingled
 with oil.   However, before  any remedy  is
 used, care should be  taken  to ascertain that
 the sting does not remain in the wound.  If
it does,  it must be extracted  by tweezers or
by squeezing.    If the pain  and  swelling
remain severe, the- eommon lead lotion, or a 
STI
514
STO
tepid poultice, will  relieve.—See Wounds,'
poisoned.
  STITCHES.—The  transient pains which
all persons are apt to experience at  times,
are probably of a  neuralgic  character.  A
stitch in the left side, such as occurs in con-
sequence of exertion, quick walking, or run-
ning, is ascribed to congestion of the spleen.
It has also been attributed to affection of the
diaphragm.  It is relieved by pressure.—See
Side, Pain in.
  STOMACH.—The  form  and  position  of
this important organ have been sufficiently
indicated  in  articles " Alimentary Canal"
and  "Abdomen;" to  these the reader is
referred, and at the same  time to article
" Digestion"  for  an account  of the latter
process.   The stomach is made up of three
different coats or layers,  the  outer  one,
being the " peritoneal" coat,  which covers
the contents of the abdomen  generally.—
See  Peritoneum.   The middle  layer is the
muscular coat, by which the churning and
wavy motions of the  stomach are performed
during the process of digestion.   The inner-
most layer is the mucous coat, which is con-
tinuous with  the lining of the  gullet and
mouth upward, and with  that of the intes-
tines downward.  In the  stomach, the mu-
cous coat is  thrown  into folds or wrinkles,
called  in  anatomical  language  "rugae,"
which extend longitudinally along the organ.
When at rest, the lining membrane of the
stomach is of a pale pink colour, but when-
ever its peculiar functions  are called into
exercise by the .presence of food, it becomes
much  reddened by the increased determi-
nation of blood toward it.
  The chief disorders to which the stomach
is liable have already  been entered into
under the head of "Indigestion;" and such
affections  as  cancer,   perforating ulcer,
spasm,  &c.  have  been  sufficiently consi-
dered in the  general articles on  these sub-
jects.  Blows over the region of the stomach
are often serious, and  may  be  immediately
fatal.—See Blows—Shock, Sec.
  Gastritis.—Inflammation of the stomach
is not  a common disease in its acute form,
and  when  it  does occur, is usually the re-
sult  of irritant agents, such  us strong spirit,
poison, &c, applied directly to the stomach
itself.   Fever, thirst, severe pain at the pit
of the stomach, increased by pressure or by
the  presence of  food,  vomiting, especially
after food has been taken, hiccup, red tongue,
and, shortly, extreme depression of the sys-
tem, are the  usual symptoms.   Leeches and
poultices to  the pit of  the  stomach, cold,
sometimes, iced water,  or  barley or  gum
water, to  allaj  thirst,  and clysters, either
aperient or opiate, will  be the most useful
remedies ; but the disease is so serious in its
nature,  and so rapid in  its progress, that it
should at once, if  possible, be put under
regular medical treatment.
  STOMACH-PUMP.—See 1'imp.
  STONE.—See Gall-stone—Urine, &c.
  STONE-FRUIT — Generally  speaking, is
less digestible when eaten raw than the other
descriptions of fruit; to healthy persons,
however, when ripe, and  consumed  in mo-
deration, it is  not  injurious.  Plums have
acquired a  character for causing disorder
and diarrhoea, which they scarcely deserve.
Undoubtedly, with  some  persons  they dis-
agree, and, indeed, with  all, if  they  are
eaten immoderately or in bad condition; but
that they, or fruits generally, are the cause
of the regular  autumnal or British cholera,
is a fallacy which  has  been established in
the  popular mind, in  consequence of  the
season at which plums are ripe—the "plum
season" being coincident with that at which
people in this  country, who have  been  ex-
posed to the effects of  the  summer's heat,
are most liable to that outbreak of accumu-
lated bile  which is known as bowel com-
plaint, or English,  or British, or  summer
cholera, [the cholera morbus, of the United
States.]   The fallacy  is principally  mis-
chievous, because it closes the eyes of peo-
ple generally to the real cause of a disease,
which, with more or less  severity, so regu-
larly makes its appearance, and thus pre-
vents their adopting those measures of pre-
caution which would insure them against its
attacks.
  Refer to Biliary Disorder, Sec
  STONE-POCK.—A name applied to hard
pimples.
  STOOLS. — The  evacuations   from  the
bowels always  afford important indications
of the state of health;  they are, therefore,
generally watched by medical men in cases
of illness, and  as a general rule should  be
saved for their inspection.
  In infancy, the discharges from the bowels
are generally lighter coloured than they are
as life advances—this, perhaps, being partly,
but  not altogether, due to the usual  milk
nourishment, which, even in adults, if taken
largely, tends to give a  lighter colour to the
stools.  In  infancy, moreover, the appear-
ance  of the natural evacuations is liable to
vary greatly in colour,  and, especially when
there is disorder, acidity, &c, to  assume a
green tinge, either as directly passed from
the bowels, or soon after exposure  to the air,
even if the motion has,  in the first instance,
been  of a  yellow or  orange hue.   The na-
ture of these green evacuations is scarcely 
                  S TO

satisfactorily  explained;  they  generally,
however, follow attacks of pain, with su-
perabundant acid.  As children get  beyond
infant life, the stools, particularly in those
with light hair and complexion, are apt to
become either entirely or partially of a clay-
colour, evidently from deficiency of bile.  In
such  cases, it is  not uncommon for gray
powder or  calomel to be given, with a view
of increasing  the  flow  of bile, which these
medicines certainly do, and for a  few days
the motions are improved in appearance;
but only for a few days—they soon  become
as unhealthy  looking  as ever;  the  benefit
derived from the mercurials was only falla-
cious, or worse, it was injury rather than
benefit.  The  true  cause of  these clay-
coloured stools, in most instances,  is the in-
ability of the  blood to furnish an  adequate
supply of the healthy  bile; consequently, to
stimulate the  liver to  secrete  an increased
quantity under these circumstances, is to
impoverish  the blood.  A  course of iron
tonics, with a good supply of animal food,
and, if need be, a littie wine or malt liquor,
is much more  likely to bring the motions to
the colour of health, permanently and bene-
ficially.  Not  that an  occasional dose  of
gray  powder  may not be useful,  but it is
not the remedy.   In adult life,  the stools
become clay-coloured, or chalky, from a dif-
ferent cause or causes, the most usual being
obstruction  to the flow of bile; (see Jaun-
dice;) but also from deficient secretion con-
sequent upon disease  of the liver, such  as
occurs in drunkards.   The stools may vary
in consistence, being either too hard or too
liquid: the former is the case  in persons of
costive habit, in whom the faecal contents
pass so slowly through the bowels, that their
liquid components  are too much absorbed.
—See Costiveness.  In  the latter  case, the
too liquid condition of the motions is asso-
ciated, generally, with tendency to diarrhoea.
—See Diarrhoea.   The form of the motions
may, by  its peculiarity, convey  important
information: thus, in an enlarged state  of
the "prostate"  gland  at the neck  of the
male bladder,  they assume a flattened form,
or they may be diminished in size by nar-
rowing of the  gut.—See Stricture.  The ge-
neral  bulk  of the stools  must  of  course
depend much upon the amount and  quality
of the food; inattention to this fact some-
times  misleads.  It is not uncommon for
persons to imagine, that if the  bowels are
regularly moved once  a day, they must be
in a  perfectly free state, forgetting, that
though  they may discharge  a  portion  of
their contents, thev do  not necessarily dis-
charge all; and such is really the case.  In
15                sro

 old people especially, enormous  accumula-
 tions of faecal matter are apt to take place,
 while the person is  under  the  impression,
 that  because there is a  daily  stool, the
 bowels  are periodically fully relieved.  On
 the other hand,  again, the popular impres-
 sion seems to be that the bowels fulfil no
 other office than that of a passage  for the
 food refuse.  This fallacy has already been
 alluded to under articles " Alimentary Ca-
 nal," "Digestion," &c.
   Various articles of food, such as the seeds
 and skins of fruits, will, as mentioned above,
 affect  the appearance of  the  stools,  and
 medicines do so more especially.   Iron, in
 particular, forms an  inky black with the
 colouring matter of  the bile, and as persons
 are often unnecessarily alarmed at the ap-
 pearance, the circumstance should be made
 known, when  iron  is prescribed.    Rhu-
 barb, senna,  &c, in some degree,  impart
 their colour to the stools.   Mercurials mo-
 dify them, causing an olive or  deep green
 appearance,  which  may be kept up for a
 length of time  if mercurials are too con-
 tinuously given.   Persons are thus deceived
 at times, and under the idea that the motions
 do not become healthy, go on purging with
 the  mercurials, which are themselves the
 cause of the  unhealthy appearance.   Other
 purgatives may have  the  same effect in a
 lesser  degree.   In unhealthy states of the
 system, and especially in some febrile affec-
 tions, the stools  become much more offensive
 than  usual.  When  such  is the  case, the
 bowels  generally require  purging.   The
 stools  may  contain  blood.  If  this  comes
 from the stomach, or high up in the intesti-
 nal canal, it  is usually black and  pitchy in
 appearance,  and  often  highly  offensive:
 stools of this kind often occur after severe
 bleeding  at  the nose, when the blood has
 been swallowed.  The blood may be  fresh
 and  clotted, either dark or florid.—See Piles.
 In some cases the stools contain large quanr
 tities of mucus, simple or gelatinous  look-
 ing,  or they contain  matter.  In all such
 cases, the motions should be kept for inspec-
 tion, and a medical  man sent for as  soon as
 may be.  In Asiatic cholera, and sometimes
 in its British simulator, the stools resemble
 thin gruel or "rice-water."  Straining at
 stool may arise  simply from costiveness, and
 therefore is probably habitual:  it is, more-
 over, one of the chief evils of costiveness^
 for not only is it apt  to induce rupture in
 the  predisposed, but, in the aged, it  may
 bring on head attacks.  Straining, or, as it
 is called medically,  "tenesmus," occurs as
 a consequence  of an inflamed and  swollen
 condition of the lining  membrane of tor
5 
STO
510
S U F
rectum, (see Rectum,) sueh as occurs  in di-
arrhoea, &c.; there is  the  sensation as if
the bowel was still unrelieved, and constant
instinctive efforts  are made to free it: they
only increase the evil,  and should,  by  an
effort of the will,  be desisted from if possi-
ble.  In children, straining nnd sitting too
long when  the  bowels* are  evacuated, may
cause falling down of the bowel.   The cus-
tom should  be corrected.
  STOVES—For  heating apartments,  are
eertainly apt to  prove  most unwholesome
substitutes  for the common  open fire-place,
if but for the one  reason, the very defective
ventilation  they afford, if they afford  any at
all.  Moreover,  a stove, even constructed on
the best principles, is apt to cause a dryness
of the  air of an apartment, which not only
causes  most uncomfortable sensations, espe-
cially about the head, but is really injurious ;
and further, in many forms of stove, vapours
of sulphur or of carburetted hydrogen are apt
to escape.  In any room  heated by a stove,
extra  provision should be made both for
ventilation, (see Bedroom,) and for furnish-
ing moisture to the atmosphere.
  Refer to  Chimney.
  STRAINING.—See  Stools.
  STRAMONIUM.—See Thorn Apple.
  STRANGULATION.—See Suffocation.
  STRANGURY.—See Bladder.
  STRAWBERRY.—This  delicious  fruit
must be classed  with the most wholesome
productions of  the vegetable kingdom.   It
is recorded of Fontenelle that he attributed
his longevity to  them,  in  consequence  of
their having regularly cooled a fever which
he had every spring; and that he used to
say, " If I can  but reach the season of
strawberries."    Boerhaave  looked upon
their continual  use as one of the  principal
remedies in cases of obstruction and vis-
cidity,  and in putrid disorders.   Hoffman
furnished instances of obstinate  disorders
cured  by them,  eveu consumption; and
Linnaeus says, that by eating plentifully of
them he kept himself free from gout.  They
are good even for the teeth.
  STRICTURE.—See Urethra—Urine.
  STRUMA—Scrofula.—See Scrofula.
  STRYCHNINE—See Ncx Vomica.
  STUN.—See  Brain, Concussion of.
  STUPE.—A  piece  of cloth or  flannel
soaked in hot water as a means of fomenta-
tion.—See Fomentation.
  STUPOR—Coma.—See Coma.
  STYE.—See Eye.
  gTYPTICS—Are applications, usually of
an astringent character, which possess the
power  of arresting hemorrhage.  The re-
medies classed under  astringents may all
be used as styptics, but  many of them are
not generally had recourse to as such—that
is, as external means of arresting bleeding:
it is to  these that the term styptic is applied
in this  article.
  Oak-bark  decoction,   and gall-nuts  in
powder or infusion, which owe their efficncy
to the tannin  they contain, are  used  as
external  styptics, and "Ruspini's styptic,"
formerly  much in vogue,  is said  to be a so-
lution  of  tannin in  spirit.—See Oak.  In
addition to these, matico and turpentine are
Btyptics derived from  the vegetable  king-
dom ;  also  the  agaric  fungus popularly
known as the "fuzz-ball," which is frequent-
ly applied to bleeding wounds, and  with ap-
parent benefit.   From the mineral  kingdom
many  styptic applications may be derived,
such as the salts of iron,  especially the sul-
phates of copper and zinc, the acetate of lead,
and  the nitrate of silver.  Cold, the actual
cautery, or red-hot iron, kc. &c. are all styp-
tic applications.—See the various articles.
  Refer to Hemorrhage.
  SUBSULTUS.—Spasmodic  jerkings  of
the  muscles, which occurs in various dis-
eases of debility, such as fever, &c.
  SUCKLING.—See Children—Child-Bed
—Nurse, &c.
  SUDDEN DEATH.—See Death.
  SUDORIFIC—A promoter of perspiration,
or diaphoretic.—See Diaphoretic.
  SUFFOCATION —Is  the   term  usually
applied to that condition  in which the air is
prevented from entering the lungs by agents
which  do not  compress  the windpipe,  as
they do  in hanging or  strangulation, the
distinction being,  that in the  latter case
the vessels  of  the neck  are usually com-
pressed, and add to the state induced in the
chest,  a  congested  condition or accumula-
tion of blood in the brain.   In the former,
the effects are complicated, are purely those
of suffocation, or as it  is called in medical
language,  "asphyxia."   In  this condition
the  atmospheric  oxygen being  excluded
from the  lungs, the blood  is  unchanged,
either  partly or totally, according to the
completeness of the obstruction.   In this
unaltered state it passes back to the  heart,
(see Circulation,) by which  it is sent with
more or  less activity through the  arteries,
and  coming in contact with the nerve tis-
sues, it acts upon them  as a poison, pro-
duces  convulsion,  &c.   The vessels  of the
lungs and  the  heart, missing their  accus-
tomed  and proper  stimulant, (the arterial
blood,) gradually cease to  act,  and life'i
machinery stands still.
  Suffocation is the result of such accident*
as immersion in an  atmosphere of  carboBic 
                  S UF

acid gas, or " choke damp," of drowning,
of foreign  bodies  becoming  lodged in the
gullet or windpipe, of spasm.—See Larynx,
Sec. Sec.   As these causes of the accident are
all  treated of  respectively,  it is unneces-
sary to enlarge upon them here.
  lt is requisite, however, by way of cau-
tion, to  notice some  causes of  accidental
suffocation, which  are sometimes fatal.
  People who  eat  greedily,  or who, as in
the  aged,  are  unable  to  chew  their food
properly, are  sometimes suffocated;  (see
Gullet;)  the  accident, too,  has  sometimes
followed  vomiting   in intoxication.  A cu-
rious case of the kind is recorded, in which
a man, who, after vomiting, was put to bed
drunk, was shortly after found dead—suffo-
cation having been  caused by a small piece
of potato skin  so fixed  over the opening of
the larynx  as perfectly to stop the  passage
of air.   In children,  a small  body like  a
pea  or  cherry-stone,  accidentally drawn
into the  air-passages, has caused  suffoca-
tion; and, very recently, a case was record-
ed  in which a young  man was  killed by
being forcibly pushed into a sack contain-
ing bran.  The bran drawn into the wind-
pipe caused suffocation.
  Infants may  be   suffocated, oftener  per-
haps than  comes to light, by the very re-
prehensible practice, followed by some igno-
rant nurses, of giving them a bag of wash-
leather or cloth filled with sugar, to suck,
in order to keep them quiet; if  this  chances
to get too far in the throat, it will certainly
Buffocate.  Death by suffocation  in infants
"overlaid," by heavy-sleeping  nurses, is
far from being a  rare occurrence;  and,
indeed,  it  may happen  simply from  too
great an accumulation of clothes over  the
mouth and nose.
  Other  causes might be cited—the above
are perhaps sufficient to excite caution.
  SUFFUSION—Is a medical term usually
applied  to  the  eyes when they are blood-
shot and  watery.
  SUGAR.—This important article of food
and luxury is for the most part  a  product
of the vegetable kingdom, but  not  entirely
bo, for it occurs in milk, and in  eggs  in
Bmall quantity, and is also produced by the
animal body, under conditions  to be here-
after noticed.
  Sugar  is formed principally of  two dis-
tinct varieties — cane, or  ordinary sugar,
and sugar of  fruits, or grape sugar.  Both
are composed of the elements, carbon,  oxy-
gen, and  hydrogen, but  differ somewhat in
the  proportions in which  these  are com-
bined.  In addition to the above sugars, Lie-
big enumerates  a third, a non-cryatallizable
         2T
L7               SUG

 variety;  and  milk or manna sugar  also
 differs  from them  slightly in  composition.
 Cane, or ordinary sugar, is produced by the
 sugar-maple,  by the  birch,  by beet-root,
 carrots, &c.;  but its  chief  source is the
 sugar cane, from which  it is most  easily
 and abundantly extracted.   To effect this,
 the canes are crushed  between heavy roll-
 ers, and the expressed juice,  after under-
 going certain operations of heating, is left
 to  crystallize,  the dark uncrystallizable
 portion known as treacle or molasses being
 permitted  to  drain off.  The crystallized
 sugar which remains is the brown or Mus-
 covado  sugar  of  commerce.   As  may be
 expected,  it  contains many impurities;
 moreover, the treacle which  drains from  it
 is rather the result of  bad preparation, es-
 pecially in the application of heat,  than  a
 necessary product.   It is, in fact,  grape
 sugar,  which  has  been formed from  the
 cane  sugar  by  the decomposing influence
 of heat.  In order to produce the  refined
 sugars of the shops, other processes of re-
 solution, filtration, &c. require to be gone
 through.
   Cane  and grape  sugar differ from  each
 other in some important  particulars.  The
 former  is only produced  naturally, "it  is
 crystallizable," "and, when pure, not prone
 to deliquesce, or to alter when exposed to
 moisture, or to a moderate temperature."
   Grape sugar is also a natural production,
 but can be formed by art, from starch, &c,
 (see Fermentation;)  it does not crystallize
 regularly, and the aggregations into which
 it forms are very prone to attract moisture.
 Pure  cane  sugar  ought, therefore, to  be
 crystalline and free from moisture;  when  it
 contains grape sugar, which it frequently
 seems to do, either by natural formation,
 or by designed adulteration,  it is liable to
 become clammy and  moist.   According to
 the investigations  of the  "Lancet Sanitary
 Commission," from which much  of the in-
 formation contained in this   article is de-
 rived, experiments  show  clearly that  cane
 and grape  sugars  coexist in most, if not
 all, the colonial brown sugars, and even in
 some  of the  lump sugars,  and  that  they
 even exist together in the cane itself.  The
 amount of the admixture of  grape sugar  is
 important, not only from the tendency which
 it imparts  to the whole to become moist,*
 but  because  it possesses  a  much  lower
 sweetening power, and  is much more prone
 to fermentation than the cane sugar.   The
 latter, when purified, is generally free from

  * It is  to be feared, however, that all the  moistur'
 in many of the sugars retailed  is not attracted froiti
 the atmosphere.
5 
S I- Cr
518
S U G
grape  sugar, and  from mnny of the  other
impurities  with  which the ordinary brown
sugars  are  intermingled — considerations
which render the purchase of coarse sugars
a very doubtful piece of economy.
  The  chief impurities  found in  brown
sugars, as  imported into England, are por-
tions  of  the cr.ne, and vegetable  albumen
which imparts a strong tendency to ferment-
ation, anci also assists to nourish the sugar
acarus or insect,  which,  as shown by  Dr.
Hassal, exists in greater or less proportion
in nearly all the brown sugars sold to  the
public.   This disgusting impurity in food
is, it is said, so considerable in size, " that
it is plainly visible to the unaided sight."
When preseut in sugar it may be detected
by  dissolving a  couple of teaspoonfuls of
the sugar in a large wineglassful of tepid
water,  the  solution being permitted to re-
main at rest for an hour, "at the end of
that time  the  animalcules will  be found,
some on the surface of the liquid, some ad-
hering to the sides of the glass, and others
at the  bottom, mixed up with the  copious
and dark sediment, formed of  fragments of
cane,  woody fibre, grit,  dirt,  and  starch
granules, which usually subsides on the so-
lution of even a  small quantity of sugar in
water."   The  idea  has been  suggested,
that the  disease known as the  "grocers'
itch,"  to  which those  who handle  sugar
much  are  liable,  may be caused  by this
insect,  which closely  resembles the  itch
acarus in form.    A minute species of fun-
gus is also  generally met with  in  the  moist
Bugars.
  The refined sugars sometimes retain traces
of the albuminous  matters, serum of blood,
or white of egg,  &c. used in their purifica-
tion; also,  traces  of lime, lead, iron, &c,
acquired in the preparation.   According to
the Lancet reports,  an examination of fifteen
samples of  lump sugar gave the following
results:—That  in  nine were fragments of
cane, of  sugar  insects or fungi,  to be  de-
tected; that in three there were traces of
grape sugar; in  ten, of animal matter ; and
in all, of flour.
  According to the same report, an exami-
nation  of thirty-six samples of moist sugar
showed—That the  sugar insect was present
in the  whole of  the samples, and in  many
of them in great numbers.  That fungi were
also present in all, and  besides these, the
fragments of cane, grit, &c. already men-
tioned.   It is evident that pleasure in food,
health, and economy  ire more consulted by
purchasing the refined than the moist sugars.
Probably the time  is not far  distant when
the latter will be unsaleable.
  Milk sugar, which differs from the sugars
already noticed,  "occurs  in  commerce in
thick  crystalline  crusts, which are usually
yellowish, yellowish brown, or dirty,  from
want of care  and  cleanliness in its prepara-
tion ;" when  purified,  however, it becomes
very white and hard.  Its sweetening power
is weak, and  it is capable of undergoing the
vinous ferinentntion.
  As  an article  of nutriment, sugar is of
course the representative of the saccharine
principles, which include starch, gum,  &c.:
the position  which these  principles  hold,
nnd the part they fulfil in the processes of
nutrition generally, having been sufficiently
entered into under article " Food," it is un-
necessary to  repeat them here.
  With  regard to the digestibility of sugar
by different  individuals, there  is consider-
able variation.   Some persons cannot con-
sume  it, even in small quantity, without be-
ing disordered and suffering  from acidity,
while  others  seem actually to digest their
food better when an amount of saccharine
is mingled with it.  In the West Indies, and
other  countries where sugar  is cultivated,
the inhabitants, the negroes especially,  are
said to  improve in health and appearance
during the sugar season, when  they consume
it plentifully ; and, undoubtedly, a moderate
proportion of this  pleasant   aliment  is a
wholesome article of  nutriment for  people
generally, except under those peculiar states
of constitution, or rather of  disease, when
the tendency of  the  assimilative powers
generally  is  to form sugar even from diet-
etic principles which could scarcely be ex-
pected to yield it.  This animal sugar has
not only been detected in the  blood, but in
the stomach, after a person had  been  fed
for  days upon animal  food alone.  More-
over, recent  researches render it  probnble
that sugar is formed, naturally, in  the liver.
In medical practice, sugar is  used princi-
pally  to cover the nauseous taste of drugs,
which, it must be confessed, are often made
much  more nauseous by the admixture; it
is also useful as syrup in aiding the forma-
tion of pills,  &c.  Sugar is a powerful anti-
septic.—See  Diabetes.
  Refer to Fermentation—Food—Syrup, Sfc.
  SUGAR of LEAD.—See Lead. '
  SUICIDE.—Suicidal  Tindinct. —The
distressing state  of  mind  which  seems to
impel individuals to self-destruction,  has
too exclusively beer, viewed in its  metaphy-
sical light alone,  without reference to those
states of bodily disorder which unquestion-
ably induce great changes upon  the views
and feelings, particularly in  pe-sons natu-
rally disposed to melancholy.   The follow 
SUI
519
SUI
 Ing observations of Dr. Forbes Winslow, in
 a lecture recently published in the Lancet,
 are most  pertinent to the  question.  He
 Bays—" It  is  the  prevalent opinion,  even
 among persons otherwise well educated and
 intelligent,  that this desire of self-destruc-
 tion is, in the majority of cases, a mental
 act, unconnected with a disturbed condition
 of the  bodily  functions, and incurable by
 any process of medical treatment; that the
 mental depression which is so generally as-
 sociated with  the invisible tendency,  is an
 affection of  the mind per se; the physical
 organization having no direct  connection
 with what is termed the spiritual impulse.
 This metaphysical  view of the matter  is
 fraught with much mischief; and, I have no
 doubt, has led  to the sacrifice of many valu-
 able lives.  It is a matter of  the  highest
 moment that the public mind should be un-
 deceived upon this  point.  Right views on
 this subject ought  to be generally diffused.
 It is of consequence to establish the belief
 that the suicidal idea is almost generally con-
 nected with a morbid condition of the body,
 and is often the only existing evidence of
 such an affection; that it is, with a few ex-
 ceptions,  universally associated with  phy-
 sical disorder, disturbing  the  healthy ba-
 lance of the understanding;  and that this
 bodily affection, which  is in nine cases out
 of ten, the cause of  mental irregularity,  is
 easily curable  by the judicious  application
 of remedial  means.   The tendency of the
 spiritual or metaphysical view of the ques-
 tion is to create a distrust in remedial mea-
 sures, and the poor man who is  struggling
 against an  almost  overwhelming desire to
 destroy himself, is  induced  to  neglect en-
 tirely his lamentable condition,  under the
 belief  that  he is  literally placed  beyond
 the reach of curative agents, and that the
 only remedy for his mental suffering is death!
   "If a person in this unhappy  state of
 mind is induced to  believe that his mental
 despondency is but  a  consequence or effect
 of a disturbed  bodily condition, influencing,
 either directly or indirectly, the natural and
 healthy operation of the brain and nervous
 system, and giving rise to pjerverted ideas
 —that his malady  is curable—he  may be
 induced to avail himself of the means which
 science  has placed  at  the disposal of the
 physician, and thus be protected against his
 own insane impulses."
   " Where  no disease is suspected, no re-
 medy will be sought.   Tell a man who has
 attempted to destroy himself  that he is  per-
 fectly sane—that his judgment is  sound-
that his will is not  perverted—that  the im-
pulse  which urges  him  to the commission
 of suicide is not associated with any devia-
 tion from corporeal health—and you incul-
 cate ideas not only fallacious, but most per-
 nicious in  their character and  tendency.
 We might, with as much truth, tell  a per-
 son playing with a lighted taper at the edge
 of a  barrel of gunpowder,  that his  life  is
 not in jeopardy, as to say  to a person dis-
 posed  to  suicide, that he is in the perfect
 enjoyment of health, and requires no moral
 or medical treatment.  It may be laid down
 as an indisputable axiom, that in every case
 of this kind, bodily disease  may,  upon a
 careful examination, be detected.  I never
 yet saw a case where a desire  to commit
 suicide was present, in which  there was not
 corporeal indisposition."
   While it is of the highest importance that
 the connection which exists between the tend-
 ency  to suicide and  derangements of the
 general health, or any condition of disease,
 should  be well attended  to, it would per-
 haps  be dangerous to lead persons to the
 idea that  all depended upon  physical de-
 rangement. This there maybe, (perhaps is,
 in the  majority of cases,) at  times giving
 rise to irresistible impulses, at  least appa-
 rently irresistible, for how far they are so,
 man cannot judge;  but to  base  too much
 upon the bodily condition, may hold out in-
 ducements to those who  are  afflicted with
 the suicidal tendency to abandon that moral
 and religious control of their actions, which
 is so  powerful,  and  which  in  many cases
 will overcome in the end.  The subject of
 suicide is one which it is impossible to sepa-
 rate from  religious considerations, when  it
 is considered among Christian men ; and  if
 these  men truly believe that God does assist
 those  who  look for his aid  in  the hour of
 trial and temptation,  they cannot think that
 in such an hour as  that, when  one of his
 creatures  contemplates the violent destruc-
 tion of the life  which  he has given him,
 that God will not aid, if his help is sought,
 and strengthen  the combat of the higher
 powers of the mind against  the lower  prin-
 ciples;  for suicide is  selfish and cowardly.
 If an  elevated religious and moral tone had
 nothing to do with  controlling the propen-
 sity to crimes, and to that of suicide among
 the number, statistics would not furnish the
 evidence of  the  preponderance  of  these
 crimes  amid people  who notoriously cast
 aside the practical regulation of religion in
 their lives, individually or socially.
   By  these remarks  the author  does not
 intend in  any way to weaken   the  force of
the previous ones of  Dr. Winslow,  but to
caution the mind, lest the consideration of
the physical should obscure  that  of th« 
S U L
,V20
SUL
 spiritual. Nevertheless, it is probable, that,
 in the fir^t instance, more benefit will be de-
 rived  by treating the affection as a phy-
 sical disorder.  When an individual afflicted
 with suicidal tendency can be thoroughly
 kept under surveillance in private, the effect
 of well directed medical treatment may be
 tried; otherwise, the best and safest plan  is
 to commit the  sufferer to  a well-regulated
 asylum.—See Insanity.
  The  subject  of  human  responsibility,
 where,  overcome by the evil tendencies ori-
 ginating in physical derangement, it  ceases
 to be  responsibility, is perhaps one  which
 man can never fathom; but it is one which
 ought  to  be  upheld to the  utmost in such
 conditions as a tendency to  suicide.  While
 giving every attention  to the medical treat-
 ment of the physical condition, there  should
 at the same time be given every encourage-
 ment to those who show the least tendency
 to this  derangement,  to keep, if they  can,
 and  as long as tjiey can, the reins of reason.
 The  mind can, and often  will,  overcome
 mental  depression from physical causes, but
 it must be exerted.  The reader is referred
 to some observations  under article  Habit.
 The  tendency to suicide is found to be least
 in persons who are occupied out of doors.
  SULPHATES—Are  salts, in which the
 base, such as an alkali, or a metallic  oxide,
 is united  with sulphuric acid.—See  Copper
 —Magnesia.—Z'nc, Sec.
  SULPHUR—Belongs to   the  elementary
 bodies.   It is found in large  quantities in
 Borne volcanic countries, such as Sicily, from
 whence, hitherto, the chief supply has been
 obtained.   It also occurs  in the  form of
 metallic sulphurets, such as those of iron,
 usually called pyrites,  from  which, in Swe-
 den nnd other places, sulphur is procured.
 In the  combination  of sulphuric acid with
 different bases, such as lime, magnesia, &c,
 sulphur is again found, so that  in one  way
 or other  it  is  one of the  most abundant
 constituents of  the globe.   In the vegetable
 kingdom,  sulphur occurs, as in the  mustard
 tribes,  in the grains,  &c. ;  in  the animal
 kingdom it forms a constant element^of the
 albuminous and fibrinous tissues.
  The pale " sulphur yellow" colour of  sul-
phur, and its brittle crystalline texture, are
sufficiently familiar in  the form  of  stick or
roll sulphur.  The "flowers of  sulphur" is
made by"" sublimation," that is, by exposing
crude sulphur to heut sufficient  to cause it
to rise  in the  form of vapour, the  latter
being condensed in  a cool receptacle, when
it takes  the form of the  well  known "flowers
of sulphur."  Roll sulphur is now made by
simply  fusing the  s iblimed sulpaur,  and
 casting it in the form of sticks.  In medical
 practice, sulphur, is variously employed, its
 best-known  application, however, being for
 the cure of itch, in  the form of ointment.—
 See I'ch.   In various skin diseases, sulphur
 is  prescribed  by medical men;  it is also
| used as a mild laxative in pregnancy and
 in  cases of piles.  For  the latter  purposes
 it  is advantageously milled  with three  or
 four  times its weight of cream of tartar, or
 with its  own   weight  of magnesia.   The
 sublimed, or flowers of sulphur., is the form
 in  most common use; but the precipitated,
 or  milk of sulphur, is rather a more elegant
 preparation.   One very serious objection to
 the use of sulphur is the abominable  odour
 which it imparts to  the person, particularly
 to  the insensible perspiration.  There is no
 doubt that it passes off by the skin in con-
 siderable quantity—so freely, indeed, as  to
 blacken silver which the individual taking it
 may  happen to carry about with him.
   The dose  of sulphur  as  a  laxative is,
 alone, two drachms; when mixed with cream
 of  tartar or  magnesia, from  half a drachm
 to  a drachm.   It is best given in a  little
 milk.  [Many  persons,  however,  prefer
 taking it in molasses.]
   SULPHURIC ACID, or  Oil of Vitriol
 —Belongs to the class of mineral acids.  It
 is a compound of sulphur and oxygen gas,
 in  the proportion of one of the former  to
 three of the latter.   As  usually met  with,
 it  contains a certain amount of water, but
 it may be obtained pure, and in the form of
 a crystalline solid, " glacial sulphuric acid."
 Sulphuric acid  was formerly procured  solely
 by  distillation  from  the sulphate of iron, or
 green vitriol, and indeed is so yet in  some
 places.   It  is  now made  in England on
 an  immense  scale, by decomposing sulphur
 along with saltpetre  in immense lead lined
 chambers.   As usually met with, sulphuric
 acid  is a liquid of  oily consistence—hence
 its  name, oil  of vitriol.  It  ought  to be
 colourless, or nearly so, but  frequently  it
 has a brownish tinge from the presence of
 impurities.   It is highly corrosive, destroying
 with  great rapidity whatever textures, living
 or dead, it may happen  to come in contact
 with.  When mingled with  water  a  great
 development of latent heat  takes place; in
 some proportions, indeed,  so great  ns to
 raise the  temperature  of  the mixture ns
 high  as 300° Fahr.  After cooling, the bulk
 of the mixed fluids is considerably less than
 that  which  they occupied separately,   lor
 medicinal purposes, sulphuric acid is  used
 diluted in the proportion of one part and a
 half of acid to fourteen and a half of water;
 and it is better  for unprofessional person* to 
SU L
521
SUL
 buy it thus prepared.  Indeed, unless abso-
 lutely required  in  a concentrated form for
 some special object, sulphuric acid should
 never be kept in a private  house otherwise
 than diluted.  Some lamentable poisonings
 have happened in consequence of neglect of
 this  precaution.   When concentrated sul-
 phuric acid is mingled with water, the de-
 velopment  of heat which  occurs  must  be
 borne in  mind—otherwise the vessel, espe-
 cially a glass one, may be cracked, and in-
 jury to clothes or person be the result.  The
 mixture is best made by adding the acid to
 the water in small quantities at a time, and
 mixing each  by agitation, before  more is
 added.   Indeed, the water  ought to be in a
 Btate of agitation when the acid  is added,
 for if not, the extreme weight of  the latter
 will carry it to the bottom of the vessel, and
 there cause hea?t to be so strongly developed
 as to crack it.
   As a medicine, diluted sulphuric acid is
 extremely  valuable.  In  relaxed states  of
 the system it is one of our best tonics, given
 in doses of from ten to twenty drops in a
 large wineglassful, or two ounces  of water.
 In this way it preserves tone, and checks
 the perspirations in pulmonary consumption,
 and,  when  the  case is suitable, improves
 both appetite and digestion.  It also exerts
 considerable diuretic properties. Sulphuric
 acid  is a powerful  controller  of internal
 hemorrhage, (see  Abortion;) it is  also one
 of the commonest   additions  to  gargles.
 Some  persons  find  this medicine gripe a
 good  deal,  and if  taken  by  nurses  it  is
 almoBt  certain  to  disorder  the infant.   In
 other  cases, however,  ten  drops  adcTed  to
 small well-diluted doses of Epsom salts, are
 serviceable.  When sulphuric acid  is taken
 medicinally, it ought, like the other mineral
 acids, to be  sucked through  a quill, or small
 glass tube, to prevent injury  to the teeth,
 on which it  acts  powerfully; and  it is well
 to rinse the mouth with water containing a
 small proportion of  soda immediately after
 taking the dose.   In consequence of its em-
 ployment for various household purposes—
   Poisoning by sulphuric acid is not very
 uncommon, and, if the acid be strong, is one
 of the most distressing accidents  of  this
 nature which can happen.  The person  is
 generally  conscious  of the description of
 poison which has been swallowed.   Accord-
 ing to  the  strength of the acid,  there  is
 intense burning pain in all  the  parts, from
the mouth  to the  stomach, with  which  it
 has come in  contact, and if it be of corrosive
strength, these parts look  white and  shri-
velled.  There is also vomiting of shreddy
and bloody mucus, great constitutional de-
         2  t2
 pression, and, probably, if the acid has been
 strong, speedy death.
   In such cases, the first thing to be done
 is to neutralize  the action of the poison by
 alkaline and demulcent remedies.  Magne-
 sia, chalk,  lime-water, potash, soda, soap-
 water,  wood-ashes,  milk,  and  oil, are all
 remedial; and in such a case, that which is
 first to be procured is  the  best;  if there is
 power of choice, magnesia or  chalk  is  ge-
 nerally preferable.  In the  absence of either
 of  these antidotes, a portion of wall plaster
 or mortar, rubbed up  with milk  or  water,
 may be used. At the same time, fluids must
 be  given very copiously.   When injury has
 resulted from the application  of corrosive
 sulphuric acid externally, the best proceed-
 ing is to wash  the parts freely with water
 alone, or with water  containing an  alkali,
 as soap-water does.
  Aromatic sulphuric acid is a pleasant
 form of medicine which  might with advan-
 tage  be more used  than it is at  present:
 the  dose  is  from ten to twenty drops in a
 wineglassful of  water.
  Sulphuric Ether, which is  more gene-
 rally known as  "ether," is procured  by the
 action of sulphuric acid on alcohol, and by
 distillation.    It is  a  perfectly  colourless
 limpid fluid, of  very light specific gravity,
 and very volatile:  its odour, peculiar and
 penetrating, is usually called the  " etherial
 odour."   It is chiefly employed in medicine
 as a "diffusible" stimulant, that is, it acts
 very rapidly and energetically as a  stimu-
 lant when taken into  the  stomach, and on
 that account is peculiarly valuable in some
 diseases, such  as angina, spasms, &c, at-
 tended with sudden violent symptoms; it is
 also a powerful restorer  in the depressed
 conditions of the system, such as faintness,
 &c.   For  the  above  purposes  sulphuric
 ether is  given in doses of twenty drops in
 water.  A more convenient form, however,
 is the spirit of sulphuric ether, which con-
 sists of one  part of  the ether mixed with
 two parts of alcohol;  it acts in the  same
 way as sulphuric ether—the dose about forty
 or fifty drops in water.  The transient effect
 of ether renders it in many cases less valu-
 able than sal-volatile, or the spirits, such as
 brandy. Its antispasmodic power is increased
 by the addition of opium. When bottles con-
 taining this  ether are opened at  night, its
 highly inflammable character, even in liquid,
 but especially in vapour, ought to be borne
 in mind, and care taken that lighted candles
 are not too nearly approached.  In  giving
 ether, it is not to be forgotten that it floats
on the top of the water, and thus, that if a
bottle containing three or four doses of me- 
SUP
522
S W  E
dicine, of which ether forms an ingredient.
be  not shaken  before each dose is  poured
out, more than the proper proportion of
ether will be poured out first.
  Ether,  from  its extreme volatility, eva-
porates rapidly in the ordinary atmosphere,
and in doing so  occasions a considerable
amount of cold; of this, advantage is some-
times taken in  medical practice when such
an effect  is required.  The power of ether,
when inhaled,  to cause " anaesthesia," or
insensibility to pjain, is the characteristic
which  has excited  most attention  of  late
years; the  superior and  more convenient
effect of  chloroform has, however,  thrown
this, comparatively at least,  into the back-
ground.  Inhalation of  ether is a proceed-
ing which should never be  tampered with
by unprofessional persons.
  SUMMER.—See Seasons—Heat,  &c.
  SUN.—See Heat—Light, &c.
  SUPPER.—The last  meal of the day is
properly  supper,  and  some of the modern
dinners would  more aptly fall under the
former designation.   Much has  been said
respecting  the  unv/holesomeness of eating
suppers—much depends on circumstances.
Generally speaking,  animal food once a-day
is sufficient for  most; if, therefore, an indi-
vidual for whom it  is enough,  after  a suffi-
cientl}- good meat dinner, adds a superfluous
meat supper shortly before retiring  to rest,
there can be little  wonder if he pays the
penalty in sleep disturbed  by dreams and
night-mare,  and  by a  furred tongue  and
unrefreshed waking in the morning.  This
is  especially the case if the superfluity is
indulged  in after a dinner made in the latter
part of the day.  If dinner is early, if much
exercise  is  taken between  that  and  the
evening meal, and if supper  is not eaten at
too late  an  hour, many persons  can take
with benefit a moderate proportion of animal
food.
  It certainly  is  better not to eat  a  meal
heavy, either in quantity or quality, before a
period of inactivity and sleep so prolonged
as that of the night; but there is no doubt
that much of the bad character of supper as
a meal, has arisen from its being too  often
one of superfluity.  Those to whom suppers
are most injurious are the plethoric, or such
as Buffer from head  symptoms.   Some per-
sons, however, especially dyspeptic invalids,
do  themselves  harm  by  abstaining  from
suppers of every kind, even after the  prin-
cipal meal has been  taken early in the day.
They do this under  the idea that all sup-
pers are  bad,  and suffer, in consequence,
from uneasy sensations  in the stomach dur-
ing the night, and from a sense of exhaus-
 tion in the morning, both of which may en
 prevented by  a  moderate  supper of  lighl
 food, such as  is  generally found to ngroe
 best; many a dyspeptic will find his morn-
 ing meal better digested after a light sup-
 per than without.
 ,  Refer to Breakfast—Dinner, Sec.
   SUPPOSITORY — Is a,medicine in a solid
 form intended to be passed up into the rectum.
 In some  cases, this mode of administering
 remedies is very convenient, especially when
 the stomach cannot receive them readily.
 Generally, it is most suitable in  painful dis-
 eases—such as those of the bladder, womb,
 &c.—situated in  the vicinity of the  lower
 bowel.   In such cases, the suppository  must
 of course be anodyne, usually opiate, which
 may be thus  made to exercise  its effects
 without disordering the stomach.  A grain
 of powdered opium, with fife or six of firm
 henbane  extract, makes  a  very good  sup-
 pository.  A suppository may be introduced
 into the  bowel rfn the point of  the finger,
 both being well greased; the operation is,
 however, better and more conveniently done
 by the suppository tube made for the  pur-
 pose.
   SUPPRESSION.—The cessation, or  non-
 development of an ordinary secretion or
 excretion.
   SUPPURATION.— The formation of pus,
 or matter.—See Inflammation—Pus, Sec
   SURGEON  and  SURGERY. —Literally,
 by the word surgeon is meant an individual
 who employs his hands in the treatment of
 diseases; and, by consequence,  one whose
 practice is limited to the external treatment
 of external affections, and  such as require
 manual interference for their removal. Prac-
 tically, no such distinction can exist.
   Refer to Physician—Practitioner, Sec
   SUSPENDED ANIMATION.—See Death
 —Drowning—Carbonic Acin—Hanging—
 Suffocation, &c.
   SUTURE—In surgery, means  a joining,
 by means of threads or stitches, of the edges
 of a wound.—See  Wounds.
   In anatomy, the term is applied tothe junc-
 tions of the bones of the skull.—See Skull.
   SWALLOWING.—See Alimentary Canal
 —Gullet—Throat, &c.
   SWEAT, or  Perspiration—Is  the  fluid
 thrown  off from  the  blood, "excreted,"
 through the agency of the skin, or rather
 of the glands  contained within  the texture
 of the skin.—See Skin.
   Refer to Di /phoretics.
   SWEETMEATS.—See Confectionary.
   SWEET SPIRIT OF NITRE.—See Ni-
 trous Ether.
!   SWELLED LEG.—See Lbq. 
                 S WE

  SWELLING.—Increase of size of different
portions of the textures of the living body
may arise from  a variety of  causes.  The
swelling may be either of a fluid or of a solid
character.   In the former case, it may be
caused by increased accumulation or deter-
mination of blood in  or  to  the part,  the
blood being still contained within the blood-
vessels. More usually, however, fluid swell-
ing is caused by blood or other fluid not con-
tained within  the vessels, but effused into
the textures where the swelling occurs.  Of
this nature  is the swelling  which  occurs
after violence; it is, in fact, the result  of
the effusion of blood—inward  bleeding—or
of serum into the tissues.   The formation
of matter also  causes swelling.  Fluid swell-
ings are in many cases of rapid formation;
solid swellings,  from  their nature, are  in
general necessarily of slow  increase.   In
rupture, of course, the presence of gas  in
the  protruded bowel  renders  that a cause
of  swelling,  though comparatively an un-
frequent one.   As the different  forms  of
swelling are noticed under other articles, it
is unnecessary to reiterate them here.—See
Tumour.
  SWINE-POCK, or Swine-pox—Is a va-
riety of chicken-pox, characterized by the
conical  form  of its vesicles.—See Chicken-
pox.
  SWOON.—See Fainting.
  SYMMETRY.—The term, as applied  to
the human form, includes that proportionate
adaptation of  the various parts of  the body
to one another, which gives, not only grace
and beauty, but strength;  and, it may  be
added, in some degree, health.   The latter
observation is especially applicable to the
symmetrical development of the trunk  of
the body, which can  scarcely be unsymme-
trical, and still less, deformed, without the
contained vital organs being injuriously im-
peded in their functions.  Deformed per-
sons suffer more than others from bad health,
and if they are subjected  to an  attack  of
acute disease affecting the impeded organs,
they are more  liable to succumb.   Thus,  an
individual, in  whom  spinal curvature,  by
distorting the ribs, &c, injures the symme-
trical development and proper capacity  of
the chest, is more liable to chronic affection
of the lungs and heart, and such attacks as
bronchitis, and the like, are more severely
felt.  Want  of symmetry, or  deformity  of
the limbs, is less important than when the
trunk is affected, the importance  varying,
of course,  with  the nature of the case; it
may, however, and does occur, that unsym-
metrical development, of the  lower limbs
especially, leads  ultimately to greater  or
!3                S 1" M

 less distortion of the  trunk also.  More
 over, in many cases, want of symmetry must
 be regarded as the sign of  a constitution
 hereditarily weak, or as the result of sickli-
 ness in childhood.
   The subject of symmetry is an extensive
 one, embracing, as it does, the  theories of
 ideal beauty, and the  standards of  mea-
 surement, proportional  and otherwise ; into
 these it needs not to enter here, but it may
 be adopted  as a general rule, that the  sym-
 metrical development of a race or nation
 must in some degree be commensurate with
 their general  sanitary condition, the means
 of obtaining proper nourishment, and  their
 free exposure to light and air.   Under arti-
 cle "Light" it  was stated that Humboldt
 has attributed  the absence of deformity
 among the Caribs, Mexicans,  Peruvians, &c.
 to the constant exposure of the body at large
 to strong light; and, under the same article,
 the effect of a diminished supply of light, in
 giving a tendency to the  production of de-
 formed children, was also alluded to.  Analo-
 gous effects will be found to follow, accord-
 ing to the fulfilment or not of other sanitary
 conditions.  There is no surer sign of a peo-
 ple advancing higher in  the scale of comfort-
 able subsistence  than the improvement  of
 their physical development and symmetry.
 The reverse of this is  seen  in the degene-
 racy of some of the Irish in the more re-
 mote districts on the west coast, in the In-
 dians of the Rocky Mountains,  and  others.
 Although comparative  symmetry  is  to  be
 met with  among many  nations,  and in the
 persons of individuals,  absolute symmetry,
 in the sense of perfect  balance,  and corre-
 spondence of the two halves  of the body, is
 probably not  to be found, and  exact  mea-
 surements go to prove  that  there  always
 exists some disparity  between the corre-
 sponding degrees of different sides.
   Symmetry is not, however,  confined to the
 actual development of  healthy  tissues : it
 extends to and influences many forms of dis-
 ease, such as often occurs  in the symmetri-
 cal distortions, so to speak,  of  gout, rheu-
 matism, &c.
   Refer to Deformity—Spine,  Sec
   SYMPATHETIC NERVE.—See Nervous
 System.
   SYMPATHY.—In man, and probably in
 the higher animal tribes, there exists between
 certain different portions  and organs of the
 same living body, a bond of  connection, or
 at least  of  relative action, through which
 excited or diseased action in the one is ex-
 cited in the other,  "sympathetically,"  as
 it is called, or by " sympathy."  It is evi-
 dent, however, that what are called sympa
5 
Y  M
:>24
S Y M
thetic actions arise, apparently, at  least,
In very  different ways.   Some  which  nre
classed as such are evidently the result of
contiguity,  others  of reflex  action, (see
Nervous System,) or at least of  nervous com-
munication, others  of  derivative action.—
See Derivative.
  SYMPTOMS.—In astate of perfect health,
all the functions of  the living body are per-
formed in a regular series, nnd according to
certain modes of action, which we recognise
as those of health.  When, however, these
Beries or modes become deranged or altered,
there arise certain signs, or, as they  are
generally called, " symptoms," which,  as
they vary according to the nature  of  the
cause  that  produced them,  afford  to  the
medical man a clue to the detection of  the
cause, more  or  less perfect,  according to
the state of his knowledge, experience, and
means of investigation—they in fact furnish
the means by which he  forms his " diag-
nosis" in the first instance, and which guide
his opinion as to the treatment aud ultimate
issue  of the case.
  There are certain symptoms, both general
and special, which are too marked to escape
detection;  some, indeed,  are  forced upon
the attention by the complaints of the suf-
ferer, and  others  are  too palpable  not to
attract the notice even of the  unobservant.
Beyond these plain and palpable symptoms
of disease, however, which "he who runs
may  read,"  there  are  others  which  lie
deeply hidden from ordinary eyes, which it
requires  all  the advantages  of knowledge
and experience,  of  educated ear and eye,
and of patient attention  to discover, and,
when  discovered, to read.  There are many
sigus  and characters brought to light in  the
explorations  of the physician,  both  in  the
living and in the dead body, which he may
see. but  cannot read correctly, if he  can
read  them  all.   Again, there are  signs
which one  man  can see  as symptoms,  but
which another cannot, and therefore passes
them  by unheeded ;  and  further, there  are
other  symptoms which one-man can not only
Bee, but interpret,  but of which another, if
he sees them at  all, can  make no  use.   In
this lies  the  difference, in one department
of practical medicine at  least, between  the
skilled and unskilled practitioner.   It does
not follow of necessity, that  the man who,
from  his knowledge of  symptoms  and  of
what  they indicate,  is most successful  in
the investigation of disease, is so likewise
in its  treatment, but the chances are greatly
in his favour.
  If many symptoms pass before the eyes
even of the most skilful, which either can-
not be seen, or, if they nre  seen, cannot be
correctly  interpreted,  how superficial  must
that knowledge of disease be which unpro-
fessional persons can gather from the com-
paratively  few symptoms they are capable
of observing or appreciating?   How cau-
tious, then, ought such persons to  be when
circumstances call for their management,
temporary or permanent, of even the  most
trivial ailments!   In observing and forming
deductions from symptoms, the first ques-
tions ought to be—do they indicnte an ncute
attack?  have they  supervened suddenly?
and if so, to what can the attack be traced?
Has there been exposure to cold and wet,
or to checked  perspiration ?—those fruitful
sources of inflammatory and rheumatic affec-
tions.  Has there been exposure to conta-
gion in any form, or to malaria of any kind,
or is  there any prevailing epidemic?  Can
any violence, at no very distant date, account
for the attack ?  Careful consideration  of
the " history"  of the nffection will often
throw much light  upon its nature.   Again,
if  the usual  symptoms of  fever  indicate
inflammatory affection, it is to be considered
whether pain or uneasiness  in  any  part,  or
disordered function of any organ,  indicate
that the  disease  has  localized itself.  If
inflammatory  symptoms  are  absent, the
spasmodic character of pain, (see Spasm,) or
the nervous character of the  general dis-
order,  become question for consideration.
Should the symptoms of ailment be chronic,
the same consideration of the history and  of
the hereditary tendencies onght to be enter-
ed into, and attention  particularly directed
to  the fact of there having been progressive
loss of flesh,  habitual  complaint of cold,
unusual  lassitude, alteration in  the com-
plexion, difference in sleeping, &c.
  By  systematizing inquiries and  observa-
tions, a much clearer idea will be gained  of
the state of an individual who  is an object
of care.and solicitude, than by making them
at random.  Thus, beginning at the Head,
attention should be directed to  any  unusual
sensations  complained of by the person,  or
any  unusual  manifestations  apparent  to
others.   These are  pain, giddiness,  affec-
tion of the senses, confusion of thought,  or
impairment of mental  power;  flushings,
twitchings, drawing of the features to obc
side:  disturbed sleep;  moaning;  grating of
the teeth ;  sleeplessness or too great somno-
lency.  Passing downward to the Organs of
Respiration:  alterations in the character of
the voice;  in the respiration, as to the fre-
quency or otherwise;  in the power  of lying
in  any or every posture,  are all matters for
observation; also any  habitual oough, and 
SYN.
525
TAB
 its character.  When  the  Digestive Organs-
 are disordered, the period of their chief dis-
 order, as connected with taking food, is an
 important  symptom;  whether  the  uneasi-
 ness comes  on quickly after  a meal, or not
 for nome hours;  whether it  is  worse after
 long fasting, or the reverse ;  whether there
 is habitual vomiting, &c.   With respect to
 the Bowels,  the  nature of the motitns or
 stools is to be inquired into, and especially
 the fact  of thorough  daily relief.  In in-
 quiry into the state of the urinary organs,
 the amount of the secretion, its nature as
 to colour, or  its tendency  to  deposit  sedi-
 ments immediately after being passed, or
 when it becomes cool, are principal objects.
 If the calls  are  too  frequent,  it is to be
 noticed whether this depends  on increased
 quantity  or  on diminution,  which  causes
 irritation  from greater concentration.  In
 this  way, by carefully and systematically
 considering a case, even an unprofessional
 person may acquire very considerable know-
 ledge of its leading features, sufficient pro-
 bably to enable him to refer to those articles
 in this work from which  he  will  derive
 proper information; in many cases, sufficient
 to open the  eyes to  a condition of  health
 that calls for  the  prompt submission  to
 proper medical  advice.   When  this  is
 determined on, the  observation of symp-
 toms, either in  his own case  or in  that of
 another, such as a child, will enable any in-
 dividual to furnish a medical man, even at
 a first interview, with such  a history as will
 afford him  much  assistance in  forming his
 opinion.
  Refer to Diagnosis,  Sec. Sec.
  SYNCOPE.—A state  of swoon or fainting.
 —See Fainting.
  SYNOVIA, or  Synovial Fluid—Is the
 fluid which is secreted  within the joints by
 the lining or synovial  membrane,  for the
 purpose of lubricating  the  opposed cartila-
 ginous surfaces of the bones, and facilitating
 their movements upon one another.  It con-
 tains  a considerable amount  of albumen,
 and from  its unctuous quality  is  known
 popularly as  "joint-oil."  When, from any
 cause, a joint becomes the seat of irritation,
 there is apt to be a greatly  increased secre-
 tion of the synovial fluid.  This takes place
 in  what is called  " white-swelling"  of the
 knee.—See Knee.
  SYPHILIS, or the Venereal Disease-
 Is a disease contracted in consequence of im-
pure connection. The fearful constitutional
consequences  which may result from this
affection;  consequences, the fear of which
may haunt the mind  for years, which  may
taint  the  whole springs of health,  and be
 transmitted to circulate in the young blood
 of innocent offspring, are indeed  terrible
 considerations—too terrible  not  to render
 the disease one of those which  must  un-
 hesitatingly be  placed under medical care.
 In the mean time, if any delay must occur,
 the pustules (sores) which may be observable
 should be well touched with caustic, the diet
 should  be reduced and deprived  of stimu-
 lants, and the bowels acted upon by mode-
 rately  active  aperients,  violent  exercise
 being at the same time avoided.
   Whatever the circumstances may be,  the
 author  would,  once and  for all, warn  the
 reader against placing any trust in the spe-
 cious advertisements connected  with  the
 disease  in question, which are so persever-
 ingly and  disgustingly paraded before  the
 public eye, by quacks, who  endeavour to
 fleece the silly dupes who resort to them, by
 first exciting their fears.
   SYRINGE.—This well-known  instrument
 is useful  domestically for many purposes,
 and its  employment  is  recommended  in
 various  articles in the present work.  Gene-
 rally speaking, the ordinary pewter syringes
 are procured too small to be of much use:
 an instrument capable  of holding an ounce
 of fluid  will be found a convenient size.
   SYRUP.—A saturated solution of sugar in
 water.  A great variety of medicinal syrups
 are made, but many of them are compara-
 tively little  used.    The ordinary simple
 syrup is made  by dissolving,  with the aid
 of gentle  heat, five pounds of refined sugar
 in  thirty ounces^ of water.  Syrups made
 with unrefined sugar are much more liable
 to ferment than those made with it purified.
 —See Sugar.   A syrup should  always, if
 possible, be kept  in a situation  with the
 temperature under 55° Fahr.
   SYSTOLE—Is the contractile action of the
 heart, by which  the blood is  expelled  from
 the cavities.  It is the reverse of diastole.—
 See Diastole—Heart, Sec.

   TABES, or Tabes  Mesenterica—Means
 a disease  characterized by wasting or atro-
phy.—See  Atrophy.   The term is, however,
applied  to a special diseased condition which
causes atrophy, the essential nature of which
is a scrofulous or tuberculous affection of the
 " mesenteric glands" (see Digestion) through
which the chyle, or nutrient: fluid extracted
from the digested food, passes on its way to
the blood.  The  disease, in  fact,  may  be
called consumption in the belly; for, though
differing in many respects from  consump-
tion in the lungs, there are many points of
analogy between the two maladies.
   Mesenteric tabes is a disease almost pecu 
TAR
526
TAB
 liar to the scrofulous constitution, whether
 hereditary or  engendered, and  it  usually
 occurs previous to  the  completion  of  the
 twelfth year, most frequently previous to the
•ninth ; some cousider that  children, while
 nursed at the breast, are less liable to  be
 affected by this form  of  scrofula, but  the
 rule is by no means absolute.
   Probably,  the first  symptom  which  at-
 tracts attention in  a child  becoming  the
 subject of tabes, is.the progressive emacia-
 tion, coincident with undiminished and often
 greatly increased appetite, sometimes with
 depraved  appetite,  the   child evincing  a
 strong desire for such indigestible food as
 cheese more especially.  Along with these
 symptoms there has generally been com-
 plaint at different  periods, perhaps  two  or
 three  times in  the day, of pains  in  the
 belly,  which  probably were attributed  to
 griping.  The  stools, if attention is or has
 been  directed  to them, are found to be  un-
 natural, irregularly costive or relaxed, often
 frothy,  and  the  colour,  especially,  much
 lighter than  in health, apparently from de-
 ficiency of bile—the evacuations look clayey
 or chalky.  If the disease has made some
 little  advance,  there  may, or may not,  be
 Borne amount of tenderness of the belly  on
 pressure.  There is usually fretfulness and
 irritability of temper, with tendency to flush-
 ing  in the evening, and  a  perspiration—
 which smells  heavy and  disagreeably—at
 night.  As  time advances, the emaciation
 becomes  more marked, and  the attenuated
 limbs  contrast strongly with  the  abdomen,
 which, probably, but not always, becomes
 tumid.  The features lose their plumpness,
 the skin  of  the face is wrinkled, and  the
 whole countenance  often approaches  in  ap-
 pearance that of an aged person.  The veins
 are promiuently  marked  on  the white skin,
 and the latter is often strongly contrasted
 with the  preternatural redness of the lips.
 When  the disease reaches an advanced stage,
 hectic  fever is  regularly established, and
 the  patient  dies exhausted,  if not cut off
 previously by some acute attack of inflam-
 mation.   The predisposing cause  of this
 disease is, certainly, in the  first place,  the
 scrofulous constitution ;   its development,
 however, is greatly favoured by those defi-
 cient  sanitary  arrangements to which  the
 poorer classes are  exposed,  especially  the
 influence of damp and ill-ventilated  rooms,
 combined with deficient food.
   There is a prevailing popular id.ea, that a
 naturally large  or prominent  belly  is  an
 indication of a tendency to the disease in
 question.  This, however, does not appear
 to be the case; neither is the prominence of
the abdomen  always  a mnrkfd symptom,
unless,  indeed, it be  occasioned  by  flatu-
lence, until the later stages of the disease;
and then the enlarged glands can frequently
be felt through the thinned walls of the ab-
domen,  which, moreover,  are covered with
enlarged, and often tortuous  veins.
  Mesenteric tabes is so fatal a disease, es-
pecially if it is  allowed to make any pro-
gress  before treatment  is adopted, that  its
first symptoms cannot  be too soon  detected
and attended to ; and those who have chil-
dren under their care, who exhibit scrofulous
tendencies, (see Scrofula,) ought to be alive
to the possibility of its taking place.  Should
its occurrence be suspected,  the safest and
best plan will be to place  the patient under
proper  medical  care  at  once.   Medicine,
however, is  not  more  reqiusite than strict
attention  to  sanitary  regulations,  to  the
ventilation,  dryness of the  sleeping and
other  apnrtments ; to  exercise in  the open
air, to  due  clothing, with flannel next the
skin,  and to the  food, which ought to  be
nourishing, consisting  of  well-cooked fresh
meat, mutton especially, at least once a day,
or well-made nourishing animal broth, nou-
rishing  puddings, &c.;  but with avoidance
of all  cheese, pastry, &c. A little port-wine,
or porter, may be  useful in some cases, but
of this a medical attendant-can only safely
judge.  \\ ith regard to medicine—the pale-
ness of the  motions suggesting the idea  of
deficient secretion of bile, often gives rise to
undue perseverance in  mercurial remedies.
For remedies in this disease the  reader is
referred to article "Scrofula;" indeed, the
general treatment of that state of constitu-
tion is so similar to what is required  in tho
mesenteric affection that it is superfluous to
repeat  it, with  exception of  noticing the
almost  specific  powers of codliver-oil  in
many  cases  of this  disease:  the  following
may serve as illustration:—A child eight
months  old was  shown  to  the  author, very
reluctantly,  by its mother, who, as well as
her relatives generally, had  abandoned  all
idea of its living beyond  a  few days.  It
was a complete specimen  of the  advanced
stage  of mesenteric disease ;  the limbs were
shrunk  till  they resembled  sticks covered
with parchment;  the features withered and
old-looking ; the prominent belly was hard,
knotty,  and  covered with enlarged veins,
and  the  infant   screamed  almost  perpe-
tually, as  if in constant pain.  With some
persuasion the  parents consented  to try
codliver-oil,   given  in  teaspoonful  doses
twice  a day, with the same quantity rubbed
into the belly  twice  a day.   Under this
treatment the child at once  began  *o im- 
T AM
527
TAR
 prove,  and in the course of three or four
 months  had lost  every  appearance of dis-
 ease. He is now a fine, healthy boy. Similar
 treatment checked the disease  in  an  early
 Btage in a younger brother of the above pa-
 tient.
   Before taking leave of the subject, it is
 proper to notice a habit  by which children
 predisposed to this and other scrofulous dis-
 eases, are apt greatly to injure  themselves;
 it is that of sleeping with their  mouths and
 heads under  the  bedclothes.   It should
 never be permitted in  any child.
   Refer to Atrophy—Digestion—Scrofula, Sec.
   TAMARINDS—Are produced by a  tree,
 which belongs to  the leguminous or pea
 tribe, a  native, of India,  &c,  and also cul-
 tivated largely in the West Indies, for the
 sake of the acid pulp of the pods, which re-
 semble somewhat those of the common field
 bean.  Tamarinds are  brought to this coun-
 try either simply dried or preserved in su-
 gar, in jars or casks.  The appearance  of
 the pods mingled with fibrous substance and
 seeds, and immersed  in  syrup, liquid,  or
 partly crystallized, is sufficiently well known.
 Preserved tamarinds  are cooling and  ape-
 rient, and a welcome addition to  the  sick-
 room dietary in many febrile diseases.  They
 are most beneficially employed in the  form
 of infusion made with hot water,  and per-
 mitted  to become cold.   A pleasant  ape-
 rient whey is made by boiling an ounce of
 tamarind pulp in a pint of milk.   The  acids
 of the tamarind  are chiefly  the citric and
 tfirtjiric
  TANNIN and  GALLIC ACID.—Tannin
 is the active astringent principle of the nut-
 gall.—See Gall—Nut.   When exposed to the
 atmosphere in a  state of  moisture, it ap-
 pears to attract oxygen, and to be converted
 into  gallic acid.   Both tannin  and gallic
 acid  are powerful  astringents, and  are
 widely diffused  as the astringent principle
 throughout the vegetable kingdom.   The
 former is met with in the  form of a yellow-
 ish powder, the latter  in  fine, white, silky-
 looking crystals.   Both are soluble in water,
 and in solution are used externally for the
 same  purposes  as astringents  generally;
 from half a drachm to a drachm in half a
 pint of water forming an  astringent lotion.
 Tannin or gallic acid is generally given in-
 ternally in the form of  a pill, in hemorrhage
 and other similar affections, in doses of three
 to six grains every two or  three hours if re-
 quisite.
  TAPEWORM—Also  called  T.f.nia.—See
 W(orms.  [Pumpkin seeds have  been already
mentioned as  a cure for  this  complaint.—
See Pumpkin.]
I   TAPIOCA—Ts  a starchy  substance,  or
 fecula, like sago.  It is procured from  the
 root of a shrub, which is cultivated chiefly
 in the West  Indies.   The  root, which is
 known as the " bitter  cassava," contains a
 juice possessed of highly narcotic poisonous
 qualities; this juice is  thoroughly removed
 by washing, and the starch, or tapioca, dried
 in the form of grains,  resembling, (but two
 or three times the size of,) the sago grain.
 Tapioca is used  in sick-room  cookery  for
 the same purposes as arrow-root and sago.
 Dr.  Christison  remarks  of  tapioca, "no
 amylaceous substance  is so much relished
 by infants about the time of weaning; and
 in them it is less apt to become sour  during
 digestion  than  any other farinaceous food,
 even  arrow-root not excepted."
   An  imitation "British tapioca" is made
from  potatoes, and is very wholesome.
   Refer to Fecula.
   TAPPING — In medical  practice, is the
withdrawal of fluid which has collected  in
unnatural  quantity in  any of the natural
cavities of the body.   The  operation  can
only be performed by a medical man.
   TAR and PITCH.—The well-known black
viscid substance tar, is obtained from the
wood chiefly of the Scotch fir, by the agency
of heat.  The  process, which varies in detail
according  to  the situation, is essentially
what is called " distillation per descensum,"
that is to  say, the wood, being placed in a
hollow of the ground, or in a pot, is kindled,
and  being covered up,  is allowed to burn
with a smothered combustion; by this means
the tar is formed,  and is collected by suit-
able arrangements at the bottom of the re-
ceptacle in which the process is carried on.
For  medical  purposes,  tar has  been used
from the most ancient times,  and within re-
cent dates its employment has been strongly
advocated  by  different persons,  more espe-
cially  by  Bishop Berkely,  as a remedy  in
chest affections, chronic  bronchitis, incipient
consumption, &c.  Tar  is usually adminis-
tered  in the form of tar-water, which is best
made by digesting—stirring occasionally—■
one ounce  of  tar  in  thirty-two ounces  of
water  for  seven or  eight  days,  and  then
straining.   The dose is  half a pint twice  a
day mixed with milk.   The vapour of tar
has also been recommended, but has not
been generally employed. Tar is now chiefly
used as an external application in some cases
of skin disease, either in the form of water,
or in that of ointment, made by melting to-
gether by heat, equal parts of tar and suet,
and squeezing  through linen.   Pitch  is the
hard black brittle residue left after tar has
been exposed to heat.  It is little used. Pillr 
                  TAR               5!

made of pitch are a  popular, and certainly
at times a  successful  remedy, in bleeding
piles.
  Refer to Piles.
  TARANTULA—Is a  species of large spi-
der,  common in  southern Europe,  the ve-
nomous bite of which produces effects similar
to those of the scorpion sting.   Many fabu-
lous tales of the effect  of the tarantula bite
were formerly currently received.
  TARAXACUM—See Dandelion.
  TARTAR  on the TEETH.—See Teeth.
  TARTAR  EMETIC,  or Tartarized An-
timony.—See Antimony.
  TARTARIC ACID—Belongs to the class
of vegetable acids.   It is the characteristic
acid of the grape, from which  source  it is
procured.    In the fruit it  exists in com-
bination with potash, as bitartrate of potash,
or cream of  tartar, the acid when prepared
being separated from the alkali by chemical
process.  For an account of the  mode in
which cream of  tartar  is  obtained,  the
reader is referred to  article "Potash."
  Tartaric acid is met with both in crystal
and powder, generally  the latter.  Its prin-
cipal  use is to form the acid ingredient for
effervescing  mixtures of various kinds; and
for this purpose  it is well adapted, whole-
some, and cheap.  It is also a good solvent
for quinine.
  Refer to Effervescing.
  TASTE.—See Tongue.
  TAXIS.—See Rupture.
  TEA.—Few articles  consumed  by  man
as food, require more careful consideration
in every point of view  than this important
and widely-used  product  of the  vegetable
kingdom; which, as we  shall see,  is  not
only a luxury, a cheering but  not inebriat-
ing stimulant, but a valuable addition to
the essentials of healthy nutrition.   The
tea-plant is  a native of China, .Japan, and
Tonquin; and until late years,  the supplies
to this  country were all brought from
China. Its cultivation,  however, in the pro-
vince of  Assam, in India, has  opened up  a
new source,  and one which promises even-
tually to be  advantageous in every way.
  " The  principal varieties of black tea*
are Bohea,  which is  the  commonest  and
coarsest  description,  Congou,  Souchong,
Caper, and  Padre-Souchong,  and Pekoe,
which are of the highest quality, the last
consisting of the very young, and of the un-
ex pa tided leaves : and  which, when clothed
with  down, constitute  flowery Pekoe.   The
principal varieties of green tea are Twan-

  * The above  extract, and  much of the information
contained in this article* i«  derived from the Lancet \
Report*.
28                TEA

 kay, Hysonskin, Young Hyson, Hyson, Im
 perial, and Gunpowder, which, in green tea,
 correspond with  flowery  Pekoe  in black.
 There is  but one species  of the tea-plant,
 from which the  whole of the  nbove  nnd
 many other varieties of tea are obtained—
 the differences depending upon soil, climate,
 weather, age of  the  leaves, and  mode of
 preparation.   The plants  from which black
 teas are prepared, are grown chiefly on the
 slopes  of  hills nnd  ledges  of  mountains;
 while the green-tea shrubs are cultivated
 chiefly in  manured soils."
   Tea in itself possesses a natural fragrance
 which  requires  no  addition,  the  Chinese
 themselves saying,  " that only common tea
 requires  scenting;" nevertheless, there are
 various scented  teas  which  are  said to  be
 in  high  estimation  even in  China.  The
 principal constituent of tea which it yields
 for  solution when infused,  in  addition  to
 its  characteristic nitrogenized  constituent
 "theine," is the  astringent principle tan-
 nin.—See  Tannin.
   Tea, it  is  well known, is liable to  im-
 mense adulteration—much after it reaches.
 this  country,  but partly  in China.  It is
 said " the Chinese annually dry many mil-
 lions of pounds of the leaves  of different
 plants  to  mingle with the genuine," and
 " the leaves of the following species have
 been detected from time to time  in samples
 of tea of British fabrication :—beech,  elm,
 horse-chestnut, plane, bastard-plane, fancy
 oak, willow, poplar, hawthorn, and sloe."
   One of the most frequent adulterations of
 tea is its  admixture with exhausted leaves
 which have been redried.  " lt was  sup-
 posed,  in  1848, that there were eight manu-
 factories for  the  purpose of redrying ex-
 hausted tea leaves  in  London  alone, and
 several  besides  in various  parts of  the
 country.    Persons were  employed to buy
 up the  exhausted leaves  at hotels, coffee-
 houses, and other places, at 2%d. and 3d. per
 pound.  These were taken to the factories,
 mixed with a solution of gum, and redried.
 After this, the dried leaves,  if  for  black
 tea, were  mixed  with rose-pink and black-
 lead, to face them,  as it  is termed by the
 trade."
   Catechu is  a  frequent addition to  the
 exhausted  and other leaves, in  order to
 supply the astringency which  is wanting.
 This drug forma also a principal constituent
 of  such   articles  as  " La  Veno  Beno,"
 "Chinese  Botanical  Powder,"  &c, which
 are sold to be added to tea,  as chicory is tc
 coffee.   It is  perhaps superfluous to add,
j that such  additions are highly deleterious,
 and  should never be  employed.   Sulphate
>8 
TEA
529
TEA
 of iron or green vitriol, rose-pink, logwood,
 plumbago, indigo, &c, are all used at times
 iu  the adulteration  of  tea.  Adulterated
 teas are seldom sold alone,  but  are  mixed
 in  greater or less proportion with the ge-
 nuine.  In the Lancet Report it is stated,
 "That out of twenty-four samples of black
 tea  purchased of tea-dealers  and grocers
 resident in  the metropolis,  [of  England,]
 twenty were genuine,  and four adulterated;
 the former being Congous and Souchongs,
 and the latter  samples  of  scented  Pekoe
 and scented  Caper."
  Green tea is so  greatly adulterated, that
 although there certainly is a genuine pre-
 paration of  this  kind,  it seems doubtful
 whether any  is sold pure.  From authentic
 examinations,  "it appears   that  all  the
 green  teas that  are imported  into  Eng-
 land are faced or covered superficially with
 a powder consisting either of Prussian blue,
 or sulphate of lime, or gypsum," or of some
 other  colouring-matters.     The  principal
 conclusions arrived at' in the Lancet Reports
 from the examination of many  different
 samples of green tea are—
  " First. That these teas, with the excep-
 tion of a few of British growth and manu-
 facture from  Assam, are invariably adulte-
 rated—that is to say, are glazed with colour-
 ing-matters of different kinds.
  " Second.   That  the   colouring-matters
 used are in general Prussian  blue, turmeric
 powder, and  China clay,  other ingredients
 being  sometimes,  but not frequently, em-
 ployed.
  "Third. That of these colouring-matters,
 Prussian blue possesses properties calculated
 to affect health injuriously.
  "Fourth.   That  in England  there  is
 really no such thing as a green  tea—that
 is, one which possesses the  natural  green
 hue considered to characterize that kind of
 tea.
  "Fifth.  That green teas, and more espe-
 cially the gunpowders, in addition to being
 faced  and  glazed, are   more subject  to
 adulteration  in  other  ways than  black
 teas."
  The chief adulteration is the spurious or
 "lie tea," manufactured in China from
 other leaves  than those of  the  tea-plant.
 It is impossible that  any systematic  adul-
 teration of  an article of diet of  such uni-
 versal  consumption as tea can fail  to be
 most injurious to  the health of the com-
 munity at  large, and  especially to  that  of
 the poorer classes, who buy the low-priced
 teas in small quantities at a time; and who,
moreover, in  many places at least, have  a
strange predilection  for  green teas, which
         2 U                            3'
 we have just, seen are scarcely to be  met
 with  free  from adulteration.  The subject
 is one which demands attention from every
 one.   Nor is  the adulteration  an active
 evil only—it is a  passive one also ; for, by
 diminishing the amount  of the  " theine,"
 the active principle  of tea, it deprives the
 poor  consumer of nitrogenized aliment,
 which to him  stands  partly in lieu of ani-
 mal food.
   It is probable that there are few more
 remarkable facts in the history of mankind,
 than that which has been brought to light
 by the recent researches of  organic chemis-
 try, respecting the identity of composition
 of the principles  to which  tea, coffee,  and
 also cocoa, owe their characteristic proper-
 ties.  On this  head Liebig remarks, " We
 shall  certainly never  be  able to discover
 how men were led to  the use of the hot in-
 fusion of the leaves of a certain shrub—tea
 —or of a decoction of certain roasted seeds
 —coffee.  Some cause there must be, which
 would explain how the practice has become
 a  necessary of life to whole nations.  But
 it  is surely still  more remarkable, that  the
 beneficial  effect of both plants on the health
 must be ascribed to one and the same sub-
 stance, the presence of which in  two vege-
 tables  belonging to different natural fami-
 lies, and the produce  of different quarters
 of the globe, could hardly  have  presented
 itself  to the boldest imagination.   Yet re-
 cent researches  have  shown,  in  such  a
 manner as to  exclude all doubt, that  caf-
 feine, the peculiar principle of coffee, and
 theine, that of tea, are in all respects iden-
 tical."  The above facts are the strongest
 possible argument in favour of the assump-
 tion, that man, as  he advanced in civiliza-
 tion, required  for comfort, and probably
 also for  health, some, at least, occasional
 addition to the simple element.  What  can
 be more significant of design  than this—
 that we find in two distinct  quarters of  the
 habitable   globe,  man  using,  as a  daily
 drink, two distinct forms of vegetable in-
fusion, made, the one from a leaf, the other
from  a berry, each  produced  by totally
different  plants,  and  yet  each  exerting
nearly the same physiological action upon
man ?  This was calculated  to excite admi-
ration ;  but how much more when  the  re-
searches of modern science  elucidated  the
startling  fact,   that  nations in  different
quarters of the globe had  ignorantly  but
instinctively been  led—we  speak  now as
regards  science—to  adopt  for  the  same
purpose, these  apparently dissimilar mate-
rials,  which yet owed their characteristic
properties to active principles identical  in 
TEA                *>30                TEA
composition.  Nay, further, that the nations |
among whom tea and coffee were originally j
met with, were those whose diet is chiefly
vegetable,  consequently who  consumed  a'
larger quantity of non-nitrogenized food, at
least  of food which did not contain  a due ;
proportion of nitrogen for supplying  the
wants of the healthy system, and especially
for furnishing sufficient for the nitrogenized
constituents  of  bile ?  Nny,  science  has j
further pointed out, and Liebig has shown, i
that from the relation existing between the
azotized  vegetable  principles, theine, caf-
feine, (and  also  theo-bromine,)  and  the
azotized  constituents  of bile, that  tea and
coffee " are, in virtue of their composition,
better adapted to this purpose," to supply
the biliary azotized principles,  " than  all
other nitrogenized vegetable principles."  It j
is further singular, that  the above is sup-
ported by  what  we might almost call  an j
instinctive habit among many of the poor of |
our own country, who are unable to procure
animal (azotized) food, but who will  make
every effort to procure tea and coffee.  The
custom  is, and  is  no doubt felt  to  be, a
salutary  one, although injury is frequently
done  by the  unnecessary  large quantity of
tepid  liquid consumed.  Indeed, if  we con-
sider  the sugar taken with tea as furnishing j
the carbon of the  bile, and  the theine  its ,
nitrogenized  material, whether the bile  be j
formed in the blood or in  the liver, we here
have  its  essential  constituents.   Tea  and
coffee, moreover, are  particularly adapted
for the use of the sedentary,  a class  pecu-
liar to civilized life.   In these persons, the
metamorphoses of the tissues being reduced I
for want of motion, the amount  of azotized
material available for the formation of  bile
is diminished.  Persons of sedentary  habits
are also extremely apt to  take an excess of
non-azotized  food.  Tea  and  coffee  being
capable of furnishing the proper  azotized
compound, the use of these substances may
promote the conversion of that  excess into
bile;  and accordingly may favour the com-
bustion  of carbonaceous  materials,  which
would otherwise  accumulate  in  the  blood
and produce languor, lassitude, and oppres-
sion.  We have here  a chemico-vital effect
exerted upon the living system by the active
principles of  tea and coffee, analogous  to,
but perfectly distinct from that exerted  by
alcohol;  we have also to consider the  effects
of these principles upon the nervous s\ stein,
different but  parallel to those  of the  spirit.
Like alcohol, the first effect of tea and cof-
fee is exerted upon  the  stomach and  its
nerves, these  effects doubtless being  modi-
fied by the hot liquid in which the articles
are generally  taken.   The  first  effect  ii
Btimulant.
  Probably,  there is  no  substance,  not
strictly medicinal, which exerts so powerful
an influence upon  the nervous system as tea,
especially the green variety,  of which many
individuals cannot take even  the  smallest
quantity without experiencing  the most dis-
agreeable effects; they become faint; the
action of the  nervous system  is disturbed,
the hand trembles,  the  heart palpitates;
sometimes gastric spasm is induced, but
more  generally a feeling of raking at the sto-
mach, and of extreme hunger shortly after
a full meal;  lastly, there is  extreme wake-
fulness.   " There are  some females  upon
whom green  tea produces nearly  the  same
effect  us digitalis; and it has been medi-
cinally employed  in the diseases  for which
that herb has so decidedly obtained a high
reputation.   Desbois, of  Rochfort,  has, by
the use of it, cured many nervous diseases,
which have arisen from accelerated circula-
tion.   Dr. Percival had an idea that green
tea possessed nearly the same power as does
digitalis, of   controlling  and  abating the
action of the heart.  " It is  upon the nerv-
ous system that the effects of tea are chiefly
manifested;  green tea, especially, is  dis-
tinguished by this property.   It is said that
a strong solution of it, applied to the sciatic
nerve  for half an hour, has caused death.
Introduced in only a small quantity beneath
the abdominal integuments of a frog, it pro-
duced complete  paralysis  of  the hind  legs,
lasting for some hours."   Administered as
an  injection  to  a dog,  it caused  a perfect
paralysis of  the  bladder  and  intestinal
sphincters, a partial loss of power in the
hind legs, and a total loss in the tail."  "A
poultice of green tea-leaves,  applied over
the human  stomach, has caused  sickness
and vomiting;  over  the  abdomen,  colicky
pains  and purgings; over the heart, faint-
ness and irregularity of pulsation ;  over the
kidneys, diuresis."  Were it requisite here,
many more instances of the poisonous effects'
of this herb  might be cited.  True, these
are chiefly the results of green tea ; but in
some, black tea will produce nearly similar
symptoms.   Where  individuals  have  any
tendency to  dyspeptic  affections, they are
very apt to be aggravated by the use of tea,
which  occasions  severe  gastrulgia;  these
cases  are familiar to every medical man;
they are frequently cured, solely by enforc-
ing the  disuse  of the beverage, which, in-
deed, ought to be done in all such cases.
   Mr. Corfe, in his lectureB on the " Physi-
ognomy of Diseases," mentions a case very
closely imitating cancer  of the  ttomach, 
TEA
531
TEE
 which completely and  rapidly recovered as
 soon as  the  tea was given up ;  and in the
 Lancet very many cases are recorded to the
 same effect.   The action  of tea, in exciting
 mental  phenomena,  is equally remarkable
 with its influences upon the body.  Most
 Btudents are familiar  with  its power  of
 clearing the mind and facilitating its work-
 ing; many, too, have experienced its bane-
 ful effect, in preventing sleep and occasion-
 ing mental irritability.   At times, however,
 the disorder  of the  faculties of the mind,
 under the influence  of  strong tea, amounts
 nearly  to insanity.   Millingen  says of it,
 "In some it  is highly  stimulating and ex-
 hilarating ;  in others its effects  are oppres-
 sion  and lowness  of spirits; and  I  have
 known a person who could never indulge  in
 this beverage without experiencing a dispo-
 sition to commit suicide."
   Many cases of hypochondriasis are trace-
 able to the inordinate use of  tea.  Enough
 has now been said  to  prove  the powerful
 immediate action  exerted by tea upon the
 constitution and nervous system when taken
 immoderately, or  even  in moderation,  by
 people of peculiar idiosyncrasy.   Generally
 speaking, however,  black tea  (green  tea
 ought never to be an article of regular con-
 sumption) when taken  in moderation, pro-
 duces effects  at once agreeable  and bene-
 ficial; the gentle stimulation to the stomach
 certainly assists digestion, especially if the
 beverage be taken toward the close of the
 process,  or three or four  hours  after a full
 meal.  Taken along with  food it is at times
 serviceable; it is thus  used by the Tartars
 to counteract indigestion  occasioned by the
 use of raw flesh. _ The stimulant properties
 of tea are not so strongly exhibited when  it
 is taken  with  a  solid meal as when with  a
 small quantity of light  food.  When taken
 in excess at any time, or too soon after  a
 full meal, the warm  liquid is  apt to debili-
 tate the stomach, and to interfere with the
 regular process of digestion. Notwithstand-
 ing,  however,  the  evils  resulting from  the
 abuse of tea-drinking by some,  or its dele-
 terious effects upon  a few peculiarly  con-
 stituted individuals,  there can be no doubt
 that the salubrity of the infusion to the ge-
 neral mass of  the community is established
 on sufficient testimony to outweigh  any ar-
 gument founded on individual cases.
  The moderate use  of the beverage is of
 course alluded to.   In cases where  it evi-
 dently disagrees, it  ought to  be given up
 altogether; and it may be taken as  a  rule
for most,  that two cups of moderately strong
tea, morning and evening, are sufficient, and
aot too much for health.  If this quantity ;
 is exceeded, not only is it apt to cause nerv-
 ousness, but the amount of warm fluid de-
 bilitates the stomach.
   Refer to Breakfast, Coffee, Opium, Sec.
   TEARS. — The  watery saline  secretion
 named the tears, is formed  by the "lachry-
 mal gland," (see Eye,) which is situated in
 the outer and upper corner of the socket or
 orbit.   The secretion is continually passing
 over the forepart of the eyeball, keeping it
 clear,  bright, and free from dirt, and facili-
 tating the movements  of the eyelids,  any
 superfluity of moisture beirig taken up  at
 the inner angle of the lids, and conveyed
 into the  nose.—See Eye.   The increased
 secretion of tears is a remarkable  instance
 of mental influence over the body; still more
 so when  it is reflected that infants do not
 shed tears in  their crying.   It would seem
 that mere crying from physical causes is not
 sufficient to cause increased secretion,  and
 that some amount of intelligent mental emo-
 tion must be conjoined.
  TEETH—Are hard substances  placed  ge-
 nerally at the  entrance of  the  alimentary
 canal of animals, for the purpose  of com-
 minuting the  food.   True  bony teeth  are
 met with only in the  higher or vertebrated
 classes of animals; and in the highest class,
 the mammalia,  to which man himself be-
 longs  they are found to be  placed in single
 rows in each  jaw.   Even  a  superficial  exa-
 mination of the teeth of  different animals,
 makes evident  how specially they are  con-
 structed  with  reference to  the  habits and
 food of the being whose purposes they sub-
 serve.  There are the sharp-edged, chisel-
like "incisor"  teeth of the  rabbit or hare:
 the sharp-pointed, conical  "canine" teeth
 of the dog,  and of other  carnivora;  the
broad, crushing "molar," or back teeth, of
the graminivora and grain-feeding animals.
In the  case of a man, who is calculated to
subsist on  a mixed  diet, we find  all  the
Fig. cxxviii
above forms of teeth, but in a modified de-
gree.   The teeth of the  human adult are
thirty-two  in  number,  arranged  in  twc
arched rows, containing  sixteen  in each. 
TEE
r>!12
TEE
The teeth in each of the arches correspond
to one another, but those of the upper arch
in most jaws overlap the lower.  Fig. cxxviii.
represents the teeth of one-half of the adult
lower jaw.  Of these,  1 marks the two in-
cisors;   2 the  canine teeth;   3 the  two
" bicuspid," or two-pointed, or  false molar
teeth; and  4 the  true molars,  three  in
number; that is, eight teeth in  all,  on one
side of the one jaw, giving, of course, six-
teen for  the  single jaw, or  thirty-two for
both upper and  lower jaws.  In the child,
the number of the first temporary or "milk
teeth," is not  so great as in the adult by
twelve.   There  are the four  incisor and
two canine teeth in each jaw, but the true
molars (fig. cxxviii. 4) are entirely absent,
their  place being supplied  by four  tempo-
rary molar teeth, two  on each side, which
occupy the situation of the bicuspid teeth
(fig. cxxviii.  2)  in  the adult.   About the
seventh year of age, when the shedding of
the first teeth is commencing, but it may be
later, the child cuts the first of  the true or
permanent molars. These  teeth appear
without direct reference to the shedding of
the first set of teeth, as they do not occupy
the site of any of the latter, but, so to speak,
break new ground for themselves.
  Every tooth  is divided externally  into  a
orown, (fig.  cxxix.  1,)  and  into a fang, or

                Fig. cxxix.
root,  (3.)  At  the point where the  gum
ceases, the tooth is slightly contracted, (2,)
and this, which marks  the division between
the two other portions, is called the neck of
the tooth.  When  a tooth is divided  verti-
cally, as shown in the magnified section of
an incisor tooth, (fig. cxxix.,)* there is seen
covering its exposed portion,' or crown, the
"enamel," (4,) which  thickest at the supe-
rior part, nnd gradually thins off townrd the
neck, where it ceases.   At this point, how-
ever,  begins another  substance,  the  " ce-
mentum," or "crusta  petrosa," (6,)  which
gradually increases in  thickness  toward
the extremity of the fang, where  it leaves a
perforation, through which  the vessels  and
nerve pass to  the  interior or pulp cavity,
(7,) which occupies the centre of the tooth.
Between this pulp cavity  nnd the enamel
on  the crown, and between it and the outer
bony casing or  cementum on the  fang, lies
the tooth bone, dentine or ivory,  (5,) which
constitutes the great bulk of the tooth.
  Probably, no structure  in  the  animal
body, not even the eye itself, evinces more
striking  evidence  of   wise design  than
is to  be  found  in  a  completely  developed
tooth—still more when the processes of its
development are traced, as they have been,
from the first papilla or appearance of pre-
paration for the future structure.  These,
indeed,  are wonderful and  beautiful,  but
how much  more  wonderful to  find  that
before an infant has yet breathed the air of
this world,  the preparation is  made in its
jaws for the development of its future per-
manent teeth, not to be made apparent for
eight or nine years after, when the enlarge-
ment of the bones  permits this development
and renders it necessary.

                Kin. cxxx.
* Todd Mtd Bowman's PhytkHegical Ana'omy.
Fig. cxxxi.
  The calcareous enamel of the teeth is com-
pose'! almost entirely of earthy or mineral
constituent, the animal matter not constitut-
ing more  than  two per  cent, of the whole 
TEE               533                TEE
 It  covers  the entire exposed  portion,  or
 crown of the teeth, (fig. cxxix.)  The ena-
 mel is not, as might be-supposed, a homoge-
 neous structure, but is composed,of numbers
 of  minute  hexagonal fibres or rods, or, ac-
 cording to  some, "prismatic cells," as shown
 when magnified, (fig. cxxxi.,) placed side by
 side; a transverse section  of these  fibres,
 presenting  the  hexagonal  divisions,  (fig.
 cxxx.)  The diameter of these fibres is said
 to be about the ^^a of an inch.  They are
 not straight, but,  as represented, have a
 wavy  appearance; their  inner  extremities
 rest in shallow depressions on the surface of
 the tooth-bone, or ivory; their outer ends form
 the surface of the crown of the tooth.   By
 this arrangement of its structure, the enamel
 is evidently most perfectly adapted for sus-
 taining the pressure, &c.  to  which it  must
 be  liable in the process of mastication.  The
 "tooth-bone,'L "dentine," or ivory,  which
 constitutes  the  great bulk  of  the  tooth,
 (fig. cxxix.,) and on which the enamel rests,
 is composed of numbers of branched tubes,
 which radiate  from  the  central  cavity.
 Through these tubes, the branches of which
 intercommunicate   in all   directions,  the
 fluids of the tooth permeate ;  moreover, the
 firmness of their walls and of  the surround-
 ing fibrous substance, and the radiating and
 waved course of the tubes, gives the  entire
 mass  of dentine or ivory the greatest possi-
 ble power of resistance.  The cementum, or
 crusta, which forms the thin bony covering
 of the fang or root of the tooth, (fig. cxxix.,)
 resembles ordinary  bone in structure.  It is
 the enlargement of  this bony crust which is
 sometimes  found upon the fangs of teeth.
 The pulp (fig. cxxix.) contained  in the tooth
 cavity, is largely supplied  both  with  blood-
 vessels and nerves,  which enter  at the per-
 foration in  the extremity of the  fang, (8.)
  The separate  sockets, or  " alveoli," into
 which the  teeth are so firmly fitted,  corre-
 spond to the  shape  and directions of the
 fangs, to which they are united  by a some-
 what  elastic "periosteum," and  by commit
 nicating blood-vessels.
  The bicuspid  or  false  molar teeth  fre-
 quently have a fang forked at the extremity,
 each  division being perforated.   The true
 molar teeth have two, three, and sometimes
 four fangs each.
  In infancy, the period of teething, or the
 coming forward  of  the first set,  the  tem-
 porary or milk teeth, always occasions some
 amount of  disturbance in the  susceptible
 young constitution.—See Children.
  The order in which the teeth  are succes-
sively developed varies  considerably: the
following average of periods is given by Mr.
        2 u2
 Erasmus Wilson.  The teeth  of  the lower
 jaw generally appearing before the corre-
 sponding ones of the upper.
            TEMPORARY TEETH.
    7th month, two middle incisors.
    9th   "    two lateral incisors.
   12th   "    first molars.
   18th   "    canine.
   24th   "    last molars.
            PERMANENT TEETH.
    6£  year, first permanent molars.
    7th  "   two middle incisors.
    8th  "   two lateral incisors.
    9th  "   first bicuspids.
   10th  "   second  bicuspids.
   11th, 12th, canine.
   12th, 13th, second permanent molars.
   17th, 21st, third,or last permanent molars,
               or "wisdom teeth."
   The  first teething in infancy  is  always
somewhat critical, (see Children,)  but  even
the second is  not always free from irritant
effects  upon the  constitution,  and epileptic
and other  attacks have  dated from this
cause and period.
   There are a few instances on record of a
third partial teething even in old age.
   The  carelessness or neglect in  the  pre-
servation of the teeth, which prevails among
all classes,  and especially among  the lower
orders, can  result only from ignorance  of
the important purposes they subserve in the
animal economy, and  of how  closely their
perfection  and  efficiency are  linked  with
health;  there is no question that the pos-
session of a good set of teeth may make  all
the difference between a hale and prolonged
old age, and premature decay of the powers
of life.—See Digestion.  Moreover, the dis-
order of the stomach produced by the insuf-
ficient mastication and comminution of the
food, which must be the  consequence  of
deficient teeth, tends still more to increase
the evil.  For since the teeth may, as nails
and hair on the  skin, be considered as de-
velopments  from  the  mucous  membrane
which lines the digestive organs, they sym-
pathize  with,  and  suffer  from,   whatever
affects that lining membrane; consequently,
there is no  more certain cause of  decay in
teeth than indigestion, and particularly if
the saliva becomes acid.
   There is no question, however,  that al-
though chronic indigestion is very liable to
assist decay in teeth, the process takes place
much more quickly, from any cause, in some
persons than it does in others.   There cer-
tainly is hereditary tendency in this as in
other peculiarities of constitution; for the
members of one  family preserve their teeth
sound much longer than those of another, 
TEE
534
T  E E
though equal care is bestowed on them.  At
the same time, proper attention to the teeth
will  do much to preserve a naturally defi-
cient set, and  vice versd.
  The teeth being constantly moistened with
the saliva, are continually liable to become
incrusted with the animal matter and earthy
salts contained in  that  fluid, forming what
is popularly known as the " tartar" upon
the teeth.  This formation would accumulate
much  more rapidly than it  does in those
who  neglect their  teeth,  were it not par-
tially removed at each meal by the friction
of the food in course of  mastication ; this
is seen when  persons, as  they do in  fever,
lie long without food ; the  teeth become at
times quite crusted over.   The author met
with a strong example of  the kind lately in
the case of a girl of bad constitution, in
whom, from avoiding eating on one side  of
the mouth in  consequence of a tender de-
cayed  tooth, an accumulation of tartar  of
considerable thickness entirely covered not
only the decayed tooth itself, but those next
it, requiring considerable  force and  chisel-
ling to detach.   It  formed, in fact, a calca-
reous case over the tooth.  Although partly
removed by the food during mastication, the
tartar cannot be so entirely, consequently
it tends to accumulate around the necks of
the teeth at the margin of the gum,  and in
time drives  back, as it  were, the  gum, ex-
posing the parts of the  tooth which are not
protected by the hard and resisting enamel,
to the action of the influences which speedily
induce decay.  Besides the tartar, there has
been observed to accumulate from neglect,
especially between the teeth, a filiform fun-
goid-like growth.  In no way is it possible
to remove these  continually forming incrus-
tations but by the brush, or at least by some
substitute for the brush, by which tolerably
active friction can  be employed.   Neither is
it well to trust too much to dentifrices, or
tooth-powders: the brush and plain water is
amply sufficient for most purposes ; a small
addition of fine white soap is found to faci-
litate the cleaning  of teeth in some  cases,
but never should rough or acid tooth-pow-
ders be used: they may,  it is true, clean
the teeth more quickly,  but they do this at
the expense of  the enamel, which,  in the
first  instance, is gradually worn away me-
chanically, and in the case of the acid,
chemically dissolved.   If a tooth-powder is
perfectly impalpable, it is difficult  to see
how it can  assist the  cleaning of the teeth
at all; and is, therefore,  just  as well dis-
pensed with. When, however, the gums be-
come spongy,  and  the teeth inclined  to
loosen, it may be well to  use some astringent
 application for the purpose of .strengthening
I the gums ; tincture of camphor dropped into
 water is commo ily used, but—although not
 fully proved—it  has been thought to injure
 the integrity of the teeth themselves;  it is,
 therefore, as  well  avoided, especially  as a
 few drops of tincture of myrrh on the tooth-
 brush is equally  efficacious, and is free from
 suspicion.  The  powder or tincture of rha-
 tany-root  may be used  for the  same  pur-
 pose.  [A useful  and harmless tooth-powder
 is the following:—Take of powdered  Peru-
 vian bark and myrrh, each half  an ounce,
 powdered  orris-root two  ounces, and pre-
 pared  chalk  one  ounce,  the  whole  beiug
 finely sifted.]  As a general rule, however,
 the use of a tolerably  firm  brush  twice a
 day,  or after each meal, and  with water
 alone, is quite  sufficient  to preserve  most
 teeth in purity and  soundness.   It is really
 surprising to what ail extent cleaning the
 teeth  is neglected,  even by persons in re-
 spectable  stations in life; nnd  among the
 majority of the lower-classes it seems never
 to  be thought of.  Putting comfort, cleauli-
 ness, and refinement aside, on the score of
 health alone  the habit ought  to be  prac-
 tised, and  among all classes  ought  to be
 taught to children.   There is no doubt that
 where the food is simple, and health and di-
 gestion good, there is  much  less tendency
 to  the accumulation of  tartar about the
 teeth ;  but this  immunity is certainly not
 enjoyed by the  lower  classes in England,
 who suffer greatly from decayed  teeth.  It
 has been thought that the hot food and fluids
 used by civilized man tends to promote the
 decay of the  teeth, and probably they do,
 if the habit is acquired, as it is by some, of
 taking these  very  hot.   The  use of the
 teeth to crack nuts, to bite hard substances,
 and the like, is apt  to chip off the enamel,
 and thus to expose the tooth to certain de-
 cay.   ISonie  medicines have an  undoubted
 tendency to injure the teeth; certainly mer-
 cury given to affect the gums  does so, and
 this should always be a serious considera-
 tion with a medical man in using the  drug
 to  this extent, in the case  of the young es-
 pecially.  The miueral acids act chemically,
 by dissolving the enamel; they ought, there-
 fore, always to be sucked through a quill or
 glass tube, and the mouth  rinsed with  water
 afterward, [or with water containing  a lit-
 tle super-carbonate of soda.]   Pru-sic acid
 given   medicinally has  been  thought to
 injure  the teeth  ; iron medicines discolour
 them, if the teeth are not brushed after the
 dose.   Under article " Grape,"  the author
 has noticed a singular effect of the acid of
 that  fruit in dissolving  off  the  enamel. 
TEE
535
TEE
Another cause of decay is the lodgment of
particles of food in the  interstices between
them;  these the  brush will remove,  but
the use of toothpicks of any kind is most
injurious.
  As  the calcareous,  almost crystalline,
enamel is the great protection of the inner
and more easily acted on components of the
tooth, its removal quickly gives a tendency
to decay, which, once begun, tends to spread,
unless means are used to  stop it.  This is
best done by means of the  "stopping" pro-
cess, with gold or other material, as prac-
tised  by dentists.  To be thoroughly done,
Btopping requires considerable care,  the re-
moving—scraping out—of the decayed por-
tions of the tooth, &c.; it therefore requires
to be effected by the  dentist, and he should
always  be resorted to for the purpose, care
being taken to ascertain that the stoppage
js not—as has occurred—of such a metallic
nature as will injure the constitution.   As
a temporary stopping, which any one may
insert for themselves, nothing answers  bet-
ter than a piece of gutta-percha, softened
in water,  and pressed well into the cavity,
which it should fill; it will thus often retain
its place for months.  Care must be taken,
however, that  this or  any other stopping
does not press injuriously upon the nerve—
otherwise severe suffering may ensue. When,
in  the course  of decay, the cavity of the
tooth, which  contains  the nerve pulp, is
opened  into, toothache begins;  the nerve
becomes highly sensitive, probably inflamed,
and not only is extreme pain excited by the
slightest cause—a crumb lodging in the ca-
vity, or a draught of hot or  cold fluid—but
the slightest jar  upon  any portion of the
tooth is most acutely  felt.  The pain of
toothache may continue with more  or less
severity and intermission for a long time,
till either the  sufferer is driven to the per-
manent cure of having the tooth extracted,
or, as often happens, the pain ceases of itself,
or under the use of some application.   Un-
doubtedly,  extraction is the  only  certain
cure for toothache;  and when a tooth is so
utterly decayed that it cannot be stopped,
and  is of  no use, its removal cannot too
Boon be submitted to.  At the same time, it
is worth while to suffer a little pain to save
a tooth that is likely  to do  after-service, and
that will bear stopping after the irritation
of the nerve has subsided  or been subdued.
The aching  of a decayed tooth is very often
excited by cold, by disorder of the digestive
organs, &c. &c.; when, therefore, the  pain
commences,  the  possibility  of such causes
should be investigated, and if they exist,
they should  be rectified.—See Cold—Indi-
gestion, Sec.  If, however, after this has been
done, the neuralgic irritation still continues,
it  may  be advisable to give quinine, and
alse  opium, as  recommended  under article
"Neuralgia:" counter-irritation, in the form
of blister or mustard-plaster behind the ear,
being also used.  The agonizing ache of the
tooth itself requires to be quickly relieved,
if  possible, independent of the above reme-
dies, which  are  to remove  the  tendency.
The  applications  used  to cure  toothache
would make  a long list; among the latest,
chloroform and creasote are  the most use-
ful, especially the latter, the chief objection
to which is its  disagreeable smell.  Strong
ammonia  is also sometimes used  with suc-
cess  ; it probably acts partly by neutralizing
acid matters within the decaying tooth. The
most effectual application which the author
has ever used is composed of creasote and
strong  solution of ammonia, of  each  one
part, tincture of myrrh two parts.   In some
cases the  ammonia and myrrh is effectual
without the creasote.  [Laudanum and  oil
of cloves  are favourite domestic remedies,
and  sometimes  afford  relief.]   All  these
liquid applications are best introduced into
the decayed tooth by means of a small pellet
of cotton  wool, soaked in them, and lightly
laid  in  the cavity.  If  pressed in, its me-
chanical pressure on the nerve may coun-
teract  the good  effects  of  the  remedy, or
even aggravate the pain.  If the first use
of an application does not relieve, the piece
of cotton should  be removed, and a fresh-
charged portion introduced; this is often
successful.   The  applications  which  are
most generally serviceable  in  toothache,
are  stimulants, which  seem  to act  by de-
stroying the sensibility of the nerve.  This
is sometimes more effectually done by means
of a red, or  rather white, hot wire, which
destroys the  nerve pulp altogether; the mo-
mentary pain is severe, but if the operation
is well done, the  tooth is rendered insensi-
ble,  and consequently serviceable.  Recently
this operation has been performed in a more
elegant and  agreeable manner, by means of
electric heat.  The wire is  fitted into the
tooth cold, and momentarily heated to  in-
candescence  by  a galvanic  current.  The
operation requires to be managed by a den-
tist.  It  is  sometimes  difficult to find the
opening into the pulp cavity of a tooth when
small;  not unfrequently it is situated at the
neck of the  tooth, where both enamel and
cementum are  thinnest.
   The wisdom-teeth, or last molars, are pe-
culiarly susceptible of this species of decay. 
TEE
53ti
T  E M
 When the gums are much inflamed in tooth-
 ache, much  relief is  sometimes given  by
 lancing them freely around the tooth.
   To extract a  tooth, being merely a me-
 chanical  operation,  certainly  requires  no
 great amount of knowledge, and is one per-
 formed  in some villages, still,  by the black-
 smiths,  some of  whom, by practice, tact,
 and strength of arm, perform it very well,
 though  perhaps not so  easily as  the  pro-
 fessed dentist,  who  uses improved instru-
 ments.  The fact, however, is  sufficient  to
 show that  any one, such as  an  emigrant,
 inclined to reuder himself useful, and  per-
 haps make a little odd money, in an out-of-
 the-way place, may acquire the art. At the
 Bame time, perhaps, few  would willingly
 trust themselves in  the hands of  an ama-
 teur, except from the dire necessity of a fit
 of  toothache; but as that necessity is  not
 an uncommon one, the accomplishment  of
 tooth-drawing may be  found  not  at  all  a
 useless one in some situations.  The faculty
 can  scarcely be acquired properly,  without
 a few practical  lessons, which there can  be
 little difficulty in obtaining, in  this  country
 at least.   Various instruments are used for
 the purpose of tooth-drawing; the  forceps
 or pincers for the single, and the key for
 the double, being the  old and most com-
 monly used forms.  Some dentists now dis-
 card the key, and use forceps only, of varied
 shape and construction, to suit the different
 positions of the tooth to be extracted. Pro-
 bably, an  unprofessional person will  find
 the key and the forceps the instruments  of
 the use of which it will be the  most service-
 able to acquire a knowledge; and as this to
 be sufficient must be practical, all that is
requisite here is to add a few memoranda
 of the proceedings which might escape the
memory.
  The key (fig. cxxxii.) is of the form repre-
sented, with the  handle placed orosswiae.
Fig. cxxxii.
  The bolster (1) aots as a fulcrum ;  the clnw
  (2) is  fixetl to the  neck of the tooth, inside
  or  outside, as may be  most convenient  for
  drawing,  nnd  the bolster  made to  press
  against  the gum  on the other side.   The
  head of the patient being fixed by an assist-
  ant, if the  operation is on  the lower jaw,
  the tooth is twisted out  by the foroe of the
  leverage of the  bolster against the  gum or
  jaw.   When the upper jaw  is dealt  with, it
  is most convenient to seat the patient on the
  floor, or on a very low stool.   The  bolster
  should be padded by a piece of lint wrapped
  round, otherwise it bruisos the gum unne-
  cessarily.   It is better with a  gum-lanoet
  to separate  the gum  from  the tooth pre-
  viously to drawing, otherwise  the  former
  may be torn.
   For  the single teeth  the forceps are used.
  These vary somewhat in form, and should be
  selected  by some professional friend;  they
  should not  be so close or  sharp as  to risk
  cutting the  tooth through.  When used, one
  blade is  to be fixed behind, and the other
  in front.of the  tooth,  just within  the  gum
  margin, nnd the head being  fixed, the tooth
  is drawn  straight  out of its socket  by the
  force of traotion, accompanied with a slight
  rotatory  motion.
   It is impossible in the space of this work
  to enter as fully  into this subject as might
  be; for those who desire more information,
  there are popular works published upon it
  at a moderate prioe.
   TEETOTALISM.  — See Intoxication —
  Stimulants.
   TEMPER.—See Passion.
   TEMPERAMENT—Is a term which  took
  its  origin in the earlier stages  of medical
  science, when the  constitution of the body
  was  supposed to depend upon the propor-
  tional mixture or " tempering" of the  four
  principal  fluids or humours—the blood, the
  phlegm or lymph, the yellow, and the black
  bile.   Hence,  corresponding with  these,
  there waB  the "sanguine," or blood  tem-
 perament, the "phlegmatic," or "lympha-
 tic," the  "bilious," and the "atrabilious,"
 or "melancholic."   As  these  distinctions
 are  applicable to certain recognised types of
 constitution, they are still retained, with the
 addition  of the  "nervous"  temperament.
 The sanguine temperament  is usually dis-
 tinguished by the  ruddy complexion,  blue
 eyes, and brown hair, and  generally full
j large habit of body, with vigorous perform-
 ance of the functions of life.  The  phleg-
 matic, generally  now called lymphatic  tem-
 perament, is almost the reverse of the first.
 The functions of  life are usually more feebly
 performed, probably owing to the deficient 
TE M
537
TEN
quality of the blood,  the skin is pale, the
hair light in colour.  The choleric or bilious
temperament is characterized by black, often
curling  hair and  beard,  the  latter being
generally thick and strong; the eyes dark,
the complexion  ruddy  though  dark,  and
the circulation  good.   In the melancholic
temperament the hair is black  but straight,
the skin is dark, but wants the red tinge
of the true bilious; the circulation and the
functions are slow and languid.  The above
temperaments  are  not   unfrequently  met
with strongly defined in individuals, but in
the majority they  are mixed  up one with
another.
  Refer to Complexion—Diathesis.
  TEMPERANCE.—See Stimulants.
  TEMPORAL.—Connected  with the  tem-
ples.
  TENACULUM—Is a slender  hook,  (fig.
cxxxiii.,) to which a handle is attached, used
by Burgeons  for laying hold  of and  pulling
               Fig. cxxxiii.
 forward  a bleeding artery, so as to  permit
 of its being secured.  The instrument may
 be made  to shut up into a handle or  not, as
 convenient.   It might be  found useful in
 emigrant life.—See Artery—Instruments.
  TENDERNESS—On pressure of any por-
 tion of the body, is a symptom which is al-
 ways much regarded in the investigation of
 disease, seeing that it is in most instances,
 if it is not in all, indicative of irritation or
 acute inflammation.  In making pressure,
 however, to ascertain  the existence of ten-
 derness,  care must be taken, if possible, to
 bear upon the  part examined with a suffi-
 ciently extended surface of the  hand, and
 not to press too quickly or forcibly—other-
 wise the  mere roughness of the examination
 may cause pain,  and  give the  appearance
 Of tenderness.
  TENDO-ACHILLIS— Is the  remarkably
 strong tendon  which  connects the muscles
 of the calf of  the leg with  the heel.   Any
 one  may  feel it in his  own person.  It is
 chiefly to be noticed here, on account of the
 not  very  uncommon  accident  of rupture,
 to which  it is  liable,  particularly in heavy
individuals.  Perhaps, in making some un-
 usual exertion, there is felt the sensation at
 of a violent blow upon the tendon, and if
 the person does not fall to the ground, he at
 once finds the power over the foot is lost.
 If the  place  is  examined, the space  left
 between the  ruptured ends of the  tendon
 may be distinctly felt.   It is, of course, im-
 portant that the injury to a part on which
 locomotion so  greatly depends, should be
 efficiently  repaired;  the  case, therefore,
 should  always, when possible, be  treated
 by a medical  man.  The accident, however,
 is  one  liable  to happen  in out-of-the-way
places; with  a little care its treatment may
be efficiently managed even by an unpro-
fessional person,  at  all events till skilled
assistance is  obtained.   The principle  of
treatment is, by relaxing the muscles of the
calf, to permit the  ruptured ends  of  the
tendon to approach one another.  To effect
this, the palpable proceeding is to bend the
knee and foot, as represented, (fig. cxxxiv.)
To  retain  the position, it  is sufficient to
attach a strong cord or tape (1)  to the heel
of a slipper placed upon the foot; to attach
a corresponding cord (2) to a band of some
stout material, (3,)—stout calico will do—put
round the lower part of the thigh ; and this
being done, to tie the two cords together,
so as to preserve the  requisite  amount of
flexure, which must be- kept up for at least
four or  five  weeks, at the  end of which
period,  gentle  and  gradual extension  of
the  heel may  be tried, but no  attempt at
walking  should be made for a considerably
longer period.   Ultimately,  if the  case is
properly treated,  perfect  recovery takes
place.   For some time  after the above acci-
dent, it is  advisable for the  person to wear
a high-heeled, laced boot.   Some apply a
light bandage in addition to the apparatus
described above.
  Refer to  Wounds. 
TEN
538
T  II I
  T E N D 0 N S — Popularly called  " the
guides," [and " leaders," or " sinews,"] are
the strong  fibrous extensions, by means of
which the muscles are attached to the bones.
All tendons  are  liable to  be  divided by
wound or by rupture :  in  these cases the
nature of the accident  is indicated  by the
loss of  power over the limb or  members.
The treatment required is similar in prin-
ciple to that for ruptured Achillis tendon—
the relaxation of  all the muscles which are
connected with the injured part, for a suffi-
cient period to permit union.
  Refer to  Ganglion.
  TENESMUS—Is the sensation in the rec-
tum (see Rectum)  which causes involuntary
straining, or effort, to  empty  the  bowels.
It is a frequent symptom  in diarrhoea, dy-
sentery,  &c.
  Refer to  Diarrhoea—Dysentery—Stool.
  TENT.—A piece of lint,  sponge, or other
material used for dilating openings, or for
keeping open wounds.
  TERTIAN.—See Ague.
  TESTICLES—The male organs, are liable
to various  affections.   Inflammation is ac-
companied  with severe  pain  and swelling;
it requires  the treatment  of inflammation
generally—leeching, fomentation, poultices,
calomel, and Dover's powder, and aperients,
with perfect rest  in bed and low diet.  En-
largement of the veins—varicocele—accumu-
lation of fluid, (see Hydrocele,) and various
chronic enlargements and diseases, occur in
connection  with these glands, but, for all, a
medical man's attendance  is absolutely ne-
cessary.  In the mean time, if the symptoms
are urgent  and painful,  perfect rest in bed,
avoidance of all stimuli,  and attention to the
state of the bowels are the best measures.
If circumstances prevent absolute rest, sup-
port  should be given by a bag-truss,  or by
some such contrivance as that recommended
in article "Prolapsus."
  TETANUS—Lock-Jaw.—See Lock-J aw.
  TETTER.— A  term  applied to  various
forms of skin disease.—See Skin. Diseases
of-
  THEINE.—The active principle of tea.—
See Tea.
  THEO-BROMINE.—The  active principle
of cocoa, resembling theine and caffeine  in
composition.—See Cocoa.
  THERAPEUTICS—Is the art and science
of the application of remedies for the  cure
of  disease. — See  Medicine,  and  Medicine,
Practice of.
  THERMOMETER, on Measurer of Heat.
—The principle upon which this instrument
depends is  the expansion or  contraction of
a fluid according  to the increase or diminu-
 tion of  sensible heat.   The fluid  used is
 sometimes spirit, but more generally  it is
 mercury, on account of the equable manner
 in which this fluid  metal alters its volume
 with  change  of  temperature.    For  the
 purposes of the  measurement of  heat, a
 thermometer is constructed by  enclosing
 the  mercury (or spirit) in a perfectly closed
 or "hermetically sealed" glass tube, with a
 bulb or  expansion  at one  end.  To this tube
 a regularly marked or graduated  scale is
 attached, which indicates the changes under-
 gone  by the mercury within  the tube, in
 accordance  with  the changes in tempera-
 ture.    These scales may be,  and are, dif-
 ferently graduated  It is here sufficient to
 notice the scale of  " Fahrenheit," which is
 universally  used in this country.   In the
 Fahrenheit scale, or thermometer, the zero
 or starting point,  or 0°, is placed  :!2 de-
 grees below the temperature at which water
 freezes,  consequently the  freezing point of
 water is placed at 82°.   Between this and
 the  boiling point of water there  are  180°;
 the  latter, consequently  is marked on the
 scale  212°.   Between these points,  there
 are  other temperatures recognised, and usu-
 ally marked  on most  thermometers—they
 are  "temperate"  at  55°;  "summer-heat"
 about 7b° ; animal  or blood-heat" 98°; and
 "fever-heat" about 109°.  A  thermometer
 is  an instrument  which  ought  now (con-
 sidering the low price) to be found in every
 house.  For practical purposes, such as as-
 certaining the temperature of baths, &c, it
 is best  to have the tube fixed to  a metallic
 scale.
   Refer to Bath—Bedroom, Sec
   THIGH.—The portion of the body which
 extends  from the hip to the knee  is  com-
 posed principally of a mass of fleshy, power-
 ful  muscles.  The fold (the groin) at the
 junction of  the thigh with  the trunk, is one
 of the most important regions of the  body
 in a surgical point of view, for here is the
 most  usual  seat of rupture, (see Rupture,)
 and  at  this point, toward the lower  end,
 the  large vessels which  pass to  and  from
| the  lower  extremity lie  very  superficially.
 Wounds of the  groin are,  therefore, parti-
 cularly  dangerous, and, if  the main artery
! be perforated, life is placed in the most im-
| mediate peril.—See Artery.  A little  below
 the  groin, the vessel  becomes more deeply
 imbedded in the  muscles,  and  ultimately
 passes round the  inner  side of the thigh-
 bone  to reach  the ham.   The  thigh-bones
 (see Skeleton, fig. ctvii. 12) are the longest
 bones of the skeletoa.  From their ball and
 socket-joint at the hip, they incline  inward
 toward  one another at the knee.   This in- 
                 T HI               b'c

clination is more especially marked in the
female,  in consequence of the greater width
of the pelvic bones.
  Refer  to Hip — Knee—Pelvis—Fractures,
Sec.
  THIRST.—See Diluents.
  THORAX.—The chest.—See  Chest.
  THORN-APPLE, or Datura Stramoni-
um, ["Jamestown" weed.]—Thorn-apple is
naturalized in Britain. It is an annual plant,
and grows about four feet in height.  The
leaves are much toothed, of a light green, and
the flowers white and trumpet-shaped.  The
fruit, which is the most conspicuous part of
the plant, is about the size of a walnut, and
is covered with prickles  or  thorns, whence
the name   In the shops, the leaves, stems,
and  capsules or fruit, with the seeds, are
sold, cut up together, for  smoking, the mode
in which  the drug  is principally used  in
this country.  It  relieves the paroxysms of
asthma, and other  affections of the breath-
ing dependent upon spasmodic  causes.  It
is also now made up in  the form of segars
for the  same purpose; but, being a some-
what  powerful narcotic, in either way must
be used with  caution.  At first, not more
than ten grains weight of the leaves should
be  smoked, the  dose being  gradually in-
creased to thrice that quantity.
  THREAD-WORM.—See Worms.
  THROAT.—The throat  comprehends the
parts situated  at the back of the mouth,
and includes the uvula and soft palate, with
its  arches, and the tonsils ; also the  pha-
rynx, or funnel-like muscular expansion  at
the top of the gullet, (fig. cxxxv.)  The ap-
pearance  of  the  throat, looking through
the mouth,  any one may verify in his own
person.   In  the  illustration*  the  view is
supposed to  be from behind, the pharynx,
or upper  portion  of the  gullet, being laid
open.    The openings of the  nostrils  are
seen,  (fig. cxxxv.  1.)  At 2 is the uvula with
the arches of the soft palate on each side;
3  is  the  back part  of   the tongue,  just
behind which is  situated  (4) the glottis  or
opening of the windpipe.  These parts are
attached above to  the skull, (7.)   At 5 is
represented  a portion of the  gullet-tube
not laid  open, and at 6 the  tube  of the
trachea  or  windpipe, which lies in front of
the gullet.—See Neck.  A little considera-
tion of  the figure will  enable  any  one to
get a tolerably clear idea of the parts, and
their  relative positions,  of this most im-
portant  region of the body.   For further
information the reader is referred to articles

 * For this f gure and some others in this work the
author  is indebted to the valuable Manuals of Mr.
Cuurchil
TIN
Fig. cxxxv.
Cut-Throat—Gullet, which includes choking
—Mouth—Neck—Palates—Tongue—Tonsils—
Sore- Throat — Digestion.  Also Larynx,  in
article Lungs.
  THROMBUS.—A small tumour caused by
the escape of blood into the surrounding
tissues, after a vein has been opened, as it is
in bleeding from the arm.
  THRUSH.—See  Aphtha.
  THYMUS GLAND.—A  glandular  body
situated  behind the upper portion of the
breast-bone.   It is larger at birth, and dur-
ing the first year  of infancy, than  at any
future period of life.
  TIC-DOULEUREUX.—See Neuralgia.
  TIGHT-LACING.—See Education.
  TINCTURES—Are solutions of medicinal
substances in alcoholic spirit, either " rec-
tified" or  "proof."  Rectified spirit, which
consists of eight parts of alcohol  to one of
water, ought to have  a specific gravity of
838.  Proof spirit, which  consists  of five
parts of rectified  spirit  to  three of water,
ought  to  have a  specific  gravity of 920.
The above different strengths are employed
according to the  solubility in spirit of the
active  principles  of the drug from  which
the tincture is  made.  Some drugs,  such
as  camphor, are entirely dissolved in rec-
tified spirit.  The  general  directions for
making tinctures are,  that the drug, if it is
in solid  substance, should be divided into
small  fragments,  or  into  coarse or fine
powder, as the case may be.  It is then to
be macerated in the  spirit in a closed bottle
for a certain period—generally  from seven
days to a  fortnight, and  after that strained
through a cloth, or filtered through paper.
or  both.—See Filler.   During the  macera-
tion, the  bottle is to be frequently shaken,
and when the straining takes  place, the
;9 
T I N                540               T O B
aolid  is  to  be  freed  from  the fluid  as
thoroughly as  possible,  by pressure  in a
cloth.  This may be, and is done by hand,
but much  more  effectually by means  of a
" tincture press" for the purpose.   Indeed,
some substances, such  as squill, cannot  be
at all properly exhausted without  the  aid
of a press.   Within the  last few years, the
system of preparing tinctures by  "perco-
lation"  has  been  adopted,  especially  in
Edinburgh.  It is a very exoellent method,
but requires considerable practice to carry
out well.
  As medical  preparations, tinctures  pos-
sess many special advantages, not the least
being their preservative properties; more-
over, the form of tincture often  facilitates
the use of a drug in a state of solubility, and
therefore of activity, which could  not  be
attained in any other way.  Except  in those
cases, when the stimulant action of the spirit
is desirable, tinctures  are best adapted as
vehicles for such medicines as  act in small
doses.  If the action required from medicine
be not stimulant, or rather the reverse, the
form of tincture cannot be employed  with
advantage, that is, if such a dose is required
that the  stimulant  properties of  the spirit
will be sensibly manifested.   For instance,
although rhubarb is an  aperient medicine,
which may safely be given alone, even when
fever exists, it would be very injurious  un-
der such  circumstances  to give it for  its
aperient  action in  the form of tincture, in
which  case the dose must be  from  half an
ounce  to  an  ounce or more.   Even in the
case of the comparatively mild antimonial
wine, the author has frequently had to point
out the injury which may result from dosing
children—suffering from inflammatory  at-
tacks, or head affection—with  this prepara-
tion, in quantity certainly sufficient to  in-
jure.   Of  course, when  tinctures,  such  as
those of rhubarb,  ginger, orange-peel, &c.
&c, are avowedly stimulant, aud given for
Btimulant  purposes, the presence of  the
spirit is  rather an assistance than other-
wise; but the  rule should be borne in mind,
that unless stimulant action is required or
at least admissible, a medicine ought never to
be given in tincture, if the dose which must be
administered involves  an  amount  of spirit
which will be felt by the system.
  The list of  tinctures  is a very long one;
the following will be found most  useful  for
domestic use:—
  Tincture of  Arnica—Columbo—Camphor
— Cardamoms  compound — Catechu — Gin-
ger— Henbane — Iron  Muriate, or Tincture
of  Steel — Lavender compound—Myrrh —
Opium, or Laudanum—Opium compound,
or Paregoric—Orange-Peel—Rhubarb com-
pound—Squill.
  To  the  individual articles the reader is
referred:  in a few, directions for preparing
the tincture are given ;  but, generally speak-
ing, it is  both  more convenient and econo-
mical  for domestic  purposes   to purchase
the tinctures ready prepared.
  TOAD.—The poisonous properties of this
reptile have at times  been doubted, but it
seems well ascertained that the follicles of
the skin do contain an extremely acrid fluid,
capable of acting on the body  like  the poi-
son of the wasp, or of snakes.—See  Wounds,
Poisoned—Stings.
  TOASTED BREAD—If not cut too thick,
and if toasted slowly, is probably somewhat
more  digestible  than  simple  bread—it is
more thoroughly cooked. Toast,  when soaked
with melted butter, is one of the most  un-
wholesome and irritating articles of diet an
invalid can take.
  TOAST-WATER.—See Cookery.
  TOBACCO.—This  article,  a luxury, a
drug, or a poison, is the leaf of  the Nicotiana
tabacum, a native of America, both Northern
and  Southern, but now cultivated exten-
sively throughout the world, and even capa-
ble of  being so in the climate  of England.
The leaf  is large and oval-shaped.  Very
many kinds of tobacco are  met with;  the
Virginia, which  is  one of the  strongest, is
used in medical practice in the form of in-
fusion, but  is no  remedy for domestic em-
ployment.  Tobacco, however, requires con-
sideration on  account of  its  too  widely
extended use,  as a stimulant or sedative, as
the case may be, by so many individuals in
every quarter of the globe.  The effects of
tobacco upon  the human system vary ac-
cording to the mode in  which it  is taken into
the body.   Applied locally, as in the familiar
form of snuff, it acts as a powerful irritant;
taken into the stomach, or injected  into the
bowels—as it sometimes  is by  medical men
—in the form  of infusion, it depresses pow-
erfully the action of the  heart,  causing
fluttering, and a sense of sinking about that
vital  organ, with  deadly faintness, and a
tendency to relaxation of the bowels, and if
the dose  be large, death.   Taken  into the
system by the lungs, in the form of vapour,
as it is in smoking, its narcotic rather than
its sedative action is exhibited;   it acts
upon the brain, causing giddiness, inclina-
tion to vomit, &c, and at  the  same time it
depresses.  The effects of tobacco, especial-
ly as it is usually employed, vary of course
according to  the strength and nature of
the variety used, and  also according to the
original constitution and  acquired habits of 
TOB
541
TOB
 the  individual.   There are few, perhaps, if
 any, who, on first commencing the use of to-
 bacco, escape unpleasant effects from its
 narcotic and sedative properties, and some
 individuals never lose their susceptibility to
 be affected thereby. Yet others become so far
 habituated to the use of the drug, that these
 effects are not developed  ; and others seem
 to  become  capable of   deriving peculiar
 restorative influences from its use,  experi-
 encing, especially under  conditions of ex-
 haustion or irritability, a mixture of stimu-
 lant and sedative action which is described
 as peculiarly grateful.
  A drug  which is capable of acting so
 powerfully upon the system as tobacco, can-
 not, certainly, be habitually  made  use of,
 without  its  influencing the functions of the
 body more or less ; much more, probably,
 in some than in others,  but  to a consider-
 able extent in all.  Opinions vary  greatly
 as  to the actual influence which tobacco,
 when habitually used, exerts upon the con-
 stitution; this  may perhaps  be accounted
 for  by the fact  that  some from whom the
 opinions have  proceeded have themselves
 been lovers of the  "weed," and naturally
 prejudiced in its favour;  few,  however, are
 found  to defend it as  entirely innocuous,
 and medical men generally are agreed, that
 in some constitutions  at  least, it is highly
 injurious.  Upon those of the melancholic
 temperament,  it  seems to exert peculiarly
 injurious effects.
  When the habit of snuffing causes injury,
 it is more usually to  the digestive  organs,
 and in  some persons it certainly gives rise
 to dyspepsia; indeed, according to Dr. Prout,
 it may occasion  malignant  disease  of the
 stomach and liver.  Chewing tobacco acts
 as an excitant upon the salivary glands; if
 the saliva is swallowed, the narcotic proper-
 ties  of the drug  are called into action.
  The  most obvious injury which is apt to
 result  from  smoking, more or less, accord-
 ing  to the extent in which it is indulged,
 is disorder  and  irritation of the digestive
 organs, frequently accompanied  with de-
 pression of  spirits, and at times with ex-
 treme nervous  irritability, the latter being
 more especially manifested in an inveterate
 smoker, if,  from illness  or any cause, his
 habitual indulgence is interfered with.  Very
 recently, the author saw this well exempli-
 fied  in the case  of  a strong countryman, a
 constant smoker, but otherwise not  intem-
 perate.  He was attacked with fever ; in the
 course  of a  few  days,  in  consequence, ap-
parently, of the  interrupted  use of  the to-
bacco—for by no other reason could  they be
accounted  for—nervous  symptoms  set in
         2V
 with extreme violence, threatening a speedy
 fatal  termination,  and requiring the con-
 tinual use of  opium  to  keep them  in  anv
 way under  control.  In  many persons ad-
 dicted to smoking, especially in  those who
 naturally possess  the " melancholic"  com-
 plexion, the skin seems to acquire a darker,
 and somewhat of a greenish hue.  Accord-
 ing to Dr. Prout, a tendency to urinary dis-
 order—oxalic  acid—is excited.   The  local
 injury caused by tobacco-smoking is well
 ascertained; the bad effects, doubtless, are
 partly due to the heat of the process.  Under
 article "Lip," the  occurrence of  cancer, in
 those who habitually smoke from  a short
 pipe,  was noticed;  the injury to the teeth
 from  smoking, and especially their disco-
 louration, is  notorious;  and,  further, we
 have  the  valuable  authority of  Dr.  Green,
 of New York,  to prove that disease of the
 throat and  air passages  is apt to follow in-
 dulgence in  this  useless petty vice.   He re-
 marks,  " as an  exciting  cause, the use of
 tobacco,  in  my  experience, has proved  a
 powerful agent in the production  of follicu-
 lar disease of  the throat.  Acting as a sti-
 mulant, directly and  constantly, upon the
 mucous follicles of the fauces and throat,
 and greatly  increasing, as it does, the secre-
 tion of these glands, its employment, as we
 should conclude, & priori, must have a .direct
 tendency to  develop the  disease,  especially
 if a predisposion  to  the affection exists;
 hence it has occurred to me, to notice that
 of a great  number of cases of throat-evil,
 which during the last year or two  have come
 under  my observation, a large  proportion
 of them have taken place in individuals who
 had been, or were at the time, in the habi-
 tual use of tobacco.   My attention has been
 called  more particularly to  this subject,
 from having noticed, several years ago, some
 observations on the use of tobacco, in laryn-
 geal and bronchial  affections, by an eminent
 surgeon of this city.   After having alluded
 to the almost universal  use of tobacco in
 the countries  of Northern  Europe, he  ob-
 serves,  'In  one very fatal and distressing
 form of disease,  to  wit, laryngeal phthisis
 and bronchitis, among public speakers, the
 fact is very clearly  established, that  the
 moderate  habit of smoking, by the drain it
 accomplishes, and its  anodyne qualities, has
 been eminently useful, at least as a preven-
 tive of that  peculiar malady so frequent in
 the United  States, especially among  the
 clergy.'  From this opinion of  my distin-
 guished countryman and  friend, I am com-
pelled  to differ entirely,  by  the  statistical
facts which I have obtained on this subject.
Not only has the use of tobacco, in any and 
TOE
542
TON
all its  forms,  proved to my experience an
exciting  cause of laryngeal  disease,  but
where its employment has been persisted in
during the treatment of any case,  I  have
found it  impossible to restore such to per-
fect health."
  Enough, perhaps, has now  been said to
convince, that, although the use of tobacco
may  be  indulged  in  by some, perhaps  by
many, and to  a considerable extent, with-
out very evident injury, there is a large pro-
portion of constitutions to which it is almost
a direct poison, sapping  the whole founda-
tions of health.  The wide extension of the
use of tobacco by man  since  its introduc-
tion  from the "new world,"  in the middle
of the sixteenth century, is one of the most
Bingular facts of human history: for it is to
all, perhaps, at first,  a nauseous, acrid, dis-
agreeable drug, which causes uncomfortable
Bensations in whatever form it is used.  Pity
it  is, it should ever  prove otherwise, and
that  men should  continue to poison them-
selves, and render their neighbours uncom-
fortable,  by  indulgence in  so  hurtful a
custom.
  The objections to smoking  tobacco as a
mere habit do not of course  extend to its
employment as a remedy in disease, parti-
cularly of an asthmatic character, in which
some persons derive the greatest benefit
from its moderate use.
  In any case, in which the use of tobacco
has produced the symptoms described at  the
commencement of  this article in an alarm-
ing  degree, general  treatment, somewhat
similar to that pointed  out  under article
" Belladonna," may be employed.
  TOES.—See Bunion—Corn—Fracture,
&c.
  TOLU.—See Balsam.
  TONGUE.—The  organ  of speech  and
taste (fig. cxxxvi.) is composed of muscular
fibres running through it in different direc-
tions, mingled with a considerable amount
of cellular and fatty matter; it  is  abun-
dantly supplied with  vessels and  nerves.
The tongue is  divided in the centre by a de-
pressed  line,  the "raphe\" (fig. cxxxvi. 3.)
It is  covered by a dense mucous membrane,
continuous with that  of the mouth, on which
are numerous "papillae," small  toward  the
tip,  but  becoming  much  enlarged  (fig.
cxxxvi. 2) toward the base of the tongue.
At the tip, underneath, the tongue, as any
may  see in their own  person, is confined by a
bridle or tie,  or "fraenum;" at its root, the
tongue is connected hy  a curved  bone, the
"hyoid," the extremities of which  are  re-
presented, (4, 4 ;)  between these, at the base
of the tongue, is the "epiglottis," (6.)—See
Throat—Larynx, ,\c.

                Y\j,. cxxxvi.
  It is superfluous here to dwell upon the
well-known  facility  of motion  and acute
sensation by which the tongue is enabled to
perform its well-known functions of speech.
—See Speech.   Taste  may  be regarded as
similar in kind to the sense of touch, but
us more exalted in degree:  some  amount
of solubility in the substance placed in the
mouth appears  requisite for its  develop-
ment.  Taste,  like other sensations, is liable
to alteration and perversion in disordered
states of the system.
  In a medical point  of view, the  tongue
has to be  regarded both with reference to
its own disorders, and  to the indications  it
affords of disorder in other parts of the sys-
tem.  The tongue is liable to inflammation,
although cases of it are rare.  W hen it occurs,
the most prominent symptom, in addition to
the constitutional affection, is the enormous
swelling, which causes the organ  to  pro
trude from the mouth, and at the same time
threatens suffocation ; it is, therefore, a very
serious  affection, and one which  requires
the immediate attention of a medical man.
The remedial  measure which gives most re-
lief is to  make two free longitudinal inci-
sions down each side of the tongue; these,
of course,  admit of copious bleeding, but
as the tongue diminishes in  size, the  cuts
and the flow  of blood also  diminish.  The
remedy is  one  which might be practised by
an unprofessional person in a case of urgent
necessity; at least it would be better to do it,
even at some risk, than to permit  an  indi-
vidual to  die  of  suffocation, while  medical
assistance was being procured.  Ulceration
of the tongue  may occur as a symptom of 
TON                543               TON
 digestive disorder, as a consequence of mer-
 curial salivation, or from local causes, such
 as the presence of decayed teeth, especially
 with ragged or sharp edges.—See Aphtha—
 Indigestion—Mercury, Sec  Of course,  when'
 teeth-stumps are the  exciting cause, tiiey
 should at once be removed. In any cases of
 ulceration, the local  treatment recommended
 under "Aphtha" may be pursued with ad-
 vantage.
   Cancer of the tongue is one of the  most
 distressing maladies to  which humanity is
 liable ;  it may in some cases be removed with
 advantage  by an operation ; at  all  events,
 any persistent sore upon the  organ should
 be submitted, without delay, to the examina-
 tion of a medical man.   The disease is most
 frequent in women.   For Tongue-tie.—See
 Children—Speech.
   As  all are aware, the condition  and ap-
 pearance of the tongue are indications almost
 always consulted by a medical man in inves-
 tigating a case of disease, and  most valuable
 guides they are  at times, when experience,
 observation, &c. have given the power of
 reading  them  aright.    When  the appear-
 ances of the tongue, however, are admitted
 as evidence, consideration must  always be
 given to the natural state of  the organ in
 the individual, for some  never have a clean
 tongue, while in others  it  scarcely becomes
 furred, even when considerable  disorder is
 going on in the system.  In chronic disorders.
 especially of the digestive organs, the most
 valuable indications are often afforded by
 the tongue, immediately  after  the night's
 sleep, before food has been taken.  Persons
 who sleep with  their mouths open generally
 have  a dry tongue  in consequence, but in
 most  persons in health, the mouth  should
 be  pleasantly moist on  awakening in the
 morning; if it is the reverse, if the  tongue
 is dry,  or  clammy,  or viscid, and covered
 with  fur, there is usually disorder of the
 digestive organs, permanent or temporary,
 from  some indiscretion  in food,  and espe-
 cially in the use of stimulants.  In feverish
 conditions  of  the   system generally, the
 tongue  is liable to become dry.  The ap-
 pearance of the fur on the tongue varies
 greatly; it  may be  thick  and dirty-white,
 as it  is in stomach  and  febrile  disorders,
 and especially in sore-throat;  it  may  be a
 thin creamy-looking  white, as  in  inflamma-
 tory disease within the abdomen ; or it may
be yellow, as in biliary disorder.  It may be
patchy, as in scarlatina;  or, the centre and
Bides of the tongue being preternaturally
red, as in some forms of  intestinal irrita-
tion, may contrast with the white fur in other
parts.  Further, the tongue may be morbidly
 clean and red also  in  intestinal  irritation
 and in hemorrhage;  in  the former  case,
 perhaps, feeling sore as if scalded ; or the
 papillae may be elongated as in scarlatina.
 Again,  partaking  of the  general anaemic
 condition of the system, the tongue may be
 pale, when it is also usually broad and flat,
 indicating general  want of tone  and flac-
 cidity of fibre.  The motion? of  the tongue,
 moreover, when it is protruded, give a clue
 to the state of the nervous  system espe-
 cially ; thus, in paralysis, it is drawn to one
 side ; in delirium tremens and nervous affec-
 tions, it is tremulous;  in the low stages  of
 fever, it perhaps cannot be protruded at all.
  Such are  a few indications afforded by the
 tongue.  As the appearances in each parti-
 cular disease are adverted to under the in-
 dividual articles, it is unnecessary to pursue
 the subject here.
  TONICS—Are  remedies which improve
 the health, muscular tone,  or  vigour of the
 system; many medicines, properly so called,
 possess this  power, and are therefore classed
 as tonics; but other means of health, both
 mental  and  physical,  are  included in the
 category.
  When an individual is in  good health, the
 muscular fibre throughout  the body, both
 voluntary and involuntary,  possesses a cer-
 tain amount  of  tone,  or  "tonicity,"  the
 flesh feels firm, and the actions performed in
 obedience to the will are effected regularly
 and  decidedly.   When,  on  the other hand,
 the health becomes impaired, the  muscles
 and  fibres  generally become "flabby and
 incapable of continued exertion, but  are
 sometimes irritable with the  tremulousness
 of debility."  These  changes  in  tone are
 most strikingly manifested in children, in
 whom they take place with great rapidity;
 every mother and nurse is practically aware
 of the fact, and judges greatly—and rightly
 —of the health  of  her  young charges, by
 the firmness of the flesh.  The connection
 between  a state of proper tone or the re-
 verse, with the actual physical condition of
 the muscular fibre, may be " demonstrated
 by detaching a muscle from the bodies of
 two  animals in  these  opposite  conditions,
 and ascertaining the strength by appending
 weights to it;  the  muscle  taken  from the
 healthy animal, or that  in  a  state of tone,
will  sustain a much greater weight  than
that which is in the opposite state."  Tonics,
 therefore, are remedies  which tend to cor
 rect the want of the tone  above described,
 by exciting  the reverse  or  tonic condition.
 In this way, food of particular kinds  may
be regarded as tonic.  The ' condition" of
the horse, as all know, is a state in which 
T O N                544                 T O K
the muscular power and endurance is aug-
mented to a high pitch,  by means  of  the
stimulant power  of dry corn food, in con-
trast  to  the comparatively weak muscular
tone which can be obtained from green food.
  Indeed, if the word tonic be taken in its
widest sense, it would include a vast number
of agents; medically,  however,  it is used
more  restrictedly.
  The medicinal  tonics  may be  classed
as—
  Tonics which act indirectly, by first influ-
encing the stomach, and increasing  its di-
gestive powers.
  Tonics which act directly by passing into
and  exerting their  influence through  the
blood.
  The first, or the indirect or stomach tonics,
are chiefly the vegetable  bitters; of these
the most important, at least  in a domestic
point  of view, are—
  Buckbean,          I    Gentian,
  Columbo,           I    Qunssia,
  Chamomile,            Salicine.
  Peruvian Bark,
  The second, or  direct tonics, include
  Iron in its various preparations, and
  The Mineral Acids;
to which, perhaps, may be added the vege-
table  acids.
  The non-medicinal tonics are—
  Cold in its various forms and applications,
  Exercise, and
  Mental emotions of a pleasing and stimu-
lating charncter.
  From the above it may be seen that the
action of a tonic is of a stimulant  or  ex-
citant character; it is,  however,  distin-
guished  by its permanency,  in contradis-
tinction to the transient action of stimulants
proper.   In order, therefore, to  insure  the
proper action of a tonic, it  is requisite to
administer it in small doses—which  do  not
cause appreciable stimulation—but at short
intervals, once,  twice, or three times,  ac-
cording  to circumstances, in the twenty-
four hours.  At  the same time  there is n
limit  to  the  use  of  tonics; some, such as
iron, if too long continued, are apt to occa-
sion uncomfortable sensations in the head
and elsewhere: and bitter tonics, if given
regularly for a length of time, at last tend
rather to weaken than  to strengthen  the di-
gestive powers.   On this account, it is to be
feared,  that  the  now fashionable "bitter
beer," although a mo^t excellent beverage
and tonic in some states of the system, may,
if taken too continuously, tend rather to mis-
chief  than benefit.  As the employment o'
tonics in different affections and states of
the body is entered into  in  the individual
articles,  it  is  unnecessary to pursue th«
subject further here.—Refer to Excitants.
  TONSILS.—Are the almond-shaped bodies
Bituated on  each side  of the " fauces," (see
Throat,) and between  the folds or "pillars"
of the soft  palate.—See Palate.  They are
glands which secrete a mucous fluid.
  The tonsils  are liable to inflammation,
constituting "sore-throat,"  or quinsy.- See
Sore-throat.  They may also be the scat of
ulcerations, and often become enlarged.  In
the  former  case  (ulceration)  astringent
gargles  may be used,  and any disorder of
the general health attended to.   Enlarge-
ment of the tonsils is a very common affec-
tion, particularly in scrofulous constitutions,
and may come on very early in life.   When
considerable, it may occasion some difficulty
in swallowing, and always gives  rise  to
thickness of speech; the subjects of  it, too,
are more than usually subject to attacks of
sore-throat, or quinsy.  When the enlarge-
ment is great,  and causes much inconveni-
ence, it is remedied by the  simple and not
very painful operation of slicing off the most
prominent  portion  of each  gland;  this  of
course must be done by a surgeon.   When,
however, the operation is not required, or is
objected to, much may be done to reduce the
size of the glands, by the persevering use of
astringent  gargles,  (see  Gargles,)  [or  by
painting them occasionally with tincture of
iodine,] and by attention to  any deficiency,
as want of tone in the general health.
  See Scrofula—Sore-throat—Debility,

  TOOTH-ACHE.—See Teeth.
  TORMENTIL, or Tormbntii.la Officina-
lis—is a plant native to England, and  com-
mon on moor-ground or hill pastures.  It
bears a smallyellow flower, with four (rarely
five) petals, and the stems  are straggling.
The root of the tormentil is so  powerfully
astringent that it  is used in various places
for tanning, and the same property gives it
active remedial powers,  which have  been,
perhaps,  too much overlooked.  There  is no
reason why  tormentil  should not be used iu
place of more expensive and farther fetched
astringents.  The root, which is  the  part
used, is short and thick for  the size of the
plant; dark brown externally, and reddish
within.   When powdered it is given in from
half-drachm to drachm doses.   The decoc-
tion  is made by boiling two ounces of ths
bruised root in thirty ounces of water, till
it is  reduced one third, and  straining.  The
dose of the decoction is an  ounce and half.
It may also be used as an astringent gargle
or lotion.
  TORPOR.—See Debility, Slg. 
TOT
545
TRA
  TOTAL ABSTTNENCE.-See Stimulants.
  TOUS-LES-MOIS.—A substitute for ar-
row root,  now imported into  this  country
from the West Indies, where it is said to be
equally esteemed with the latter for dietetic
purposes.   The  starch  granules are  con-
siderably larger  than those of arrow-root.
  TOURNIQUET—From the French, to turn,
is an instrument (fig. cxxxvii.) used by sur-

                Fig. cxxxvii.
 ge-ns  to  stop the flow of blood in a limb
 du ing operations, or after accidents.   For
 tht latter purpose, the tourniquet might be
 fouud  of  great service in  out-of-the way
 plaies, and might well form  an addition to
 the outfit  of the emigrant.   The instrument
 consists, essentially, of an upper and lower
 plate,  (1  and 2,) which can be separated
 from each other by means of a strong screw,
 (3.) Connected with the plates are  rollers,
 (4,4,)  and through  these  rollers  is run a
 strong band of webbing or other material,
 (5,) with  a buckle  (6) at one end, and a
 movable pad, (7.)  When  the tourniquet is
 applied, the band (5) is buckled round the
 limb, and  the pad (7) is so  adjusted as to
 press upon the course of the main vessel.—
 See Artery.  A moment's consideration will
 make it evident how a turn of the  screw (5)
 will, by shortening or lengthening the  band
 round the limb,  either tighten or relax the
 pressure exerted by the  pad, (7,)  and so
 control the flow of blood through any vessel
 over which  the latter may be placed.   The
 size of  the  pad may of course be increased
 if desirable.
  The  above remarks will probably make
 evident the invaluable assistance which may
be derived from  the  tourniquet, in. cases of
wound  or  accident.   As,  however,  the in-
strument may not be always forthcoming, it
is to be borne in mind, that its principle of
        2 v2                            !
 application is pressure on the course of a
 bleeding vessel,  by means of a pad, secured
 by a band round the limb, which can  be
 tightened  or relaxed at pleasure, and that
 these effects may  be  brought to bear  by
 means of a pad of the first convenient ma-
 terial at hand—a folded stocking will  do—a
 pocket-handkerchief tied  round  the  limb,
 and a short stick  to tighten  the latter  by
 twisting.   Refer  to Artery, Arterial Hemor-
 rhage.
   TOWN.—See Houses, Life, and the various
 articles referred to under Sanitary.
   TOXICOLOGY.—The study  of  poisons.—
 See Poisons.
   TRACHEA.—The windpipe.—See Lungs.
   TRAGACANTH GUM.—See Gum.
   TRAINING—Is a system which has been
 practised both in ancient and modern times,
 for bringing  the  animal body  up to as high
 a pitch of health, tone, and muscular power
 as  possible.  If  the  ulterior  purposes  for
 which training is practised in these days are
 neither desirable nor elevated,  the system
 itself, and  the effects of it, are worthy  of
 attention as bearing upon  the subject  of
 health and development.  Of  course,  those
 in whom great muscular  power  is desired
 as  the result of training, must  possess  at
 first some  amount of constitutional vigour,
 good assimilative  powers, and be free from
 disease,  or even disorder  of  a temporary
 nature;  if the latter should exist, it must
 be removed by medicine or otherwise.
   The body being in good health, the object
 in training must be to get as  much food
 as possible, containing "albuminous  prin-
 ciples," well assimilated, (see Food,) that is
 to say,  although saccharine and vegetable
 substances  must  be  taken  in sufficient
 though small proportion to maintain health,
 it  is upon  the animal muscular  fibre, that
 of beef or  mutton especially, and also upon
 the dry farinacea, such as bread, on which
 reliance must be placed to supply the  albu-
 minous, or plastic elements  of  muscular de-
 velopment  and power.   Animal food, there-
 fore, (beef and mutton especially, as  being
 most easily digested,)  must be  freely  al-
 lowed, and must, moreover, be well digested.
 In order to insure proper assimilation and
 health, coincident with  the  consumption  of
 a large allowance of animal  food, abundant
 exercise is  absolutely requisite.  This, it  is
 true, must exhaust a  greater  amount  of
 muscular tissue than if the  individual kept
 at rest;  but by the stimulus it  imparts  to
 all the functions,  and to those of digestion
 and circulation in  particular, it seems  to
confer  the power  of  assimilating strong
nourishment in greater proportion  than  is 
T R A
54ti
T R O
requisite to repair the loss  by the waste I
arising from increased muscular movement.
Thus, there are the two first principles of '
training, the healthy assimilation  of abun-
dant strong nourishment—lean animal food
—and the working up, so  to speak, of that
nourishment into the system by the aid of
regu"ar exercise, not carried to that  stage
of excess in which the stomach and  other
assimilative organs partake of  the exhaus-
tion, and fail in their functions.  In order,
however,  that  the  assimilative  processes
may work to full advantage, the other func-
tions must  be in healthy working order ; the
capacity  of the lungs should be good where
great strength is required, and the air drawn
in pure and dry ; the skin should be clear of
all impediments to its important fulfilments ;
sleep should be sufficient to thoroughly re-
cruit the frame, (see Sleep,) and should be
taken on a tolerably hard bed, with light
covering, which will not tend to cause per-
Bpiration, or to relax.  Much fluid is to be
avoided,  and if stimulants are  taken, table
beer is  perhaps the best; wine, mingled
with water, next; but spirits never.  As
above stated, where muscular development
is the object, animal food, with  bread, must
be the staple;  vegetables being used  only
in sufficient quantity to  preserve  health;
but all puddings,  pastry, or soft food of any
kind, is incompatible with the end in view.
  In fact, training, being  the endeavour to
bring the physical power and endurance up
to the highest possible pitch, is a system of
hygiene, from which all may derive informa-
tion respecting  the management  and  im-
provement  of  health, without  their object
being the cultivation of brute force.
  It must  not, however, be imagined  that
it is laid down  as a principle,  that animal
food in large quantity, or even at all, is ab-
solutely requisite  for  the  development of
great muscular power: this experience tells
us it is  not.  Some of the  most  powerful
and hardy nations of old  subsisted solely
on vegetable food, and many modern tribes,
noted for  strength and  endurance,  do so.
These facts, and  many others which might
be cited, prove  that great muscular power
is quite  compatible with  a vegetable diet,
if combined with  habitual  muscular exertion.
There can be no question, however, that by
means  of animal food, the system may be
more quickly worked up to a state of  high
tone and condition, but for temporary pur-
poses only ; the state is one, in  fact, of arti-
ficial excitement, and cannot be maintained
f.>r  any great length of time.
  Refer to  Food, Sec.
  TRANCE.—Catalepsy.—See Catalepsy.
  TRAVELLING—Is both  an excitant nnd
a tonic, and, as a remedial measure, in some
cases offers advantages by no other mode
attainable.—See Recreation.   Most persons,
when undergoing continued travelling, suf-
fer from slight  irritable feverishness of the
system, particularly if the usual  rest be
interfered with; the effects of this are best
counteracted by spare diet and  avoidance
of stimulants.   Animal  food, if taken at
all,  should be  so  sparingly ;  and the  best
restorative—except,  of course, in  real de-
bility,  when wine is required—is a  cup of
tea or coffee.  A warm bath at about 92° is
an excellent soother of the  system after
travelling.
  TREMOR, or Trembling—Is a symptom
and accompaniment of nervous debility and
exhaustion, as exemplified in those  who
exhaust the system by the abuse of ardent
spirits.   In some  diseases, such as fever,
the  occurrence of  tremor is a grave symp-
tom, indicative of giving way of the vital
power.
  Refer to Nervous—Delirium  Tremens.
  TREPHINE.—A circular saw used by sur-
geons,  for removing portions of the skull.
  TROCAR—Is  an instrument used  for
piercing  cavities of  the body, such  ns the
abdomen or chest, for the purpose  of giv-
ing exit to fluid.   The trocar is usually so
fitted inside a  metallic tube,  or "canula,"
that  when it pierces the body  it carries the
latter along with it; the  trocar being then
withdrawn from the tube,  leaves  a clear
passage for the fluid.
  TROCHES—Lozenges.—See Lozenoe.
  TROPICS and TROPICAL DISEASES.—
As might he expected,  the forms  and types
of disease, which occur in  hot, tropical cli-
mates, are  frequently very different from
those which are met with in this and other
temperate regions.    Under articles, "Accli-
mation," "Bile," "Cholera,," "Dysentery,"
" Fever," " Heat," " Liver," &c. the reader
will  find information illustrative of the ef-
fects  of  a  residence  in  a warm  climate
upon the system;  to enter into the subject
further, here, would answer  no  good  pur-
pose.  The  author would strongly advise
all individuals  about to proceed to a warm
climate,  to  consult  some medical  man of
repute—and there  are  many to be met with
—who, from practical experience  and re-
sidence in such climates,  is  competent to
advise upon the subject,  and to  point out,
in writing, if possible, the  peculiar causes
and  symptoms of  disease  to be guarded
against and attended to.   Beriberi  is  a
disease attended with  dropsical symptoms,
which  is  almost peculiar to India.  Bar- 
TRU
547
TUR
 biers, a disease which was at one time con-
 founded with the above, is also peculiar to
 the Indian coasts, but is accompanied with
 paralysis.  Like  many other tropical dis-
 eases, it is said to be induced by imprudent
 exposure to night air.
   TRUSS.—See Rupture.
   [In the United  States, those who require
 a truss should go to a good surgeon, in pre-
 ference to those advertising quacks so often
 consulted.]
   TUBERCLE.—See Scrofula.
   TUMOUR.—A swelling of any kind, in the
 widest sense  of the word, but the term  is
 usually restricted to a permanent swelling.
 Tumours are  met with in every situation  in
 the body, and differ  greatly in their charac-
 ters and tendencies.  Of these, it would be
 perfectly impossible for inexperienced and
 unprofessional persons to judge; as an inva-
 riable rule, therefore, whenever a tumour is
 discovered to  exist,  it should be submitted
 to the examination of a  medical  man  with-
 out delay, and  all  rubbings and  the like
 avoided;  they are not likely to do good, and
 may do much  harm by irritating, and there-
 by causing increased growth.  Tumours are
 dangerous from their nature, or from their
 situation.  In  some parts of the body simple,
 unmalignant   tumours may attain a  very
 large—an  enormous—size, without  threat-
 ening  life, or, indeed,   causing  inconveni-
 ence, except from their  bulk.   Rapid and
 great increase of bulk is most usual in tu-
 mours which are pendent.   Of all tumours,
 those of a malignant or cancerous nature
 are most dreaded, and  generally cause the
 most pain.—See Cancer.
   A tumour, however, may give rise to many
 painful symptoms, particularly if its growth
 be rapid, simply from the stretching of the
 parts around it, or of the nerves which pass
 over it; this often occurs in tumour in the
 neck.
   If,  after a  tumour has been  discovered,
 any delay must  necessarily arise before  it
 can  be examined  by a  medical man, and
 if it exhibits  signs of irritation or inflam-
 mation, the best remedies are perfect rest,
 low diet  free  from stimulants, the regula-
 tion of the bowels, and  the application of
 cloths  wet with  cold or tepid water, or,  if
 need be, of a  few leeches.  If a tumour  is
 inconvenient from its weight, it  should be
 supported.
   Refer to Cancer—Cyst—Swelling. Sec
   TUN BRIDGE  WELLS—"Is one of the
most agreeable summer retreats in England "
" But it  is in the absence of humidity, as
deduced from  hydrometric observatious, the
rain-gauge, &c,  that the climate  of  Tun-
 bridge Wells surpasses that of most piaces;"
 "its  true distinctive character and pre-
 eminence 'consisting' in the momentous ele-
 ment of atmospheric dryness."   The nature
 and medicinal qualities of the Tunbridge
 Wells mineral spring are well calculated to
 aid this very salubrious property of the air,
 as  it holds iron in solution in its purest
 and simplest state of combination, that  of
 a carbonate, with very little other foreign
 ingredient,  and  with  a  sufficient  quantity
 of carbonic gas  to render it a grateful and
 wholesome stimulant to the stomach.  The
 water from this spring proves highly bene-
 ficial in all cases of simple debility, and in
 such debility as is complicated with sluggish
 movements in  the glandular  system, where
 no inflammatory action or serious obstruc-
 tions exist.
  "People troubled with any fulness about the
 head should avoid Tunbridge or its wells."*
  Refer to Chalybeates—Iron, Sec.
  TURMERIC—Is  procured  from  the root
 of a plant—the Curcuma longa—cultivated in
 Hindostan, China,  &c.   It is usually sold in
 powder of a dark lemon-yellow colour.  Tur-
 meric is a warm aromatic, and is used chiefly
 for its colour, and as a condiment, especially
in the formation of curry powder.
  TURN of LIFE.—See Menstruation.
  TURPENTINE—Of various kinds,  is an
 exudation, chiefly from different species of
 pines.   Common turpentine is the fluid re-
 sinous exudation from the Pinus sylvestris, or
 Scotch fir, and  others of the  pine  tribe.
 From this the volatile oil of  turpentine, or
 " spirits of turpentine," as it is often called,
 is obtained by distillation, the dry substance
 which remains constituting resin.—See Re-
sin.   Oil or spirits  of turpentine is a valu-
 able remedy, either externally or internally.
 In the former case, if applied to the skin,
 by means of cloths soaked in it, it is a pow-
 erful counter-irritant, acting like mustard,
 and sometimes even blistering.   It  is often
 employed for purposes of counter-irritation
 in inflammatory diseases  in  the abdomen
When thus used, it should be warmed by
placing  the pot  or bottle  containing the
turpentine in hot water.  In rheumatic af-
fections,  lumbago, sciatica, &c, turpentine
is a valuable  addition to  liniments.  One
part to two of the ordinary soap  liniment
may be  used.  As an  external  application
in burns, turpentine has been much  used.—
See  Burns.
  Internally, in small doses, turpentine acts
chiefly upon the  kidneys, increasing the
flow of urine considerably, and giving it at
* Lee's Baths of England. 
TUR               54s                L L C
the same time the odour of sweet violets.
»n larger doses, turpentine acts as a purga-
tive, and has  been chiefly used in this way
in half-ounce doses, combined with an  equal
portion of castor-oil, to destroy and carry off
worms in the intestinal canal.—See Worms.
As an internal remedy in rheumatic cases,
turpentine  often proves of much service, in
fifteen-drop doses giveu twice or three times
a day in milk.   It may also be given in simi-
lar doses in cases of hemorrhage, as from the
bowels, or in purpura.—See Purpura.
  When a large dose of turpentine is taken
internally,  it is apt to cause sickness,  with
a feeling of giddiness resembling  intoxica-
tion ;  after this  it usually purges freely,
especially if combined with another purga-
tive, such as  castor-oil.   If  the  purgative
action of turpentine is not freely developed,
it will, in some  persons, affect the kidneys
severely, causing  symptoms  of strangury,
similar to those which occasionally follow a
blister,  and to be alleviated in  the  same
way.—See Blister.
  Various  methods of taking oil of turpen-
tine are recommended, one of the most usual
being thnt of emulsion, made with the yolk
of one egg for every two drachms of the oil,
and  distilled  or  soft  water.   The author
generally gives it and finds it well taken in
milk,  the oil being added  to the  milk just
before it is swallowed.
  As  an  addition to clysters in stoppage of
the bowels, in worms, &c, turpentine is fre-
quently used in the proportion of from half
an ounce to an ounce and a half to the pint
of gruel  or barley-water.   After turpentine
has been used in  a clyster instrument, the
latter should be well cleansed by warm soap-
water being passed through it.
  Refer  to Clyster,  Sfc.
  TURNIPS.—The turnip belongs to  the
cruciferous plants, or mustard tribes.   It is
nutritious,  containing vegetable  albumen
and fibrine in considerable proportion, and
also  saccharine  matters;  these,  however,
are combined with much water.   The turnip
is somewhat laxative and diuretic;  it  is,
however, liable to disagree and cause  flatu-
lence in persons of weak digestion.  A turnip
poultice  is sometimes used, but is  disagree-
able from its smell.
   TYMPANITIS—Is  unusual distension of
the stomach and intestines with gas.   This
is apt to occur in fever and in acute inflam-
mation within the abdomen.  In such cases
it is a symptom  which  must often be seri-
ously regarded. Tym* mitis, however, some-
times occurs as a chronic affection.  In any
case,  it may proceed to a great extent, dis-
tending enormously the whole abdomen and
| impeding  the breathing.  Clysters of assa-
 tVviida, rue, turpentine, or other stimulant
 aromatics give relief; and  aromatics, sal
 volatile,  tincture  of  cardamoms, &c,  are
 often  given internally, but many cases de-
 rive more benefit from the mineral acids.
   Refer to Cli/s/er—Rue—Mineral Acids.
   TYMPANUM.—See Ear.
   TYPE  or a DISEASE—Is the combina-
 nation of characteristic, prominent symp-
 toms,  which mark  all  the cases of a prevail-
 ing disease, such as fever, &o.
   TYPHUS.—See  Fbvkr.

   ULCER and ULCERATION.—An ulcer is
 a sore which discharges  matter, and which
 arises from loss  of substance, or separation
 of continuity in any of the living structures.
 When  a  wound, instead of healing up at
 once " by the first  intention," remains open,
 discharges healthy pus or matter, and  pre-
 sents  upon the  surface small red points or
 granulations, it  is a specimen of a healthy
 ulcer, or one tending  to heal.   But though
 ulcers, whether  healthy or the reverse,  may
 be the result of external violence or wound,
 they more generally  take their origin  in
 causes from within; they depend upon some
 constitutional  or bodily cause,  usually one
 which produces debility of circulation, gene-
 ral or local: as a consequence,  the nutri-
 tion of these tissues dependent  on  healthy
 circulation is interfered with, and the  pro-
 cess of absorption which is ever going on
 within the body, (see Absorbents,) by remov-
 ing the tissues  more  rapidly than  the loss
 can be supplied, gives rise  to  loss of  sub-
 stance or ulceration.  At  least  this is  one
 of the explanations given of the nature of
 the process.  Ulceration  may  occur  both
 within and  on  the surface of  the body;
 under article " Bone," caries was described
 as an  ulceration of  bone.   Ulcers also oc-
 cur in the mouth  and throat,  and, indeed,
i on anj' portion of   the  membrane lining
| either the respiratory or digestive passages.
 Respecting these forms of ulceration what-
 ever is requisite  has been  entered into in
 other  articles;  in  this place, external ulce-
 ration of the skin  is only treated of.
   Ulcers may occur on any portion of the
 surface, but their  most frequent site, out of
 all proportion, is  upon the  legs, and  upon
j the left ofteuer than upon  the right:  they
| are moreover much  more common in the
 aged than in the young.   If it  be borne in
 mind  what was said  about the dependence
 of ulcers  upon impaired efficiency of the
 circulation in a part, the reason for  their
 occurrence on the  lower extremities will be
| obvious,  when it is reflected how far  the*« 
U L C               549                ULC
members are removed from the centre of the
circulating power, and how greatly the re-
turn of the blood upward  must be inter-
fered with by the influence of'gravity. The
upward flow of the blood (see Veins) is pro-
moted by a variety of agents, and is greatly
assisted by the valves with which the veins
are provided.   When these valves, as they
often do, become deficient or  useless, the
important uses they subserved become ob-
vious ;  the veins of the leg are now exposed
to the  full weight of the  column of blood
above,  no longer supported  by the  valves,
and  they become tortuous and  swollen, or
as it is called, "varicose."—See Veins.  In
this  condition of the veins  there exists the
commonest cause of ulcer: the blood in the
large veins being retarded, reacts upon the
circulation in the smaller, or " capillary"
branches, and sooner or later ulceration is
the result.   This ulceration may arise spon-
taneously, without obvious cause, but very
often it is determined by some slight injury;
a, scratch, a bruise,  or an abrasion causes
slight inflammation,  and gives the first start
to the  ulcerative process,  which  extends
with greater or less rapidity, according to
circumstances, and gives rise to ulcers pre-
senting very different  appearances.  Into
the  minutiae of these appearances it would
be useless to enter here;  some  ulcers pre-
sent an angry, inflamed appearance,  with a
blush of inflammation extending for a con-
siderable distance around;  some are sur-
rounded with hard  swelling,  without much
apparent inflammation, and the sore ap-
pears to lie deep, surrounded  by thick edges.
In some the surface of the sore seems glazed
and smooth, in others the granulations are
large, prominent, and pale, constituting what
is called proud  flesh. Some of  the sores
are but little felt, others are  intensely pain-
ful  and irritable.   Although  it  has been
said that a large proportion of ulcers de-
pend upon a "varicose"  condition  of the
veins,  all do not; many are occasioned by
constitutional or other causes.  Indeed, the
existence and  appearance of an ulcer will
often afford to a medical man a good index
to the  state of the system generally.
   There are cases of ulceration which  re-
quire all the skill and patience which a me-
dical  man  can bring to  bear upon their
treatment, and where an ulcer is continued,
and appears to extend, it should always  be
placed under proper medical superintend-
ence.   There  are, however,  certain general
rules of management which may be adopted
with advantage by  unprofessional persons
either in their own persons or on  those ot
others.
  The great requisite in the treatment of
ulcers of  the lower extremity is rest, and
rest in bed, or at  least in the  horizontal pos
ture, so that the  circulation of the  affected
limb may become properly balanced.  It is
often surprising  how  quickly, under this
proceeding alone, and  without other  treat-
ment, the swelling around an ulcer subsides,
and  the sore itself alters to a more healthy
character.   Indeed, there are cases  which
only require rest to get well.  In many cases,
however, especially of old standing, further
treatment is requisite.   If there is  angry-
looking inflammation and a  foul  sore, the
one has to be subdued and the other cleansed,
in the first instance by poultices continued
for  two or  three days, after which water-
dressing (see Dressing) may be substituted,
and  if the ulcer improves under  its use,
continue till  the cure is complete.  It may
be necessary, however, if the surface of the
ulcer appears pale, and  the granulations
large and flabby,  to substitute for the water
an astringent lotion of lead, zinc, or tincture
of myrrh, or to  touch  the surface  of  the
sore lightly with  lunar-caustic, or sulphate
of copper or blue-stone. These liquid dress-
ings of water or lotion  are  far preferable
in every way to ointments.  It is desirable,
even while  the patient is confined  to bed,
to support the limb and retain the dressings
by means of a roller bandage applied from
the toes upward ;  and this is especially re-
quisite if, or when, the rest of the  recum-
bent posture is abandoned.   In many cases
of ulcer, however, it occurs that rest cannot
possibly be taken; in such, the  treatment
by strapping with  plaster, and by the use
of a supporting well applied bandage, offers
the  most  benefit, and  best chance of cure;
even in these cases, however, it is desirable
if possible, to procure the subsidence of the
inflammation and swelling by a  few days'
rest. When strapping is used, the leg ought
in the first instance to be well washed,  and
the hairs shaved  off; a roller bandage  (see
Bandage, fig. ix.) is then to be applied from
the  toes to a little below the sore.   Strips
of plaster rather more than an inch broad,
and  long  enough  to  go once and  a third
round the limb,  as shown in the figure on
the  following page, (exxxviii.  1,) are then
applied, piece by piece, each one overlapping
the preceding, from  an  inch  below to an
inch above the sore.   The mode of applica-
tion is this:—The strip being heated, its
 centre is applied to the side  of the limb op-
 posite  the  sore,  and the ends are brought
 round  to  overlap  as  represented, care be-
 ing taken in the application of both strap-
 ping and  bandage, that  they lie evenly,  so 
ulc
Fig. CXXXTiU.
as to afford equable and sufficient  support
to the limb, and  especially to the veins.
With such a dressing as the above, an indi-
vidual may be permitted to take a consider-
able amount  of  exercise.   [Many  cures
have been accomplished by it.J  The dress-
ing will require changing every two, three,
or four days, according to circumstances;
if the discharge is  very profuse, it  is well
to cut a  piece  out  of the  plaster  directly I
over the sore.  [Or pour cold water over it I
daily, and then dry the limb with a towel.]
Diachylon  plaster  is  commonly used  for
strapping, but for irritable skins soap plas-
ter is preferable; in some cases even this
cannot be borne.   Of course these rules as
to position,  support, &c , apply more espe-
cially to ulcers situated on  the lower  ex-
tremities.  When an ulcer appears to depend
on any particular  derangement of  the  ge-
neral health, the latter should be attended
to; the bowels especially must be kept  un-
loaded,  the  contrary  condition   tending
greatly to cause and  keep up  the varicose
condition  of the veins.  In  the aged, in
whom the  functions and circulation  gene-
rally are torpid, much benefit often results
from the use of moderate doses of opium—
this is a point, however, which ought to be
regulated by a medical man.
   In some cases, in which an ulcer has been
in existence so long that it  has become ns
it were an established  excretory outlet  for
the system, it cannot be healed up  without
danger of some other disease, such  as apo-
plexy, &c. supervening.  As circumstances
may, however, render  the healing  of even
an old sore both safe and desirable, a me-
dical  man  should be  consulted.   Serious
accidents occasionally occur in consequence
of an ulcer on the leg opening into one of
the veins.   When this  occurs, a large, or
even fatal quantity of blood may be lost in
a short time, unless the individual,  or some
other, has sense enough to elevate  the limb
above the level of  the  body.—See Hemor-
550                U R I

   rhage,  Veins, $c.   In dressing ulcers, the
   mistake is  often committed of  being too
   assiduous in cleansing their surface, wash
   ing off the  pus  or  matter which  lies upon
   it, ami which in some  measure is a  protec-
   tion against irritation.  This should not he
   done.  The  pain of  an ulcer underneath
   either  bandage, or  piaster and  bandage,
   may often be  alleviated by simply sonking
   the dressings with cold or tepid water, with-
   out removing them.
     Refer to Bandages— Veins, Sec
     UMBILICUS.—The  navel.—See Childbed
   —Children—Rupture, Sec.
     URETER.—The tube which  conveys the
   urine from  the kidney into the bladder__
   See Kidney.
     URETHRA—Is the  passage  of the urine
   from  the bladder. — See  Bladder.    This
   passage is  liable to be nffected in various
   ways, especially in males.  Sometimes it is
   injured by violence;  at others, small  stones,
   or cnlculi, are npt to be impacted in  it, nnd
   cause much suffering.—See Urine.  The most
   frequent affection, however, of  the urethra,
   is  stricture, or  diminution of  its calibre.
   This  painful disorder in  males genernlly
   takes its origin from diseases contracted  in
   the irregularities of  early  life, especially,
   but  may  continue to  afflict  (or  punish)
   even in old age.   Stricture is, of course, of
   every degree, but sometimes proceeds so far
   as to occasion  complete impediment to the
   discharge  of urine, causing much distress
   and  suffering,  and  requiring  the  instru-
   mental interference of the surgeon.—See
   Catheter.   If there  is  any  necessary delay
   in  procuring assistance, the measures re-
   commended  in article  Bladder—Stoppage  of
   Urine—will  give relief in the  mean while.
   In this disease, as well ns  in  others which
   affect the urinary  organs,  it  is again re-
   pented, avoid the quacks.
     UKINE.—This most important excretion,
   is  purely an excretion : that  is  to  say, it
   does not, after its formation, fulfil any pur-
   pose connected  with the living system, be-
   fore  it is thrown out of the body ; in this
   respect, differing from such an  excretion  as
   the bile, which, although it is constituted
   of  elements  filtered off from the blood,  to
   the purification of the  vital fluid, yet, cer-
   tainly fulfils  important ends in the digestive
   processes, and,  if Liebig be correct, in the
   development of animal heat also.
     The minute structural arrangements  in
   the kidney,  whereby  the secretion  of the
   urine from  the  blood  is  effected,   have
   already  been sufficiently entered into.  To
   article " Kidney" the reader is  referred.
     The urine  being separated or  " secreted.' 
                 URI                 5i

solely from the blood, and being thrown out
without serving  any purpose in the living
economy,  must,  by  simple  reasoning,  be
supposed to contain  ingredients from which
the body ought necessarily to be freed, and
which could .not be retained without injury.
Such  proves  to be  the case, for, complete
suppression of the  secretion cannot con-
tinue  above a few hours without symptoms
of narcotic poisoning being developed, and
death ensuing, if the function be  not re-
stored.  Urine consists of water holding in
solution certain  animal  principles  and  a
proportion of saline  constituents.   The
principal and most characteristic ingredient
of the urine,  however, is its  urea,  a body
which  acts as a  base  to, or  combines with
acids.  It is the retention of this compound
in the blood which causes the symptoms of
narcotic poisoning already alluded to, when
the urinary secretion is suppressed.  Above
half an ounce, on the average,  of urea is
excreted  in  the  urine of an  adult  in the
twenty-four hours ; but in some cases, when
rapid emaciation  goes  on, the proportion is
greater, the urea being  in  fact  a product
formed from the used-up tissues of the body.
Next  in importance  to the  urea  of  the
urine  is its peculiar acid, generally known
as uric or lithic acid.  It is this acid, which,
when  in  excess,  constitutes  the yellow  or
red crystalline gravel, or " sand," which is
so frequent in many  persons.   This acid
exists partly in combination with ammonia,
forming what is known as the " lithate," or
"urate of ammonia."
  In  addition  to, these two  principal and
characteristic constituents,  urine contains
various animal and colouring matters, also
muriatic, sulphuric,  and  phosphoric  acids,
in combination with  lime,  magnesia, and
soda, all these being  derived from the blood.
Further,  there is always mixed  with the
urine  a  certain  proportion of  " mucus"
derived from   the bladder and urinary pas-
sages.   Moreover,  other  ingredients, not
natural to it, are apt to be intruded into
this fluid, such as the albumen of the blood,
or blood itself, pus or matter, oxalic acid,
&c.  The average quantity of urine secreted
by the kidneys of a  healthy man  in the
twenty-four  hours  is from  thirty-five to
forty ounces,  containing  from six to seven
hundred grains of solid matter.   Both fluid
and solid matters, as already stated, are de-
rived solely from  the blood ; not, however,
we have every reason to  believe, from the
healthy constituents  of the blood, but from
those  which  have become  " effete," which,
having served their purpose in the economy,
have been taken into the current of the cir-
51                URI

I culation, probably, for the sole purpose of
 being brought  under the power of the ex-
 creting organs.  Not only, however, do the
 kidneys  separate the  used-up  materials
 which  have  formed part of the organized
 frame—they also lay hold of, so to speak,
 and  throw out  from the  blood, many ill-
 digested  and  useless matters which  have
 been derived from the food.
   From the above account of the sources of
 the urine constituents, it cannot excite sur-
 prise  to find the fluid varying, as all know
 it does, at different times.  Even within the
 limits of health, the  variations are regular,
 almost periodic.   Thus,  after a fluid meal,
 such as breakfast, or  after much fluid  has
 been taken, the kidneys secrete largely, the
 urine  is  plentiful, but  generally  pale in
 colour—it is  the urine from fluids.   Again,
 after a solid meal, such as dinner, the urine
 is less abundant, it is darker in colour, and
 probably has the odour of some ingredient
 of the  previous meal—this is the urine of
 solids.  Lastly,  if no heavy meal has  been
 taken just before retiring to rest, the urine
 is probably a mean between that of the fluids
 and that of the solids—it is the urine of the
 blood, and, being less likely to  be influenced
 either by solids or fluids which have  been
 taken into the system, affords the best index,
 as far as the urine is concerned,' of the bodily
 condition.    This  is  the  reason why  the
 "morning urine"  is  so  often  examined, in
 preference to that passed during other pe-
 riods of the twenty-four hours.  Although
 exposed to the  above sources of variation,
 urine, if perfectly healthy,  ought  to  be
 transparent,  not  only  when  passed,  but
 when  it becomes  cool,  a just  perceptible
 cloud,  composed of  healthy mucus,  being
 only visible at the bottom of the vessel. The
 colour ought not to be too dark, and the fluid
 should be acid when  examined by means of
 litmus.  The specific gravity  ought not to
 vary greatly  from the healthy  average  of
 1 018—that is to say, for any length of time,
 or except from some  obvious cause.   In hot
 weather, in this climate, and in hot climates
 generally, when the  action of the skin is
 so much increased, it, of course, leaves less
 fluid to be drained  from the  blood by the
 kidneys ; and as the solids to  be carried off
 by these glands  still remain  the same, or
 nearly so, the specific gravity of the smaller
 amount of fluid  must be proportionally in-
 creased. Here we have an obvious cause for
 the change, no less obvious than that which
 gives a large quantity of pale urine of low
 gravity if an individual indulges in fluids
 Further, we know that nervous individuals,
 of both sexes, and especially hysterical fe- 
URI                552                 URI
mate*, will occasionally secrete very large |
quantities of colourless urine.   Such varia-
tions, therefore, cannot be considered to be
the  result of disease, but  when permanent
Increase or diminution of the quantity of
urine (see Diabetes—Dropsy— Bright's  Dis-
ease) occurs, without  being accounted  for,
and  especially if symptoms of  constitutional
disorder or  debility,  or  of  dropsy, show
themselves, a medical  man should  at once
be consulted.
  Perhaps the most  common disorder to
which  the urine is liable, is  excess of its
usual constituents,  the lithic  or uric acid.
That is, in such excess, that  instead of re-
maining dissolved,  as in  healthy urine, it
becomes "precipitated;"  in  other words,
there is so much of it that the urine cannot
hold it  dissolved.   Thus, uric  acid may
exist uncombined, in which case it is depo-
sited in  the form  of crystalline  sand, of a
yellow or red hue; very commonly, however,
it exists  in the combination with ammonia,
as a " urate of ammonia," in  which case it
does not crystallize, but takes  the form of a
cloudy precipitate.   This urate of ammonia
forms  the  fawn-coloured  sediment,  with
which most are familiar, as a consequence
of a chill or of a common  cold.   It also as-
sumes a pink, sometimes a deep red or pur-
ple hue, especially in affections of the liver;
indeed, whatever colouring-matter exists in
the  urine, the urate  seems  to  attract it
strongly.   Urate  of ammonia is extremely
soluble in warm water or  urine, and much
less  so in cold, so that, although when  the
urine is passed, it may contain it abundantly,
the secretion  is perfectly  transparent,  and
it is  only as it cools, and can no longer hold
the urate in solution, that the latter becomes
visible.   This excess of lithic  acid, alone or
combined, in the urine, may  arise  from a
variety of causes. One of the most frequent
temporary occasions of it is suppressed per-
spiration.  The skin is constantly excreting
acid  (lactic  acid) along with  the perspira-
tion, so that when the  latter is checked, the
acid  is thrown back upon the system.  Here
the wonderful  power  by  which  one organ
"compensates" for the deficiencies of an-
other, is brought into action: the  kidneys
assume  in  some measure  the office of the
temporarily disordered skin,  and cast  out
the acid, not as lactic,  but as uric acid, from
the  system.    Another frequent cause  of
excess of uric acid   is  the introduction of
injurious  (probably often   lactic) acid into
the system  in  food or drinks.   The malt
liquors,  especially when in the least " hard," I
or old and acid, are  most fertile sources of |
uric  acid,  from  which brewery-men  and
labourers,  who  often  drink largely of old
and acid beer, are extremely apt to  suffer.
—See Ale.   A third source of  uric ncid, or
red or pink gravel, is disorder of the digestive
organs,  especially if too full a diet of ani-
mal food, be indulged in.   There are other
causes of uric  acid  excess, such as  extra
fatigue, especially if it gives rise to feverish-
ness,  &c.  Moreover,  uric  ncid  may exist
in excess in the blood, and  yet may not be
manifested in the urine ; such  is the case in
gout —Sec Gout.
  The white sand or gravel  is  by no means
so common as the red, and is usually con-
nected  with  an  alkaline condition of  the
urine ; it, and  indeed the white  sediments
generally, are more  usually met with in  the
aged, and in states of debility.  Oxalic acid
occurs frequently in the urine  of dyspeptic
persons, but  may be  occasioned  by food
which contains the acid naturally, such as
rhubarb.   Its presence cannot be detected
without  the aid of the microscope.   Albu-
men in the urine has been  already alluded
to.—See Bright's Disease.  Blood  mny occur
in the urine in small quantity,  giving  the
fluid merely a dark smoky tinge,  or  it may
be discharged in large quantity  us nearly
pure  blood.  In some  cases,  matter  and
thick glairy mucus are discharged with  the
urine.   In  pregnancy,  occasionally, a thin
creamy-like scum  forms on the urine, if it
be allowed to stand for a day or  two.  De-
viations  from  the healthy character of  the
urine are important, first, as indicative of
deranged states of the system ;  and, second,
from their  own local effects.   Some indivi-
duals are much more liable to have the urine
disordered than others, but in  none can  the
condition be permitted to continue without
risk, nor ought  it to be without  the cause
being investigated.   Such  temporary dis-
orders  as  that  produced  by  cold  are  in
themselves comparatively unimportant, nnd
the best remedy is to restore the functions
of the skin by warm  baths, diaphoretics, &c.
  When red, or pink, or fawn-coloured gra-
vel appears to be permanent, and to be con-
nected with derangement of the digestivs
organs,  the symptoms  should  not be neg-
lected.   If food has been  taken  at  all in
excess, it should be reduced, and the allow-
ance of animal food especially, moderated,
mall liquor  of every kind  being  sedulously
avoided.  If stimulants are necessary, a little
Bound sherry, or brandy, or gin with water
are the  best.   Exercise should  be  taken
freely,  but  not to exhaust;  the skin should
be well cared for by frequent ablution.  As
regards medicine, the alkalies at  once natu-
rally suggest  themselves as remedies, and 
URI
553
URI
 most valuable they are, (see Potash—Soda;)
 they quickly  cause the  acid  to  disappear,
 and were the disappearance of the acid all
 that is required, they alone might suffice;
 but the cause of the gravel, especially of the
 pink variety, is generally some derangement
 of  the  digestive  processes, which must be
 rectified if permanent amendment is desired.
 On this account, the safest plan is to con-
 sult a medical man on the subject; but if
 this is  not done, some one of the tonic bit-
 ters should be combined with the alkalies;
 in  fact, the digestive organs  should be at-
 tended  to as recommended in article " In-
 digestion."
   One caution is here requisite.  Persons
 who have been  the  subject of red gravel
 ape very apt to  continue too long the use
 of  alkaline remedies, and thus seriously to
 injure  the constitution  and  the digestive
 powers, nnd in the  end  to induce a perma-
 nent alkaline condition of  the urine,  which
 js  a more serious  and intractable malady
 than the opposite acid state.   The presence
 of  white  gravel  is often  so  indicative of
 serious disease, that as soon as its presence
 is  suspected,  a  medical man ought  to be
 consulted.  The tendency  to  its formation
 is frequently  difficult to remove.  One of
 the best remedies in alkaline urine is the
 nitro-muriatic acid;  it is  likewise a  most
 valuable remedy  in the  oxalic  acid urine.
 Oxalic acid is itself very  soluble,  but occurs
 in  urine in a comparatively insoluble  form,
 in combination with lime,  in the  shape, as
 seen under  the  microscope,  of  beautiful
 eight sided crystals.  This form of gravel
 is  far  from  being  uncommon,  but  when
 abundant and persistent,  it is  often asso-
 ciated with hypochondriac indigestion in the
 melancholic  temperament.   Whatever  the
 form of the gravel, the skin and the digestive
 organs  require  especial attention.   It is
 always desirable to keep the  flow of urine
 free, and  for  this purpose sweet nitre, or
 infusion  of  broom  or dandelion, are well
 adapted.  Many find gin, used in modera-
 tion, of much service.  When, however, the
 symptoms of gravel are constant, a medical
 man ought to be consulted, for it is not solely
 the immediate inconvenience which is to be
 obviated,  but  the liability of the gravel,
 whatever its nature, to accumulate,  either
 in the kidney or bladder—in which case the
result  is either  a  most  painful attack,  a
 "fit of the gravel," or the  formation  of
 "stone."
  " A fit of the gravel" is caused by a small
gravelly concretion, or'stone, passing  either
from the kidney down the ureter into the
bladder or through the  passage—the ure-
         2 W
thra—from the bladder; in either case giv-
ing rise to intense suffering.  When the pas-
sage is from the kidney to  the  bladder, the
pain often comes on suddenly, is felt chiefly
in the groins and down the thighs,  some-
times occasioning cramp ; it remits, and if
pressure be made deep in the groin, there is
tenderness.  The symptoms of  the passage
of a small stone from the bladder are  some-
what similar, varied of course by situation;
there is often  sickness  and vomiting.  In
such cases, the best means of  relief, till a
medical man sees the case, are  the  warm
bath, hip  or  general, and  hot  applications
generally.  Opiates in tolerably large  doses,
equal to twenty or thirty drops of the tinc-
ture, are required at intervals to allay pain,
given either by the mouth,  or in warm clys-
ters of tolerable bulk, which give relief by
acting as an internal fomentation.  Copious
draughts of demulcent drinks, barley-water
and the like, are advisable.  Sweet spirits
of nitre may be  given, and if the acid is
known to be red habitually, the alkalies will
be useful.  Solution of potash, in twenty-
drop doses, is  perhaps  the best.  Should
great  tenderness  at the seat of pain come
on, leeches may be required; but the  above
measures will suffice to give much relief, till
the case is visited by a medical man.
  Stone,  that is,  a concretion of  gravel so
large that it cannot pass by the  natural out-
lets, may  form  either in the cavity of the
kidney or  in that of  the  bladder.   This
affection is more common either before pu-
berty or after middle age.
  When a stone forms in the kidney, it gives
rise to a constant sense of  uneasiness, or of
pain in the back and loins,  extending down
the thighs.   These uneasy sensations  are
always  aggravated  by motion,  especially
that of riding,  either on horseback or in a
carriage, and after such exercise the  urine
is apt to be tinged more or  less  with blood,
or to contain  small blood-clots.   When the
pain is  severe,  sickness may be  produced.
The stone in the kidney may continue with-
out change of situation, and with  but little
enlargement,  for  an indefinite  time; but if
it  descends into  the ureter, it then gives
rise to the painful symptoms,  a  fit of the
gravel, above described.  When a stone has
descended into  the bladder, the  symptoms
it occasions are in some respects similar to
those caused  by one lodged in  the kidney,
but are more severe.  The calls to empty
the bladder are increased in frequency, the
attempt causes  pain more  or less, and the
stream  of urine  is apt  to  be  suddenly
checked,  probably  by  the stone falling
against the opening.  In such cases, if long 
UTE
554
V E I
 continued, the urine is apt to become loaded
 with  thick  mucus, or with  pus or matter. ,
 The suspicion  of  such a malady  as  stone j
 ought at once to be the signal for  the case
 being  properly examined.   In the  mean |
 while, as little movement as possible should
 be made ; demulcents (see Demulcents) taken
 freely will be found  useful;  and if there is
 much  pain, it may  be soothed by opiates,
 given either by the mouth or in the form of
 injection.
   Incontinence of urine  in  the aged, stop-
 page of the urine, and strangury  are suffi-
 ciently entered into in  article  " Bladder,"
 to which the reader is referred.
   Incontinence of  urine in the  young, wet-
 ting the bed, is frequently a most  annoying
 habit,  and one, moreover, which is  often not
 to be  overcome without much difficulty; it
 may even  continue  up to the time of  pu-
 berty,  or  beyond  it.  Various  methods  of
 treatment are employed—nitrate of potash,
 saltpetre,  given for some time to the amount
 of half a  drachm in  the twenty-four hours,
 to a child  of seven or eight  years of age, is j
 said to be sometimes successful.  The quan-
 tity may  be  given  in three doses of  ten
 grains each, dissolved in barley-water. Ben-
 zoic acid,  in six-grain doses, in  the form of
 [•ill, given twice a day, is used by some: the
 author has found the tincture of muriate of
 iron, "tincture of steel," answer well, in
 doses  of ten drops, twice or thrice a  day.
 This  remedy   is   peculiarly adapted  for
 weakly children.    In all such  cases  it is
 extremely  important that,  without being
 purged, the bowels are kept  lax.  The quan-
 tity of fluid permitted should be kept  at a
 medium, but the amount  taken in the after-
 noon and evening must be curtailed as much
 as possible.   In addition  to the above reme-
 dies, either the cold douche to the lower part
 of the  back, or the cold  hip-bath  at night
 or in the morning, whichever is found most
 beneficial, may be employed.
  Dribbling of urine, either  in the aged  or
 in those confined to bed by some continued
 and exhausting diseases, U a not unfrequent
 occurrence, which  occasions much discom-
 fort both to the patient and  others, in con-
 sequence of the offensive amironiacal odour.
 This is best counteracted by  bags filled with
 peat charcoal,  when  it  can be procured,
 placed under the patient,  or by bag.- of bran
 slightly moistened with  diluted sulphuric
 acid.—See Sulphuric Acid.
  Refer to Urethra.
  UTERUS—See Womb.
  UVA URSI.—Bear-berry is a low,  creeping
shrub,  which grows  in rocky heath ground
 throughout Northern Europe, including Bri-
 tain [as well as in the United States.]   Its
 leaves, which are used in medicine for their
 astringent properties, are deep green in co-
 lour, somewhat resemble those of the box, but
 are thicker and more leathery.   As nn  as-
 tringent, particularly in urinary nffcctions,
 the uva ursi might be advantageously used
 in localities where it is found.  The dose of
 the dried, powdered  leaves  is from ten to
 forty grains.  The decoction is made with
 one  ounce of the bruised leaves to one pint
 and  a half of water, boiling down to a pint,
 the dose one and a half fluid ounces.
   UVULA.—See Palate—Throat, &c.

   VACCINATION.—See Cow-pox.
   VALERIAN.—The  root of the Valeriana
 officinalis, or common valerian, is one of the
 most useful and generally used remedies in
 hysteria, and in spasmodic attacks generally.
 This plant grows commonly in England, usu-
 ally  about moist hedge-bottoms, woods, &c,
 showing its heads  of lilac-coloured flowers
 in the month  of August.  The root, which
 has a powerful peculiar odour, consists of a
 number of rootlets, about the thickness of a
 crowquill,  which  proceed from  a central
 stock.  Valerian is given internally in va-
 rious forms, but the preparation generally
 employed is the ammoniated  tincture, in
 drachm or drachm  and  a half doses, in an
 ounce and a half of water; this preparation
 ought to be purchased  ready made.   The
 common tincture, of which the dose is  the
 same as the above, is made  by macerating
 five ounces of  the bruised root in two pints
 of proof spirit.   The dose of the powdered
 root is half a drachm.   [The fluid extract
 is also an excellent preparation.   It  may
 be given in doses of from thirty drops to a
 teaspoonful.]
  VALVES.—These mechanical  agents  are
 found connected with the  circulating system.
  Refer to Heart—Veins.
  VAPOUR-BATH.—See Bath.
  VARIOLA — Small-Pox. — See  Small
 Pox.        0
  VEAL—Like young meats generally, is*
 not so digestible as the flesh of the  adult
 animal, but it is rendered more injurious to
 persons of weak  digestion by the conven-
 tional modes of cooking with  melted butter,
 ■fcc.  The objection  to veal, as invalid diet,
 does  not extend to  the broth  made from it,
 which is often  peculiarly adapted to the re-
quirements  of  convalescence and  illness,
from the amount of gelatine it contains
  VEGETABLES.-^ See  Food —Grains -
and articles on individual vegetables
  VEINS.—The veins are  the  vessels  or
membranous canals through which the blood 
V E I
555
VEI
 Is conducted back to  the heart (see Circu-
 lation) after it has passed through the capil-
 lary vessels, and been  brought into intimate
 contact with the tissues of the body.  While
 passing through  the capillaries,  the blood
 undergoes the change from arterial or red
 blood to venous  or black,  or rather dark
 purple blood.  Its  mode of progression is at
 the same time altered; instead of the for-
 cible,  intermittent  propulsion which  at-
 tended its passage through the arteries, it
 moves through the veins more  equably, and
 without  pulsation,  except  occasionally  in
 the large veins of the neck.   Its  progress,
 however, is accelerated by muscular move-
 ments.  Moreover, as  the aggregate calibre
 of the  branches  of the  veins distributed
 throughout the body is considerablytgreater
 than that of the large trunks into which the
 blood  is  collected as  it  approaches  the
 heart, the current of the venous blood must
 be accelerated as it enters these large vessels.
  Like the  arteries, the  veins have three
 coats,  an  external or protective,  an inner
 or lining,  and  a  middle  or  fibrous.    It
 is in the latter that  the  principal differ-
 ence as to thickness between  the two  sets
 of. vessels principally exists,  the  middle
 coat of the vein  wanting the  elastic  fibre
 of the  artery; consequently, when veins
 are emptied of their blood, they become flat
 and  collapsed, whereas  arteries  preserve
 their cylindrical  form.   A  further differ-
 ence exists in the interior of the two vessels
 —the veins, particularly of  the extremities,
 are  furnished  with  valves,  distributed at
 intervals.   These  valves  are so arranged,
 that  while  they permit the  free flow of the
 blood toward the heart, they do not permit
 its retrocedence.   A  moment's  reflection
 will  make  evident how greatly this valvu-
 lar arrangement  must assist  the (for the
 most part upward) current of the blood in
 its return  toward the heart; how great the
 inconvenience  attendant upon  its impaired
 efficiency  will  be  shown presently.    The
 veins generally are divided into those which
 lie deep and accompany  the arteries,  and
 into  the  superficial  veins.  The most  im-
 portant of the latter, as far as a work  like
 the present is  concerned, are  the external
 jugular veins of the neck, generally so evi-
 dent  in thin people; the  veins at the bend
 of the arm, (see Blood-letting,)  the veins of
 the lower  extremity, and  those of the rec-
 tum,  the hemorrhoidal veins;  moreover, in
 addition to  the veins  properly so  called,
there  are  the venous  sinuses.—See  Sinus.
When a vein is wounded, either by accident
or design,  the blood flows from it in a con-
tinuous stream, with much  less force than
 from an artery, and dark in colour; more-
 over, the bleeding from  a vein is generally
 more easily arrested  than it is from  the
 elastic, muscular, arterial tube, assisted by
 the  pulsation of the heart; comparatively
 slight pressure  by a  pad,  or  otherwise,
 being sufficient  to restrain the flow from
 the former.—See Hemorrhage.   A wounded
 vein  generally heals quickly, and the cur-
 rent  of  the  blood  through  it  is uninter-
 rupted.  In order to arrest the flow of blood
 through  an artery,  it is  necessary to make
 pressure  between  the bleeding  point  and
 the heart, or trunk  of the body ;  in the case
 of a vein, the  reverse  must  be done.   In
 almost  all cases, however, in which it is
 desired to stop bleeding  from  a vein, press-
 ure  directly over  the wound is the best
 remedy.—See Ulcer—Varicose.
  Veins  are liable to inflammation from
 wounds,  from inflammation  extending from
 the  adjacent  parts, &c.    This  is  a most
 dangerous affection, and  frequently resists
 the best-directed efforts of medical skill.
 The  affected vessel is painful,  feels hard,
the skin covering it and the  parts  around
are red  and inflamed; and there is much
constitutional fever, which tends  quickly
to a low or typhoid form.  The most that
could be  done by an unprofessional  person
in such  a  case would  be to use  repeated
fomentations to the inflamed  parts, and to
 administer from quarter  to half grain doses
of opium with two  grain doses  of calomel,
 every three, four, or five hours, according
 to circumstances, until the arrival of a me-
 dical man.
  A "varicose"  condition of the veins is
 chiefly met with  on the  lower extremities.
 The  affection consists, essentially,  in  the
veins becoming elongated, so  as to  permit
 of their assuming a tortuous knotted condi-
 tion, while they  are at the same time  en-
larged.   The state is  usually  associated
 with obliteration or deficiency, more or less,
 of the valves within the  veins, so that  the
 weight of the entire superincumbent  column
 of blood  bears with distensive  force upon
the vessels, and upon  those parts of them
 which are  most dependent.   The most fre-
 quent causes of the varicose veins are such
 as cause  impediment to the upward  flow of
the blood through the large veins of the ab-
 domen.   In this way, pregnancy, if frequent,
is a most common exciter of the condition:
habitual  costiveness, diseases of the liver,
 tumours  of any kind within the abdomen,
 act in a similar  manner.  The  truss worn
on account of rupture, or garters too tightly
 tied, likewise excite the  varicose condition,
 which is usually more common  in persons 
V E X
,v>r>
V E X
whose occupations  require much standing,
especially if they are of tall stature.  The
inconveniences which ultimately result from
a varicose condition of the veins of the leg
have  been sufficiently  pointed out  under
article "Ulcer."   The causes  of it,  which
have been just alluded to, naturally suggest
the best means of alleviation and cure, that
is, the removal as  far as possible of  all in-
terruptions to the upward flow of the  blood,
and the horizontal  posture of  the  body or
limb.   As these conditions, however, cannot
in all  probability be perfectly  carried out,
it is desirable that  in all cases of varix the
veins  and limbs  generally should  be sup-
ported by some one of the forms of elastic
stocking:  these  can now be obtained at so
moderate a price, that none need be without
their  valuable aid.  It is often surprising
how immediately the use of well-applied me-
chanical support, such as the elastic stock-
ing affords, removes the uneasy and painful
sensations connected with the  condition of
the veins in question.    Some individuals
cannot, however, wear  an elastic stocking
of any kind ;  for such cases,  an elastic tape
fixed  to the  foot by a stirrup, and wound
spirally round the  limb, has been  success-
fully  employed.    Spaces of  about three
inches being  left between the  spirals, each
time the band crosses the vein, it acts like
a valve.   Other methods of curing  varicose
veins, such as tying, &c, are had recourse
to by surgeons,  but as  long  as sufficient
comfort and  relief can be obtained  by the
use of elastic supports,  they  are  perhaps
better avoided.
   VENEREAL.—See Syphilis.
   VENESECTION.—See Blood-Letting.
   VENISON—The flesh of the  deer,  like
that of other wild or hunted animals, is par-
ticularly  digestible,  and is probably ren-
dered more bo by the custom of long keeping.
In Dr. Beaumont's  table of the digestibility
of various articles of food, " venison-steak"
is noted as  taking but one hour and  thirty-
five minutes for digestion ; beef-stea_k being
noted in the same  table  as requiring three
hours.
   VENTILATION—Is the  renewal  of the
air contained in  enclosed  spaces.   The ob-
ject of the operation is to provide in the first
place for the escape or withdrawal  of air
which has become deteriorated from  any
cause,  such  as animal respiration;  and  in
the second to supply the place  of the dete-
riorated withdrawn air, by that which  is
fresh and pure.   Under  the head of ventila-
tion, moreover, the heating  and  cooling  of
air may, perhaps, be included.   Under such
articles as Air, Aeration, Blood, Lungs, fcc,
the requirements of the animal constitution,
which render a  regular supply of pure  air
necessary for health, have been  sufficiently
entered into, and need  not be repeated; and
under article Bedroom, information on the
subject itself  will be  found—to those the
reader is referred.  The  entire surface of
earth is subject  to a vast system of ventila-
tion, effected by means of the currents of
air, or winds, which are continually passing
over it,  especially by those which,  like the
" trade," and other winds, blow  continu-
ously in  one direction for  months together.
   In some respect ventilation is the neces-
sity of a nation living in a variable  and cool
climate,  and of a people who have  attained
proficiency in architecture, and particularly
in domestic architecture.   In  hot climates,
where the breezes from without are rather
courted  than shunned at  all times, ventila
tion,  except in  the way of cooling, is un
called for as a systematic arrangement.  In
the ruder ages  of our own country,  when
shuttered instead of glazed windows pre-
vailed, and when buildings and fittings ge-
nerally were defective,  ventilation was abun-
dantly, though unintentionally provided for,
and especially  as long as the  wide,  lofty
chimney-place remained.—SeeChimney. But
at length, when  the art of building attained
greater perfection, when doors and  windows
were made to fit tight and well,  the ventila-
tion was interfered with by the very perfec-
tion of the work, and as practical, scientific
knowledge of sanitary matters was but little
diffused  or cultivated,  we have the  fact of a
community suffering evil  in consequence of
an art being  more rapidly advanced than
the practical science  which  ought neces-
sarily to accompany it.  Now, however, not
only are scientific and  professional men well
aware of the necessity for providing proper
ventilation of all enclosed places occupied by
man  or  animals, but most educated people
generally are alive  to the fact, and  have
some idea at least of the principles on which
the necessity  is based.   We cannot return
to the old unintentional ventilation of  badly*
built dwellings and old-fashioned chimneys,
consequently, the desideratum has been to
find those systems of ventilation which shall
combine efficiency with comfort and economy,
and which  in many instances can be most
easily adapted   to buildings already con-
structed, without reference to  any plan of
ventilation  at all.   Unfortunately, even of
the public erections, liable as they are to be
filled with living beings, there are too many
destitute of any provision for renewing the
air deteriorated by the breath  and exhala-
tions of the assembled crowds.   Moreover, 
V EN
557
VEN
m many instances where an attempt at ven-
tilation  is  made, the unscientific  mode  of
its execution and  arrangements renders it
abortive, or nearly so.  Apertures may be
made in  walls  or  roofs,  but without some
method  of  renewing the air, they are com-
paratively  of but  little  use.   Ventilation,
that  is movement of the air, may and is ef-
fected in various ways.  Bellows, which force
the air through the place  to be ventilated,
have been employed, but except in special
eases they  are not  used;  screen  and fan
ventilators  to  withdraw the air have also
been constructed, but by far the most effi-
cient and, in a country like Britain,  gene-
rally applicable ventilating agent, is  heat.
As heated  air  has a natural  tendency  to
ascend,  and as  all air and vapour which
passes off from the animal lungs or skin is
heated, in  obedience to  the above law it
ascends, and in doing so must  leave  space
to  be supplied by the surrounding cooler
air.  Such  is the natural ventilation under
which we all live; but to be  efficient, it is
evident that the air which supplies the  place
of the impure, warm, respired air which has
ascended,  must be pure  also.   If one or
more persons are seated in a  closed room,
which has no exit for the air above the level
of the nostrils and mouths of the occupiers,
the heated air which, has ascended  can only
accumulate above, that is at the top of the
room; and  as it gradually cools, being dis-
placed by fresh supplies of warm air, it must
necessarily  descend  to be rebreathed.  In
this way the circulation of the  confined air
goes  on, every breath rendering it  more de-
teriorated and unfit to support  animal life,
till at length, if the circumstances were con-
tinued, life could not be  supported at  all.
The first remedy for this state of  things,
         2 w2
 which presents itself to the mind, is to make
 apertures in the roof above, to permit the
 bad air to  escape, and when nothing else
 can be done, such a  proceeding  is better
 than no  provision at  all.  Moreover,  the
 efficiency of such apertures as  ventilating
 ngents  may be  considerably increased,  by
 fitting them with a short tube of some kind,
 divided by a partition, so as to  admit of a
 double  current,  one upward of heated, and
 another downward of cold fresh air.   When
 there is both roof and ceiling to an apart-
 ment, (fig. cxxxix.,)'the ventilation may be
 considerably  assisted   by  "cowls"  (fig.
 cxxxix.  1)  fixed to  the roof, so  that  the
 wind blowing through  them may  tend  to
 draw off the air  admitted into the space (2)
 from the apartment below by means of the
 apertures, (3, 3.)
  Dr.  Boswell Reid found  in  his experi-
 ments, that cool  air admitted into a crowded
 room by the floor, was raised from ten  to
 twenty degrees of heat before it reached the
 heads of the people, solely by the  heat  of
 their bodies, evidently showing that this
 natural ventilation, as it  may be called, if
 simply  facilitated  by openings in  the roof
 for  the escape of the ascending impure and
 heated air, is capable to a certain extent of
 correcting the necessarily deteriorated  at-
 mosphere of a  crowded  room.   But even
 under the most advantageous circumstances,
 the effects it can produce must be very in-
 ferior to those which  result from the em-
 ployment of artificial heat, which, whenever
 it is in any way  available, ought to be made
 an  active agent in the processes of venti-
 lation.
  In mild climates,  and in fine summer
 weather,  open doors and windows  are  at
 once the readiest and best means of renew-
 ing the air of dwellings and other places;
 as  these,  however, cannot be available  in
 cold weather, or during the night, it is ab-
 solutely requisite  that  sleeping and  other
 apartments, in  which  no fire is burned,
 should  be  provided  with some  means  for
 permitting the free admission of fresh, and
 exit of deteriorated air. These means, how-
 ever, must  necessarily  vary with circum-
 stances, such as  the relative situation of the
 apartment, its height,  window,  &c.   They
 may be directed so as to accomplish the re-
newal of the air in'two distinct ways.  The
 first, by providing for the escape of the im-
pure air by openings in some portion of the
 walls, windows,  or ceiling above the ordi-
nary level of the head  of an occupier, and
for  the admission of fresh air in such a man-
ner that no injurious current or  draught is
established. 
V  E N
V  I  C
  Th«  seccnd mode may be effected as fol-
lows :--
  If a house is small,  and especially if a
fire, ns in a kitchen, is left lighted  during
the night, there are currents of air which
set to  that  fire from  every room.  In this
way, if means  for admitting the fresh ex-
ternal  air into  a bedroom  are established,
the door being left ajar, or having a perfo-
rated panel, there is a continued but gentle
flow of air  through  the apartment  to the
door.  Even without a fire actually burning,
there will be a current of cold  air  toward
the portions of a dwelling which have  been
warmed by the fires and occupation of the
day.  This  mode  of ventilating,  however,
belongs rather  to that effected by artificial
heat.   A brisk  fire is undoubtedly an excel-
lent ventilator,  but even this, with the low
chimney-piece,  must  in a  great  measure
supply itself from the fresh air which comes
in at the lower  parts of the room, and leave
that in the higher parts,  which  most re-
quires  renewal, untouched. To obviate  this,
chimney-ventilators, such  as that  of Dr.
Arnott's, (see Bedroom,) have  been intro-
duced, and probably offer the most efficient
mode, and that which is most  generally ap-
plicable, of drawing off the deteriorated air
of a room.   In the absence of a regular tire,
or in combination with  it,  gas burners are
commonly  employed  as ventilators,  each
light being placed under a tube, with a bell-
shaped mouth,  and the tube itself made to
communicate with the  chimney.  By  this
arrangement, not only is the general air of
the room carried off, but also that which is
rendered impure by the  burning gas.   In-
deed, the arrangement is one which in  some
modification or other ought to be connected
with all gas-lights.
  While, however, every care is taken  to
renew  the air in  the interior  of dwellings,
obviously the measure will be a useless one,
unless  the  air  introduced  from without is
itself pure.  In this way the system of ven-
tilation becomes connected  with sanitary
arrangements generally, such as drainage,
&c, and, indeed, with whatever  tends to
render the air  around dwellings unwhole-
some.   Whatever the condition of the  sur-
rounding atmosphere,  that  portion of it
which  is admitted into dwellings for  pur-
poses of ventilation, ought not to be taken
from too near the level of the soil;  for not
only is it liable to be  more  damp, but also
to be impregnated with any malarious agen-
cies which  may possibly exist.—See  Ague.
  One  other mode of  ventilation requires
notice: it is that exerted  by the  chemical
action  of  lime,  which, by absorbing the
carbonic ncid gns of  the  atmosphere, nol
only removes  a  noxious agent, but  by the
removal of the gns gives space to be occu-
pied by fresh air from without.  The method
may be  useful  in  some situations, which
cannot be otherwise  ventilated.   It  is best
effected by a quantity of newly slaked lime,
spread on a board.
  In a brief sketch  like the foregoing, it
would be useless to attempt  more than an
outline of the principles of a subject so ex-
tensive as ventilation ; neither would it be
necessary here,  as the most useful  details
wiii be found under the heads of the various
subjects  alluded  to  in  the  article.   One
instance  alone,  related by Mr.  Chadwick,
and well known to those who take interest
in such matters, will be related to illustrate
the powerful influence  of  ventilation upon
health.   There existed  in Glasgow a large
tenement, known by the name of the " Bar-
rack ;" it consisted of many rooms, each let
out to one or more families, so that not less
than '"00 poor people inhabited the building.
The consequence of this overcrowding was,
that fever was always in the place, and "in
the last two months of  1831, there occurred
fifty-seven  cases  of  the disease.   At  the
suggestion of a medical man, there was fixed
into the ceiling of each room a tube, which
was made to communicate with the chimney
of  a neighbouring  factory.    In this way an
efficient  system of  ventilation  was esta-
blished  with tucli  good effect,  that, there-
after, fever  was almost entirely banished
from the place."
  VENTRICLE.- See Circulation—Heart,
  VERDIGRIS—Is an acetate of  copper.
It is prepared chiefly in the wine  countries,
by acting upon plates  of copper, by means
of  the husks and other refuse of the  grape,
which are made to undergo the acetous fer-
mentation.   Poisoning by verdigris some-
times occurs : it is to be treated in a similar
manner to that from the sulphate  of copper,
or blue vitriol.—See  Copper.
  VERTEBRAS.—See Spink.
  VERTIGO.—See Gidoinkss.
  VESICATION.—Blistering.—See Blister.
  VESICLE.—A little  blister, or elevation
of the epidermis or scarf-skin, by clear fluid.
In the first stage the cow-pock is in the state
of a vesicle, but in the loter stages, when
the clear fluid becomes turbid, like matter,
it becomes a pustule.
  liefer to Sl.m,  Sec
  VICARIOUS ACTION—1« action  set up
in one part of the body  ns a substitute for a
similar action in another.  It occurs chiefly
in connection with menstruation.—See Men-
struation. 
                 V I x

  VINEGAR, or  Acetic  Acid. — Acetic
acid is the volatile  acid  principle, which,
diluted with water, constitutes vinegar.  The
acetic  acid itself may be got very strong and
concentrated by various chemical processes;
it is also obtained of considerable strength
by the  destructive distillation of wood; when
thus procured,  it  is  named  pyroligneous
acid, or  "wood-vinegar."  Vinegar  is a so-
lution  of acetic  acid in water; it is of vari-
able strength, and  contains colouring-mat-
ter, and usually, also, spirituous and etherial
principles.   It is prepared from wine, malt,
sugar,  cider, &c. &c.; and also, as stated
above,  from wood.  Except in the case of
the last,  it is produced by the acetous  fer-
mentation, which is carried on under a tem-
perature approaching 80° Fahr.
  The  wine vinegars, or French  vinegars,
are made chiefly from the lighter  wines by
a careful process of  fermentation.   They
are usually better and stronger than those
of British manufacture, and more free from
adulteration.  British vinegars  made from
malt, sugar, &c, generally want the aroma
of the  French;  most of them contain  sul-
phuric acid, in the proportion of one thou-
sandth part, as permitted by law, but some-
times in  much  larger quantity.   Vinegars
are also  liable to contain metallic impuri-
ties, owing to the readiness with which they
act on many metals with which they may
come in contact  in process of  manufacture.
These  impurities are got rid of by the pro-
cess of distillation; consequently a distilled
vinegar, or acetic acid, is used  for medicinal
purposes.  The  addition of sulphuric acid
to malt vinegar  is permitted,  to counteract
a tendency to pass into the putrefactive  fer-
mentation.   The colour of the brown vine-
gars is generally imparted by  burnt sugar.
According to the investigations of the "Lan-
cet Commission," it appears that the chief,
and almost the sole adulteration of vinegar
is by sulphuric acid, in excess beyond  the
legal quantity.
  The  domestic  manufacture  of vinegar is
so simple, that those who wish it can easily
render themselves independent of the manu-
facturer,  and, indeed, many  housekeepers
do manufacture  their own. It  is not uncom-
mon, at least in  some parts of the country,
to see standing near the  fire a large brown
jar, tied  over with a porous cloth, in which
the process of vinegar-making is carried on
by means of the "vinegar-plant," as it is
called.   Of this  plant, which is in the form
of a large, flat, leathery fungus, Mr. Fletcher,
a correspondent in the Lancet, gives  the fol-
lowing  account and mode of using:—"Put
the plant—a young one—in an earthen  jar,
39               VIN

 add to it half a pound of the coarsest moist
 sugar, and half a pound of treacle, with five
 pints of milk-warm water; cover it lightly
 over so as to keep out the dust, but not the
 air, and then put it in a moderately warm
 place;  there let it remain seven weeks, not
 disturbing it more  than you can help.   At
 the end of that time, pour off  what is now
 the clear vinegar, and keep it in well-corked
 bottles for use.  Again add to  the plant the
 same quantity of water, sugar, and treacle,
 as  before.   At the end of the  second seven
 weeks, the plant will have become like  two
 thick pancakes, and  they may be easily di-
 vided, care  being taken not to  tear the old
 or new plant. If the plant is exposed to the
 cold, or kept too long out of  the liquid, it
 will become black, and  die."   Another re-
 ceipt is  given in the Lancet as follows :—
 " For every gallon of hot water take eigh-
 teen ounces of sugar, and when the syrup
 has cooled  to 75°, add  four per cent., by
 measure, of yeast.  When  the vinous fer-
 mentation is pretty well advanced, in the
 course of two  or  three days,  rack  off the
 clear wash from the lees into a proper cask,
 and add one ounce  of  wine-stone, and one
 of crushed raisins for every gallon of water.
 Expose   it  in a proper manner, and for a
 proper time, to  the  acetifying  process, and
 then rack off the vinegar, and  fine it upon
 beech-chips."  It  should be afterward put
 into bottles, which are to be well corked.
   The action of vinegar upon the  system
 requires to be considered both in a medicinal
 and in a dietetic point of view.
   The strong acetic acid is a powerful irri-
 tant, causing redness, and if long applied,
 blistering of the skin.  It is also used as an
 external application to warts, corns, &c,
 which it often quickly removes, acting as a
 solvent  to their albuminous and gelatinous
 constituents. [It is also an excellent article
 as an escharotic dressing to certain stages of
 open cancer, cloths wet with it being applied
 to the sores.]  When the strong  acetic acid is
 employed as a solvent for aromatic essential
 oils, it constitutes the aromatic vinegar, or,
 as  it was  formerly called, " thieves' vine-
 gar."   This preparation derived its name
 and its  reputation as an antidote  to conta-
 gious emanations, from  its first having been
 used in the  time of the plague,  by those who
 wished to plunder  the houses or persons of
 the dead or dying without risk.  If they
 escaped, it was probably from the confidence
 inspired by the possession of such a supposed
 protection—for  vinegar,  of any kind,  can
 afford no real protection against contagion;
 that is,  it can exert no chemically destruc-
 tive effect over the contagious emanations in
5 
V I 0                560                 V I S
 tho  fr-xy that  chlorine does.   Nevertheless,
 vin^ar, plain or aromatic, either sprinkled
 abouv,  or burned in  a sick  room, is  often
 agreeable and refreshing; only, its use should
 not be permitted to supersede more essential
 purificavions.   Vinegar, diluted with water,
 in the proportion of one or two tablespoon-
 fuls to the half pint, is used for sponging the
 Bkin in febrile diseases.  It  is also  a good
 addition to  gargles in sore-throat.  Before
 the more powerful astringent gargles are
 used, one sixth-part of vinegar may be added
 with advantage  to the warm  gruel or water
 gargle.  It assists the separation of the
 tough mucus, which is apt to cling about the
 throat in such caseo.
  As an internal remely, vinegar is but little
 used; it is, however, employed as a solvent of
 a few medicinal  substances.—See Squill.  As
 a dietetic condiment,  vinegar is unquestion-
 ably  useful  and wholesomo; more so, how-
 ever, to some persons than to oiLers.  It  is
 generally considered, in common with other
 vegetable acids,  to  promote the digestion of
 oily food, and probably there iti something
 instinctive in its frequent addition to such
 aliment.  But if, in moderate proportions,
 vinegar assists digestion, taken immoderately
 it is very injurious, destroying the digestive
 powers, and even inducing actual disease of
 the stomach. It is  from this  injurious effect
 upon the digestion, that vinegar has acquired
 the  reputation  for  reducing corpulency,
 which occasionally  tempts foolish  people to
 have  recourse to it for this  purpose.   The
 practice cannot  be too strongly condemned.
  VIOLET.—The  flowers of the common
 sweet violet are employed to impart  their
 colour and fragrance  to a syrup, which is
 often given to children for colds and coughs.
 It is said to be slightly laxative.  The root
 of the sweet violet possesses gentle emetic
 powers,  similar to those of ipecacuanha.
 The two roots have some resemblance in form.
  VIPER.—See  Wounds, Poisoned.
  VISION—Is the  power of taking cogni-
 sance of the size,  colour, position, &c. of
 objects, external to the body, by  means of
 rays of  light, which  are received upon  a
 nervous expansion,  capable of conveying the
 impressions  received  by it to  the sentient
 being.  In the lowest tribes of animals, the i
organs of vision, or eyes, are of compara-
 tively simple construction, but the same or-
gans in man are most exquisitely elaborate.
 Under article "Eye," this structure  has al-
ready been entered  into as far as space per-
 mitted.   Fig. cxi. represents  a diagram* of
  *Thi/>, it must be remembered, is only a diagram,
not a picture.
FlR cxi.
the section of the human eye, representing
the parts essential to vision—first,  a  dark
chamber, (1,) lined by the nervous  retina,
and  glazed  anteriorly by the glass or cor-
nea, (2.)  The  rays  passing through the
cornea, and striking  upon the nervous re-
tina, would probably  be sufficient to convey
to the  mind  an  impression of  light and
shade, and, perhaps, a general, though con-
fused idea of external objects ; but to confer
the perfect,  accurate  vision we enjoy, other
arrangements were necessary; consequently,
we  find the lens (3) suspended, as it were,
in front of an exquisitely transparent jelly,
which  fills the cavity (1) and the space be-
tween  the lens, and  the cornea filled with
transparent fluid.  The  result is, that the
rays proceeding from external  objects,  in
their passage through these various trans-
parent substances, become so collected and
arranged (fig. cxii.) that by the time  they
                  Fig. cxii.
reach the back of the eye, or the sensitive
nervous retina, they form in it exact minia-
ture pictures of external objects— the picture,
however, being placed up-ide down.  This,
perhaps, will be better understood, by trac-
ing the  direction of the  rays  proceeding
from the objects (fig. cxii. 5) to the reversed
image of it  formed at the back of the eye,
(fig. cxii. 1.)  In addition to these arrange-
ments for collecting and arranging the rays,
there  is  superadded the  iris  (fig. cxi. 4)—
(see Eye)—in the centre of  which is  tho
aperture of the  pupil, through  which  all
the rays pass ; and as the iris  has the power
of diminishing or enlarging  this aperture,
it acts as a regulator of the amount of light 
VIS                561                VIS
 idmitted into the interior of the eye.  How
 it is, that, although images are formed in
 the  retina in  a reversed position, we see
 them correctly,  is not at present satisfac-
 torily explained.
   Every one who has used a lens or magni-
 fying glass, is aware that in oder to see an
 object distinctly through it, it must be kept
 at a certain definite "focal" distance from
 the object.  The same law applies to the eye;
 its lenses are so regulated, that the focal
 distance of most healthy, well-formed eyes
 is the  convenient distance  of  about  ten
 inches; in  other words,  in  order that an
 object, such as print, may be distinctly seen,
 that its  image  may form a distinct picture
 in the retina of the eye, it  requires to be
 placed  at  the  above distance.  Now,  the
 proper collecting and arranging of the rays
 of  light  which  go  to  form  the  image of
 external objects in the retina in the interior
 of the eye, although they depend  partly
 upon the substance of the transparent bodies
 or lenses  the  rays  pass through,  depend
 also greatly upon the curves of the  lenses;
 that is, if sight is to be perfect at a distance
 of ten inches, the curve of the cornea espe-
 cially (fig. cxi.  2—cxii.  4) must bear a defi-
 nite relation to  the  rest of  the  eye.  It,
 however,  occurs, that  in many eyes, the
 cornea, instead of the usual curve, projects
 too much, is too convex; the consequence is,
 that the rays which pass through it from ex-
 ternal objects  placed at  the  ordinary dis-
 tance from the eye, are too rapidly collected
 or brought together,  so that,  instead of
 forming the distinct or focal  image exactly
 in the retina, they form it a  little in front,
 as at fig.  cxii.  2, and therefore confusedly
 To remedy this, a person in whom the cornea
 is too  convex,  instinctively brings  objects
 closer—sometimes very close—to  the eye,
 as, by doing so,  according to the laws of
 light, he causes the distinct  image  formed
 in the eye to be thrown farther back, that
 is, to be  formed  in  the retina, instead of
 before it.   The condition  is in fact that of
 "short sight."   As, however, it is neither
 convenient, nor always possible, to approach
 objects close to the eye, it is usual to remedy
 the defect bj the use of glasses, which, be-
 ing made  concave,  the  reverse of the too
 convex cornea, counteract the effect of the
 latter,  by somewhat scattering  the rays of
 light before they reach the eye.   In old age,
 generally, the condition of the eye is ex-
 actly the reverse of  the  above,  the  cornea
 becomes flattened, so that instead of collect-
ing the rays too quickly, it does not collect
them quickly enough; consequently, thedis-
 act  image they form,  or ought  to  form,^
 will fall rather behind the retina, as at fig.
 cxii. 3, and  the  image in  the retina will be
 indistinct.   To remedy this defect, convex
 glasses or lenses are used,  in the form of
 spectacles, &c, as they assist the cornea to
 collect the  rays more quickly  than in its
 flattened condition it is capable of  doing.
 Such  are the nature, causes, and rational
 modes of correcting  some of the most com
 mon derangements to which  vision is liable
   Vision may be interfered  with by causes
 which obstruct the  access of light  to  the
 nervous expansion <y retina, or  by those
 connected with the retina itself, or with its
 nervous communications in the brain.—See
 Amaurosis—Brain.   In  the former case,
 " specks," or opacities on the cornea, opaci-
 ties of the   lens, constituting "cataract,"
 (see   Cataract,)  inflammation,   acute   or
 chronic, may be the  obstructing causes.
 But,  whatever the case, or whatever  the
 probable cause, when so delicate and valu-
 able an organ as the eye  is concerned, no
 time  should  be lost in submitting it to pro-
 per medical examination.  For further  in-
 formation see Amaurosis—Cataract—Eye.
  VIS MEDICATRIX NATURAE, Tendency
 to Health, Natural  Powers of Recovery,
 or of  Healing, are all phrases expressive
 of the same thing: of that power or tend-
 ency implanted in a living, organized body
 by its  Creator, to restore to a state of order
 whatever portion of its  living organization
 may,  by circumstances,  have been thrown
 into disorder.  By disorder,  is here meant
 either what medical men call " organic dis-
 ease," that is change of structure palpable
 or appreciable; or what  they call "func-
 tional disease," or "functional disorder,"
 in which  the functions  of a part only are
 affected, or in which, if structure is altered,
 our means of investigation  are not sufficient
 to enable us  to detect  the change,  and  we
 can only judge of the disease by its func-
 tional  symptoms.
  The existence of a power tending to health
 (of a vis  medicatrix  naturae) has been re-
 cognised from the earliest times;  but medi-
 cal  men have never explained in what that
 power consists;  it is, probably, connected
 with that principle of life which all created
 things derive from  Him who made  them.
 Without it the efforts of the physician  'or
 surgeon would be futile.  The ends of  the
fractured bone might be placed in  apposi-
 tion, or the  edges of  the wound drawn to-
gether, but in the absence of the vis medi-
catrix, they would remain  so only  so long
as retained in place  by art,  however long
the artificial  restraints  might  be applied.
 True it is that the natural  tendency to cure 
V IS
'o&2
V  I S
may be  much weakened—may be almost |
apparently absent—may be vanquished by
the power of  disease, and at last  is  van-
quished  by the power of death; but  why
and how this is, we know not, cannot know,
till we explain what that is  which we call ,
" vis medicatrix,"—nay. further, till we ex-
plain  the  why and wherefore of disease,
why each and  all  possess certain tendencies
to disease, which may, sooner or later, ac- I
cording as they are favoured or not by cir-
cumstances, show  themselves,  and  over-
come the natural tendencies  to health and
order in our material systems.  These things
are connected  with the  deeper arcana of
our being.  In this  place the question re-
quires  more practical consideration.   Not-
withstanding  the  recognition of the   "vis
medicatrix" from the earliest times, it has
too often been  lost sight of in the treatment
of disease  and injury, especially in former
years;  physicians and  surgeons acted  as if
they were  the real powers  for  restoring
health, instead of only being the assistants
of those powers, and in this way arose an ar-
tificial, officious system  of medicine, and a
meddlesome surgery, from which the worst
results ensued.  The natural powers, instead
of being assisted, were thwarted, and embar-
rassed  or weakened; if  they  did ultimately
succeed in throwing off the disease, or in re-
pairing the injury, it only served  to prove
what the natural powers could do even under
bucIi circumstances.  In times gone by, a gun-
shot wound was treated with  scalding oils,
scarified, &c.  &c.;  it is now more simply
and successfully conducted to cure by the
use of water alone.—See Dressing.  To sim-
ple wounds, balsams and spirits of various
kinds were applied, which now under the
plain water dressing quickly and painlessly
get well.  But even now, so  strongly is the
idea of the healing power of plasters enter-
tained  by the  popular  mind, that  the  cure
of a wound is  attributed  directly to  these
applications, which only fulfil the  mecha-
nical end of holding its edges together, that
is, of putting  the  injured parts in such a
position that the natural powers of healing
can be exerted.
   Formerly, small-pox, fever, and such dis-
eases,  were treated by stimulant* within,
and by the stimulant action of heat without,
in the  form of hot rooms, closed curtains,
and  loa<ls  of  bed-clothes; ami, as the re-
verse of this, it is not long since the natural
powers, that would cure if  the}' were per-
mitted, were  weakened  by  indiscriminate
bleeding.    Even  now,  numbers  in  this
country do not think it possible to get rid I
of any disease without drugs.
  By these observations, it is  not  meant tc
weaken the confidence of any in the cura-
tive or salutary powers of medicines, which
are true and real blessings:  but  it  is in-
tended to point out how,  by losing sight too
much of the natural implanted power  of
resisting and throwing off disease possessed
by the  living  body,  injurious systems  of
officious  meddling  prevailed.   Indeed,  it
may be, that at present the current  has set
too  strongly the  other way, and mnny are
too much inclined to  be altogether skeptical
as  to  the  sanative  powers of  medicine.
This, it need scarcely be said, is an extreme
equally vicious with the other which trusted
all to it alone.   We know that the vis medi-
catrix naturae, the natural tendency to health,
is strong, and  will often prevail even in the
most  adverse  circumstances; but we also
know that  it is often weak, that it fails  to
overcome, or that while it is fighting the
battle, its  resources, its " commissariat,"
so to speak, fails.  In such coses  we know
that assistance must be given from without
by those means, or agents, which He who
gave the one  power  within the body, has
endowed with powers capable of  assisting
that power, of  aiding it in the combat.
  Nothing, perhaps,   makes the above re-
marks more obvious than the circumstances
which occur in continued fever.   This dis-
ease is generally  admitted to  be  a  con-
tinued  state of  disordered  action  in the
system, in which  (although at times the
powers seem to be completely overwhelmed)
the  tendency is in a  large number of cases
to run  a certain course, ending in recovery,
or in the victory of  the tendency to health
over the acting causes of disorder.  None,
perhaps, are bold enough to profess to cure
a fever—to profess to remove the disease by
active treatment, either directly medicinal,
or otherwise; and the  man who  attempts
it will  probably  do   so  at  the peril of hia
patient.  The wise physician  is content  to
leave to the  vis  medicatrix  the removal
of a disturbance  for" which  he can  offer
neither rational explanation nor method of
direct cure.  But  if in eschewing all active
interference, he defers to the power  within,
in rendering his  assistance to that  power,
he fulfils  a most important—a  necessary
office, and often assists to save a life, which
the  unassisted powers of  the  body must
have lost.
  The  office of the physician in such a ca^e
is to preserve those   outward conditions of
health which it is every man's duty to pro-
vide for himself when  he  has  health and
strength to do so, albeit these conditions now
require nice management.  The blood of the 
V I s
563
V 0 M
 fever patient is disordered, (poisoned.)  The
 office  of the physician must be, by seeing
 that his patient draws pure air into his lungs,
 to facilitate the purification of the vital fluid.
 The exhalations of the body by the skin, &c.
 are depraved;  he must see that by the re-
 moval of these,  and of all things which can
 absc* b and retain them,  the diseased action
 is not assisted;  the excretions  into the
 bowels are depraved, offensive, morbid ; the
 due evacuation of these must be attended to;
 the natural appetite and power of digestion
 is all but annihilated,  but a process is going
 on within,  which is  consuming, burning up
 the  frame-work, and may  come  to  bear
 upon the vital tissues.  To prevent this, the
 medical  man  must support  strength by
 gelatinous soups, &c, which pass  easily, and
 with little digestive  effort, into the circula-
 tion ; and,  if the  disease  goes on, if the "vis
 medicatrix" is still combating, and requires
 but a little time longer, if then all the avail-
 able supplies for carrying on the ordinary
 processes  of  vital  warmth, &c.  are ex-
 hausted, he must,  with  wine or  brandy,
 (alcoholic fuel,) keep, almost artificially, the
 machinery  at work.   In such  offices as the
 above, and many  more,  surely there  is
 abundant room for the skill, the  judgment,
 the interference,  of  a medical man, without
 his attempting  to take into his own  hands
 the  office of that power  which  he cannot
 supersede, but which he may greatly thwart.
 In such a  disease as  fever, it is true, me-
 dicine, although often, or  rather always,
 requisite, is not  so to   the  same extent
 that it is in other  diseases.   But even in
 others, in which, such as neuralgia, we can
 often directly trace  the removal  of the dis-
 order to the administration of the  remedy,
 we can only look upon  the  power of the
 latter  as the assistant to the natural  tend-
 ency  to  cure.    There are, it is  certain,
 some diseases,  such as  cancer,  which re-
 sist  not only all efforts  for  their  removal
 from within, but all the assistance we can
 give by remedy.  Why it is  so  we cannot
 tell.   That  they  are thus  "incurable." is,
 probably, because we are ignorant of the
 remedy which might give the assistance to
 the natural  tendency to health, which would
 enable it to overcome the disease, just as
 there are certain obstinate ulcers, or affec-
 tions of the skin, which resist many modes
 of treatment, and at last  yield  under the
 influence of a particular  remedy—-but yet
 to the remedy can  only be  ascribed the
 power of assisting.
  The present subject has been dwelt upon,
because, as  already observed,  from the ex-
treme which at one time existed, of trusting
 all, or to say the least, too much to medi
 cines, drugs, &c, there certainly has been
 a tendency in  many to discard these alto-
 gether, and to  trust entirely to the powers,
 the "vis medicatrix naturae."  As  in most
 other things, in the medium will be found
 the  best  course;  and he, probably, will
 treat disease most successfully, who endea-
 vours, as in the free ventilation, &c. around
 the fever patient, to put the natural powers
 of  resisting and casting  off disease in as
 favourable  a position  as  possible,—who
 trusts those powers, but  yet watches their
 operations,  and who is prepared, with full
 confidence  in the efficacy of medicines, to
 use them  decidedly and  actively, when ra-
 tional ground for doing so appears.
  There has been, undoubtedly,  far too much
 trusting  to drugs alone,  and far too great
 neglect of the  general principles of health,
 in the treatment of disease, but it is folly
 on  that account to attempt to cast aside
 medicines altogether.  If the Author of all
 things implanted in the living animal  body
 a "vis medicatrix," he also endowed other
 substances with the capability  of assisting
 that power.  We  can  see how the neglect
 of the first was  an error ; surely to ignore
 the last must be so too.
  VITRIOL. — See Sulphuric   Acid  and
 Sulphates.
  VOICE, or Vocal Sound —  Produced in
 the larynx, (see Lungs,)  is the endowment
 of animals generally, and differs  from speech,
 possessed by man alone ;  the latter, physic-
 ally speaking, depending upon  the forma-
 tion and action of the parts about the mouth.
 Crying, singing,  and the sound of  speech,
 all  depend upon the action of the  larynx,
 which partakes of the  characters of both a
 wind  and  of  a stringed instrument.  In
 some  diseases, the alteration in the voice is
 very  characteristic.  In  Asiatic cholera, it
 acquires  a  very  peculiar pitch:  in con-
 sumption, it is often of a  remarkable hollow
 character.  In some forms of disease it may
 be almost lost.—See Aphonia.
  liefer to  Cry  of Children—Reading Aloud,
 Sec.
  VOMITING—Is the action of discharging
 the  contents Of  the stomach  through the
 gullet and  mouth by muscular effort,  or
 rather by a  combination of muscular efforts.
 Formerly, it was imagined that vomiting
 depended upon " convulsive" action of the
 stomach alone.    After that it was  thought
 that the stomach was passive in the  act, and
 that  the pressure  of  the muscles   of the
belly,  thrown into violent action, was the
 sole cause.   It is now well ascertained that
both these agencies are called into play when 
VOM
564
V O M
vomiting occurs.  That the  stomach does,
by the action of its  muscular fibres, assist
in the expulsion of its contents, but that its
efforts are greatly aided by the  muscles of
the abdomen, including the diaphragm.—See
Diaphragm.  Every  one  is  conscious  that
previous to the act of vomiting,  a deep  in-
spiration is taken.  By this  the  diaphragm
is forced downward toward the cavity of
the abdomen,  and being there fixed,  or ren-
dered tense, by the  contraction of its own
fibres, it offers a fixed  point of resistance,
against which the  stomach can  be pressed
by  the  contraction of the muscles  in  the
forepart of the  abdomen.  At the moment
that this almost convulsive pressure is  ex-
erted on the stomach, and by the stomach
on its contents, the muscular fibres  at  the
" cardiac" junction of the stomach with the
gullet (see Stomach) are relaxed, so as to
permit  of   the passage  upward  of  the
matters contained in its cavity, while, at the
same time, the  glottis is  closed, so  as to
protect the  larynx and air-passages, as in
swallowing.
  Vomiting is frequently preceded by nau-
Bea,  (see Nausea,) but not  always.  Pro-
bably it is not so in the vomiting of infants
which overfill their stomachs, for nausea is
a sensation which  causes uneasiness and
distress, and yet the little creatures gene-
rally look  remarkably  happy while they
relieve  their  stomach of   the  overload.
Again, some persons, especially dyspeptics,
possess  the power of vomiting at will, and
can, without  any  feeling of nausea,  dis-
charge the contents of the stomach ; neither
is there  much, if any feeling of nausea con-
nected with the vomiting which  sometimes
follows coughing, sobbing, &c.
  The causes of vomiting  are very nume-
rous. It may depend on local irritation of
the stomach by bile, mucus, &c,  or by indi-
gestible food,  by medicine, or by poison ; it
may be  excited  by the  mechanical effects,
and probably through the intimate nervous
communication in  cough,  hiccup, sobbing,
laughing, &c.  lt is often sympathetic with
and  symptomatic of disease  or accident  in
distant parts, or of excited action in distant
organs, as in the case of the womb in preg-
nancy, or  in  sea-sickness.    Irritating  or
tickling the throat likewise causes vomiting.
In some persons, disagreeable or peculiar
tastes, smells, and even  sights and sounds, I
will  give rise  to vomiting:  mental emotion
will produce it, and certain  drugs, such  as
tartar emetic, give rise to it if injected into
the blood.   At the onset of  acute disease,
vomiting is a common symptom.  When a |
person becomes affected with vomiting, it is
! of course well to keep these various  canse«
 in mind; for though, in the  majority of in-
 stances perhaps, vomiting depends upon dis-
 order in the stomach itself, it must evidently
 be of much  consequence to  recognise it  as
 symptomatic of disease, which is often of a
 serious character.
   When vomiting  has  been  preceded  by
 symptoms of indigestion, or when it  is of a
 bilious character, accompanied with  furred
 tongue,  &c,  the probability is that  it de-
 pends upon   the presence of bile or other
 matters.   In such cases, if the natural pro-
 cess  of  relief appears  inclined to  be suffi-
 ciently energetic, it will be enough to assist
 by drinks of tepid-water or  gruel, or of
 chamomile-tea; if the  action is  not suffi-
 cient, an emetic (see Emetics) may be given
 to fulfil  the natural  indications.   These
 attacks  of spontaneous vomiting  from  dis-
 order of the digestive organs are frequently
 accompanied with diarrhoea, but when  this
 does  not occur, it is generally advisable to
 give  aperient medicine in  some form, and
 as the  stomach often  remains unsettled,
 nothing seems sooner to restore it than a
 few effervescing draughts, either simple or
 containing a tonic bitter.—See Indigestion.
   Vomiting,   however,  may  continue from
 simple  irritability  of system  or  stomach,
 after the irritation in the latter organ has
 been  removed; when  it  does, means  for
 allaying that irritability must be  resorted
 to, similar to those  employed when the  vo-
 miting is the result of sympathy, as it is in
 pregnancy, &c. &c.   In  any case, obstinate
 vomiting is  so distressing a symptom, and
 one so injurious to some patients, that it is
 desirable at all times to put a stop to it.  For
 this purpose the remedies recommended are
 very numerous.
   If  there is offending matter on the  sto-
 mach, which  is the  cause of the vomiting,
 it is of course useless to attempt to stop the
 latter till the former has been removed, as
 adverted to above.
   As general remedies in vomiting, efferves-
 cing  draughts  are  the most safely  usable
 by an unprofessional person; also alkalies,
 or magnesia, if there is acidity;  and with
 these it is advisable at times to combine a
 stimulant,  sal-volatile,  or if calcined mag-
 nesia  is  used,  a  little sherry.  Creasote
 might be employed in an emergency without
 medical  sanction, but certainly not prussic
 acid,  which is often so efficacious in  proper
 hands.   Besides internal  remedies,  assist-
 ance  may be derived from external applica-
 tions, such as three or  four leeches  to  the
 pit of the stomach if there is much  tender-
 ness,  or a mustard-plaster, or blister; po'si 
W AI
565
WAL
tion, too, whether recumbent or not, may
make  considerable difference.   It  may be
well not entirely to  neglect  the  indication
of appetite, or of any unusual craving for
food of a particular kind; its  gratification
may stop  the  symptom.  When  vomiting
comes  on without obvious cause, and when
it continues to recur, a medical man should
be seen at  once, for it may be symptomatic
of serious  disease.   If without obvious rea-
son, it happens  shortly after  a meal,  and
especially  if more than one person is af-
fected, the possibility of  poison is not to be
forgotten.
  Refer to Creasote—Emetics—Nausea—Poi-
son—Sea- Sickness.

  WAISTCOATS,  UNDER.—See Clothing
—Flannel—Wash-Leather, &c.
  WAKEFULNESS.—See Age, Old—Sleep,
&c.  [The fluid extract of valerian, in doses
of forty  drops  to half a teaspoonful every
two hours, will often  afford relief.]
  WALKING — Is the natural exercise of
man, and for  the  strong and healthy it is
the best.   Even in the case of the debili-
tated and of the aged, it  should not be neg-
lected : no other mode of exertion diffuses
the  blood  and  accelerates its  circulation
bo  t-horoughly throughout  the body.  The
principal caution required for such persons
is not to continue their exercise till exhaus-
tion occurs.  Children are not unfrequently
injured  and weakened  in constitution  by
their daily exercise being a walk, too often
carried to  fatigue,  especially  in  summer.
When  attainable,  a  play-ground  in  which
rest and exercise can be taken alternately,
and at will, is much preferable to the former.
Any unusual peculiarity in walking, espe-
cially in children or  young  people, should
not be  permitted to pass  unnoticed; it may
be the first indication of spine or hip-disease.
  Refer to Exercise.
  WALLS  and WALL-PAPERS.—The prin-
cipal object, on the  score  of health, to be
regarded in the  external walls of dwellings
is that they shall be sufficiently  thick for
warmth, and not of  such  porous material
as will too  readily absorb or give out moist-
ure.  Some kinds of stone  and badly-made
bricks  do  this, and  render dwellings  un-
wholesome. The defect of outer walls, either
as regards material or  thickness.^ may be
considerably ameliorated  by lathing  and
plastering  within.   In covering  the inner
walls of  houses  either with paint or paper,
too  little regard, perhaps, has hitherto been
paid to  the effect of the  materials  which
are  used on health.   In another part of this
work, it was stated that  colours containing
         2X
lead and arsenic have been found to affecf
injuriously the occupants of rooms to the
walls of which they have been used.  More-
over, as light exerts so strong an influence
upon health, it  is not unlikely that  wall-
colours, [and papers,] especially in the vari-
ation from light to dark, may be found to do
the same.  [Chamber papers should also al-
ways have small and  irregular figures, to
prevent the eye, especially of an invalid,
from being fatigued or strained by constant-
ly looking  at it, as is often the case during
sickness, especially in brain affections.]
  Wall-papers are of course  liable to the
same objections as wall colours, and also to
another connected with the size, by means
of which they are attached.   This will be
best illustrated  by the  following  " Hints
on  Paper-hanging," from a late  number of
Household Words:—
  " Many a fever has been caused by the
horrible  nuisance of  corrupt  size used in
paper-hanging  in  bedrooms.  The nausea
which the sleeper is aware  of  on waking in
the morning, in such  a  case, should be a
warning needing no repetition.  Down should
come the whole paper,  at any cost or incon-
venience, for it is an evil which allows of
no tampering.  The careless  decorator will
say that  time will  set all  right—that the
smell will go off—that  airing the room well
in the day, and burning some pungent thing
or other at night, in the mean time, will do
very well.   It will not  do very well; for
health, and even life, may be lost in the in-
terval.   It is not worth while to have one's
stomach  impaired for  life,  or one's nerves
shattered,  for the  sake  of  the  cost  and
trouble  of  papering  a  room, or a whole
house, if necessary.   The smell is not the
grievance, but the token of the grievance.
The grievance is animal  putridity,  with
which we are shut up when  this smell  is
perceptible in our chambers.   Down should
come the paper,  and the wall behind should
be scraped clear of every particle of its last
covering.   It is  astonishing that so lazy a
practice  as that of putting  a new paper
over an old  one  should exist to the extent
it does.   Now and then an incident occurs
which  shows the  effect of  such absurd
carelessness.  Not  long ago, a handsome
house in  London became  intolerable to a
succession  of residents, who  could not en-
dure a  mysterious bad  smell which  per-
vaded it when shut up from  the outer air.
Consultations  were  held  about drains, and
all  the particulars that could be thought o',
and all in vain.   At last  a  clever young
man, who examined the  house from top to
bottom, fixed bis  suspicions  on  a certain 
W A L                066                W  A L
room, where he inserted a small slip of glass
in the wall.  It was presently covered, and
that repeatedly, with a sort of putrid dew. j
The paper was torn down, and behind it was
found a mass of old  papers, an inch thick,
stuck together with their layers of size, and
exhibiting  a spectacle  which we will not
sicken our readers by describing."
  WALNUTS—Are about as wholesome and
unwholesome as nuts generally.   The infu-
Bion of walnut-tree leaves has been highly
extolled as a remedy in scrofula.
  WARM BATH.—See Bath.
  WARM FLUIDS.—See Dihtnts—Heat,
&c.
  WARTS—Are enlargements of the papillae
of the true skin, and thickening of the cover-
ing epidermis or scarf-skin.   They are most
usual in children, up to a little beyond pu-
berty, and  generally occur  on the hands,
sometimes on the face.   In the latter situa-
tion they are  better not interfered  with.
When situated on the hands, they often dis-
appear of themselves.   When  their removal
is desired, strong acetic acid,  applied every
two or three days, is certainly the best re-
medy ; caustic, however, or tying, or cutting
them  off, are   measures also resorted  to.
When a wart  on the  face,  especially  in
those  advanced in life, appears inclined to
become ulcerated, or irritated, it ought to  be
shown to a medical man.   It may require
removal, from  degenerating into cancer.
  Refer to Skin.
  WASHING.—See Ablution.
  WASH-LEATHER, or Chamois  Leather
—Is often  serviceable  when worn  next the
skin, as  an  under waistcoat, by those subject
to rheumatism.
  Refer to  Rheumatism.
  WASP.—See Stings.
  WASTING.—See Atrophy—Tabes.
  WATER.—This  apparently simple fluid,
considered  by the ancients as one of the
elementary or simple bodies, is composed  of
the two  gases, oxygen and hydrogen, in a
state of chemical combination, in the pro-
portion  of eight parts  of the former to one
of the latter, by weight.  Chemists demon-
strate the gaseous  composition of water in
two ways:  they either decompose  the fluid
by means of electricity, and collect the two
eases separately, or they form it by causing
the two  gases to unite in proper proportion.
Indeed,  the formation of water by the union
of the gases, may be witnessed by any one
in the moisture evolved inside a  gas lamp,
in consequence of  the union of the burning
hydrogen with the  oxygen  of the atmo-
sphere.
  Water, when perfectly pure, is trauspa- [
1 rent and colourless, without taste or smell.
 It freezes at 32°, and  boils at 212° Fahr. It
 is, however, impossible, perhaps, to procure
 perfectly pure water,  except by tho process
 of artificial distillation;  even rain-water,
 which is the purest natural water, although
 collected at a distance from human habita-
 tions, is found to contain traces of ammonia,
 and  sometimes of nitric ncid ; if collected
 near dwellings, it is of course liable to con-
 tract much greater impurity.   Nevertheless,
 rain-water, being the product of natural dis-
 tillation, that is, having passed into the at-
 mosphere in the form of vapour,  before its
 descent as rain or snow, is free from the
 saline and other impregnations which it ne-
 cessarily possesses as  soon ns it has come in
 contact with the earth.   It would require a
 volume, fully to illustrate the important ne-
 cessities and expediencies which  water ful-
 fils  to creation generally, and to  man  in
 particular.  Three-fourths of  the weight of
 his  body is composed of it, and a due supply
 of moisture is  absolutely requisite for the
 performance.of the functions  of  life, espe-
 cially those of  digestion and nutrition.  As
 the  body is continually suffering loss of its
 water by the  action  of the kidneys,   skin,
 lungs,  &c,  so  it is constantly in  need  of
 fresh supplies.   These are furnished mainly
 by drinks of various kinds, but also in con-
 siderable quantity  in  the  solid   aliment.
 V\ heat flour contains  about 14 percent, of
 water, fresh meat about 75, and cow's  milk
 about 87 per cent.,  and other things in like
 proportion.
   With  the exception  of air, no necessity of
 man's  living existence, perhaps, exercises
 more powerful  and direct influence for  good
 or evil, than  the  water he imbibes;  indi
 rectly, also, it affects his moral  condition,
 whether considered as a beverage or accord-
 ing  to its economic uses.  Notwithstanding,
 however, the acknowledged utility in every
 way of a free supply of pure water, it  must
 be considered not only an anomaly, but a
 disgrace to  the boasted civilization of the
 first half of the nineteenth century, that so
 little attention has been given  to  supplying
 the  people with this necessary of healthful
 existence, physical and moral.   In   their
 provision for water, the ancients  far,  very
 far surpassed the moderns, as  the  remains
 of their magnificent aqueducts testify, and
 bestowed great care  and  expense on the
 means of  procuring  it pure.  As stated
 above, rain or snow  furnishes water  freer
 from  impurities than that procured  from
 any other source;  the absence of all saline
 impregnations especially, renders such water
 peculiarly well adapted for cleansing pur- 
WAT                 567                WAT
 poses ; it dissolves  soap easily and readily,
 not curdling it  ns the hard waters do.   As
 rain-water is  seldom used for  drinking, on
 account of its vapid taste, its having run off
 lead-covered roofs  is comparatively of less
 consequence;  but as it may be  used  for
 cooking,  it should be borne in  mind that it
 may acquire poisonous  impregnations from
 the above source.
   Rain-water  which  has descended  upon,
 and  entered the  earth, becomes, as stated
 above, impregnated with impurities of vari-
 ous kinds;  these vary according to circum-
 stances ;  they are  classed as mineral  or
 saline, and as vegetable  or animal impuri-
 ties.  There may also be impurities which
 are wholly dissolved in the fluid, and others
 which are merely mechanically suspended;
 the latter are capable of being completely
 separated  by filtration—the  former  are
 not.
   The most important and generally abun-
 dant saline impurity in water is the bi-car-
 bonate of  lime,  from  which  hard water
 chiefly derives its character; besides this
 salt of lime, however, there  are also often
 present bi-carbonate of magnesia, and sul-
 phate of lime,  bi-carbonates  of soda and
 potash, common   salt and iron; the latter
 impurity,  however,   is not  very  common,
 except in mineral springs; when  it  does
 occur in  a water commonly used,  it gives
 an inky taste, and causes a yellowish tinge
 in clothing washed in it.
   The earthy salts,  that is,  those of lime
 and magnesia, are the chief sources of hard-
 ness in water;  excess of carbonic  acid and
 the  presence of  iron  are occasional causes
 not  often met  with.   Filtering such water
 does not  in any  way modify its hardness.
 When the hardness of water arises  from ex-
 cess of carbonic acid, exposure to the air re
 moves the inconvenience in a great measure,
 and also does so  slightly  in water rendered
 hard by the presence of the bi-carbonates
 of lime or magnesia  ; such waters, however,
 are softened in some degree by long boiling,
 which causes the separation of the salt  of
 lime or magnesia, in the form of an insolu-
 ble carbonate; this  is in  fact the chief con-
 stituent of the crust or "fur" which forms
 inside of  boilers, kettles, &c,  in  districts
 where the water  is hard.  It is said  that
 when it is desired to remove this fur, it may
 be done by boiling in the vessel a solution of
 muriate of ammonia.
  The separation of the  earthly salts may
 be effectually accomplished by  the process
patented by Dr. Clarke, of Aberdeen.
  This process is based  upon  the follow-
ing:—
   The bi-carbonate of lime,* that is, lime 11
combination with two parts of carbonic acid,
is soluble to a considerable extent in water,
and is thus dissolved in hard waters gene-
rally.  Again, lime or quick-lime, which has
been  entirely freed from carbonic acid, is
also soluble in water, (see Lime;)  but when
lime is in combination with one part only of
carbonic acid, it is perfectly insoluble, being
then  in a state of chalk.  It  will now be
evident, that if the clear solution  of quick-
lime,  that is, of lime without any carbonic
acid at all, is mixed in proper proportion
with water which dissolves lime,  combined
with two parts of carbonic acid, and that if
that which has no  carbonic  acid takes one
part from that which has, an insoluble car-
bonate will be formed, and fall to the bot-
tom, leaving the water free  or nearly so
from  lime, and  thus  the hardness will be
removed.   The annexed will probably make
the above somewhat more intelligible.
  Soluble   (Lime...........1
Bi-carbonate-< Carbonic
  of Lime.   I  Acid.........i-
  So'uble   ]
Quick-lime. (
Lime..........1
  Mixed in the water,
divide the Carbonic Acid,
and form two parts of
insoluble Carbonate of
Lime, which falls to the
bottom.
  Those who desire more information on the
above important process, will find it detailed
in the excellent  report of Dr. Clarke given
before the  Parliamentary  Commissioners.
The same gentleman speaks strongly of the
importance  of a due supply of soft-water,
especially to the  poorer classes;  and re-
marks, that  owing to the additional expense
in soap, and to the extra wear  and tear  of
clothing when the washing is done in  hard
water, habits of cleanliness are discouraged
both as regards clothes and person.  It may
be  remarked,  that hard  waters  are far
more frequent either from streams or sunk-
wells ; and that springs, especially from the
surface of hilly or undulating countries, are
often  extremely soft, such  springs being in
fact  supplied by  surface  water — that is
water which has only percolated through the
upper  strata,  and has not passed through
those which  furnish the deeper springs, with
their  saline, lime, and magnesia impregna-
tions.
  For  purposes of drinking and cooking,
and especially  the former,  the importance
to a population of a due  supply of good,
pure water,  cannot be over  estimated.  If
the water is impure, it  either injures the
health or drives people to take it in combi-
  * As the same demonstration belongs to magnesia,
which is moreover much less important, and less abun-
dant than lime, the latter only is mentioned on account
of brevity. 
W A T                568                W A T
nation, too often with Bpirits, or under other
forms, and thus engenders habits of drink-
ing.   It  is, indeed, not improbable,  that
many of  the artificial drinks have been re-
sorted to solely as substitutes for bad water.
In the choice or appreciation of a drinking-
water, people  will, perhaps,  be  greatly
guided in their judgment  as to pleasant-
ness by  the nature of that to which  they
have been accustomed.  As  a general rule,
however, most people prefer a water which
contains  a slight amount of mineral ingre-
dient.  At the same time,  those  who  have
habitually drunk  even very hard water, do
not at first relish  that of a softer character.
Water which has been drawn for some time,
becomes, as all know, unpleasant and vapid;
this is often accounted for  by the loss of
carbonic acid, or  air, which  most water
contains  naturally; but  Dr. Clarke denies
this cause,  and  attributes  the  change  to
increased temperature.   Another, and pro-
bably more powerful cause  of the acquired
unpleasantness than either  of the above, is
the facility with which water attracts at-
mospheric  impurities and exhalations, and
there are generally sufficient of these to be
met with.
  A small amount of mineral ingredient may
not be, and probably is not injurious; but
water containing any great  amount cannot
be  regularly  consumed  without  risk  to
health,  although  more to  some constitu-
tions  than to others.  It is tolerably certain
that the origin of "bronchocele"  is con-
nected with the presence of lime and  mag-
nesia salts in the waters  of the districts in
which the disease prevails.   Dr. Paris  says,
" We  have known patients, after drinking a
glass  of water, from a sense  of weight and
oppression at  the  stomach, at  once  pro-
nounce the existence of foreign  ingredi-
ents."  Dr. Prout remarks,  "With respect
to waters, it  may be observed,  that  hard
and impure waters possess  great, and gene-
rally very unfavourable influence in urinary
diseases."   Bad  as hard  waters may be,
those impregnated  with decaying vegetable
or animal  matter of any kind are beyond
comparison worse, and are  fertile sources
of disease.  Indeed, there is every evidence
to show  that  fever may be  directly origin-
ated in a locality, from the drinking-water
of the inhabitants  being contaminated with
decaying substances, and also that the pre-
disposition to  attacks of malignant cholera
is greatly increased thereby.   Dysentery is
another  disease which has often originated
from  drinking bad—especially marsh-water.
Such water often contains insects or animal-
culae.  From  these,  and from  mechanical
impurities, it may, however, be freed by fil-
tration.—See Filter,   lt  ought also to  be
remembered, that though the water may  be
good when drawn, if it be preserved in bad
receptacles,  such  as butts, the  wood  of
which  is decayed, or in cisterns lined with
lead, on which the water acts, (see Lead,)
or where it is exposed to contract impuri-
ties from the atmosphere,  a really whole-
some fluid may be  converted into an un-
wholesome or even poisonous one.
  lt is perhaps going too far  to  say  that
man should never drink  any thing but the
natural beverage provided for him; that it
is the   only  wholesome, regular  drink  of
healthy men, is certain; but to contend that
it never should be  varied, is  inconsistent
with the law which  seems  so general, that
change within certain limits is more benefi-
cial than unvarying uniformity.  Moreover,
if water be the most abundant natural beve-
rage,   milk and  vegetable juices furnish
others  in great abundance, and there can
be no question that tea and  coffee  are  pro-
vidential  provisions  for  man's health and
comfort.—Refer to Tea—Stimulants, <jv.   At
whatever other times water is drunk, and in
whatever proportion to other beverages, it
is never more beneficial to the majority  of
people  than on first rising in the morning;
then, a draught of pure fresh-drawn water
is a most admirable persistent tonic, which
may be continued a life through ; it has,
too, the advantage of stimulating the bowels,
and assists to keep  them open.  Some few
persons of weak  digestive and  nervous
power   cannot take a large draught, though
they may a small one.  Another most whole-
some  period for a good draught  of water,
with persons of  tolerably  good  nervous
power, is just before dinner.  Many, how-
ever,  commit the error  of drinking water
too largely with their meals.  This acts  in-
juriously by washing down the food insuffi-
ciently masticated, by giving a sort of arti-
ficial appetite, so that more than enough is
consumed, and injures  digestion by lower-
ing the temperature of the stomach.  Too
large  a draught  of cold  water when  the
body is heated—especially if exhausted—it
is well known, is apt to  prove serious, per-
haps fatal.—See Shock.  In disease, both as
an external application, (see Ablution—Af-
fusion, Sec,) and as an  external remedy,
water   is most valuable;   and, indeed, in
febrile diseases attended with  much thirst,
may be allowed  largely  with  the greatest
benefit. Moreover, pure cold water is gene-
rally  preferred, at least for a  time, to all
the artificial drinks.  There is among  the
poor, and even among others, an unaccount 
WAT
569
W E A
 able prejudice against  allowing the sick to
 drink cold  water.   There need be  no fear
 when  it is craved by feverish thirst; indeed
 few febrifuges excel it  as a remedy.
   In  conclusion, other  sanitary  arrange-
 ments and  regulations are  comparatively
 useless, without a good and easily  accessi-
 ble supply of pure water; without it, clean-
 liness in person, or  clothes, or house, is im-
 possible, sewerage arrangements  cannot be
 properly carried out; and, in short, welfare,
 both physical and moral, it might  be  said
 spiritual, depends upon it.
   Refer to  Diluents—Baths—Cold—Heal—
 also to sanitary articles generally.
   WATERS, MINERAL.—A mineral water
 is one which differs  from the fluid  as it  usu-
 ally flows from the earth, in possessing, na-
 turally, sensible taste or smell, or a higher
 temperature than ordinary.
   Mineral waters are usually divided  into
 Saline—Chalybeate— Sulphureous — Acidu-
 lous— and   Hot. . The  principal  mineral
 springs in  Britain  are adverted  to under
 separate articles in the  present work; those
 who desire more information will find  it in
 the  useful publications of  Mr. Lee on the
 Watering Places,  Baths,  &c,  of both  this
 country and the continent.   [Those in the
 United States are chiefly found in the States
 of New York, Virginia,  and Kentucky, and
 the American reader will do well to  consult
 the  work of Dr. Bell,  of Philadelphia, on
 Baths  and  Mineral Waters.]
  WATER-BEDS  and  CUSHIONS. — See
 Bed, Elastic.
  WATER-DRESSING.—See Dressing.
  WATERBRASH — Pyrosis — Is  a  dis-
 order characterized by copious vomiting of
 clear  fluid—either  sourish  or tasteless—
 from the stomach.  It is a frequent  accom-
 paniment of chronic indigestion, and those
 who live much on innutritive vegetable food
 are peculiarly liable to it.   Before the fluid
 is brought up, there  is often pain, more or
 less  severe, experienced at the pit  of the
 Btomach.  Improved  diet, and the treatment
 of indigestion generally, are the most  suit-
 able measures.  Under article "Saliva," an
 affection which is generally confounded with
 waterbrash is alluded to.
  Refer to Indigestion.
  WATER  IN  THE CHEST—[Hydrotho-
 rax]—Is the effusion or throwing out of the
 watery or serous portion  of the blood  into
 the cavity of the pleura between the lungs
 (see Lungs)  and ribs.   Such an occurrence
may  be the  effect of two  different causes;
the  most usual, especially when the water
forms  rapidly, being inflammation  of  the
pleural covering of  the lune;s, or  pleurisy.
         2x2
 —See Inflammation.  In this case the effu
 sion of fluid is usually confined to one side
 of the chest.
   Water in the chest, however, especially in
 the aged, may be caused by affection of the
 heart or lungs, and obstructed circulation,
 in which case it often occurs on both sides,
 and is accompanied  with  other  dropsical
 symptoms.—See  Dropsy.  The difficulty of
 breathing, caused by a collection of water
 in the chest, is often extremely distressing,
 and is liable to be aggravated or relieved by
 particular positions of the body.  When the
 effusion is large,  it very perceptibly bulges
 out the side on which it is situated.   When
 there is air  as well as fluid  in the  cavity,
 slight  shaking of  the  body  causes  a very
 audible splashing sound.  These symptoms,
 however, more generally follow after pleu-
 risy.
   It is not likely that an unprofessional per-
 son could detect the presence of water in
 the chest; suspicion of such being the case,
 should at once cause proper medical  assist-
 ance to be sought; in the mean time, the pal-
 liative remedies recommended in "Dropsy"
 may be resorted to, and if the  breathing is
 very distressing,  and the patient not very
 debilitated,  a large  blister may be  applied
 over the chest, as a me.ans of affording tem-
 porary relief.
   Refer to Dropsy—Lungs—Inflammation.
   WATER  IN   THE  HEAD. — [Hydro-
 cephalus.]—See  Brain.
   WATERSTROKE.—A rare form of "wa-
 ter in the  head," characterized by its very
 sudden  development.   It has invariably
 proved fatal.
   Refer to Brain.
   WAX—Is a secretion of the bee, formed
 from the  sugar which  it collects, or with
 which it may be fed, and is not, as usually
 has been imagined,  formed from the  pollen
 or flower-dust.  AVhen first formed it is said
 to be quite, white,  becoming yellow from
 contact with the honey. In this yellow con-
 dition it is, when  the combs  are melted  to-
 gether, the common beeswax of the  shops.
 It is,  however, purified and  bleached  for
 medicinal  purposes, and is  then generally
 met with in  the form of round white  cakes.
 Wax is now only used  in medicine  in the
 formation  of, and for giving  consistence  to,
plasters, ointments, &c.
  WEANING. —  The  weaning  of  infants
must depend upon  two considerations, the
 condition and health of the mother or nurse,
 and the age  of the child.  If  the mother be
 in such a condition  of health  that she can-
not nurse her infant, with benefit either to
herself or it, weaning of course must take 
W E A
570
W U I
 place at once ;  but in the generality of cases,
 the proper time is about the ninth or tenth
 month, when the first  four teeth have ap-
 peared.    Indeed, the  development of the
 teeth may be taken as  the signal that other
 food is  required;  if,  therefore, their ap-
 pearance is  delayed, suckling  may in most
 instances be prolonged, for the reason that
 the late appearance of the teeth is frequently
 associated with delicacy of constitution, and
 then it is desirable for the  child to be kept
 longer at the breast.
   Previous to weaning, the child should be
 gradually accustomed  to other food-   It is
 desirable for weaning to take place in fine
 weather, when the infant can be carried  a
 good deal out of doors.   Should disorder of
 the bowels  or other  symptoms of illness
 arise, it  must be  managed  as recommended
 under article  " Children," to  which  the
 reader is referred.
   Refer  also to Nurse.
   WEATHER.—See Climate—Seasons, &c.
   WEEPING EVE—Is the flow of tears over
 the cheek, in consequence of the  lachrymal
 sac  and  passage into  the nose  being ob-
 structed.   [It  often requires  an operation
 to cure it.]
   Refer to Eye.
   WEIGHTS and SCALES—Are most ne">
 cessary adjuncts to tne domestic laboratory,
 &c.  As all, probably, are aware, the weights
 used in the dispensing of medicines are spe-
 cial for the purpose, constituting apotheca-
 ries' weight.    In  apothecaries' weight the
 pound nnd ounce  are the same as in Troy
 weight;  that is to say,  the pound contains
 5700 grains,  or twelve ounces of 480 grains
 each. Instead,  however, of the ounce being
 divided into pennyweights,  it is divided into
 eight drachms  (or drams)  of  sixty  grains
 each, each dram containing three scruples
 of twenty grains each.   The following table
 illustrates  these  divisions, and also  the
 peculiar signs of the various divisions em-
 ployed by medical men:—
                    Symbol.         Grnirs ,
  One pound............  lb. ...12 ounces 57001
  One ounce............  Ji... 8 drams  4>-0
  One drachm or dram  ^i... 3 scruples 00
  One scruple  .........  Qi...20 grains   20
  One grain  ............  gr.  i.
  The weight itself  is simply signed  thus,
3 ;  the additional mark thus, gi, stands for
one, or thus  for £ij ; so with  grains,  it is
gr i, or gr. ij, or gr. iij, as the case may be.
When it is desired to express halt a weight,
it is written thus,  Jss, or ^ss.  The weights
themselves are  always made of brass, the
grains in thin plates  stamped with as many
dots  as  they  weigh  grains, the heavier
 weights with the character of each: weightB,
 however, are made, the grains with the num-
 bers in figures, and the others with  both
 figures and the name legibly  stamped upon
 them.   L'nprofessional  persons  who  may
 lot-get, or who may become  confused  with
 the characters, will  find it  more  advan-
 tageous to provide themselves with weights
 of the latter kind.
   The scales employed for dispensing medi-
 cine  are generally of  brass, and should be
 of a convenient small size, care being taken
 to ascertain that  they weigh true.  After
 these  scales  have been  used,  they should
 always be well wiped—otherwise they are
 apt to become corroded.  On account of this
 tendency, the scale  "pans" are sometimes
 made of glass, and also of the metal plati-
 num ; but the former are of course liable
 to get broken, nnd  the latter are very ex-
 pensive.  Neither are requisite; the brass
 are perfectly  sufficient, with the most ordi-
 nary care.
   WEN.—The popular name for a tumour,
 especially when situated  about the  throat.
 —See Tumour.
   WHEAT.—See Bread—Grains, &c.
   WHEY.—See Milk.
   W HITE-LEG—[Milk-Leo.]—See Leo
   WHITE-SWELLING.—See  Knee.
   WHITES—Called  by medical men Leu-
 corrhea.—This extremely common and trou-
 blesome female discharge  may  occur  in  a
 variety of constitutional conditions and  cir-
 cumstances, but more  generally it is asso-
 ciated  with  general debility, and  almost
 certainly so, if it has continued profuse for
 any length of  time.  For  the  latter reason,
 it ought not, as too  often is the case, to be
 neglected, for not only may the constitution,
 the general  health and strength, be fatally
 injured by it,  but  a comparatively mild and
 easily removable  affection may be  con-
 verted into one of  an inveterate  and serious
 character.
   The importance  of these remarks may be
 imagined, when it is stated that  Dr. Ash-
 well, one of the highest authorities on these
 subjects, says, " Of all the diseases peculiar
 to the sex, there is none so common.   Few
 married  women,   particularly if they  are
 mothers, escape its attacks."  By the same
 authority, the varieties of the affection  are
 divided into the mild, acute  form, accom-
 panied with more  or less  inflammatory ac-
 tion :  the chronic and inveterate or habitu-
ally e- tabli.-iied leucorrhea;  and  the  va-
riety symptomatic  of other diseases, as of
the womb, &c.
  An acute or inflammatory form of "whites"
may arise in those who are in tolerable health 
W HI
571
W H I
the symptoms being so mild that they are
either unattended to, or are quickly removed
by rest in every sense of the word, local and
general, by cleanliness, and  by such  anti-
phlogistic means as reduced diet and gentle
aperients, especially mild salines, with per-
haps one or  two doses of gray powder, at
bedtime.
  In those of plethoric habit, especially in
„he middle periods of life, the inflammatory
symptoms may be of greater severity, re-
quiring the  above treatment  to  be more
vigorously carried out, and combined  with
fomentations, hip-baths, and leeches; at the
same time, in such cases, whether mild or
severe, it will be advisable both to cleanse
and soothe the internal parts, by the use of
tepid water and  a syringe.  When  all in-
flammatory  symptoms  have  disappeared,
some astringent wash may  be substituted
for the simple water, and used either cold
or tepid, whichever appears to be most bene-
ficial.  Some of the forms of lead lotion
(see Lead) answer well;  or one made  with
five or six grains of sulphate of zinc to the
ounce of water; or an alum wash in similar
proportions  to the last, or decoction of oak
bark, or  of  green  tea ; in short, any  mild
astringent.  It must be  remembered,  how-
ever, that in all cases, the strictest cleanli-
ness is absolutely requisite, both as preven-
tion and cure.   Indeed,  the neglect of this
is one of the most  frequent causes of the
disease.  When whites occur in a weak in-
dividual, they may, (being unaccompanied
with any inflammatory action,) require the
use of astringents from the first, with tonics,
mineral acids, quinine, and iron, with good
diet, and wine, or malt  liquor; probably also
tepid or cold salt-water hip-baths.    The
bowels in all such cases require strict at-
tention, and should be regulated  by castor-
oil, rhubarb and magnesia, or by cold clys-
ters.  In tolerably strong habits, small doses
of  Epsom salts, in combination with sul-
phuric acid, answers extremely well.   Due
attention should of course be given to  exer-
cise, and rest at nights must be taken upon
a hard bed.
   In the milder  attacks of leucorrhsea, a
little  well-applied  domestic management
will often be sufficient to remove the symp-
toms;  but when these become in the least
urgent, a medical man ought to be consulted,
before the disease becomes habitually local.
To allow of its continuance, from motives of
mistaken delicacy, or  from carelessness, is
a serious, it may be a fatal mistake; for, as
stated above, its  continuance gradually un-
dermines the powers of the constitution, and
dropsy, consumption, and other diseases of
debility, may be originated in consequence.
Moreover, when family is desired, the wish
is  not so likely to be accomplished as long
as the discharge continues, and miscarriage
is more  liable to occur.  The ordinary func-
tion  of  menstruation,  moreover, is  apt  to
become  deranged.—See Menstruation.
  As  a  further reason for submitting con-
tinued or severe cases of  the  affection  in
question to the care of medical men, is the
fact of the white discharge being at times
symptomatic of disease connected with the
womb.  Sometimes, however, it is the result
of irritations in the  bowels, caused  by ac-
cumulations in  them,  and sometimes  by
worms.   To sum up, it should be remem-
bered, that  the disease is  often  the result
of neglect  and want of sufficient  cleanli-
ness ; that it may occur in a form more  or
less inflammatory, when it requires sooth-
ing remedies; that after  the inflammatory
stage, and often without it, especially in the
debilitated, it requires  astringent and tonic
treatment,  rather  than relaxing;  that  if
neglected, it is liable  to become an obsti-
nate disorder,  and, by its continuance, seri-
ously to injure the constitution; and that it
may be  symptomatic.  Lastly, that  in  all
but the  mildest cases, the nature of the dis-
ease requires proper medical treatment, and
perfect  rest in every  sense.   This  article
cannot be concluded without the  fact being
alluded to, that the  occurrence of the dis-
ease in  its aggravated form, and the occa-
sional consequences  it then gives rise to,
have  been the means of raising  unfounded
suspicions of moral impurity, and of creat-
ing  discord where  it ought not to exist.
Never ought such  ideas  to be entertained
for one  moment in the  mind, still less given
in words, except when  based upon the care-
ful examinations and opinions of more than
one medical man.
   Refer to Menstruation.
   WHITEWASHING—By means of lime, is
one of the most powerful  means  of general
household  purification which it is possible
to employ, especially on  the large scale  on
which such purification is often required in
the dwellings of the poorer classes, particu-
larly in towns.   Lime absorbs powerfully
the carbonic acid from the atmosphere; and
in this, and probably in other ways, tends
greatly to remove  the  most fertile sources
of disease.
   The effect of whitewashing with lime in
this way could not be more strikingly shown
than  it was in one of  the recent epidemics
of fever in Edinburgh.  According  to Mr.
Ramsay's  Report  to the Commissioners of
Police,  " The business of whitewashing was 
                W 11  I                5<

commenced on the  11th of September, nnd '
continued to  the 30th of October, and less
extensively up to the 14th of December," I
during which period, he states, there were
washed—                                |
    "090 staircases,
     1631 passages,
     2120 apartments, exclusive of
     1212 places  cleaned previous  to that
date, making a total of 6553 different places,
at a total expense  of £77."   Mr. Ramsay
further states, "The effect of these  lime-
washings on the epidemic  has been  matter
of great interest to myself; and  I  have
watched with the most  anxious care to as-
certain  whether any new cases of fever oc-
curred in dwellings  previously subjected to
purification ;  and I  have pleasure in  saying,
that out of a great number of cases reported
to me, with two exceptions, the whole turned
out to be cases of relapse."
  Beyond these, Mr. Ramsay failed to dis-
cover any other cases.  The above is strong
evidence.  It might render it a question for
boards of guardians and others, whether,
to supply gratuitously every necessitous oc-
cupier of a house  with lime sufficient to
whitewash once, if  not twice  a year, might
not be real economy, and diminish  poor-
rates, as well as disease.  Moreover, it has
been pointed out, that free light, and light-
coloured walls, tend to  promote health ; in
this  way, the  white colour of  lime-wash
must  be  an additional counter-agent to
causes of disease.
  Refer to Houses—Light—Walls.
  WHITLOW — Is   abscess of a  finger or
thumb,  but in this situation is rendered ex-
tremely distressing, and  even  serious, as
regards the use of  the  member, in conse-
quence  of the matter being generally con-
fined  by the  firm skin,  and subjacent firm
fasciae or fibrous membranes which are con-
nected with the tendons, by means of which
the fingers are moved.   The matter  often
has great difficulty  of reaching to the sur-
face, and of being discharged, and probably
lies next the bone.    The consequence of all
this, especially if the inflammation  is very
acute, is to give rise to disease of the  bone,
or to mortification  of the finger  generally ;
in either case, the member is rendered worse
than useless, or requires amputation. Whit-
lows  are certainly  more common in  those
who employ their hands in hard labour, also
in cooks and individuals who are exposed to
wounds from  bone-. &c.
  The symptoms are deep-seated throbbing
pain  in the  affected member, which con-
tinues increasing till it  becomes almost in-
tolerable; the finger feels "ready to burst," \
2                W II I

and  if examined, the  skin  is found  tensj
and hard, and more or  less inflamed. Tf no-
thing be done to remedy this state of things,
the symptoms increase, the  whole arm  be-
comes  affected, is more or less swollen and
inflamed, especially  in the  course of  the
absorbent vessels, (*ee Absorbent,) and  the
glands in the arm-pit are swollen and pain-
ful.  At  last the matter finds  exit some-
where, by the skin becoming ulcerated,  not
unfrequently about  the nail.   When  this
happens, there  is relief to the severe symp-
toms, but probably  so much mischief has
been done to the member, that  the results
above described—mortification or death of
the bone and the finger—occur, and it is
lost.   To  prevent  such  a  serious conse-
quence, it  is needless to say  that active
measures should at once be resorted to, and
the case seen by a medical man  as soon as
possible.
  On the first  symptoms of whitlow occur-
ring, however, the disease may in some cases
be arrested at once,  by thoroughly rubbing
over the whole  of the affected member with
lunar  caustic.   This proceeding, however,
must be resorted to at once, and accompanied
with reduced diet and  active purging, with
blue pill and black draught.  It must be con-
fessed, too, it is more  efficacious in  those
the skin of whose fingers has not been hard-
ened by labour, and  in whom the disease is
generally least  severe.  But the most ef-
ficacious proceeding  in whitlow,  when there
is evidence  of  matter  having formed, (see
Inflammation—Pus,)\s to lny open the finger-
down to the  bone, by means of  a lancet or
knife.   This proceeding, of course, ought
to be dojje by a medical man if possible, but,
under circumstances, it might he resorted to
by an unprofessional person. It  is certainly
attended with  great momentary pain,  but
gives otherwise verygreat relief, and often
saves a finger.   After it is done, the ordi-
nary  treatment of  abscess, poultice  and
wnter-dressing,  will be requisite.  When
from timidity on the part of a patient (al-
though chloroform might certainly be used)
or other cause, a whitloV is not opened early,
the onlyproceeding isto poultice  assiduously
till the matter finds vent, to support  the
hand and arm in a sling,  to regulate  the
bowels, and  to soothe the excessive suffering
by opiates.   After the  matter is  discharged,
poultice for a short time, followed by water-
dressing, will be most  suitable, if the finger
is saved.  In some of these cases, the simple
poultice or water dressing require* shortly to
be exchanged for a more stimulating and as-
tringent application.   None answers better
than tincture of myrrh, in  the  proportions 
WIL
573
WO M
  of from two drachms to one  ounce to the
  half-pint of water.
    WILLOW-BARK__See Salicine.
    WIND.—See Flatulence.
    WINDPIPE.—See Lungs.
    WINE—Strictly  speaking,  is  the  fer-
  mented  juice of  the grape alone.   It, or
  rather sherry wine only, is used medicinally
  to  form a vinous tincture, or "wine" of
  various  drugs.   The most commonly used
  preparations are the wines of aloes, of anti-
  mony, of colchicum,  of ipecacuanha, and of
  opium.—See Articles.   For the  dietetic pro-
  perties and uses of wines, the  reader is re-
  ferred to Stimulants.
    WISDOM-TOOTH.—See Teeth.
    WOMB.—In medical language, the Uterus.
  This most  important  organ is, in its ordi-
  nary  condition,  situated  in  the cavity of
  the pelvis, but when distended, as in preg-
  nancy, it rises into the  cavity of the abdo-
  men.—See Abdomen.  Somewhat triangular
  in form, it is covered  by the general lining
  membrane of  the  abdomen and pelvis, the
  peritoneum, and is held in its place  by va-
  rious  ligaments.   The   affections of  the
  womb may be considered as those which are
  connected  with   the  state of   pregnancy,
  (see Pregnancy,) and  those which are not.
  In the latter case it is liable, though rarely,
  to be the seat of inflammation, the affection
  being characterized by the usual symptoms
  of inflammation, local  and constitutional,
  and requiring the same  management as in-
  flammatory affection  (peritonitis) of  the
.  bowels generally.  Congestion of blood, en-
  largements, tumour,  and polypus; diseases
  of its neck, including cancer, &c, are among
  the affections  to which the womb  is  liable.
  It is  also  exposed to displacements, (dislo-
  cations  as it were,) from  before backward,
  or the reverse; and, likewise to coming or
  "falling" down, or, as  it  is called, "pro-
  lapsus."  The latter occurrence is the most
  usual after the  time of  child-bearing is
  past,  in women who have borne large fami-
  lies, and especially in those who have neg-
  lected  themselves  after   confinement,  by
  getting up too soon.   It is, therefore, a fre-
  quent complaint among the lower  orders,
  who are in a measure  forced  to neglect
  themselves under  the circumstances.   The
  falling  or  prolapsus  of  the womb  is  per-
  mitted  by general laxity of the parts, but
  especially  of the ligaments which ought to
  retain the  organ in place.   It is further
  aggravated by the congested and enlarged
  state  of it, which thence  results.  Such a
  state  of  matters cannot be too soon recti-
  fied, and by all means ought  to be placed
  under the management of a medical  man,
 who will recommend such  a one of the va-
 rious instruments contrived for  such cases,
 as may appear most suitable.  In the mean
 while, rest  in the  horizontal posture, and
 general  soothing treatment, are the  best
 palliatives.   And if, in the  mean time, cir-
 cumstances  render it impossible  for  the in-
 dividual to remain quiet,  comfort will  be
 derived from the use of such a bandage as is
 represented in the article " Prolapsus." The
 other displacements of the womb, backward
 or forward,  are more usual in its enlarged
 condition—in  pregnancy  especially ;   the
 former is often the result of permitting the
 bladder to become unduly distended, so that
 by its weight it presses  the womb out  of
 place, and  into such a position that it can-
 not easily recover itself.   In these, and inr
 deed in all affections of this organ, the as-
 sistance  of  a medical  man cannot  be  too
 soon procured. Domestic treatment can do
 little or nothing for their permanent relief,
 although it  may, if properly directed, pal-
liate  considerably the more urgent symp-
 toms.  The  affections  of the womb  may of
course develop with greater or  less rapid-
 ity;  some are sudden  in  their  onset, and
 urgent in their symptoms ;  others arise al-
 most  imperceptibly, and go on slowly.  In
most  cases,  however, there is sense  of un-
 easiness  and  dragging weight  about the
 parts, perhaps actual pain of more or less
 severity ; the. functions of  the bladder may
 be interfered with, and irritability or diffi-
 cultly occasioned; or  difficulty or pain be
 experienced in emptying the bowels.  Under
 some circumstances, discharges of blood  or
 matter may  take place.—See Menstruation—
 Whites,  Sec    The  constitution may  sympa-
 thize more or less, and irritable fever arise,
 or obstinate vomiting, or  dyspepsia, with-
 excessive nervous irritability and hysteria.
 Under circumstances,  when  symptoms  like
 the above, or others suspected to be in con-
 nection with  the womb, show  themselves,
 an individual can scarcely err in assuming,
 if possible,  entirely the horizontal posture.
 If there is  much pain, and especially any
 symptoms of feverishness,  fomentations  to
 the lower bowels, perhaps  leeches,  may be
 used;   and  when the suffering is great,
 opium given by the mouth or in  clyster. At
 the same time, the strictest  attention must
 be paid  to the due action of the bowels, by
 means of castor-oil, senna,  &c, or,  in full
 habits, by salines, perhaps  following mode-
 rate doses of blue-pill; but all preparations
 containing aloes must be sedulously avoided.
 Clysters of cold, tepid, or warm water simply,
 or rendered more aperient by the  addition of
 medicines, are often useful.   The diet musf 
W 0 M
574
W 0 R
be regulated according to the habit and con-
stitution of the patient.  If this be full, a re-
duction, especially in stimulants, may safely
be made; but  if the habit be moderate, the
diet may be kept so too.   In the weakly and
debilitated, it may require to be increased,
especially if  there is any drain, such as
discharge of  blood, &c, going  on.— See
Abortion — Menstruation—Whites,  Sfc.   The
above are palliative measures,  which may
be safely resorted to under most circum-
Btances.  They are, however, palliative only.
Curative means can only  be carried  out by
a medical man, under whose care all affec-
tions  of  this  organ,  so  closely  connected
with  female health, happiness,  and well-
neing,  should  be placed  without delay—
without  waiting for serious symptoms to
arise.  Moreover, it should be remembered,
that there are  states of impaired health, of
a dyspeptic  and  nervous character espe-
cially,  dependent on uterine derangement,
which in  itself gives no marked sign.
  In some affections of  the womb,  it be-
comes  absolutely necessary  for  a medical
man  to  resort to  means of examination,
which, though they cannot fail to be highly
repugnant to  the feelings,  no  woman of
truly delicate  and pure mind would object
to, when it has been fully explained to her
by a  professional attendant in  whom  her
confidence is placed, that such examination
is positively required.  It may be that the
zeal of some  has led them to  disregard,
perhaps  too  much, the feelings  of patients
suffering from  these peculiar  diseases,  and
to be too ready to avail  themselves of all
means of investigation—but these are the
exceptions.
  WOMAN.—See Child-birth—Education
— Menstruation — Pregnancy — Whites,
&c.
  WOOD-SORREL.—See Oxalic Acid
  WOOL  and WOOLLEN  CLOTHING.—
Sec Clothing.
  WORMS.—There  are  various parisitic
animals which infest the human body. Some,
Buch as the  acari, occupying the external
Burfaces only, while others, called by medical
men " entozoa," are developed  and live in
the interior of the body.  Of   these the
commonest and best known are the  five
species of " worms" which infest the ali-
mentary canal.   They  are  the  common
round worm ;  the thread, or maw, or chest
worm : the long threat-worm ; the common
tape-worm, and the broad tape-worm.
  The common round worm  of the intes-
tines  was  for long confounded  with  the
common earth-worm, although it is difficult
to imagine how it could  be  It is firmer in
Biibstnnce, and much more acutely pointed
at both ends than  the  latter,  of a  palei
yellowish pink, and  more transparent.   Its
length varies  from a few inches to a foot.
This  worm  is  more  common  during the
early periods of  life, and  exists in many
children without giving rise to any apparent
disorder, unless  it is developed in great
numbers ;  very  frequently,  perhaps, after a
dose of aperient medicine, a round worm is
passed from the bowels by  a child in whom
such a parasite was not suspected to exist.
The  occurrence  not  uncommonly  causes
much needless alarm ; a very large number
of children,  to all appearance well, are so
infested, and the excretion of one worm is
no proof that there are more.   At the same
time the occurrence should  always give rise
to investigation, and to the employment of
remedies calculated to remove any more of
the animals which  may  exist.   The usual
Bite  of these round worms is in  the small
intestines ;  but, occasionally, they find their
way  into the stomach, and are vomited or
got rid  of by the mouth;  most commonly
they pass oft* by the bowels.
  The thread or maw or chest [scat] worms
are familiar to most persons;  they resemble
long maggots, or  bits of white  thread, and
are very lively in  their movements when
first  expelled.   These worms  usually infest
the lowest bowel, or rectum,  in which they
often exist  in  immense  numbers, passing
off with every evacuation,  either separate
or rolled in masses;  they  also creep from
the bowels; they are found  too, occasion- '
ally, in  the upper  part of the alimentary
canal—hence the  name of chest-worm popu-
larly given.   In  this  case  the worm  is
coughed or  " hawked" up.   The  thread
worm is most  commonly met with in chil-
dren, but also occurs in adults,  especially
such  ns  are weak and  unhealthy.   The
long thread-worm does not occur in the im-
mense numbers of the smaller  variety, but
seems to  exist  in  most  persons without
causing  much  inconvenience.   The  tape-
worms are quite  the most  formidable, and
produce the most serious consequences of
any of the intestinal parasites.   The broad
tapeworm  occurs chiefly on  the  continent.
The  common tape-worm, (fig. cxlii.,) which
is usually met with in this country, grows
to many feet in  length, extending, indeed, at
times, almost throughout the entire  length
of the intestines,   lt is, as represented, flat
and  jointed, the  edges of  the joints  being
somewhat waved. At the head (fig. cxlii. 1)
it becomes  much tapered, but, downward,
increases in breadth, sometimeB to as much
as half an  inch or more, again tapering off 
WOR
575
wou
Fig. cxlii.
 toward the tail.  In colour, it  is a dirty-
 white.   Generally, one worm only exists in
 the bowels at a time, but sometimes  there
 are more.
   The  symptoms caused by the  different
 species of worms are in some  respects si-
 milar;  they are,  more  or  less  emaciation
 although the  appetite  is good, unhealthy
 hue and pallor of the  skin, furred tongue,
 and unpleasant breath,  and frequent griping
 pains in the bowels, which  are irregular—
 the chief characteristic of  the  evacuations
 being  increased secretion  of. mucus, with
 perhaps an inclination to sliniiness.  Itch-
 ing and picking of the  nose in  children is
 often set down as indicative  of the presence
 of worms, but it is also a symptom of intes-
 tinal irritation from other causes; it can-
 not, therefore,  be considered as  conclusive.
 Indeed, it is a question whether any symp-
 tom except the appearance of worms in the
 evacuations  can  be  considered  positive.
 The appetite is apt  to  be  capricious,  and
 there are  symptoms of general digestive
 disorder.  Some  patients complain of feel-
 ing the  movements, but (except  in the case
 of tape-worm)  this is probably imaginary.
 Perhaps some of the most important effects
 produced by worms  are those which result
 in irritation of the nervous  system.  Chil-
 dren more particularly exhibit them.  They
 grate their teeth  at  night, talk  in  sleep, or
 wake up screaming; they are irritable and
 fretful.   In other cases, various  convulsive
 or spasmodic  affections, such as  St. Vitus's
 dance,   squinting,  stammering,   obstinate
 cough,  and many others, have  been  dis-
tinctly   traced  to  the presence  of worms.
The thread-worm, in addition to constitu-
tional irritation, causes much inconvenience
 from the constant and sometimes intolerable
 itching it gives rise to about the fundament.
 The tape-worm seems to cause more uneasi-
 ness in the bowels than  the other varieties,
 and its occurrence is  certainly characterized
 by more emaciation and general debility.
   The  origin of worms in   the  intestinal
 canal is unexplained, although many causes
 which favour their  occurrence are assigned.
 The water which is  habitually drunk, the
 diet,  especially if it consists of a large pro-
 portion of vegetable aliment, &c, have been
 cited as causes ; but  perhaps  no special ori-
 gin can be proved,  unless it be the depriva-
 tion of salt,  which  certainly has appeared,
 in  the  case  of prisoners punished  in this
 way in Holland, to  favour the  formation
 of  worms.  Debility,  from whatever cause
 arising, is undoubtedly the condition which
 chiefly favours the  generation of  these pa-
 rasites.
   To get rid of worms, two sets of remedies
 —purgatives and tonics—are requisite ;  the
 first to clear away  the offenders, the latter
 to correct the debility which usually favours
 their existence.
   For the round worm,  the best purgatives
 for children are calomel  and scammony, or
 calomel and  jalap,  given at intervals  of a
 few days,  so  as to purge briskly;  the tonic
 —and some preparation of iron is generally
 the best—being given in the intervals.  At
 the same time the  diet should be  strength-
 ening, well seasoned  with  salt, and ought
 to include a due proportion of fresh  animal
 food.   In  the case of  the thread-worms, the
 same general treatment is advantageous;
 but as they chiefly inhabit the  lower bowels,
 their removal is mvtch facilitated by the use
 of clysters, either of  salt-water, or of some
 bitter infusion, or of  turpentine, the latter
 being more applicable in the case of adults.
  For  the  cure of  tape-worm, many reme-
 dies, and  especially turpentine, have been
 used, but now they  may safely  be said to be
 reduced to two—the kousso and the fern, to
 the articles on which the reader is  referred.
— See  also Pomegranate.  [The  efficacy of
pumpkin-seeds  has been already referred
to.—See Tape-worm.]
  WORMWOOD.—This  common  plant,
known by its many  cut leaves, silky on the
under sides, and by its strong  odour, is not
much used in medicine at the present time,
although it is a good aromatic bitter and
tonic.  The tops should  be collected early
in August and dried.   Half an ounce may
be infused in  a pint  of water, and of this  a
teacupful taken twice  a day.
  WOUNDS—Are separations of the sub-
stance or  tissues  of the body, effected by 
wo u
576
W OU
violence.   They may, ns nil  are aware, be
occasioned by a variety of causes ;  accord-
ing to these causes, therefore, they are usu-
ally classified by surgeons  into simple cuts,
or "simple  incised" wounds: into  bruised
and lacerated wounds ;  punctured wounds ;
poisoned and  gunshot wounds;  the  treat-
ment of each variety being in some degree
different, although there nre certain general
principles which must  be observed in the
management of all; these ought to be im-
pressed upon  the  minds of those who may
be  called  upon  to direct the management
of such accidents, nnd  no kind of  medical
or surgical knowledge, perhaps, is likely to
prove more useful to unprofessional persons
in out-of-the-way places.
  The  first  circumstance,  generally,  which
calls for attention as the  consequence  of a
wound is the effusion of blood, but  none of
the consequences, perhaps, exhibit  greater
variation.  Sometimes an  extensive injury
may by inflicted, even the arm torn  off at
the shoulder, and yet the loss of blood be
extremely small; on the other hand, a punc-
ture "With a pen-knife,  if  it  penetrates an
artery, may be sufficient to place life  in the
greatest immediate jeopardy.  As a general
rule, probably, putting the opening of large
vessels out of the question,  a greater amount
of blood is lost after simple cuts than after
any other description  of wound.    When
laceration or bruising takes  place,  there  is
usually, by stretching, or otherwise, of the
coats of the arteries, a sufficient amount of
mechanical  impediment caused  to modify
greatly, if not wholly to prevent,  any he-
morrhage.   As, under  articles Artery  and
Hemorrhage, the various  modes of arresting
the effusion of blood have been fully entered
into,  it is  unnecessary to reiterate them
here.    When  a wound  is small, the  best
method of treatment is to tie it up at once
with a piece of linen rag; this is usually
sufficient  at once to stop the bleeding, par-
ticularly if  rest and position (see Position)
are attended to;  the small quantity of blood
which  may exude, quickly dries upon the
wound, and forms  a kind  of  glue  which
effectually excludes  the  air.   As no  better
dressing can be used, it  may be  left on till
the cut is well; in some cases, before using
the linen, it may be  advisable to draw the
edges  of  even  a small cut  together,  by
means of adhesive plaster, or material of
some kind.—See Plast<r.  Although linen is
mentioned in the above directions, of course,
should it not be at hand, soft calico may be
used, or other soft material.
   When a wound is extensive and the bleed-
ing profuse, it will not  do to bind it up  in
 this way;  first, becnuse  it probably  would
 not be sufficient to arrest the flow, and if it
 did so  ultimately, it  would retain a lnrge
 amount of clotted blood, either  in or about
 the wound,  in such a way as to interfere
 with the healing process.  In a large wound,
 therefore,  it is necessary that the bleeding
 Bhould  be  almost  entirely arrested (see He-
 morrhage) before it is dressed, that is, closed
 up, &c.
   The  first  end  in view when a wound is
 dressed, ir to get  as much of it as possible,
 to  heal by the "first intention,"  or by "ad-
 hesive  inflammation."—See AiXtesion, that
 is,  to get the several parts to adhere at once,
 without formation of  matter, and thus with
 as  little pain and  trouble ns may be.   When
 the wound is a simple cut, such as that made
 by the surgeon's knife, this desirable termi-
 nation may be expected, and often realized;
 even the extensive surfaces exposed in am-
 putation of the thigh will heal in this way
 almost entirely;  to attain the end, however,
 in  many  wounds, considerable  care  is re-
 quisite.   In the first place, the wound must
 not be closed so soon  as that a clot of blood
 will form between the exposed surfaces;  if
 it  does, unless extremely thin, it will pre-
 vent union   In the second place, when the
 wound  is closed, its surfaces must be placed
 in  as accurate a position as possible, and
 must be thus held together till the process
 is  complete.  To  effect  and maintain this
 apposition or contact, various agencies  are
 employed, and of these,  position is not the
 least important,  (see  Position,) that is, the
 placing of the parts so that the  surfaces of
 the wound may, as far as possible, fall into
 contact, and that, when other dressings are
 applied, there may be  no  drogging to get
 things  to  meet.   Thus, in a wound of the
 forepart of the neck, it is requisite to  fasten
 the head so as to prevent its being thrown
 back. —See Cut-throat.   At  the  same time,
 position must be regulated with a view to
I prevent hemorrhage.   The wounded parts
 being properly placed, the next object is to
 draw the surfaces into as close apposition as
 possible;  in some cases, this is sufficiently
 well  done by means  of  strips of adhesive
 plaster, (fig. cxliv. 1,) placed at such inter-
 vals  ns will permit  discharge of matter,
 should ony  form.   Frequently,  however,
 from  the   nature,  site,  or  extent  of  the
 wound, plaster is  not sufficient  to keep  the
 edges together, or to counteract the natural
 resilient  tendency of the  skin  to  retract
 when severed.   In such instances, stitches,
 or, as  they  are  called by medical  men,
 "sutures,"  are   employed.  These  consist
I of a piece of sufficiently stout silk or linen 
                 W 0 U                i

thread passed through the thickness of the
true skin,  (fig. cxliv. 2,) at about the  dis-
tance of a line  from each of  the severed
edges.   The thread is passed by means of a
curved surgical needle,  (fig. cxliii.,) and the
                 Fig. cxliii.
WO u
                 Fig. cxliv.
 two ends being tied as represented, (fig. cxliv.
 2,) bring the edges together, and retain them
 most effectually in contact; that is, provided
 the stitch is not made use of to drag parts into
 place: this it  should never do.  If there is a
 continued strain upon the sutures, not only
 do they cause much pain, but  they quickly
 cause ulceration, which, by detaching, ren-
 ders them perfectly useless.  The surfaces
 of a wound having been brought into con-
 tact, a piece of thin linen, soaked in water,
 should be  placed over it, and if possible, a
 lightly  applied bandage.   This not only
 keeps the  dressing in place, and assists to
 exclude air, but gives support, which is al-
 ways serviceable, and often, in large wounds,
 absolutely necessary.   The bandage may be
 kept wet with  cold  or tepid water, as most
 agreeable  to  the  feelings of  the patient.
 When a wound progresses well toward re-
 covery,  when  there  is  no  appearance of
 discharge,  or so little that it is neither in-
 convenient nor offensive, there  should be no
 meddling; the less the processes of  repara-
 tion  are disturbed  the better, and in some
cases  a week  may be allowed  to  elapse
before  the dressings are disturbed:  they
may of course require it before, especially
in warm weather.—Sea  Dressing.  It  ought
to be remembered,' that in the  treatment
                                 exclude
  it should  be taken as  an aphorism, that
  rest,  simplicity,  and  cleanliness are  the
  great promoters of healing ;  the last being
  best attained by the  use of water alone.
  No balsams  or similar applications should
  be employed; and, except it be a little per-
  fectly  sweet  fresh lard occasionally, oint-
  ment may be entirely dispensed with.
   The above observations have been directed
  specially to simple incised wounds;  when
  laceration or contusion accompanies the in-
  jury, the principle must be to get the wound
  as much into  the condition of a simple inci-
  sion  as possible.  To  do  this—the wound
  having been thoroughly cleansed  from dirt,
 grit, &c, by  means of a  soft sponge and
 water,  and any  foreign body which can be
 easily reached, removed—all parts not  abso-
 lutely detached from the  body  are to be
 placed  as nearly as possible in the natural
 position, stitches and plasters being used  to
 retain them,  and  free exit left for the dis-
 charge of matter; over these there must be
 applied  either poultice or water-dressing,
 and a bandage may be necessary or not, ac-
 cording to circumstances.
   Lacerated and  contused wounds are al-
 ways followed by more or less inflammation,
 with discharge of matter, and frequently by
■ mortification of some of the injured parts.
 Often in different portions of the same wound
 may be seen simple adhesion,  suppuration,
 and mortification going on at the same time.
 In consequence of these changes,  the dress-
 ings of lacerated  wounds require frequent
 renewal, the greatest cleanliness  being ob-
 served.   In the course of a few days,  after
 the infliction of the injury,  if  any parts are
 killed, or mortify,  it is  indicated by  their
 assuming the characteristic appearance, (see
 Mortification;) the wound in such cases is to
 be  managed  (modified, of  course, by  cir-
 cumstances) as directed in the above arti-
 cle.   Such  wounds,  whether  portions of
 the tissues have mortified or not, ultimately,
 (if they do well,) assume the characters  of
ulcers tending to heal, and require similar
treatment.—See Ulcer.  Punctured wounds
are often more dangerous  and troublesome
to heal than their  appearance would lead to
be supposed.   Their  danger is,  of course,
commensurate with the importance of the
parts wounded; on this account such cases
should always  be  seen by a medical man.
Generally, a simple poultice *or water-dress-
ing is the  most  appropriate  application
Rest,  too, should  always be observed, and
low diet, at least till proper advice has been
procured.  A  wound from a barbed instru-
ment, such  as a fishing-hook, may be re-
of all wounds, it is important to
the action of the air as far as possible; and | ferred to the class of punctured  wounds
          2 Y                            37 
wou
V  K L
 The best mode of extraction is to cut off the I
 dressing of the  hook, if there be  anj\ and
 to push  it entirely through by  the  shank.
 Gunshot wounds partake  more or less  of
 the  nature of'lacerations  and  contusions.
 When small shots have entered beneath  the
 skin, any that can be very easily  detached
 may be: but it is well  not to be  too assi-
 duous on this point.  In such cases, perhaps
 the best thing that can  be  done, till  a sur-
 geon is procured, is to use means to check the
 bleeding; to place the sufferer in  as easy and
 advantageous position as possible; to apply
 poultice or water-dressing to the wound, and
 to counteract shock, (see Shock,)  by the cau-
 tious administration  of  stimulants.  Either
 in this  cnse, or in that of any other wound,
 if there  is much  shock to the system, it
 must be counteracted,  and, at the same
 time, if circulation in the wounded member
 is interfered  with, means must  be used to
 preserve  sufficient natural heat, &c.
   Poisoned wounds are wounds in which the
 division of the tissues, or even the  abrasion
 of the outer skin, is  accompanied  with  the
 insertion of poison of  some kind, whether
 that of a gnat  or  of  a wasp,  of a rabid
 dog or  of a snake.  The wound  in itself is
 generally trifling, perhaps not more than a
 scratch, but its character depends upon the.
nature  of the poison inserted ; a slight mo-
mentary pain or itching may be the greatest
inconvenience, or speedy death may follow,
or the  poison may  take days or weeks  to
develop, as it does in inoculated small-pox
or hydrophobia.  When an individual  suffers
from a wound known or believed to be poi-
sonous,  immediate  steps should be  taken
to prevent,  if possible, the poison being ab-
sorbed  into the  system.  The steps to  be
taken are sufficiently detailed in the  article
 "Hydrophobia," and the minor applications
to the bites  of  gnats,  &c. will be  found
 under " Stings."  The most  serious  poisoned
wounds which can be  suffered from  are
 those of the serpent tribe: they are not only
quickly followed by extreme cold  swelling
of the  limb, but by great  or fatal depres-
 sion of  the system generally.   The  latter
 consequence has been painfully  illustrated
in the  recent instance  of  death in  ninety
 minutes,  of one of the  keepers of the Zoo-
logical  Gardens, from the  bite of the cobra
de capello, or  poisonous hooded-snake  of
 India.  In  addition to the local treatment
of the wound, (see Hydrophobia,) continued
 friction with  some oily material  appears to
be most generally useful, while, at the same
 time, stimulants  are freely  given internally
 to counteract the depression. Of course, any
 stimulant first attainable should be used;
 but ammonia appears to be most highly re-
 commenced.    In  a cominitnicntion  in  the
 Lancet, for October last, respecting the  re-
 cent death from the cobra, by a gentleman
 at one time resident in  India, it is stated,
 '• So well aware are the native medical staff,
 and all intelligent natives, of  the efficacy of
 ammonia in these bites, that they commence
 with it on the instant, not waiting for sup*
 rior advice."   A teaspoonful  of sal-volatile
 may be given every five or ten minutes in a
 wineglassful  of water, till reaction is tho-
 roughly established.
  Such cases as the above are not  common
 in England;  they sometimes, however,  do
 occur in consequence of the bite of the adder
 or viper, the only species of poisonous snake
 common to this country.   [In certain sec-
 tions  of the United States,  the  bite of the
 rattle-snake is not a  very rare accident.
 Cures  have been accomplished  by  causing
 the patient to drink  whisky until "dead
 drunk."   Sometimes a quart of whisky has
 been  required.]    The  common "ringed-
 snake" is harmless;  it  has a yellow spot
 on each  side  of  the  neck,  whereas the
 adder is of a dirty yellow colour throughout,
 marked  with   black spots, and tho  belly
 black.    Poisoned  wounds,  such as  those
 sometimes received in dissection by medical
 men, or by cooks and  others  who  have  to
 handle dead animal substances, are apt  to
 give rise to symptoms  resembling whitlow,
 and require similar treatment.—See Whit-
 low,  They may, however, place life  in much
 jeopardy by the constitutional  affection they
 give rise to, and by causing the formation
 of abscesses in various  parts  of the  body.
 Such, and indeed any severe  cases of poi-
soned wound, ought to be put under medical
care without delay.
  Refer to Ammonia—Lock-jaw—Scalp, Sec.

  YAWNING.—See (Japino.
  YAWS.—A peculiar  tropical disease, ac-
companied with a skin eruption.   The ad-
vice given under " Tropical Diseases" applies
also to this affection.
  YEAST.—See Fever—Poultice.
  YELLOW FEVER.—This epidemic dis-
ease, chiefly known  as a visitant of the West
 Indies  and of the shores of the North Ame-
rican continent, but which has  also visited
Southern Europe, is characterized by many
of the  general symptoms of fever; there  is,
it is said,  however,  peculiar headache from
 the commencement, situated behind the eyes.
 The irritability of thp stomach is a  peculiar
 feature in the course of the disease, and the
 matter vomited often assumes the appear
 ance of black coffee-grounds,  known as the 
YEW               579                ZYJI
"black vomit."  The occurrence  of  this,
with suppression of urine, is considered un-
favourable.   The yellow colour of  the skin
is  not invariable.   The advice given under
" Tropical Diseases" applies"likewise to this.
All that an unprofessional  person  could do
in the absence of proper aid, would be to
follow out the general principles laid down
in article "Fever."   [A tablespoonful  of
yeast every two hours is  a  favourite  and
often safe domestic remedy—if medical ad-
vice cannot be obtained.]
  YEW-BERRIES.—The  beautiful berries
of the yew-tree occasionally tempt  children
to eat them, and the leaves have been given
Ignorantly as medicine. Both are extremely
poisonous.   A child  has  died within four
hours after eating a quantity  of the berries.
The symptoms  appear in  some degree to
resemble those of poisoning by belladonna,
and treatment similar to that recommended
in  such cases  should be  adopted.  It is
thought  that the  poison  resides chiefly in
the seeds of the berry.

  ZINC.— This  now well-known  metal
yields some useful medicinal preparations.
Of  these the principal are  the oxyde,  the
sulphate, and the chloride.  The metal itself,
which is of pale bluish colour,  was some
years ago introduced for various  cooking
purposes, and especially for dairy utensils,
but seems to have been abandoned as  un-
suitable.—See Cream.  The oxyde of zinc
is  a white, tasteless,  rather  light  powder.
It is used externally  in the  form  of oint-
ment in various skin-affections ; the propor-
tion is one of zinc to six of lard or simple
ointment.   Internally, it is used principally
in spasmodic diseases, such as epilepsy, and
St. Vitus's dance.  In the latter disease, the
author has used  it successfully ;  the dose
from  two to six grains twice or three times
daily in the form of  pill.
  The sulphate of zinc, or " white vitriol," is
a most  useful preparation.   It is sold in
the form of small white crystals, somewhat
resembling those of Epsom salts.  It has a
strong metallic,  very  unpleasant, styptic
taste.  As an external astringent applica-
tion it is used in solution, and forms one of
the most serviceable collyria, or eye-lotions,
in the strength of from one  to four  grains
to  the  ounce  of  distilled  or rain-water.
When used  to ulcers, the strength may be
increased to double.  Its principal internal
use is as an emetic, being admirably calcu-
lated, from the rapidity with which it causes
vomiting, to empty the stomach in cases of
poisoning, as by  opium or  other narcotic
drugs.  The  dose, as an  emetic, is from
fifteen to twenty grains, in a wineglassful
of water.  The salts of zinc are said to have
themselves proved poisonous, but very rarely
so; moreover,  by the rapidity with which
they  cause  vomiting, they  must in  great
measure prove  their  own  antidotes.   In
such cases, the treatment should be similar
to that  for poisoning by blue vitriol.—See
Copper.
  Chloride of zinc is chiefly used as an ex-
ternal caustic, and also  as  a disinfecting
agent,   lt is said to  enter into the compo-
sition of Sir  W. Burnett's  "disinfecting
fluid."
  ZYMOTIC—Is a term recently introduced
into medical  science,  and is probably fami-
liar to most from its occurrence in the regu-
larly  published  reports  of the  " Public
Health."  The term  includes the" various
epidemic, endemic, and  contagious   dis-
eases, such as fever,  small-pox,  &c, which
originate, or are supposed to originate, from
a morbid poison being introduced into,  and
gradually extending itself throughout  the
system.   The process is likened to that of
fermentation,  and the term is derived from
the Greek verb signifying to ferment. 
 
CONCLUDING   ADDKESS.
   In bringing  to  a conclusion  the  "Dic-
 tionary  of  Domestic Medicine and  House-
 hold Surgery," the author solicits the atten-
 tion of his readers to a few remarks on the
 objects,  tendencies,  and uses of the work.
   The first desideratum in such a publica-
 tion was to supply, at a price which  might
 put it in the power of those of even very
 limited means, a work containing as large
 an amount of information as possible upon
 the proposed subjects,  while, at the same
 time, the range of those subjects should be
 sufficiently extensive.  It need scarcely be
 remarked, that for the attainment of these
 ends, it  has  been requisite, as far as could
 be done, to avoid repetition, and  to  make
 references  supply the place of  reiterated
 details.  Even references, however,  could
 not be  fully given  without  the  sacrifice of
 much valuable space; those, therefore, which
 are inserted, are not by any means set forth
 as complete,  but  rather as guides, to show
 how the reader may derive information by
 turning  to various parts of the  work.  No
 other plan would have admitted of the ne-
 cessary  condensation.   It certainly  would
 be more  convenient for reference, when any
 individual disease is treated of, if all par-
 ticulars as to  exact  doses of medicine, &c.
 were entered into in each separate article;
 but to have repeated this, time after  time..
 must have either greatly augmented the
 Bize of the volume or greatly curtailed the
 Bpace necessary for other subjects. Neither
 was it requisite  so  to do, for—and to this
 attention is specially  directed—all necessary
 information ought to be easily found  by re-
 ference, either to the articles on  the medi-
cines recommended, or to those suggested to
the mind by the nature of the subject under
investigation.  The author would strongly
advise the  more inexperienced  especially,
          2 y2
 never to give a medicine recommended un-
 der  any article on  a disease, without first
 turning to the article on the medicine, in
 order to  be  aware of any peculiarities in
 action, mode of  administration,  or  other-
 wise.  Moreover, it should be remembered
 that  the  graduation  of  doses to  different
 ages is given under article "Medicines."
  By some persons,  a Dictionary of Medi-
 cine is looked upon as a work to which they
 ought to  be  able to run  at any time,  or in
 any emergency, and  to find just what they
 want in a  moment.  This is a great mistake;
 in order that a work like a comprehensive
 dictionary should be found thoroughly use-
 ful, it must  be  read.  No medical  man,
 when he  consults a  volume  of  reference,
 expects to find what he wants in a moment;
 how much less likely, then,  is  an unpro-
 fessional person to do so.  True, the  effort
 has been  made in the present work, to give
 the information  as simply and  clearly as
 possible, and  when  there  is no time for
 reading: the  author trusts it has been done
 in such a mariner, that a few minutes' glance
 over an article may afford much that is use-
 ful;  but, it  is repeated,  the full benefit of
 such a work can only be  attained by atten-
 tive  perusal of the  subjects, if possible, in
 connected series.
  Throughout the  Dictionary, the endea-
 vour  of  the author  has been  to  adhere
 closely to  the doctrine of the  first few lines
 of the Preface, "  that the information given
 should be  safely usable by those who are put
in possession  of it."   In  order to do  this,
he has  striven  to take  the intelligence of
the  reader along  with him ; to give, in the
first  place, general views of  the structure
and functions of the living body, and of the
sanitary relations, external and internal, on
which  the perfect working, the  integrity,
                               581 
082                        CONCLUD1N
and health  of these depend;  to  point out
how disorder and disease is most likely to
arise or to be originated, and by what ra-
tional means—the why and the wherefore—
these are  to be  combated.  This plan pre-
cluded almost entirely the giving of prescrip-
tions, the recipes, one " good for" one thing,
and another " good for" some other thing—
of which people are £0 fond, lt is the recipe
system which has been the great stepping-
Btone for quackery, and the monstrous evil
and  system of deception is only to be got
rid  of by the diffusion of proper views of
the  true  nature  of rational medical treat-
ment ; views which make clear that this  is
not   a  mere  system  of  drugging,  but  is
founded upon a  scientific, enlightened con-
sideration of the laws which govern, and of
the  requirements which  are  necessary for
the  due preservation of  the  various  func-
tions of the  living body, in health, and not
less so in disease.  The author would add
one more to  his often repeated cautions to
unprofessional persons, not to  tamper with
Berious disease—would bid  them remember,
that many of the directions  given in the
present work are for  use, only when no pro-
per  medical aid is at  hand.
  In conclusion,  if success  and wide  circu-
lation afford  any criterion, the author has
i   ADDRESS
the  gratifying assurance, that the  " Dic-
tionary of Domestic Medicine nnd  House-
hold Surgery" has supplied a want, nnd is
likely to prove serviceable to the class of
the community for which it was  chiefly in-
tended.  Equally  gratifying is the  know-
ledge, that in the execution of a work on
popular medicine, he has not forfeited the
esteem  and  good-will  of his  professional
brethren; and that in addition to the favour
of the general press, and to that of private
professional  testimony,  some of  the  most
influential medical journals in the kingdom
have given  their  approval  of  his labours.
 He well knew that,  in undertaking a  work
of the kind, he was doing what would at first
subject him to criticism, if not to censure;  »
that he was entering upon almost forbidden
ground; on  that  ground  he never  would
have entered, but for the consciousness that
it might be trodden, not  only without injury
to the  honour of his profession, but with
benefit  to those  classes who  most require
enlightenment  on the subjects treated of;
and  that, in adding his efforts for that en-
lightenment,  he  was  giving  real, earnest
assistance  toward hastening the downfall
of quackery, in whatever guise it may show
itself.                  -          S. T.
THE  END. 
 
 
 

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