Everybody's Doctor A New and Improved Hand-Book OF Hygiene and Domestic Medicine. BY PROF. ROBERT A. GUNN, B.A., M.D., Professor of Surgery in the United States Medical College of New York; and Editor of The Medical Tribune. Author of " The Nature and Treatment of Venereal Diseases," " The Health of Women," " Medical Intolerance," "A Popular Treatise on the Eye and Ear," " Forty Days Without Food," " Diseases of the Rectum and Anus," " Mesmerism, Magnetism and Hypnotism," "Diseases and Deformities of » the Spine," &c., &c. FIRST E D ITI O JST. PUBLISHED BY THE DENNIS MANUFACTURING COMPANY (limited.) New York. A.8a5„., Entered, according to Act of Congress, in the year 1885, by the'DENNIS MANUFACTURING COMPANY, (Limited), of New York. in the Office of the Librarian of Congress at Washington, D. C. All rights reserved. PART FIRST. HOW ARE WE MADE? HOW DO WE LIVE? HOW TO KEEP WELL. PREFA6E. In presenting this book to the public, we hope to con- tribute a little toward improving the condition of mankind. We have always endeavored to make our patients understand something of themselves, that they might thereby be enabled to preserve health and shorten the duration of disease. We have recommended the perusal of popular works on Anatomy, Physiology and Hygiene, as well as those on domestic me- dicine, believing that the more people knew of these sub- jects, the more satisfactorily could the physician treat them when ill. When thus advising patients concerning the laws of health, the causes of disease, and the importance of popular knowl- edge on these subjects, we were so frequently urged to pre- pare a book of the kind, that we finally concluded to make the attempt. We have endeavored to condense into as small a space as possible, such information on medical subjects as we believed would be of value to the public. Dry technicalities have been avoided as far as possible, and every subject has been treated in a way to make it intelligible to the general reader. The treatment recommended in every case is such as we have found the most serviceable in our own practice, and can IV PREFACE. always be relied upon as perfectly safe when employed as directed. The work will prove valuable in all cases of emergency when medical aid cannot be had, and it will enable the family to dispense with the physician in many of the more common diseases. It will aid in determining when a physician should be called, and in assisting in the proper observance of all his directions. Without further comment we submit our work to the public, trusting that its perusal may contribute somewhat toward extending the popular knowledge of medical subjects, and that it may prove the means of relieving the afflicted in many households. The Author. HUTS. In using this book it is important that attention should be given to the following hints: < I. In every case where a part or organ is supposed to be dis- eased, its structure and function should be studied in chapters I and II of Part I. 2. A careful study of the remaining chapters of Part I will enable the reader to preserve health and prevent disease. 3. Before using any remedy, read the description given of it in Part III, so that you may understand its action, and the limits of the dose. 4. Always begin with the smallest dose, and gradually in- crease it till the desired effect is produced. If the action seems in any way severe, decrease the dose still further. 5. Never give medicine if there is any doubt about the nature of the disease. COHTOIS. PART FIRST. INTRODUCTION. PAGE. How arc we made?-The duties of the true physician-How to use the book.. 17-20 CHAPTER I. HOW ARE WE MADE? The skeleton-Structure and development of bone-The muscular system-The digestive apparatus-The lymphatic system-The circulatory apparatus- The respiratory organs-The genito-urinary organs-The nervous system.. .21-79 CHAPTER II. HOW DO WE LIVE ? Elements of the body-Proximate principles-Circulation of the blood-Excretions -Motion and sensation-Automatic motion-Volition-Thought and sensa- tion-Action of great sympathetic-Reproduction 80-101 VIII CONTENTS. CHAPTER III. WHAT SHALL WE EAT ? PAGE. The period of growth-Fallacies concerning food-Infant feeding-The period of interchange-Phosphorus in food-The period of decay-Relative values of foods-Animal foods-Vegetable foods-Dr. Tanner's fast 102-125 CHAPTER IV. STIMULATING BEVERAGES. Non-alcoholic stimulants-Alcoholic beverages-The theory of stimulation-Alco- hol as a food-Alcohol as a medicine-Wines-Alcohol as a poison-The alcohol controversy 126-145 CHAPTER V. HOW TO KEEP WELL. Physical development-Home gymnastics-Cleanliness and bathing-Clothing and modes of dress-Woman's dress-Tight lacing-Rest and sleep-Condition of dwellings-Air and Ventilation-Occupations 146-171 CHAPTER VI. EDUCATION OF THE SEXES. Education of the sexes-Our present system of education-The rational education of the sexes-The physiological differences of the sexes-Future relation of the sexes 172-193 CHAPTER VII. HEREDITY. Redundant fingers-Inherited conditions-Insanity-Mental impressions 194-201 CHAPTER VIII. THE WAR OF THE PATHIES. Medical intolerance-References 202-207 CONTENTS. IX PART SECOND. CHAPTER I. FEVERS. PAGE. Intermittent fever-Remittent fever-Typhoid fever--Typhus fever-Relapsing fever-Yellow fever-Dengue ,213-231 CHAPTER II. ERUPTIVE FEVERS. Small-pox, or variola-Vaccination-Varicella, or chicken-pox-Rubeola, or measles-Scarlatina, or scarlet fever-Erysipelas 232-246 CHAPTER III. MIASMATIC DISEASES. Influenza, or epidemic catarrh-Hay fever-Pertussis, or whooping-cough-Paro- tiditis, or mumps-Cerebro-spinal meningitis-Diphtheria-Cholera 247-264 CHAPTER IV. DISORDERS OF NUTRITION. Scrofula-Rickets-Rheumatism - Gout-Scurvy 265-276 CHAPTER V. DISEASES FROM SPECIFIC POISONS. Hydrophobia-Glanders-Poisonous insect wounds-Wounds of venomous serpents -Syphilis-Chancre-Constitutional syphilis-Buboes 277-293 CHAPTER VI. DISEASES OF THE DIGESTIVE SYSTEM. Stomatitis-Inflammation of the tongue-Inflammation of the oesophagus-Strict- ure of the oesophagus-Acute gastritis-Chronic catarrh of the stomach- X CONTENTS. PAGE. Dyspepsia-Neuralgia of the stomach-Ulceration of the stomach-Cancer of the stomach-Hemorrhage of the stomach-Diarrhea-Cholera morbus- Cholera infantum-Intestinal catarrh-Chronic enteritis, or chronic diarrhea -Inflammation of the bowels-Inflammation of the cecum-Inflammation of the rectum-Dysentery-Cancer of the intestines-Neuralgia of the intestines, or colic-Intestinal parasites, or worms-Congestion of the liver-Inflamma- mation of the liver-Gall stones-Jaundice-Constipation-Enlargement of the spleen-Peritonitis-Dropsy of the abdomen 294-361 CHAPTER VII. DISEASES OF THE HEART. Inflammation of the pericardium-Inflammation of the heart-Endocarditis- Rheumatism of the heart-Diseases of the valves-Hypertrophy of the heart -Dilatation of the heart-Fatty degeneration of the heart--Palpitation of the heart-Angina pectoris.... 362-375 CHAPTER VIII. DISEASES OF THE RESPIRATORY APPARATUS. Coryza, or nasal catarrh-Epistaxis, or bleeding at the nose-Ozena-Pharyngitis -Chronic catarrh-Tonsilitis-Sore throat-Acute laryngitis-Chronic laryn- gitis-CEdema of the glottis-Aphonia-Croup-Acute bronchitis-Chronic bronchitis-Asthma-Pneumonia, or inflammation of the lungs-Chronic pneumonia-Phthisis pulmonalis, or consumption-Hemoptysis, or bleeding from the lungs-Pleurisy 376-425 CHAPTER IX. DISEASES OF THE URINARY ORGANS. Congestion of the kidneys-Acute inflammation of the kidneys-Chronic inflam- mation of the kidneys-Albuminuria, or Bright's disease-Diabetes-Renal calculi, or gravel- Bleeding from the kidneys- Retention of the urine- Acute inflammation of the bladder- Chronic inflammation of the bladder-Stone in the bladder-Incontinence of urine 426-441 CHAPTER X. DISEASES OF THE NERVOUS SYSTEM. Congestion of the brain-Inflammation of the brain Water on the brain Apo- plexy-Sun-stroke- Headache-Vertigo-Aphasia-Insanity-Spinal menin- gitis -Spinal irritation -Locomotor ataxia -Infantile paralysis -Convulsions - Epilepsy-Hysteria-Chorea, or St. Vitus' dance-Catalepsy-Tetanus, or CONTENTS, XI PAGE. lock jaw-Shaking palsy-Hiccough-Sea-sickness-Delirium tremens-Par alysis-Neuralgia-Facial neuralgia, or tic-douloureux-Toothache-Sciatica. 442-481 CHAPTER XI. DISEASES OF THE SKIN. Acne-Alopecia, or falling out of the hair-Bums and scalds-Bed sores-Barber's itch-Boils-Carbuncles- Corns- Chilblains-Dandruff-Eczema-Freckles -Frost-bites-Itch-Lupus-Lice-Moles-Mothers' marks-Nettle rash, or hives-Offensive perspiration-Prickly heat-Ringworm-Scald head-Shin- gles-Tetter and salt rheum-Warts 482-502 CHAPTER XII. THE FUNCTIONS AND DISEASES OF WOMAN. Anatomy of the pelvic organs of woman-Menstruation, or monthly period- Amenorrhea, or absence of the menses-Painful menstruation- Profuse men- struation-Chlorosis- Anaemia- Pregnancy- Miscarriage- Management of labor-Care of the infant-Care of the mother-Rupture of the perineum- Child-bed fever-Gathered breasts-Inflammation of the womb-Displace- ments of the womb-Fibroid tumors of the womb-Uterine polypus-Cancer of the womb-Inflammation of the ovaries-Ovarian tumors-Sterility-In- flammation of the vagina-Leucorrhea-Vaginal injections-Vaginismus- Inflammation of the vulva-Tumors of the urinary passage- Itching of the vulva-Sore Nipples-Teething or Dentition 503-536 C HA P T E R XIII. DISEASES OF THE MALE GENERATIVE ORGANS. Gonorrhea-Gleet-Balanitis-Phymosis-Paraphimosis-Stricture-Swelled testi- cle-Prostatitis -Enlarged prostate-Hydrocele- Variocele-Spermatorrhea. 537-545 CHAPTER XIV. THE EYE AND ITS DISEASES. Anatomy of the eye-The hygiene of the eye-Defects of vision requiring spectacles - Spectacles-Diseases of the lids-The lachrymal, or tear apparatus-Stra- bismus, or cross-eye-The conjunctiva-The cornea-The iris-Cataract- The optic nerve-The choroid-Glaucoma-Amaurosis - 546-575 XII CONTEN7S. CHAPTER XV. THE EAR AND ITS DISEASES. PAGE. Anatomy of the ear-Physiology of hearing-The hygiene of the ear-Diseases of the ear 576-585 CHAPTER XVI. GENERAL SURGERY. Inflammation-Abscess-Septicemia and pyemia-Ulcers-Mortification or gan- grene-Antiseptic dressings-Wounds-How to arrest bleeding-Tumors- Cancer 586-597 CHAPTER XVII. SPECIAL SURGICAL DISEASES. Diseases of the bones-Fractures-Sprains-Dislocations-Backward curvature of the spine-Lateral curvature of the spine-The plaster-of-Paris jacket-Syno- vitis-Hip-joint disease-Diseases of knee and ankle joints-Anchylosis, or stiff joints-Knock knee-Club-foot-In-grown toe nails-Aneurism-Varicose veins-Abscess of the anus-Fissure of the anus-Fistula of the anus-Ulcers of the rectum-Hemorrhoids, or piles-Hernia, or rupture 598-632 PART THIRD, CHAPTER I. ACTIONS AND DOSES OF MEDICINES. Proportionate doses for different ages-Description of medicines, alphabetically ar- ranged 637-666 XIII CONTENTS. CHAPTER II. MECHANICAL AGENTS. PAGE. Artificial respiration- Blisters-Cupping- Electricity-Hop fomentations- Magnet- ism-Massage-Mustard plasters-Poultices 667-670 / CHAPTER III. POISONS AND THEIR ANTIDOTES. Poisoning from aconite-Arsenic-Belladonna-Carbolic acid-Chloroform- Coal gas-Gelsemium--Hydrate of chloral-Opium-Poisonous mushrooms- Oxalic acid-Strychnia 671-675 CHAPTER IV. GLOSSARY. Containing a full list of technical terms and their meanings 676-681 INDEX 683-692 IN TROD U CT I ON. "What is the matter with me ? " is a question the physician is daily called upon to answer; and if he fails to answer it to the satisfaction of the questioner, his chances of success in treatment are small indeed. It, therefore, becomes the duty of every physician to carefully examine each symptom of dis- ease and to give a candid opinion of its nature, treatment and probable result. The mystery that has so long hung around everything relating to medicine, and mystified the public mind regarding it, has done much to retard the true advancement of the healing art. It has been almost a sacrilege for the unpro- fessional to attempt to look behind the screen that has hid all knowledge of themselves from view; while to the medicine man of all ages has been ascribed almost superhuman powers. Even at the present day there are very few persons who know anything of the laws of health, and it is not surprising, when we remember that the medical profession has done all in its power to keep the people in ignorance of those laws. In consequence of this ignorance, the slightest indisposition, which is but a natural sequence of violated law, is often suf- ficient to fill the mind of the sufferer with fear, which greatly increases his trouble. Then comes a hurried visit to a physi- cian, and it too often happens that the question, "What is 18 INTRODUCTION. the matter with me?" is answered by the administration of medicine, without any inquiry as to the cause of the derange- ment or instructions regarding the proper mode of life. Many are satisfied with this silence and apparent wisdom of the physician, but the more intelligent are better pleased when the cause and nature of their diseases are explained to them. If this course of instructing patients was more generally adopted by physicians, people would have more confidence in their medical advisers, and all diseases would be more successfully treated than at present. Now, disease and suffering are largely the result of ignorance concerning our own bodies, and these will continue to prevail till they are robbed of their terrors and become unknown through the instrumentality of a widespread general knowledge of our- selves. The highest duty of the true physician is not to diagnose or treat disease, but rather to instruct people how health may be preserved, and make them so familiar with natural laws that they may themselves know what law has been violated when they feel indisposed, and what course they must adopt to restore the system to its normal condition. With this end in view the physician should instruct his patients regarding the structure of the human body, the offices performed by the various organs, the conditions necessary for the healthy action of each part of the body, and the important relations that exist between each organ, or set of organs, and all the others. With even a knowledge of the general outlines of these subjects all could understand something of the laws of hygiene, the proper observance of which, insure health, long life and happiness. Let it be the aim of physicians to impart this knowledge and of the public to acquire it, and the time will not be far distant when the question -'What is the matter with me?" INTRODUCTION. 19 will be no longer asked. Then we will all know just what ^results will follow the violation of each law of our being ; and, knowing this, we become the arbiters of our own health, and our own enlightened judgment will stand guard over our daily lives and prevent us from taking the first step toward disease. We have always advocated the importance of populariz- ing medical knowledge, and have never been asked the ques- tion "What is the matter with me ?" without endeavoring to point out what particular laws of health had been violated, to give rise to the symptoms manifested in the case before us. Whenever we have been able to make our patient understand his own condition we have always had better success in treat- ing his case, for we could then depend upon his carrying out our instructions to the letter, and that is often more important than the administration of medicines. What is true of the individual is equally true of the many. Instruct the people generally concerning medical subjects and they will not only be healthier and stronger, but when they do require the aid of a physician they will not expect him to perform miracles. A knowledge of themselves will enable them to determine what is the matter, and how to restore health before a slightly deranged function is developed into a serious disease. Then the physician becomes the doctor, or teacher, in truth, and the general condition of mankind must be improved. A careful perusal of Part I. of this work will give the reader a general idea of the structure and functions of the human body, and of the- laws regulating health and disease. The proper care and feeding of infants, the rearing and edu- cation of children, the education of the sexes, the social relations of the family and the sexes, the influence of the mind on the body, and other subjects bearing on the physical, moral and intellectual development of mankind, will also be considered in this part of the work. 20 INTRODUCTION A knowledge of these subjects will prepare tbe reader to determine what constitutes health, and to recognize any departure from it. Then a perusal of Part II. will enable him to answer the question, "What is the matter with me?" without calling upon the physician, and in many of the simpler forms of disease the remedy for the cure can be readily selected. Whenever the nature of the disease is such as to require the experience of the physician, the importance of calling him early will be frankly pointed out, and thus much suffering may be avoided. The remedies recommended for the treatment of the various diseases will be found the most recent and valuable known to the profession, and when used, as directed, can be relied on as safe, speedy and efficient in their action. Part III. will contain a brief description of the proper- ties and action of all the medicines spoken of in the work, together with their appropriate doses for all ages. The symptoms of the various kinds of poisoning will also be given, and the most effective means'of antidoting them will be so carefully described that any one who reads may under- stand. In conclusion, a complete glossary of all medical terms will be added, which will give the meanings of the words in the plainest language possible. With this arrangement of subjects it is hoped that every family will be able to find in Everybody's Doctor much valuable information that will aid them in the rearing of their children, in preserving health, and in answering for them- selves the question "What is the matter with me?" CHAPTER I. HOW ARE WE MADE? The importance of the question "How are we made?" cannot be overestimated, and yet very few outside of the medical profession have attempted to understand anything of the intricate and delicate mechanism of the human body. Indeed, until recently it has been considered almost a disgrace to have any knowledge of its structure or functions. Books that would tend to throw light on the subject have been scrupulously withheld from the household as improper reading for the young, while they have been allowed to cram their minds with impractical and absurd ideas by reading tales, stories with morals, and such like trashy literature. Adults as well as children have been content to leave all knowledge of the human body to the doctors, believing it to be entirely beyond their province to attempt to know any- thing of themselves. Happily that day is now passed, and the people are eagerly searching after knowledge in every direction. They are invading the domains of the theologian and scientist, and asking for more light on all subjects per- taining to their mental and physical well-being. In order to supply this demand, scientific subjects should, as far as possible, be stripped of their dry technicalities, and simplified so as to make them intelligible to the general 22 HOW ARE WE MADE ? reader. With this end in view we shall attempt to answer, as briefly as possible, the question: "How are we made ?" The human body is composed of a gieat variety of parts, so arranged as to perform special offices of their own, while they also act in harmony with all the others. The frame work or skeleton, is designed to give support and protection to other parts. The muscles constitute a system of pulleys, which, through their attachment to the bones and their special formation, supply the means of motion to the body as a whole, as well as to the various organs. The digestive apparatus is composed of several distinct organs, all of which are essential for the convertion of food into nutritive material for the support of the system. The circulatory apparatus, composed of the heart, arteries and veins, is employed in carrying nutrition to the various parts of the body and remov- ing some of the waste material. The respiratory organs, the lungs and air passages, purify the blood and supply it with the oxygen required to keep up the normal action of the various tissues. The organs of excretion, such as the kidneys, sweat glands, etc., remove the effete material that can no longer be used in the body. The brain and nerves act as a complex electrical apparatus, with the brain representing the battery and the nerves the electric or telegraphic wires, which together regulate and control the action of all the other parts of the body. To these we have yet to add the organs of the special senses, as the eye, ear, nose, tongue and skin, through means of which we enjoy our relations with the outer world. A brief description of these several structures is essential to enable the non-professional reader to acquire even a general knowledge of the rudiments of human anatomy THE SKELETON. The skeleton, or framework of the body, is made up of a series of bones, varying in size and shape, according to their location and office, and bound together by fibrous bands, called ligaments, as shown in Fig. I. THE SKELETON. 23 Fig. i. 24 HOW ARE WE MADE? Fig. i.-Front View of Skeleton. I, frontal bone ; 2, wing of sphenoid ; 3, nasal bones ; 4, occipital; 5, orbit of the eye ; 6, malar ; 7, 7, superior and inferior maxillary ; 8, vomer ; 9, cervicle vertebrae ; 10, clavicle, or collar-bone; 11, scapula, or shoulder-blade ; 12, sternum, or breast-bone; 13, ribs ; 14, 14, dorsal and lumbar vertebrae; 15, 15, ossa innomi- nata, or haunch bones ; 16, sac- rum ; 17, humerus : 18, radius ; 19, ulna ; 20, carpus, or wrist bones ; 21, metacarpal; 22, pha- langes ; 23, femur ; 24. patella, or knee-cap ; 25, fibula : 26, tibia ; 27, os calcis, or heel bone ; 28, tarsus, or ankle; 29, meta- tarsal ; 30, phalanges. Fig. 2.-Side View of Skeleton. I, frontal bone ; 2, parietal; 3, tem- poral ; 4, superior maxillary, or upper jaw ; 5, malar, or cheek- bone ; 6, lachrymal; 7, inferior maxillary, or lower jaw; 8, nasal; 9, cervicle vertebras ; 10, dorsal vertebras ; 11, lumbar ver- tebras ; 12, sacrum ; 13, coccyx ; 14, sternum; 15, 15, ribs ; 15a, cartilages that unite ribs to ster- num ; 16, ossa innominata or haunch bones; 17, clavicle, or collar-bone; 18, scapula, or shoulder-blade ; 19, humerus, or arm ; 20, radius ; 21, ulna ; 22, carpus, or wrist bones ; 23, meta- carpus, or palm of hand ; 24, 24, phalanges, or finger bones ; 25, femur, or thigh bone ; 26, tibia, or shin bone ; 27, fibula ; 28, patella, or knee cap; 29, 29, tarsus, or ankle bones ; 30, meta- tarsus, or foot bones; 31, 31, phalanges, or toe bones. Fig. 2. THE HEAD. 25 There are 200 separate bones in the skeleton, without including the teeth and the three small bones in each ear. These are divided into the head, trunk, upper and lower extremities. The head has 22 bones; the trunk, 52; the upper extremities, 64; and the lower extremities 62. The Head.-The bones of the head are divided into those of the cranium or skull, and those of the face; 8 entering into the formation of the skull, and 14 in the face. In infancy and childhood the bones of the skull are sepa- rate and distinct, but in the adult they become solidified so as to form a strong, solid case, for the protection of the brain against external injuries. These bones have been named according to their shape and location, as follows: the occipital,* two parietal;\ frontal,\ two ternporal,§ s phenoid\\ and ethmoid.^ Fig. 3.-Side View of Skull, With Bones Separated. I, frontal bone ; 2, parietal; 3, occipital; 4, temporal; 5, nasal; 6, malar, or cheek- bone ; 7, superior maxil- lary, or upper jaw; 8, lachrymal; 9, inferior max- illary, or lower jaw. The occipital bone (3, Fig. 3.) forms the back part and base of the skull. It is irregularly four sided in shape, convex on its outer, and concave on its inner surface. The transverse ridges and intervening spaces on the external surface, give attachment to muscles, and the smooth surface above the upper ridge is covered by the large muscle that moves the Fig- 3- * Occipital-belonging to the back of the head. \ Parietal-belonging to the side of the head. ^Frontal-belonging to front of head. § Temporal-from tempus, time ; because it marks the place where the hair first turns gray. ^Sphenoid-wedge-like. V Ethmoid-sieve-like. 26 HOW AKE WE MADE? scalp. The large opening in the lower and front part of the bone is called the foramen magnum, or great opening, and gives passage to the upper part of the spinal cord and the membranes that cover it. On either side of this opening are to be seen two smooth processes, called the condyles, which articulate with the first bone of the spine, so as to give the nodding motion to the head. The inner surface is marked with numerous elevations and depressions, which correspond with similar ones on the surface of the brain. The parietal bones (2, Figs. 3 and 4.) form the sides and top of the skull. They are four sided, convex externally and covered by muscles, and concave internally and marked like the occipital, with elevations and depressions. 'Vhe frontal bone (3, Figs. 3, and 4.) occupies the front of the skull, forming the forehead, and parts of the cavities of the nose and orbits of the eyes. The temporal bones (4, Fig. 3, and 3, Fig. 4.) form part of the sides and base of the skull. They are divided into three parts, called the squamous * mastoid^ and petrous\ portions. These bones are very irregular in shape, and present a large number of elevations, depressions and projections, which are minutely described for the student of anatomy. The broad expansion commonly known as the ear, and numerous muscles, are attached to their external surfaces. The special organs of hearing, which will be described under the heading of "The Ear and its Diseases," are situated in the interior of the petrous portions of the temporal bones, and are thus protected against external injuries. The interior surfaces of these bones form part of the cavity of the skull, which lodges the brain. The sphenoid bone (4, Fig. 4.) is of irregular shape, and is described as resembling a bat with the wings extended. It forms the central portion of the base of the skull, and the wings extend upward on the sides, in front of the sqicamous portions of the temporal bones. It received its name from a Greek word which means a wedge, and was so called because * Squamous-like a scale, f Mastoid-like a nipple. \Petrous-hard, like a stone. THE HEAD. 27 it articulated with all the other bones of the skull and bound them together. The ethmoid bone (5, Fig. 4.) is situated in the front part of the base of the skull, just behind the upper part of the nose. It is cuboidal in shape, and is perforated by a large number of small holes which give passage to the filaments of the special nerves of smell. It forms the upper parts of the cavities of the nose, parts of the inner boun- daries of the orbits of the eyes, and a part of the base of the cavity of the skull. Fig. 4. -Front and Side View of Head. 1, frontal bone; 2, parietal; 3, temporal; 4, sphenoid; 5, part of ethmoid, forming wall of orbit; 6, superior maxillary, or upper jaw; 7, malar, or cheek-bone ; 8, lachrymal; 9, nasal; 10, inferior maxillary, or lower jaw. In early life the bones of the face are also separated, but in the adult they become united with the bones of the skull and with each other, so as to form the solid bony structure which we speak of as the head. The bones of the face are named as follows : the two nasal* two lachrymal, two malar, two superior maxillary, two inferior turbinated, two palate, vomer and inferior maxillary. The nasal bones (5, Fig. 3, and 9, Fig. 4.) are two, small, four-sided bones, which together form the bridge of the nose. To their lower borders pieces of cartilage are attached, which complete the frame-work of the nose. The lachrymal bones (8, Figs. 3, and 4.) are two small plates of bone situated exterior to the nasal bones, and at the inner angles of the orbits of the eyes. By their union with processes *For definitions of these words see Glossary. 28 HOW ARE WE MADE ? of the upper maxillary bones they form canals, called the lachrymal canals, which give passage to the ducts that convey the tears from the eyes to the cavity of the nose. The malar bones (6, Fig. 3, and 7, Fig. 4.) are irregularly quadrangular in shape, and form the prominences of the cheeks, and parts of the orbits of the eyes. The superior maxillary bones (7, Fig. 3, and 6, Fig. 4.) are irregular in shape, and together form the upper jaw. Their under margins present well marked cavities which contain the upper teeth. The nasal processes of these bones complete the formation of the nose, and the horizontal plates, called the palatine processes, form the roof of the mouth. They also assist in forming the cavities of the nose and orbits of the eyes. The inferior turbinated bones are two, scroll-like bones, situated in the nasal cavities, the object of which seems to be, to give a greater surface of mucous membrane to which the filaments of the nerves of smell may be distributed. The palate bones complete the formation of the roof of the mouth, give attachment to the soft palate, and enter into the formation of the cavities of the orbits and nose. The vomer is a thin plate of bone, which, with the carti- lage attached to its anterior margin, forms the partition divid- ing the nose into two cavities. The inferior maxillary bone (9, Fig. 3, and 10, Fig. 4.) forms the lower jaw. It contains large cavities for the reception of the lower teeth, and has attached to it, powerful muscles, which give it the motions necessary for speaking and eating. The bones of the head, taken together, are so arranged as to provide bony cavities for the protection of important organs, which might be easily injured by external violence. Thus the cavity of the skull provides a case for the brain, the orbital cavities lodge and protect the eyes, the mouth pro- tects the special nerves of taste, the nasal cavities supply an accessible and secure lodgment for the nerves of smell, while the organs of hearing are imbedded in the temporal bone. The lines that mark the points of union of the several bones of the head are called suturesf and these have been * Suture, a seam. THE TRUNK. 29 separately named from Greek and Latin words, which indicate their fancied resemblance to different objects. The Teeth.-Although the teeth are not enumerated among the bones of the body, yet in a true sense they belong to the osseous system. Human beings are provided with two sets of teeth, the decidtious, or milk teeth, and the permanent teeth. At birth the teeth are undeveloped, but during the first two years of childhood 20 temporary teeth are developed. Of these, 8 are incisors, or cutting teeth, 4 canine, or dog teeth, and 8 molars, or grinders. Between the sixth and seventh year, the child begins to lose the first teeth, and by the twelfth or thirteenth year the permanent teeth have taken their place. The last molars, however, do not appear till the eighteenth or twenty-first year, and sometimes one of them may not appear till several years later. It is this fact that has given to these last, the name "wisdom teeth." The Trunk.-The trunk is composed of the spine, the ribs, the sternum or breast-bone, and the hyoid or tongue-bone. There are 26 bones in the spine, 24 ribs, 1 sternum and 1 hyoid bone. The trunk, as a whole, is repre- sented in Fig. 5. The collar-bone and shoulder-blade are seen in posi- tion above, so as to show the point of attachment for the upper extrem- ity; while the broad expansion of bone forming the lower part of the illustration, called the haunch bone, does not belong to the trunk, but shows the point of attachment of the lower ex- tremity. 30 HOW ARE WE MADE? The Spine.-The spine, or back bone, is a long flexuous and, flexible column, formed of a series of bones, placed one upon the other, called vertebrae.* (See Fig. 6.) The vertebrae are 33 in number, in early life, and have been divided into five regions, which have received the names, cervical, dorsal, lumbar, sacral and coccy- geal. The cervical region has 7 bones ; the dorsal, 12 ; the lumbar, 5; the sacral, 5; and the coccygeal, 4. In adult life the bones of the sacrum and coccyx become united so as to form only two bones. This has caused them to be spoken of as false vertebrae. This union of the lower seg- ments gives us 26 bones in the spine, which enumeration is the one used by anatomists. Each vertebra has an anterior solid segment or body, and a posterior segment or arch. These are united so as to provide processes for articulation with the other vertebrae, and for the attachment of mus- cles, and they inclose a large opening, called the vertebral foramen. Fig. 6.-Vertebral Column, or Spine. i , two semi-facets, which make a complete facet for articu- lation with head of rib ; 2, spinous process, or poster- ior projection ; 3, 4, two foramina, formed by union of intervertebral notches; 5, cervicle region; 6, dorsal region ; 7, lumbar region ; below dotted line of 7, sac- rum and coccyx. Fig- * Vertebra-from the Latin vertere, to turn. The bones of the spine were so named because of the great degree of motion of which the spinal column was capable. THE TRUNK. 31 Fig. 7 represents a cervical verte- bra, which gives a good idea of the gen- eral appearance of these bones : I, represents the body of the bone ; 2, the vertebral foramen ; 3, the point of junction of the body and arch, called the pedicle ; 4, the spinous process, for the attachment of muscles; 5, the transverse pro- cesses, also for the attachment of muscles ; 7, the surfaces of articulation with the next vertebra. Fig- 7- In each of the vertebrae, above and below the pedicle, (3 Fig. 7.) there are notches, called the superior and inferior inter-vertebral notches. When the bones are in place, as in Fig. 5, these notches are converted into foramina or canals, (3 and 4, Fig. 6.) which give passage to nerves from the spinal cord, to be distributed to the various parts of the body. Figs. 8 and 9, represent the lower and upper surfaces of the first cervical vertebra, called the atlas, because it supports the head. It differs from the other verte- tebrae in having no body and no spinous process. It has two lateral masses of bone on which are situated the superior articular surfaces, wiiicii support the head and give it the nodding motion. The second cervical vertebra is called the axis, because it has a prominent projec- tion extending upward from the body, which articulates with the atlas and gives the ro- tary or turning motion to the head. This process, marked 2 in Fig. 10, is called the odontoid process, from its fancied resem- blance to a tooth. The dorsal vertebrae are marked on their bodies and transverse processes by small depressions, (1, Fig. 6.) for their articulation with the ribs • and the lumbar vertebrae are large Fig. 8. Fig. g. Fig. io. 32 HOW ARE WE MADE? and solid so as to give proper support to all the upper part ot the body. Between the bodies of all these bones, in the living sub- ject, we find thick cushions of elastic cartilage, like india- rubber, which serve to protect the bones from striking each other, and at the same time allow of the free movements of the spine. The sacrum and coccyx, though part of the spine, are best described as parts of the pelvis, or basin. The Rihs and Sternum.-The ribs and sternum are seen from the front in Fig. 11. The ribs are 24 in number-12 on each side-and are divided into the true and false ribs. They are all attached directly to the vertebrae behind, and seven of them are separately united to the breast bone by means of bands of cartilage, or gristle. These are called the true ribs. The remaining five are called the false ribs, three being united to the breast bone by a single cartilage, while two are not con- nected in front, and are hence called floating ribs. The ribs are flat, and curved like a broken hoop, and with the breast bone and dorsal vertebrae, form the thorax or chest, which contains the heart, lungs and large blood vessels. The ribs are capable of considerable motion, while at the same time they afford valuable protection to the important organs contained in the thorax. The sternum, or breast bone, is a flat spongy bone which completes the formation of the thorax in front. The hyoid bone is situated in the upper and front part of the neck, and is entirely separate from the other bones. It gives attachment to a number of muscles of the neck and Fig. n. THE UPPER EXTREMITIES. 33 tongue, and is sometimes called the tongue-bone. It received its name from its fancied resemblance to the Greek letter u. The Upper Extremities.-The upper extremities are the long jointed appendages which are connected with the upper part of the trunk, and commonly called the arms. To- gether they contain 64 bones, 32 on each side ; and these are divided into the shoulder, arm, forearm, zvrist and hand. The shoulder is composed of two bones, the clavicle or collar-bone, (10, Fig. I.) and the scapula or shoulder-blade, (11, Fig. 1 and Fig. 2.) By means of ligaments and mus- cles these bones unite the upper extremities to the thorax, and form the prominence of the shoulder. The arm Contains only one bone, the humerus, (17, Fig. 1.) which is the largest bone in the upper extremity. Its upper end articulates with the shoulder-blade, so as to form the shoulder joint, and its lower end unites with the bones of the forearm, thus forming the elbow joint. The shaft of this bone is surrounded by muscles, and serves as a lever to facilitate their motion. The forearm has 2 bones, the ulna and radius, (12 and 13, Fig. 1.) which extend from the elbow to the wrist. In addi- tion to entering into the formation of the elbow joint, they articulate with the carpal bones, to form the wrist joint, and with each other, at both extremities, in such a way as to admit of the rotary motion of the hand The ulna forms the greater part of the elbow joint, as the radius does not touch the humerus till the forearm is well bent on the arm. On the other hand the lower extremity of the radius is expanded, so as to form the most of the wrist joint. At the lower ends of these bones are two prominent projections called the styloid processes, which are readily seen when the wrist is rested with the dorsal surface upward. In the rotary motion of the hand, the radius is twisted over the zdna when the hand is turned inward on the palm, and when the thumb is held up, the bones are parallel. 34 HOW ARE WE MADE? The wrist has 8 small, solid bones, bound together by liga- ments, in such a manner as to give great freedom of motion, as well as strength, to the wrist. They arc called carpal or wrist bones, and are separately named by anatomists, according to their shape. They arc represented in Fig. 12 by the num- bers 1, 2, 3, 4, 5, 6, 7, 8, and are shown as separated from the ulna and radius. The hand contains 19 bones, 5 entering into the formation of the palm, and 14 in the fingers and thumb. The bones in the palm, marked 9, 10, 11, 12, 13, in Fig. 12, are called metacarpal, (next to the the wrist), and those forming the fingers are named phalanges, three of which enter into the formation of each finger, and two into that of the thumb. The Lower Extremities.-The lower extremities are united to the lower end of the spine by means of the ossa in- nominata or nameless bones. These 2 bones, which are also called the haunch bones, correspond with the shoulder bones of the upper extremities. They are of irregular shape, unit- ing with the sacrum behind, and with each other in front, to form a large cavity called the pelvis or basin, which will be described hereafter. The lower extremity is divided into the hip, thigh, leg, ankle and foot-, 1 bone entering into the formation of the hip, 1 in the thigh, 3 in the leg, 7 in the ankle and 19 in the foot. The Hip.-The hip is formed by the haunch bone, (15, Fig. 1.) on the external surface of which is found a deep cavity into which the head of the thigh bone fits to form the hip joint. Fig. Jr2.- Wrist and Hand. THE LOWER EXTREMITIES. 35 The Thigh.-The thigh contains but one bone, called the femur, the longest and largest in the body. It has a prominent rounded head, which forms the hip joint by its articulation with the cavity in the haunch bone. The lower end of this bone has two large prominences, called condyles, which rest upon the large bone of the leg, to form the knee joint. The entire length of this bone is covered by strong and massive muscles, which are essential for the movements required in walking. The Leg.-The leg has three bones, the tibia, (26, Fig. I.) fibula,Fig. I.) and patella, (24, Fig. 1.) or knee-cap. The tibia is the largest, and gives the main support to the body, as it, alone, enters into the formation of the knee joint, and forms the greater portion of the ankle joint. The fibula is a long, slender bone, running parallel with the tibia, and external to it. It forms the external part of the ankle joint. The patella or knee-cap, is developed in the tendon of a large muscle, and is not directly connected with the other bones. It is classed with them, however, in consequence of its form- ing the apex of the knee, and being very essential to the movements of the leg. The Ankle.-The ankle is situated next to the tibia and fibula, and is made up of 7 short, irregular bones, called the tarsus. They are represented in Fig. 13 by the num- bers 1, 2, 3, 4, 5,6, 7, and constitute a consid- erable portion of what is commonly known as the foot. Like the bones of the wrist they are separately named by anatomists. The Foot.-The foot is made up of 19 bones, 5 metatarsal, (next to the tarsus') and 14 phalanges, in the toes. It comprises all those bones anterior to the tarsus, as seen in Fig- 13- Fig. ij.-Ankle and Foot. HOW ARE WE MADE? 36 The Pelvis.-The pelvis is the name given to the broad expansion of bone that connects the lower extremities to the trunk. It is so called from its resem- blance to a basin, and is formed by the two ossa innominata, or nameless bones, (sometimes called the haunch bones) which form the sides and front, and the sacrum and coccyx, which complete it behind. Fig. 14. Fig. 14.-Front View of Pelvis. 1, the last lumbar vertebra ; 2, 2, the intervertebral cartilages, not before shown ; 3, (faintly marked immediately under 2), promontory, or angle of the sacrum; 4, anterior surface of sacrum; 5, extremity of coccyx; 6, the ilium; 7 and 8, pro- jections on ilium, called anterior superior, and inferior spinous processes, for the at- tachment of muscles; 9, the acetabulum; b, body of ischium; c, tuberosity, or low- est part of ischium; d, spine, or backward projection of ischium; e, the pubes; f, point of union of two pubic bones; g, arch of pubes; i, spine of pubes; k, k, pecti neal line; 1, 1, the ilio-pectineal line; m, m, its prolongation to angle of sacrum; h, i, k, k, 1, 1, m, m, the brim of true pelvis; n, ilio-pectineal eminence; o, the point over which the femoral vessels pass; p, p, the ischatic notch. The nameless or haunch bones are irregular in shape, and are divided into three parts: The ilium* is chiurn^ and pubes. | The ilium (6, Fig. 14.) is the broad, twisted portion of the bone, which forms the lateral bounderies of the basin. The ischium (b. c. Fig. 14.) forms the lowest part of the pelvis, and is the part on which the body rests while in the sitting posture. The pubes (e. Fig. 14.) forms the front of the pel- * Ilium, from a Greek word meaning to twist, so named on account of its shape. \Ischium, from a Greek word meaning to support. \Pubes, so called because it is covered with hair. JOINTS AND LIGAMENTS. 37 vis, and the two lateral halves complete the formation of what is called the pubic arch, (g. Fig. 14.) in front. At the point of union of these three sections of the haunch bone, on the exterior surface, is the deep cavity called the acetabulum (9, Fig. 14.) which receives the head of the thigh bone, to form the hip joint. The sacrum (4, Fig. 14.) is a large triangular bone, situated at the lower part of the spine. In early life it is divided into five pieces, but these become united into one bone in the adult. Its upper border unites with the last lumbar vertebra, its sides join the haunch bones, and its lower border has the coccyx attached to it. The coccyx is the terminal bone of the spinal column, and is attached to the sacrum in such a manner as to be capa- ble of being moved backwards. The basin formed by these bones has a special signifi- cance in consequence of its containing the female generative organs, and giving passage to the child during labor. It is divided into the true and false pelvis, by a well marked line, the ilio-pectineal line, marked in Fig. 14 by the letters, h, i, k, k, 1, 1, m, m. The false pelvis is all that portion above this line, while the true pelvis is the portion below the line, and surrounded by the bony ring. The space included within the pectineal line is called the inlet, while the irregular inferior circumference is called the outlet. These openings are larger in the female than the male, and in a well developed woman the shortest distance across either, from before backward, should be four inches. During labor the coccyx may be pushed backward, thus increasing the antero-posterior diameter to five inches. Joints and Ligaments.-The points where the bones connect with each other to form the complete skeleton, are called joints or articulations. These are divided into three classes, viz.: Synarthrosis, or immovable; Amphiarthrosis, or mixed ; and Diarthrosis, or movable joints. lu the immovable joints, as those between the bones of the skull and most of the bones of the face, the margins are almost in direct contact. Sometimes a thin, fibrous mem- HOW ARE WE MADE? 38 brane, or a thin layer of cartilage is interposed between the articular surfaces of the bones. Even these, however, lose their characteristics in advanced life, and a complete bony union is formed. In the mixed joints, where slight motion and great strength are required, a layer of tough, elastic, fibro-cartilage, like india-rubber, is interposed between the surfaces of the bones. These are most marked between the bones of the spine, in which the backward, forward and lateral motions of the body are made possible, by means of the elasticity of the inter-vertebral cartilages. Similar motions occur between the ribs, and the vertebrae and sternum, during respiration. These joints are held in position by means of firm fibrous bands, called ligaments. The movable joints, as those of the extremities and lower jaw, differ from the others in important particulars. The bones forming these articulations are usually expanded so as to form broader surfaces, which are covered by smooth, semi- elastic layers, called cartilages. These are in turn provided with a thin covering, the synovial membrane, which secretes a fluid to lubricate the joint. The bones forming the joints are firmly bound together by means of capsules, or investing membranes of fibrous tissue, called ligaments. The ligaments are bundles of white, fibrous tissue, closely interlaced with each other so as to form pliant and flexible bands. These connect the articular extremities of bones to- gether, in such a manner as to give strength, and at the same time admit of great freedom of motion of the joints. It will thus be seen that the joints are made up of bone, cartilage, fibro-cartilage, ligament and synovial membrane. These tissues are all important, as they are often involved in the various diseases to which the joints are liable. The movable joints receive different names according to their characteristics. Thus, joints having a gliding motion, as the articular process of the vertebrae, the carpal bones, the carpo-metacarpal articulation, &c., ar'e called arthrodia', those that are capable of moving in all directions, like the hip STRUCTURE AND DEVELOPMENT OE THE BONE. 39 and shoulder, are called enarthrosis, or "ball and socket" joint; joints like the elbow, knee, and ankle, are named gin- glymus, or hinge joints ; while joints that are limited to a rotary motion, as the upper ulno-radial articulation, and that on the axis, which gives the rotary motion to the head, are named diarthrosis rotatorius, or lateral hinge joints. The ligaments of the several joints are arranged in bands running in different directions. These have all received sepa- rate names, which are not essential for a knowledge of the outlines of anatomy. Structure and Development of Bone.-With the exception of the enamel of the teeth, bone is the hardest structure of the body. It is made up of spongy material, re- sembling lattice-work, covered by a dense compact texture. During life its color is of a pinkish white, externally, and a deep red within; but in the dried state it is white, or yellowish white. It is covered by a fibrous membrane called the perios- ieum* which surrounds it like the bark of a tree, and which is as essential to the life of the bone as the bark is to that of the tree. It is principally through this membrane that the blood is conveyed to the numerous little blood vessels that penetrate the bone in every direction. The long bones have cylindrical canals, called the medul- lary canals, running the whole length of the interior of the bones, which are filled, during life, with a substance called marrow. The material which connects the ribs to the sternum, and covers the articular surfaces of the bones, is less hard and dense than the bony texture, and is called cartilage. Before the birth of a child the greater part of the skeleton is made up of this material; but as it is afterward replaced by bone, it is here called temporary cartilage. This cartilaginous condition of the foetal skeleton does not change at birth ; but the process of ossification goes on gradually for years, and is often not completed till after the twenty-first year of life. * Periosteum-the covering or bark of the bone, meaning, "around the bone." HOW ARE WE MADE? 40 Chemists have made careful analyses of bone, to ascertain its exact composition. The average results of these examin- ations give about 33.3 per cent, of organic, or animal matter, and 66.6 per cent, of inorganic, or earthy matter, distributed as follows : Organic Matter. Gelatin and Blood-vessels, 33.3° Inorganic or Earthy Matter. ' Phosphate of lime, 51.04 Carbonate of lime, 11.30 Fluoride of calcium, 2.00 Phosphate of magnesia, 1.16 Soda and chloride of sodium, 1.20 100.00 The proportions of these constituents differ at various periods of life, and under different circumstances. In young children there is a larger proportion of organic, or animal matter, while in the very old the earthy matter predominates. In rickety subjects we also find a large excess of the animal over the earthy material. THE MUSCULAR SYSTEM. It is through the agency of the muscles that all the motions of the body are performed. They constitute the greater portion of the soft tissues, and are known in all animals as "the flesh."- Through their power of contraction and their attachment to the different parts of the skeleton, they cause the bones to move upon each other at the joints, and at the same time move the body from place to place, thus constitut- ing organs of locomotion as well as motion. Muscular fibres also enter into the formation of various internal organs, and it is through the means of their contractile power that organic action is kept up. These muscles, however, differ from those attached to the bones, and this difference has led to their division into voluntary and involuntary muscles. The voluntary muscles, also called muscles of animal life, are capable of being put in action and controlled by the will. They are formed of bundles of fibres inclosed in a thin sheath. Each large bundle is made up of numerous small bundles. THE MUSCULAR SYSTEM. 41 similarly inclosed, while the small ones are composed of single fibres or threads. The delicate texture of these fibres may be understood when it is known that it requires 18,000 of them, placed side by side, to measure one inch. These prim- itive fibres are composed of little rounded bodies joined together like a string of beads. These bodies are little cells, which contain in themselves all the elements of living bodies, and the contractile power of the muscles are due to the lat- eral changes these cells undergo, under the influence of cer- tain irritations. All muscles under the control of the will are formed in this way, and the brain, through the agency of the nerves, supplies the stimulus to the cells of the primitive fibres, thus causing them to change their shape. This change affects the entire mass of cells, and thus the contraction of the whole muscle is produced. The muscles are connected to the bones, cartilages, liga- ments, and skin, by means of non-contractile fibrous tissues called tendons. These tendons are usually found at each end, while the fleshy, contractile part is situated in the middle. Muscles differ in size and shape, and many of them are named entirely or in part, so as to indicate the same. The location, the direction in which the fibres run, their uses, and points of attachment, also serve to give their names to*special muscles. In describing muscles, the most fixed point is called the origin, and the movable point on which the power of the muscle acts, is called the insertion. The involuntary muscles, or those of inorganic life, are not under the control of the will. They contract slowly, in a part of their extent, and then the contraction travels along the course- of the fibres. These muscles are found in the walls of the hollow organs of the body, as the intestinal canal , the bloodvessels, the iris, the womb, &c., and their continued action is essential to life. The fibres of these muscles interlace in various directions so as to form flattened bands, which often appear homogeneous. 42 HOW ARE WE MADE? The bands thus formed constitute a part of the organs in which they are developed. There are in all about 400 muscles in the human body, and these are divided into regions, or groups, to render their description more easy. A careful examination of the muscles will show that one muscle, or set of muscles, are opposed by another ; thus, one set of muscles close the hand, and another set open it; one muscle closes the eye, and another opens it; one set bend the head forward, and another carry it backward. Each lateral half of the body is provided with muscles exactly alike ; so when a muscle is spoken of by name, in the singular, though it refers to but one side, it will be understood as applying equally to both. Minute descriptions of the muscles are impossible in a volume like this, therefore, we are obliged to be content with a brief mention of those of the several regions. By studying the reference to Figs. 15, 16 and 17, the reader will be able to learn the names of many of the muscles, and also to locate them. As far as possible the common English names are given, but where this is not practical, the meanings of the words can be found in the glossary. Fig. 15.-Front View of Muscles. 1. occipito-frontalis, or scalp muscle; 2, orbicularis palpebrarum, or ring muscle of the eye; 3, elevator of the angle of the mouth and side of the nose; 4, elevator of the upper lip; 5, zygomatic; 6, masseter, or chewing muscle; 7, orbicularis oris, 01 ring muscle of the mouth; 8, levator menti, or elevator of the chin; 9, platysma myoides; 10, deltoid, or shoulder muscle; 11, pectoralis major, or great breast muscle; 12, latissimus dorsi, or broadest muscle of the back; 13, serratus magnus, or large serrated muscle; 14, biceps, or two-headed; 15, brachialis anticus, or front arm muscle; 16, long supinator; 17, pronator radii teres; 18, long extensor of radial side of the wrist; 19, extensor of the metacarpal bone of the thumb; 20, annular, or round ligament that binds the tendons together at the wrist; 21, tendons of the muscles that flex or close the fingers; 22, oblique abdominal; 23, rectus, or straight abdominal; 24, tensor vaginas femoris; 25, pectineus; 26, great psoas; 27, long ab- ductor; 28, sartorius, or tailor's muscle; 29, rectus femoris; 30, vastus externus, or large external muscle; 31, vastus internus; 32, ligament of patella; 33, gastrocne- mius; 34, tibialis anticus, or front tibial muscle; 35, inner surface of shin-bone; 36, the flexor tendons of the toes. FRONT VIEW OF THE MUSCLES. 43 Fig. M- 44 770 W ARE WE MADE? Fig. 16.-Front and Side View of Muscles. A, forehead; B, side of head; C, cheek; D, chin; E, position of clavicle or collar-bone; F, position of sternum, or breast- bone ; G, position of hyoid or tongue-bone; H, elbow; K, wrist; L, fingers; M, junction of fingers with hand; N, crest of ilium or upper boundary of haunch bone; 0, knee- cap; P, lower extremity of femur; Q, upper ex- tremity of tibia; R, semi- lunar cartilage separat- ing femur and tibia in knee joint; S, ligament of patella; T, point of in- sertion of posterior mus- cles of thigh; U, inser- tion of ligament of pa- tella; V, lower end of fibula; W and X, parts of annular ligament; Y, short extensor tendons of toes; Z, union of toes with foot. I, occipito-frontalis muscle ; 2, elevator of the ear; 4, orbicularis palpebrarum, or ring muscle of the eye; 5, temporal muscle; 6, large zygomatic; 7 small zygomatic; 8, ele- vator of upper lip; 9, ele- vator of upper lip and angle of the nose; 10, pyramidalis nasi; 11, elevator of the angle of the mouth ; 12, orbicu- laris oris; 13, buccinator; 14, depressor of the an- gle of the mouth; 15, de- pressor of lower lip; 16, Fig. ib. BACK VIEW OF MUSCLES. 45 Fig. 17. 46 HO W ARE WE MADE ? masseter; 17, sterno-cleido mastoid; 18, sterno-hyoid; 19, sterno-thyroid; 20, thyro-hyoid; 21, omo-hyoid; 22, dygastric; 23, scalenus anticus; 24, scalenuspor- ticus; 25, elevator of the scapula; 26, splenius; 27, trapezius; 28, great pectoral; 29, seratus magnus; 30, external abdominal muscle; 31, straight abdominal mus- cle; 32, aponeurosis; 33, a digit of seratus magnus; 34, latissimus dorsi, or broad- est muscle of the back; 35, deltoid, or shoulder muscle; 36, biceps; 37, corico- brachialis; 38, brachialis anticus; 39, triceps, or three-headed muscle; 40, prona- tor radii teres; 41, flexor carpi radialis; 42, palmaris longus; 43, flexor sublimis digitorum; 44, flexor carpi ulnaris; 45, flexor longus pollicis; 46, supinator longus 47, long radial extensor of the wrist; 48, short radial extensor of the wrist; 49, common extensor of the fingers; 50, extensor of little finger; 51, ulnar extensor of the wrist; 52, extensor of the metacarpal bone of the thumb; 53, extensor of the first phalanx of the thumb; 54, extensor of the second phalanx of the thumb; 55, extensor of the index finger; 56, adductor of the thumb; 57, flexor tendons of fingers; 58, lumbricales; 59, abductor of the thumb; 60, short flexor of the thumb; 61, abductor of little finger; 62, short flexor of little finger; 63, inter-os- seus; 64, large gluteal, or ham muscle; 65, lesser gluteal muscle; 66, tensor of fascia of thigh; 67, sartonus, or tailor's muscle; 68, rectus, or straight femoral; 69, iliacus; 7°, great psoas; 71, pectineus; 72, adductor longus; 73, adductor mag- nus; 74, gracilis; 75, inner ham string; 76, vastus internus; 77, vastus externus; 78, biceps; 79, tibialis anticus; "So, long extensor of the toes; 81, proper extensor of the great toe; 82, peroneus tertius; 83, peroneus longus; 84, the peroneus bre- vis; 85, soleus; 85a, gastrocnemius; 86, plantaris; 87, flexor longus digitorum; 88, tibialis posticus; 89, long flexor of the great toe; 90, flexor brevis digitorum; 91, abductor of the little toe; 92 and 93, extensor tendons of the toes. Fig. 17.-Back View of Muscles. I, temporal muscle; 2, posterior part of occipito-frontalis;, or scalp muscle; 3, trape- zius; 4, spleen-like muscle of the head and neck; 5, digastric, or two-bellied mus- cle; 6, back view of sterno-cleido-mastoid; 7, central portion of trapezius; 8, del- toid; 9, infra-spinatus; 11, teres minor; 12, major; 13, 14, 15, the three parts of triceps; 16, the long supinator; 17, common extensor of the fingers; 18, extensor of the thumb; 19, tendons of the extensors of the fingers; 20, anchoneus; 21, the ulnar extensor of the wrist; 22, extensor of little finger; 23, extensor of index finger; 24, latissimus dorsi, or largest muscle of the back; 25, 26, aponeurosis of latissimus dorsi; 27, the medium gluteus; 28, the largest gluteus, or ham muscle; 29, biceps; 30, adductor magnus; 31, soleus; 32, gastrocnemius; 33, tendo Achillis. Muscles of the Head and Face.-The muscles of the head and face, by their varied motions and degrees of development, give expression to each individual and make it impossible for any two persons to look exactly alike. A large muscle, which covers the entire front and top of skull, moves the scalp, and throws the skin of the forehead MUSCLES OF THE NECK. 47 into transverse wrinkles, while two small ones, just above the inner angles of the eyes, draw the eye-brows downward and inward, and produce vertical wrinkles in the forehead. One circular muscle forms the eye-lids and closes them to protect the eye, another muscle raises the upper lid in "opening the eyes," and six muscles are necessary to give the ball of the eye its motions. One ring-like muscle surrounds the mouth, and closes the lips tightly, in a circular manner, as in puckering the lips to whistle. Other small muscles raise the upper lip, draw the angle of the mouth upward and down- ward, depress the lower lip, elevate the side of the nose, move the lower jaw, and produce the several movements of the face, the rapid changes of which constitute what is called facial ex- pression. Muscles of the Neck.-The muscles of the neck are numerous and complicated. Those in front are rendered more complicated by the position of the hyoid, or tongue-bone, to which a number of the muscles are attached. These muscles extend from the breast-bone, collar-bone, and shoulder blade, upward to the head, but some of them attach themselves to the hyoid bone, while smaller muscles extend from that upward. The front muscles of the neck bend the head forward, draw down the lower jaw, and thus open the mouth, and aid in moving the organs of speech and in swallowing. The side mus- cles of the neck bend the head to the side, when those on one side act singly, and rotate the head on the spine. When both sides act together, they aid in fixing the head in the erect po- sition. The muscles in the back of the neck, draw the head backward, raise the shoulders, and fix the head. Muscles of the Trunk.-The muscles of the trunk are those that cover the front, sides, and back of the thorax, or chest, and those that form the walls of the abdomen. There are also some internal muscles that properly belong to the trunk. The breast muscles cover the upper and anterior part of the thorax. The pectoralis major, (n, Fig. 15.) or great 48 HOW ARE WE MADE? breast muscle, has an extensive attachment to the ribs, sternum and collar-bone, and is inserted into the upper part of the humerus, or arm bone. It draws the arm forward, across the body, toward the opposite side, and when it acts with the latissimus dorsi, (24, 25, Fig. 17.) the arm is drawn close to the side. The mammary gland, or breast, is situated over this muscle, between it and the integument. The muscles on the side serve in moving the ribs during respiration. The muscles of the back are very numerous, They all arise from the bones of the spine, and aid in supporting the body in the erect position. Some of them give the backward motions to the head, and others draw the shoulder-blades back toward the spine. The latissimus dorsi, or largest mus- cle of the back, (24, 2^, Fig 17.) is inserted into the humerus or arm-bone, near the point of insertion of the pectoralis major. When it acts alone it draws the arm backward, and when acting with the pectoralis major, it helps to draw it down close to the side. The abdominal muscles form the movable walls of the abdomen. Acting together they bend the body forward, and also aid in the movements of breathing. At the lower part of these muscles just above the bony margin of the pelvis, two small openings, connected by a canal, are found. These give passage to the spermatic cord in the male, and the round ligament in the female, and are only covered by delicate layers of fascia. They are, therefore, naturally weak points in the abdominal walls, and they often give way so as to allow a portion of the bowels to come through, thus constituting what is called hernia, or rupture. The spaces between the ribs are filled up by muscles, which raise the ribs so as to make room for inflating the lungs during inspiration. The diaphragm is the large muscle, situated in the in- terior of the trunk, which separates the cavity of the thorax, or chest, from that of the abdomen. It rises and falls during respiration, in which function it plays an important part. Other muscles are situated in the cavity of the pelvis, and pass outward to be inserted into the upper part of the femur. MUSCLES OF THE UPPER EXTREMITY. 49 They assist in rotating the whole leg, so as to turn the toe outward, and in drawing the thigh upward so as to approach the abdomen. Muscles of the Upper Extremity.-The muscles of the upper extremity are divided into those of the shoulder, arm, forearm and hand. The muscles surrounding the shoulder, together with some from the body, previously described, are attached to the arm, (or upper arm, as it is sometimes called,) and constitute its motors. The upward, downward, backward, and forward mo- tions are produced by these muscles. The triangular muscle of the top of the shoulder, called the deltoid, (io, Fig. 15.) raises the arm to the side of the head, while smaller muscles acting with the large breast and back muscles, draw it down to the side. The large breast muscle, the pectoralis major, (11, Fig. 15.) which is attached to the upper part of the humerus, draws the arm forward, across the breast, while the large back muscle, the latissimus dor si, (24, 25, Fig. 18.) draws the arm backward. The three muscles occupying the front part of the arm, and attached to the shoulder-bones and humerus, or arm- bone, pass down and are inserted into the upper part of the ulna and radius, or bones of forearm. By their action they draw up the fore-arm as in the attitude of striking. This ac- tion, again, is opposed by the large muscle on the back of the arm, called the triceps, or three headed muscle, (13, 14, 15, Fig. 17.) which extends or straightens the forearm upon the arm. The muscles on the front of the forearm bend the whole hand forward at the wrist, and also flex or close the fingers so as to form the fist. The action of these is opposed by the muscles on the back of the forearm, which straighten the wrist and fingers when drawn forward, and also carry the whole hand backward at the wrist. A set pf muscles, on the side of the forearm corresponding with the thumb, bend the hand toward that side, and rotate it outward so as to let it rest on its back. Another set, situated on the side corresponding with the little finger, carry the hand to that side, and rotate it HOW ARE WE MADE ? 50 inward so as to turn the palm downward. When the hand is turned outward to rest on its back, it is said to be supine, and the muscles giving the motion are called supinators, while those that turn the palm downward are called pronators, and the hand is then said to be in the prone position. Muscles of the Lower Extremity.-The muscles that move the thigh are short and thick, and arise from the pelvic bones and lower part of the spine. They form the soft, fleshy mass that covers the back of the haunch bones, and are sometimes called the ham. The long and large muscles situated in front of the femur, straighten the leg upon the thigh after the knee has been bent. These four large muscles (29, 30, 31, Fig. 15.) arise from the pelvis and thigh-bone, and unite below in a broad tendon, in the centre of which the patella, or knee-cap, is developed, like a sesame seed. This fact has given to such bones the name sesamoid. * Below the patella this tendon contracts, and is called the ligament of the patella (32, Fig. 15.) and is finally inserted into the upper part of the tibia. A large muscle, called the biceps, or two headed muscle, (29, Fig. 17.) situated behind the femur, draws the leg up backward, so as to bend the knee; while a set of muscles on the inner side of the thigh, draw the legs together. On the front of the leg there are several muscles called extensors, the tendons of which extend to the ankle and the bones of the toes. These straighten the toes, and draw the foot up in front toward the leg. The muscles on the back of the leg flex the toes and foot, and draw up the heel, so that the toes are pointed downward. THE DIGESTIVE APPARATUS. In order to nourish the body, the various elements of which it is composed must be constantly supplied to it in the form of food. This food must undergo important changes be- fore it can be taken into the circulation and appropriated by the * Sesamoid-so named because it resembled, in shape, the seed of a plant called sesame. THE ALIMENTARY CANAL. 51 tissues requiring it. The process by which these changes are produced is called digestion, and the several organs necessary to effect the changes are spoken of as the digestive apparatus. This apparatus consists of a long tortuous tube called the ali- mentary canal, and a number of accessory organs. The Alimentary Canal.-The alimentary canal is a membranous tube, formed principally of circular layers of in- voluntary muscular fibres. It extends from the mouth to the anus, is lined throughout by a delicate layer of mucous mem- brane, and measures about thirty feet in length. It presents different characteristics at various parts of its course, and for that reason it has been di- vided into sections, each of which has received a spe- cial name, as follows : the mouth, pharynx, oesopha- gus, stomach, small intes- tine, and large intestine. Fig. 15.-The Digestive Organs. I, the upper lip; 2, division of the bone of lower jaw; 3, tongue; 4, cavity of mouth; 5, oesopha- gus; 7, parotid gland; 8, sublin- gual gland; 9, stomach; 10, 10, liver; 12, point of entrance of bile to intestine; 13, 13, duodenum; 14, pancreas; 15, 15, 15, small intestine; 16 coecum where it joins the small intestine; 17, 18, 19, the colon; 20, rectum; 21. spleen. The Mouth.- The mouth (4, Fig. 18.) is the beginning of the digestive tract. It is an oval-shaped cavity which contains the teeth, and tongue. It is lined by mucous membrane, and has opening into it Fig 18. HOW ARE WE MADE? 52 little ducts, or canals, which convey the saliva from the salivary glands. Here the food is broken up and mixed with the saliva, and is in this way prepared to enter the stomach. The Pharynx.-The pharynx is that part of the alimen- tary canal which connects the mouth and oesophagus. It has opening into it, the posterior nasal cavities, the wind-pipe, and two little canals, the Eustachian tzibes, which lead to the mid- dle ear. It is often the seat of inflammation and is especially involved in all catarrhal troubles. The CEsophagus.-The oesophagus (5, Fig. 18.) extends from the pharynx to the stomach, and is about nine inches long. It is the narrowest part of the alimentary canal, and forms the passage through which the food is conveyed to the stomach. The Stomach.-The stomach is the most dilated part of the alimentary canal, and constitutes the principal organ of digestion. It is situated at the upper part of the abdominal cavity, principally toward the left side, immediately below the liver and diaphragm. It is made up of four coats ; viz, a serous, or investing membrane, received from the peritoneum, which aids to hold it in position ; a muscular, consisting of three sets of fibres, which give it the motions necessary for digestion; the cellular, a loose tissue which connects the muscular and inner coats, and finally, the internal or mucous coat. The internal coat, or mucous membrane, is supplied with innumerable fol- licles, known as mucous and peptic glands. The former sup- ply the gastric mucus, which keeps the membrane in a nor- mally moist condition, and the latter secrete the gastric juice, which is the digestive agent of the stomach. A large number of blood-vessels are supplied to the stomach, and carry a considerable amount of blood to the mucous surface, during the process of digestion. It receives its supply of nerves from the terminal branches of the same nerves that supply the heart and lungs, and it also re- ceives a great many branches from the sympathetic nervous system. In consequence of this nerve supply, the stomach is a sensitive organ, and when diseased, it affects the heart, lungs and liver, through sympathy THE SMALL INTESTINE. 53 The Small Intestine.-The small intestine (13, 13, 15, 15, 15» Fig. 15.) is that part of the alimentary canal, which immedi- ately follows the stomach. It is about twenty feet in length, and is twisted in such a manner as to occupy the central and lower part of the abdominal cavity. It is divided into three portions, viz: the duodenum, jejunum and ileum. The duodenum is so-called on account of its being equal in length to the breadth of twelve fingers, which makes it eight or ten inches long. It is the smallest part of the small intes- tine, and has opening into it the bile duct from the liver (12, Fig. 18.) and the pancreatic duct from the pancreas. (14, Fig. 18.) These ducts convey the bile and the pancreatic juice into the small intestine. These secretions and the in- testinal juice complete the digestion of those portions of food that are not digested in the stomach. The opening of the stomach into this portion of the intestine is small and funnel-shaped, and on account of its shape has been called the pylorus. The Jejunum, so called, from the Latin word meaning empty, because it was usually found empty after death, in- cludes the upper two-fifths of the remaining portion of the small intestine. The Ileum, so-called from its being twisted, constitutes the remaining portion of the small intestine. The mucous surface of the intestine is covered by num- erous little follicles, which secrete intestinal juice and mucus. The Large Intestine.-The large intestine extends from the termination of the ileum to the anus, and is about five feet in length. It is much larger in circumference than the small intestine, and is so situated in the abdomen as to form an arch, which completely surrounds the convolutions of the small in- testine. It is divided into the ccecum, colon and rectum. The ccecum is the most dilated part of the intestine, but the ileum opens into it by means of a small elongated aper- ture. Attached to the caecum is a long, narrow, worm-shaped 54 HOW ARE WE MADE? tube, called the vermiform appendix. It varies from three to six inches in length, and its cavity, which communicates with the caecum, is about the size of a goose quill. Foreign bodies, such as seeds of berries, sometimes accumulate in this appen- dix and give rise to an inflammation that is usually fatal. The colon is divided into the ascending, transverse, and descending portions (17, 18, 19, Fig. 15.) while the rectum (20, Fig. 18.) forms the terminal part of the large intestine. The Accessory Organs.-The accessory organs are those whose functions constitute a part of the process of di- gestion, and comprise the teeth, salivary glands, liver, pan- creas and spleen. The teeth.-The teeth have been previously described in connection with the skeleton. They are designed to seize and cut the food as it is taken into the mouth, and to masticate or grind it thoroughly, so as to prepare it for the action of the saliva and gastric juice. The Salivary Glands.-The salivary glands are small se- creting bodies, which communicate with the mouth by little canals or ducts. They pour their secretion, the saliva, into the mouth, and thus supply that cavity with most of its moisture. While eating, the saliva is produced in greater quantities, and mixes with the food to render it more easy to swallow, while the starches begin to be changed into sugar by its action. There are three pair of these glands; viz: the parotid (near the ear), sub-maxillary (under the jaw), and sub-lingual (under the tongue). The Liver.-The liver is a large glandular organ, situated on the right side of the abdomen, under the lower ribs, and extending beyond the median line of the body, toward the left side. It is located over the stomach and has a duct or canal passing into the small intestine. The gall bladder is attached to its under surface, and this also has a small duct, which unites with that from the liver itself, to make a connec- tion with the intestine. In Fig. 18 the liver is seen turned THE PANCREAS. 55 up so as to show its under surface-io, io, indicate the right and left divisions of the organ; 1I, represents the gall-bladder, the forked white line marks the bile duct; and 12, indicates the common duct of the liver and gall-bladder, as it opens into the duodenum. The liver is supposed to affect important changes in the constituents of the blood that passes through it, and it also manufactures the bile. The bile, so far as is known, does not aid in digestion, but it supplies a stimulus to the intestines. This stimulus keeps up the muscular contraction that gives the motion necessary to complete the intestinal digestion, the absorption of the digested food, and the elimination of the effete material from the lower bowel. The Pancreas.-The pancreas (5, 6, Fig, rp.) is a hammer- shaped gland situated across the back part of the abdomen at the lower margin of the stomach. It secretes the pancreatic juice, one of the digestive fluids, which is emptied into the duodenum through the pancreatic duct. It was named pan- creas because of its fleshy appearance, and is that part of the lower animals popularly known as sweet-breads. Fig. 19.-The Pancreas, Spleen and Duodenum. 1, 2 and 3, the spleen; 4, the fissure for the large blood - vessels of the spleen; 5, the body of pancreas; 6, the head of pancreas; 7, duode- num; 8, arteries of stomach, cut off; 9, artery of liver, c off; 10, 10, artery to spleen; 11, 11, vein from spleen. Fig. 19- The Spleen.-The spleen (i, i, 2, Fig. 19.) is situated on the left side of the abdomen adjoining the left extremities of the stomach and pancreas. It does not secrete any fluid, and its function has never as yet been ascertained. It is usually 56 HOW ARE WE MADE? supplied with a large quantity of blood during health, and be- comes very much enlarged in some fevers of a so-called ma- larial origin. It increases in size during and after digestion, and for this reason has been supposed to have some con- nection with the digestive organs. It is not essential to life, as has been repeatedly demonstrated by removing it from dogs and other animals. All these organs are situated in the interior of the trunk of the body. This interior space is divided into the thorax and abdomen, by the large interior muscle, previously des- cribed as the diaphragm. The abdomen contains the stomach, liver, large and small intestines, pancreas, spleen, kidneys, and sometimes part of the bladder when distended, and the womb when pregnant. These several parts are held in position by means of a broad membrane called the peritoneum *, which is composed of two layers. These layers surround the several organs and parts, and then pass to the back part of the abdominal cavity to be- come attached to the tissues in front of the spine. The parts are thus held in their proper positions, while a large double fold of the peritoneum extends down in front of the small in- testine like an apron. The same tissue extends to the womb and bladder, to hold them in position, and then forms the inner lining of the walls of the abdomen. It forms broad bands around the liver, which constitute the principal liga- ments of that organ. It also suspends the womb in its position in the pelvic cavity. The blood-vessels of the alimentary canal are situated between its layers and are thus, in a meas- ure, protected from injury. The surfaces of this membrane are smooth, and covered with a thin lubricating secretion, which allows of the ready movement of the several organs upon each other. It often becomes the seat of inflammations of a very ser- ious character; and the sacks or cavities fromed by the folds, fill up with the watery portions of the blood, in some diseases, and thus constitute what is known as abdominal dropsy. * Peritoneum-from two Greek words meaning to stretch or extend around. THE ABDOMEN. 57 Fig. 20. 58 HOW ARE WE MADE? Fig. 20 rep- resents the con- tents of the ab- domen and thorax, with the anterior cover- ings removed. The convolu- tions of the small intestine are seen below, while the apron formed by the peritoneum is shown just above these, turned to one side. About the middle of the cut is seen the liver partly raised from posi- tion, with the stomach under it and toward ^the oppo site side. Above these,the lungs, heart and blood-ve s seis are represented in their natural positions. A more cor- rect idea of the positions of the digestive organs of the abdomen, can be obtained Ka. 21. THE LYMPHATIC SYSTEM. 59 from Fig. 21. The diaphragm, which divides the thoracic and abdominal cavities, is shown at D; the liver at E; the spleen at F; the large end of the pancreas at G, with its body extending to the spleen ; the stomach at H ; the colon (a part of the large intestine) at I; and the convolutions of the small intestine at J K and L. THE LYMPHATIC SYSTEM. The lymphatic vessels constitute a complex net-work, which is found in every portion of the body, and which seems to occupy a position connecting the digestive with the circu- latory apparatus. Along the course of these vessels, and situated at short intervals, are small glandular bodies, which are called the lymphatic glands. The lymphatic system in- cludes not only these vessels and glands, but also similar structures, which are connected with the small intestine, and carry the digested food into the circulation. These latter are called the lacteals, and in no way differ from the other lym- phatic vessels, excepting that for a short time during and after the process of digestion, they contain a milk-like fluid. These vessels are called lymphatics, from a Greek word meaning water, from the fact that the fluid they contain is clear and transparent. They are also known as absorbents, as they absorb materials from the various tissues and carry them into the venous circulation. For the sake of convenience, these vessels are spoken of as the lymphatic and lacteal vessels. The lymphatics com- mence in the substance of the various tissues and organs, in the form of minute net-work, closely resembling that of the capillary blood-vessels. The minute branches unite with each other to form larger vessels, and these in turn pene- trate the lymphatic glands, and give off branches that are dis- tributed to their substance. After passing, through these glandular organs, they finally unite and form two great trunks, called the thoracic duct and the right lymphatic duct. The thoracic duct receives the fluids from the absorbents of the lower extremities, the intestines and other abdominal 60 HOW ARE WE MADE? organs, the chest, the left upper extremity, and the left side of the head and neck, and terminates by opening into the left subclavian vein. The right lymphatic died collects the fluid from the right upper extremity, and right side of the head and neck, and enters the right subclavian vein. It will thus be seen that the lym- phatic vessels all pass in one direction, from without inward; and that the fluid they contain is emp- tied into, and lost in, the venous circula- tion. Fig. 22 is a fair representation of the superficial lymphatic vessels, the dark lines representing the vessels them- selves, while the rounded bodies in the groin represent the glands. The deeper lymphatic vessels and glands are simi- larly arranged, and are found in large numbers in all the internal organs. The Lacteal Ves- sels.-After the food has been digested it is ready for absorption into the system. Fig. 22. THE CIRCULA TOR Y APPARA PUS. 61 This is accomplished both by the blood-vessels and a number of minute tubes that open into the intestine, called lacteals. From the mucous surface of the intestines, the lacteals pass outward, a number of them uniting to form a larger branch. These branches again unite to form still larger ones, which finally empty into the expanded lower extremity of the thor- acic duct, which has been named the receptacultim chyli, or receptacle of the chyle. The material thus carried from the intestines to the thoracic duct, mixes with the fluid from other lymphatic vessels, and is emptied into the left subclav- ian vein. We thus find that a portion of the newly digested food is carried into the venous circulation, and that fluids from the various tissues of the body are also being constantly poured into the veins. The lymph, undoubtedly, contains some of the impurities of the blood mixed with the excess of nutri- tive material, that has not been utilized. The effete material is thrown off, while the nutritive elements of these fluids are again carried by the blood to the tissues. The lymphatic glands are often the seat of inflammations, and when such is the case the whole system suffers, thus demonstrating the importance of the function performed by these vessels. THE CIRCULATORY APPARATUS. The circulatory apparatus is made up of the heart, arter- ies, veins and capillaries, and constitutes the machinery that keeps up the circulation of the blood. The Heart.-The heart is the central organ of the circu- lation, and is situated in the cavity of the chest, between two sections of the left lung, as seen in Fig. 20, and Fig. 21. It is hollow and divided into four cavities, called, the right and left auricles, and the right and left ventricles. There is no communication between the right and left sides of the heart; but there are small openings, protected by valves, between the auricles and ventricles on each side, which give passage 62 HOW ARE WE MADE? to the blood, rig. 23 represents the general shape of the heart, and the position of the blood-vessels. Fig. 23.-External View of the Heart. a, left ventricle; b, right ventricle; c, e, f, aorta; g, h, i, arteries, branches of aorta; k, 1, pul- monary artery and its branches; m, m, pulmonary veins; n, right auricle; o, as- cending vena cava; q, descend- ing vena cava; r, left auricle; s, left coronary artery; p, por- tal vein. The Arteries.-The arteries are the tubes that carry the pure blood from the heart to be dis- tributed to the various parts of the body. The arterial system starts from the left ventricle of the heart, in a large arch, called the aorta, (c, e, f, Fig. 23.) which bends down behind the heart, and passes downward to the lower part of the abdominal cavity. There it divides into two branches, which again sub- divide so that a large branch runs into each leg. All along its course it gives off numerous branches, and these in turn are divided, so that all tissues and organs of the body are supplied with small arteries to carry blood for their nutrition. At g, h, and i, Fig. 23, the aorta gives off three branches, which, with their numerous divisions, carry the blood to the head and upper extremities. A slight idea of the extensive ramifications of the arter- ies may be obtained from Fig. 24, which shows the general outline of the body as preserved by the arteries alone. The Capillaries.-The capillaries are minute bundles of blood-vessels situated at the extremities of the terminal branches of the arteries, and at the beginning of the veins. They are very small and are clustered together like bunches of grapes on stalks. They are divided into two kinds, the Fig- 23. THE VEINS. 63 arterial and venous capillaries. The blood passes from the arterial capillaries into the tissues, and from these into the venous capillaries which consti- tute the starting points of the veins. The Veins.-The veins form a system of canals that return the blood to the heart, after it has been carried to the tissues by the arteries. They begin with the little branches to which the venous capillaries are at- tached, and a number of these unite to form a large branch, and so on till two large trunks are formed. When the system is complete, the branches corre- spond in number, direction, and location, with those of the arter- ies. The two large terminal trunks are called the ascending and descending vence cavce, (o, and q, Fig. 23.) and empty the blood into the right auricle of the heart. An artery leaves the right ventricle of the heart, and sends a branch to each lung. This is called the pulmonary artery, and is shown at k, 1, 1, Fig. 23. The circulatory apparatus is then completed by four small veins passing from the lungs to the right auricle. By this arrangement a complete circuit is formed for the circulation of the blood. The two great veins carry the impure blood into the right auricle, and from here it passes through the right auri- culo-ventricular opening into the right ventricle. From the right ventricle it passes through the pulmonary artery to the lungs; here it becomes purified and returns to the left auricle Fig- 24. 64 HOW ARE WE MADE? through the pulmonary veins. From the left auricle it passes through the left auriculo-ventricular opening to the left ven- tricle; and from the left ventricle it passes into the aorta to be distributed to the various parts of the body, after which it is again returned to the right side of the heart to go through the same course as before. THE RESPIRATORY ORGANS. The respiratory organs are those that are essential to breathing. They are located in the neck and cavity of the chest, and are divided into the larynx, trachea, bronchial tubes and lungs. Through the means of these organs atmos- pheric air is carried into the lungs, where the oxygen it con- tains passes through a thin membrane, and mixes with the impure blood carried to the lungs from the right side of the heart. As the oxygen enters the blood, carbonic acid, which is a product of the waste going on in the tissues, is forced out and expelled from the lungs. The drawing in of the air is called inspiration, the forcing out of the carbonic acid is called expiration, while both together are known as respiration. Respiration has for its object the purifying of the venous blood, to fit it for being carried through the system, and the change that takes place is usually spoken of as the oxidation of the blood. When the blood is thus changed, it is carried to the left side of the heart, to be re-distributed to all the parts and tissues of the body. The Larynx.-The larynx is the upper part of the air passage, and is situated between the base of the tongue and the trachea. It may be seen at 5, 6 and 10, Fig. 25. It is composed of cartilages, connected by ligaments, and has at- tached to it numerous muscles which are concerned in speak- ing. It contains in its interior the vocal cords, and is known as the organ of voice. The prominent projection in the front and upper part of the neck, commonly called Adam's apple, is formed by a part of the larynx. The opening that connects it with the pharynx is a small elliptical aperture, called the THE BRONCHIAL TUBES. 65 glottis, and this is covered by a valve known as the epiglottis. Sometimes, while eating, a particle of food enters this open- ing, and causes a severe paroxysm of coughing, and even strangulation. Fig. 25.-Air Passages to Lungs. I, 2, 3, outlines of lungs; 4, space between right and left lung; 5,6, 10, parts of larynx; 7, II, 12, 13, tra- chea; 14, 16, 8, 18, right bronchial tube; 15, 16, 17, 21, 9, left bron- chial tube; 19, 19, large subdivisions of bronchial tubes; 20, 20, minute r a m i fie at ions of bronchial tubes. The Tra- chea.-The tra- chea, or wind- pipe, (7, II, 12, 13, Fig. 25.) is a cylindrical tube beginning at the lower part of the larynx, and extending downward for about four inches and a half, when it divides and sends a branch to each lung. This passage is often the seat of inflammation, which is usually so severe in croup and diphtheria as to cause deafh, unless the patient is relieved by an operation. The Bronchial Tubes.-The bronchial tubes, as seen by reference to Fig. 25, are formed by the division of the tra- chea. After they enter the lungs they divide and sub-divide, until they terminate in very minute sacks, called air-cells, as Fig. 23. 66 HOW ARE WE MADE? seen at 20, 20, Fig. 25. The air passes to these cells, and the oxygen it contains passes through the cell wall into the lungs. The Lungs.-The lungs are the principal organs of res- piration. They are two in number, and are situated one on each side of the cavity of the chest. They are separated by a space which contains the large vessels, and also by the heart. They are conical in shape, with the apex directed upward, and are covered by a membrane called the pleura, which also lines the cavity of the thorax. This membrane is often the seat of an inflammation, to which the name pleurisy is given. By reference to Fig. 21, page 58, the lungs and heart can be seen in their normal positions: D, represents the diaphragm which separates the thorax from the abdomen; B, shows the position of the heart; and C, C, represent the lungs, with a section of the left one removed to show its in- ternal structure. The right lung is divided into three lobes, or sections, and the left into two, the heart occupying the position on the left side, that corresponds to the middle lobe of the right lung. Each lung is composed of minute round bodies, called lobules, joined by connective tissue. Each lobule contains a net- work of arterial and venous capillaries, and minute lymphatic vessels, surrounding an ultimate air-cell. Each of these cluster around a stem and thus form interlobular arterial, venous, and lymphatic vessels, which pass out of the lobule to unite with others, and thus form the larger branches. It is in the interior of these little bodies that the impure venous blood gives off its carbonic acid, and receives its oxy- gen, which converts it into pure blood. During this process of change, the blood finds its way from the venous to the arterial capillaries, and thence to the left side of the heart, for re-distribution to the various parts of the body. In Fig. 26, the lobes of the lungs can be seen, and also the position of the heart and blood-vessels. These may be studied from the description accompanying the cut. HEART AND LUNGS. 67 Fig. 26.-Heart and Lungs. 1, right ventricle of the heart; 2, left ventricle; 3, right auricle; 4, left auricle; 5, pulmonary artery; 6, right pulmonary artery; 7, left pulmonary artery; 9, arch of aorta; 10, descending vena cava; II, innominate artery; 12, right sub-clav- ian vein; 13, right carotid artery and vein; 14, left innominate vein; 15, left carotid artery and vein; 16, left sub-clavian artery and vein; 17, trachea; 18, right bronchial tube; 19, • left bronchial tube; 20, 20, pulmonary veins; 21, upper lobe of right lung; 22, mid- dle lobe of right lung; 23, Fig. 26. lower lobe of right lung; 24, upper lobe of left lung; 25, lower lobe of left lung, Fig. 27 rep- resents the lar- ynx (12), the tra- chea (1 1 ), the heart (4), the large vessels and the interior structure of the lungs. The num- erous branches which are seen extending to the margins of the lungs indicate the ramifications of the vessels to the lobules. In conse- quence of the number of these Fig. 27. 68 HOW ARE WE MADE? hollow tubes and cells, and the delicate character of the tis- sues forming them, the substance of the lung is so light and spongy that it floats on water when healthy, but will sink when diseased. From the descriptions thus far given it will be seen that the digestive, lymphatic, circulatory and respiratory organs, are all essential to the support of the body, and they are so intimately connected that nutrition cannot go on when any one of them is out of order. THE GENITO-URINART ORGANS. These organs are usually classed together on account of some of them being .called upon to aid in carrying off the urine as well as being necessary to complete the reproductive system. The Urinary Organs.-These organs are designed to remove from the system certain effete material, which can no longer be retained without injurious effects. The substances thus carried off are certain earthy salts, and a compound called urea, which are held in solution, in a fluid commonly called the urine. The kidneys, ureters, bladder and urethra consti- tute these organs. The Kidneys.-The kidneys are two glandular organs, situated at the back part of the abdominal cavity, one on each side of the spine, and extending from the eleventh rib, down- ward, for about four inches. The urine is secreted in minute tubes, and passes to a hollow space near the internal margin of the kidney, which is really the beginning of the canal to the bladder. The Ureters.-The ureters are two narrow tubes, from sixteen to eighteen inches in length, which extend from the kidneys to the bladder. They follow the line of the groin and convey the urine from the kidneys to the bladder. The. Bladder.-The bladder is the reservoir of the urine. It is situated behind the pubic arch of the pelvis, but, some- times, when distended it rises above that bone. It will hold THE GENITO-URINARY ORGANS. 69 about one pint of fluid, but is seldom allowed to accumulate that amount of urine. The Urethra.-The urethra is a curved canal that carries the urine from the bladder. It is from eight to nine inches in length, in the male, and passes through the prostate gland and the penis. In the female it passes from the bladder along the anterior wall of the vagina, and is only about an inch and a half in length. The Genital Organs.-The organs of generation are those that are essential to the performance of the function of reproduction. They are named as follows in the male : the prostate gland, the penis, the testes and their coverings, the spermatic cord, and the seminal vesicles The Prostate Gland.-The prostate gland is a firm, glandular body, which surrounds the neck of the bladder and the beginning of the urethra. It is through this body that the ducts from the seminal vesicles enter the urethra, and it thus stands guard over the escape of the seminal fluid. The Penis.-The penis is the organ of copulation. It is spongy and vascular in texture, and under the conditions necessary for the performance of its function, becomes filled with blood, assumes a rigid and erect position, and is largely increased in size. The Testes.-The testes are two glandular bodies, the function of which is to secrete the seminal fluid. They are suspended in a sack called the scrotum, situated below the pubic arch, and between the front part of the thighs. The Spermatic Cords.-The spermatic cords extend from the testicles up over the pubes and through the openings in the walls of the abdomen called the abdominal rings. They are formed by the arteries, veins and nerves that pass from the abdomen to supply the testicles, together with the vas deferens which conveys the semen to the seminal vesicles. The Seminal Vesicles.-The seminal vesicles are two small sacks situated under the bladder. They are receptacles 70 HOW ARE WE MADE? of the semen carried from the testicles by the vas deferens. They are supplied with ducts, that under the proper stimu- lus convey the semen through the prostate gland to the urethra.* THE NERVOUS SYSTEM. It is through the agency of the nervous system that all the organs of the body are made to act in harmony with each other. In fact this system presides over and governs all the voluntary and involuntary actions in the living body. Every motion and sensation is dependent upon it. The material of which it is composed constitutes the highest order of organized matter, and in some mysterious way possesses the hidden force, or power, which constitutes what is called life. An examination of the tissues of which the nervous sys- tem is composed, shows two kinds of matter, which on ac- count of their color, have received the names of gray and white matter. The gray matter presides over all mental action, and sensa- tions, while the white matter imparts motion to all the tissues to which it is supplied. For the sake of convenience, the nervous system is di- vided into 3 parts; viz: I. cerebro-spinal centre or axis, comprising the brain and spinal cord ; 2, the nerves ; 3, the great sympathetic. The Cerebro-spinal Centre.-The brain and spinal cord are united, and constitute the great central battery of the nervous system. The substance of which they are composed, is somewhat soft and pulpy in consistency, but has dense fibres running through it. This structure seems to be necessary to enable the several parts to receive the delicate impressions that constitute the nervous functions. The brain is situated at the upper part of the cord, and is enclosed in the cavity of the cranium. * The female organs of generation will be described under the chapter on "Dis- eases of Women. ' ' BRAIN AND SPINAL CORD. 71 Fig. 28 gives a good represen- tation of the under surface of the brain and the spinal cord, together with the origins of the special nerves. a Fig. 28.-Brain and Spinal Cord. ■ The under surface of the brain is here repre- ' sented, but the several points are more clearly shown in Fig. 32, on page 75. 24, 24, 24, show the spinal nerves; 23a, the posterior roots of the nerves; 23b, the an- terior roots. Both of these are better shown in Fig. 33, page 75- 25, terminal filaments of cord; C, central section of the upper end of the spinal cord. A projection of the lower part of the brain passes through a large opening in the occipital bone of the skull, and unites with the upper extremity of the spinal cord. Throughout the entire structure of the brain, the gray matter is situated on the external surface and the white matter is located internally; while in the cord, the white is found to be the most su- perficial and the gray matter is sit- uated in the centre of the mass. In all voluntary motions, the stim- ulus originated in the brain, tra- vels through the spinal cord,thence along the nerves to the part to be acted upon. In the sense of feeling, the stimulus is applied to the ex- tremity of a nerve,and the irritation thus produced travels along the nerve to the spine where the sensa- tion is recognized, and when severe carried to the brain. It will thus Fig. 28 72 HOW ARE WE MADE ? be seen that both the brain and cord are essential for proper motion and sensation, so that when injuries affect either of these parts, and are not sufficient to destroy life, a paralysis occurs, the severity of which depends upon the extent of the injuries to these nerve centres. The Brain.-The brain is the broad, expanded upper por- tion of the cerebro-spinal centre, and occupies the cavity of the skull. It is marked by a deep fissure passing from before backward, and thus divides the superficial parts into two lateral masses, called the right and left hemispheres. It is surrounded by three membranes or coverings, one of which furnishes its principal supply of blood. It is divided into four parts; viz; the cerebrum, or great brain; the cerebellum or little brain ; the pons Varolii or bridge ; and the medulla ob- longata or middle oblong brain. The cerebrum forms the largest portion of the brain and occupies the entire upper part of the cavity of the skull. Its superior surface is represented in Fig. 29, in which the top of the skull and the membranes are removed, thus exposing to view the convolutions, or ele- vations and depressions which mark the entire surface of the brain. The cerebellum is situated in the lower and back part of the skull, and is separated from the posterior part of the cerebrum, by a broad expan- sion of the outer covering of the brain. The pons Varolii is a small section of the brain, situated on its undersurface. It receives its name from the anatomist Varoli, who first described it as a bridge, because of the fact that it formed a bond of union between the cerebrum and cere- bellum above, and the medulla oblongata below. Fig. 29' THE MEDULLA OBLONGATA. 73 The medulla oblongata extends from the lower border of the pons to the upper border of the spinal cord. It lies be- neath the cerebellum, and connects the spinal cord with the cerebral mass. In the adult male, the average weight of the brain is 49 1-2 ounces and in the female 44 ounces. The maximum weight in the male, in a large number of cases, has been found to be 65 ounces and the minimum 34; the maximum, in the adult female, is 56 ounces, and the minimum 31. These figures show that the human brain is larger than that of all the lower animals excepting the elephant and whale; the brain of the former weighing from eight to ten pounds, while that of the latter weighs somewhat more than five pounds. Fig. 30 shows the upper sur- face of the cerebrum removed from the cranium, while Fig. 31 gives a side view of the cerebrum and cerebellum. Fig. 32, repre- sents the under sur- face of the cerebrum, cerebellum, pons Va- rolii, and medulla ob- longata, and a refer- ence to the descrip- tion will show the points of origin of the special nerves of sense and other im- portant divisions of the brain matter. If a section of the brain is made, a layer of gray matter will be found covering the entire surface and extending down into the depressions or convolutions, while the deeper-seated tissues are of a white appearance. More careful dissection Fig. go. 74 HOW ARE WE MADE ? shows a large number of cavities, fissures and lobes, each of which are possessed of special functions that cannot be properly described in a popular work. The Spinal Cord.-The spinal cord is the prolongation of nervous matter, that occupies the canal formed in the interior of the spinal column. It is covered by membranes, similar to those of the brain, which are also prolongated from the cavity of the skull. The cord is usually about 17 or 18 inches in length, and weighs about an ounce and a half. It is divided into lateral halves, the same as the brain, which are united in the Fig. 3'- middle by a transverse band of gray matter, connecting two other portions of gray matter on either side. At points corres- ponding with the union of the several vertebrae of the spinal column, the spinal nerves are given off. They start from two sets of fibres, the anterior fibres arising from the white matter and the posterior from the gray matter of the cord. Before these two sets of fibres unite, a prominent knot, called a gang- lion, is seen on the posterior cord and it has been demonstrat- ed that it is essential in communicating sensation to the cord and brain. UNDER SURFACE OF BRAIN. 75 Fig. 32.-Under Surface of Brain I, Anterior extremity of median fissure; 2, posterior extremity of same; 3, anter- ior lobe of cere- brum ; 4, middle lobe of cerebrum; 5, fissure between anterior and middle lobes; 6, posterior lobe of cerebrum; 7,optic commissure; 8, pituitary body; 9, corpora albican- tia; 10, posterior perforated space; II, crura cerebri; 12, 13,pons Varolii; 14facial nerve; 15, 16, cerebellum; 18, 19, 20, 21 medulla oblongata; 22, hy- po-glossal nerve; 23, olfactory nerve, Fig. 32. 24, bulb of same; 25, 26, 27, roots of same; 28, optic nerve; 29, optic tract; 30, motor oculi nerve; 31, patheticus; 32, trigeminus; 33, abducens; 34, auditory; 35, glosso- pharyngeal: 36, pneumogastric; 37, spinal accessory. Fig. 33, represents a section of the spinal cord; A, re- presenting the cord itself; C, the anterior root of the nerve; D, the posterior root, with the bulb shown, and B, the point of union be- tween the two roots, which con- stitutes the begin ning of the spi- nal nerve. Fig. 33- HOW A RE WE MADE? 76 THE NERVES.- i ne nerve trunks differ materially from the substance of the brain and spinal cord. Instead of present- ing a soft, pulpy mass, they are found to be composed of tough, thread-like filaments. A number of these filaments are bound together in a sheath, a number of these bundles are again en- closed in another sheath, and these larger ones again unite and are surrounded by an outside sheath to form the large trunks. When a large nerve trunk divides, the smaller bun- dles are separated from each other to form the branches. Among the minute filaments, thus held together, particularly in the spinal nerves, we find both the sensitive and motor filaments. The nerves are divided into two sets, the cranial and spinal, the former arising from the brain and passing through small openings in the base of the skull, while the latter arise from the spinal cord, and pass through openings in the sides of the vertebrae. The Cranial Nerves.-The cranial nerves are nine in number, from each side, and are spoken of as the nerves of special sense, the nerves of common sensation, the nerves of motion and mixed nerves. The nerves of special sense include those that go to the nose, eye, ear, and tongue and throat, and respectively pre- side over the sen- ses of smell, sight, hearing and taste. The other cranial nerves supply sen- sation and motion to the face, mouth and throat. The pneumo gas trie nerve is composed of both motory and sensitive nerves. It supplies the or- gans of the voice and respiration Pig- 34- 77 THE SPINAL NERVES. with motory and sensitive fibres, and the pharynx, oesopha- gus, stomach and heart with motion. It will thus be seen that irritation of this nerve, either at its root or any of its branches, may be followed by serious complications of sev- eral important organs. By reference to Fig. 32, page 75, the points of origin of these nerves may be traced from the under surface of the brain, while Fig. 34 gives a good general idea of the direction they take after passing through the openings in the cranium. The Spinal Nerves.-The spinal nerves are those that take their origin from the spinal cord. There are thirty-one pair of these nerves, which are divided into regions corres- ponding to those of the spine, and are named as follows: cervical, dorsal, lumbar, sacral and coccygeal. Each nerve arises from two roots, the anterior or motory, and the pos- terior or sensory root. The anterior root originates in the white matter, and the posterior in the gray matter of the cord. The two roots unite to form one trunk, which contains the filaments of both motion and sensation. The points of origin and the union of the roots are shown in Fig. 33. These nerves, by their complex ramifications, supply all portions of the body not supplied by the cranial nerves, and the minute subdivisions of the sensory filaments extend to the skin and constitute the organs of feeling. They convey the stimulus from the brain for producing voluntary muscu- lar action, and supply part of the nerve force that keeps up the movements of the involuntary fibres. So minute are the divisions of these nerves that it is impossible to place the point of a pin on any portion of the body, without touching a nerve fibre. A general idea of this distribution of nerves may be obtained from Fig. 35, the white lines of which indicate the branches of the nerves. Voluntary nervous action is produced in two ways. First, by the direct influence of the will, which originates the impulse to move a part, and from the brain this impulse travels along the cord and motory nerves to the parts supplied by them, thus causing the motion: second, by reflex action, as when a 78 HOW ARE WE MADE? stimulus is applied to the ex- tremity of a nerve, thus producing an irritation which is conveyed along the sensitive filaments to the nerve centre, where the irri- tation is recognized and the impulse is consequently ex- tended backward over the mo- tor nerve, giving motion at the point where the irritation was at first supplied. In many of the lower forms of animal life all motion is the result of re- flex action, and, as we ascend in the scale of development, the voluntary nerve action becomes more prominent, while the re- flex actions are more under the control of the will. The Great Sympathetic. -The sympathetic nerve is so called, because it is supposed that it establishes a sympa- thy between the various organs of the body. It consists of a series of ganglia, connected by intervening nerve cords, which are situated on either side of the vertebral column and extend from the base of the skull to the end of the spine. These two cords run parallel with each other to a short dis- tance of their termination, when they unite in a single knot, or ganglion, which forms their lower extremity. These knots or ganglia are numerous, and each one may be regarded as a distinct nervous centre, with branches passing off in var- ious directions. Some branches connect the ganglia with each other, others form communications with the cere- bral and spinal nerves, while others, again, are distributed to the internal organs. The branches of this nerve principally control those organs over which the will has no direct action, ^g- 35- THE GREA T S YMPA THE TIC. 79 and they perform an important office in keeping up organic life. In all severe cases of shock, the ganglionic centres of this nerve are largely involved, as is evinced by the serious results that often follow a slight injury of an internal organ of the body. When any single organ is diseased or injured, the irri- tation of the branches of this nerve causes a sympathetic action with other organs ; and it thus often happens that some unfavorable symptom of one organ is due to a diseased condi- tion of one remote from it. This sympathy cannot be pro- perly explained, so we are obliged to accept the facts as we find them. The Organs of the Special Senses.-For descriptions of the nose, eye, ear, tongue and skin, the reader is referred to the chapters on these organs and the diseases to which they are liable. CHAPTER II. HOW DO WE LIVE? Having endeavored to answer, in as brief a space as pos- sible, the important question, "How are we made?" we are again met with the equally important one, "How do we live?" In the descriptions we have already given of the various parts of the human body, we have simply spoken of them, in the main, as they appear to the anatomist, who obtains his information from the dead body. Now we have to deal with the mysterious phenomena of life, which distinguishes all living organisms from inani- mate substances. We are unable to explain how it is that the brain, muscles, arteries, veins, nerves and bones, entering into the formation of the human body, are endowed with such wonderful powers as we see manifested in man; but we are equally at a loss to explain the mysteries of life as seen in the lowest forms of animals. If any one can explain what constitutes life in the worm, the fly, or the dog, we shall under- take to make clear all the mysteries of the intellectual de- velopments of the higher orders of animals ; but, till this is done, we must content ourselves by considering how life, as we find it, is maintained. In considering this subject we have to deal with the life of the individual, and the preservation of the species. It is ELEMENTS OF THE BODY. 81 not enough to know how we are made, if we do not know how to live ; nor would it be of any advantage to know how to preserve the life of the individual if we could not perpetu- ate the species. Every piece of machinery, as soon as it is set in motion, begins to wear out, and after a time it has to be repaired or thrown aside as useless. So every mental and physical action of the animal body is accompanied by a waste of tissue, that must be replenished to keep up the normal phenomena of life. In order to be able to answer the question, "How do we live ?" we must know of what elements the body is composed, the changes that take place in the production of waste, and how that waste is replenished. The researches that have been made in physiological chemistry, demonstrate that the human body contains four- teen elementary substances. These have been formulated from the analyses of several investigators. Bellows and others give the proportions as follows: In the body of a man weighing 154 pounds, there are of oxygen, in lbs.; hydrogen, 14 lbs.; carbon, 21 lbs.; nitro- gen, 3 lbs. and 8 ounces ; phosphorus, I lb., 12 oz., 190 grains; calcium, the metallic base of lime, 2 lbs.; flourine, 2 oz.; sul- phur, 2 oz., 21 grs.; chlorine, 2 oz., 47 grs.; sodium, 2 oz., 116 grs.; iron, 100 grs.; potassium, 290 grs.; magnesium, 12 grs.; and silicon, 2 grs. These elements do not, however, exist in the body in their own forms, but are so combined so as to form chemical compounds, called proximate principles. Prof. Dalton describes proximate principles as "any sub- stances, simple or compound, chemically speaking, that exist in an organized body, and may be extracted from it in their own form, without changing their chemical composition." Physiolo- gists divide these proximate principles into three classes : First, those derived from the inorganic world, as water, chloride of sodium, (common salt), phosphate of'lime, phos- phate of soda, and the other salts found in the body; second, the starches, sugars, and oils, which are spoken of as carbon- aceous principles ; and third, the nitrogenous principles, such as albumen, fibrin, etc. 82 HOW DO WE LIVE? The proximate principles exist in a healthy body of 154 lbs. weight, in the following proportions : Water, composed of oxygen and hydrogen, 111 lbs.; gela- tine, composed of carbon, hydrogen, nitrogen, oxygen and sulphur, 15 lbs.; Fat, 12. lbs; Phosphate of lime, forming the principal part of the earthy matter of the bones, 5 lbs., 13 oz.; carbonate of lime, also a part of the composition of the bones, 1 lb.; albumen, found in the blood and in almost every organ, 4 lbs., 3 oz.; fibrin, forming the muscles and clot of the blood, 4 lbs., 40Z., 3 grs.; fluoride of calcium, found in the bones, 3 oz.; phosphate cd soda, found in the brain and nerves, 400 grs.; phosphate of potash, also found in the brain and nerves, 100 grs.; phosphate of magnesia, found in the bones, 75 grs.; chloride of sodium, grs.; sulphate of soda, in the blood 1 oz., 170 grs.; carbonate of soda, in the blood and bones, I oz., 72 grs.; sulphate of potash 400 grs.; peroxide of iron, 9 oz., 150 grs.; silica, 3 grs. This composition of the organism, unlike inorganic com- pounds, is constantly undergoing change. The nitrogenized principles are being constantly transformed into effete matter, and the products of this decay are always discharged from the body in combination with inorganic matters, with which they are closely and inseparably united. " This molecular change is a necessary and inevitable condition of life. Its activity may be increased or retarded by various means, but cannot be arrested. The excrementitious principles which are thus formed are produced constantly by the tissues, and must be continually removed from the organism, otherwise they ac- cumulate and produce various toxic conditions." When we examine the amount of matter which is daily discharged from the body we can readily understand that this process of destructive assimilation, as it is called, must be very active. In order to make up for the waste occasioned by this constant operation new material must be regularly sup- plied to the various organs and tissues, in order that the in- tegrity of their composition maybe maintained, and that they may always be ready to perform their proper functions. All the principles necessary for the re-generation of the organism PROXIMA TE PRINCIPLES. 83 are contained in the blood. The inorganic principles are gen- erally found in the same form in which they exist in the tissues; "but the organic principles of the parts are formed in the sub- stance of the tissues themselves by a transition of material furnished by the blood." or, in other words, the material fur- nished by the blood is reduced to a protoplasm and then ap- propriated by the tissues. The physiological decay of the organism is, therefore, being constantly repaired by the blood; but in order to keep this great nutritive fluid from becoming impoverished, the materials which it is constantly losing must be supplied from some source out of the body, and this neces- sitates the ingestion of matters known as food. Food is taken into the body in obedience to a want on the part of the system which is expressed by the sensation of hunger, when it relates to solid or semi-solid matters, and thirst when it relates to water. Now these sensations of hunger and thirst are not resi- dent in the stomach as is generally supposed. They repre- sent the demand of the various tissues of the body for nutri- ment, and whatever feelings may be attributed to the diges- tive organs are the result of reflex action. The stomach and intestines may be entirely empty and yet hunger and thirst may be absent; while on the other hand, if all the elements found in the body are not supplied in the food, hunger may be present even though the stomach and intestines are filled with otherwise wholesome food. From what we have now said of the composition of the body, the changes that take place in the living organism, and the manner in which the regeneration of the tissues is effected, it follows as a self evident proposition, that our food must con- tain all the proximate principles that enter into the formation of the human body. Physiologists unanimously agree that these principles are most readily and most abundantly supplied by a mixed ani- mal and vegetable diet. The anatomical structure of the hu- man digestive apparatus shows conclusively that it was design- ed for the digestion of mixed food. Simpler than the herbiver- ous, and more complicated than the carnivorous, it partakes of 84 HOW DO WE LIVE? the characteristics of both, as can be seen by the anatomical, structure, as well as by the physiological functions of its dif- ferent parts. A chapter will be devoted to the further consideration of the question of foods. We shall, therefore, for the present, simply describe the manner in which food is converted into nutritive material, and how the various tissues are supplied with the forces necessary for keeping up their action. Food is first taken into the mouth, where it is thoroughly masticated, or ground into minute particles, and, at the same time, mixed with the saliva. The mastication prepares it for being acted upon by the gastric juice, while the saliva begins the process of converting the starches into sugar, and at the same time moistens the food, so as to render it easy of degluti- tion. As simple as these processes of mastication and insali- vation may appear, they are of great importance to perfect di- gestion. The person who takes time to chew his food before swallowing, is usually healthy, while he who bolts his food without chewing, invariably suffers from dyspepsia. The act of swallowing, carries the food into the stomach, where it is mixed with the gastric juice. The muscular actions of the stomach are such that the food is carried round and round, so as to enable it to be properly mixed with the gastric juice. This fluid acts upon what are called the albuminoid sub- stances, and converts them into a protoplasm, which is pre- pared for absorption. Some portions of the protoplasm are directly absorbed by the blood-vessels of the stomach and the remainder passes into the small intestine with the starches, sugars and fats, which are not digested in the stomach. All starchy substances, such as potatoes, wheat bread, corn, etc., and all saccharine foods, are digested by means of the intestinal juice, a secretion from the numerous glands of the intestine; while the fatty and oily portions of the food are acted upon by the pancreatic juice, and converted into a milky emulsion, commonly spoken of as chyle. Such portions of the digested albuminous food as have passed into the in- testine from the stomach, and the digested starches and sugars, are directly absorbed by the blood-vessels of the CIRCULATION OF THE BLOOD. 85 intestines and carried into the inferior vena cava; while the chyle-the digested fatty substances-is taken up by the ves- sels already described as lacteals, and carried into the re- ceptaculum chyli, and from thence through the thoracic duct to be deposited in the left sub-clavian vein, from which it en- ters the superior vena cava. Thus, by the absorption through the blood-vessels of the stomach and intestines, and through the lacteal portion of the lymphatic system, the food, after being con-verted into the form of protoplasm, finds its way into the venous circulation. Soon after the digested food en- ters the veins, it becomes so mixed with the venous blood as to lose its identity. The blood thus reinforced passes from the superior and inferior vence cavce into the right auricle of the heart. This section of the heart then contracts and forces the blood through the auriculo-ventricular opening, and the blood is prevented from running back into the large veins, by valves which are found situated in all veins, at short intervals from each other. When the right ventricle is filled with blood it contracts, and the pressure of the blood closes the valve be- tween it and the right auricle. This forces the blood through the pulmonary artery to be distributed to the lungs, and after it leaves the ventricle, the closure of valves prevents it from returning to the heart. In the lungs the blood gives off car- bonic acid and absorbes oxygen in its passage from the venous to the arterial capillaries, and is thus changed from im- pure or venous, to pure, or arterial blood. It next passes through four small veins to the left auricle of the heart, which in its turn contracts, and forces it through the left auriculo-ventricular opening into the left ventricle, when other valves close to prevent its return to the auricle. The con- traction of the left ventricle then takes place and forces the blood into the large artery leading from the heart called the aorta. The muscular fibres of this vessel contract and close a set of valves which prevent the blood from returning to the heart, while the contraction gives additional impulse to the motion of the blood, as it is carried into the branches of the aorta. In the same manner the muscular fibres of all the ar- teries keep up successive contractions after each contraction 86 HOW DO WE LIVE? of the left ventricle of the heart; and thus the blood is forced along in the minute ramifications of the arteries to the different tissues of the body. Here the tissues appropriate to their own use such portions of the blood as they require, and throw into it, in the form of carbonic acid such substances as they can no longer use. All excess of nutritous material that is not required by the tissues, and such effete material as cannot be carried off by the blood, are taken up' by the lymphatics and again carried into the veins through the thoracic -and right lymphatic ducts. The blood that returns from the tissues, charged with carbonic acid, mingles with the products of the newly-digested food and the fluids from the lymphatic vessels, before again reaching the heart, from whence it is carried through the course just described. Although it is not definitely known what exact office the bile performs in the process of digestion, yet, we believe that it is essential in keeping up what is commonly called the per- istaltic action of the intestines. This action consists in the contraction of the circular fibres of the intestinal tract from above downward, and it is observed that when such action is arrested, intestinal digestion is impaired, and the food al- ready digested is impartially absorbed, leaving the lower bowel filled with fecal matter, and thus producing the condi- tion known as constipation. Such conditions are always known to follow an inactive state of the liver. When the bile is thrown into the duodenum in normal quantities, it seems to stimulate the mucous membrane that keeps up this peristaltic action, which is essential to perfect digestion and absorption. The large intestine excretes, or throws off, a considerable amount of effete material in the form of used up animal sub- stances, which is mingled with portions of undigested food, and expelled from the body in the form of feces. The kidneys also act in throwing off waste material held in suspension in the urine. The substances thus thrown off are urea, creatine, and the urates of soda, potash and am- monia, all of which, as well as carbonic acid are formed in the body, and contain carbon, hydrogen, nitrogen and oxygen EXCEETZONS. 87 in different proportions. The urine also throws off other salts that are not excretions, as well as a large quantity of water. The skin and lungs also throw off water or watery vapor, but these are not considered excretions. In order to understand the necessity for the throwing off of so much material, it must be remembered that all parts of the living body are undergoing constant change. We are continually taking into our systems materials from without, and these are changed by the nutritive process, so that they can be assimilated by the various tissues and converted into the ingredients of which they are composed. If there was no destruction of tissue this constant supply would be unneces- sary, but as it is, it simply replaces the waste or decomposi- tion that is incessantly going on in the same tissue. With every mental action and with every motion of voluntary or involuntary muscles some tissue is consumed, and new compounds are formed through this consumption, that must be expelled from the body, to give place to new material sup- plied through the nutritive system. This supply of new material is called assimilation, while the process of waste is known as destructive assimilation. The importance of the former we have already mentioned, and that of the latter is readily seen by the injurious effects that follow when any of this effete matter is retained in the sys- tem. When the discharge of these substances is in any way interfered with, they become poisonous and soon produce de- rangements of the vital functions. Though the excretions contain the same elements as are taken into the body in the form of food, they exist in different proportions, and are entirely new compounds, formed in the body by the changes the tissues undergo in the vital pro- cesses. From careful examinations of the ingesta and egesta it is estimated that a healthy adult human subject absorbs in the form of nutriment a little more than seven pounds every twenty-four hours, and discharges an equal amount by means 88 HOW DO WE LIVE? of the lungs, skin, large intestine and kidneys. It is the con- stant chemical changes that are thus carried on in the body, that convert the latent force of the food, which is the fuel, into the vital force which is manifest in all animals and vege- tables. As important as the functions of nutrition and excretion are, they cannot be performed without the agency of the nervous system, which is designed to associate the different parts of the body in such a manner, that stimulus applied to one organ may excite the activity of another. It is also the governing or controlling system of animal life ; and in the higher orders of animals, it gives that intelligence which is only found where there is a high development of nervous tissue. As already stated, the spinal cord sends out nerves to supply the muscles and integument of the neck, trunk and extremities. These portions of the body are endowed with two important functions, namely, the powers of motion and sensation, both of which reside in the nerves. The power of sensation is that which enables us to re- ceive impressions from external objects, and through it we are enabled to obtain information in regard to the physical quali- ties and properties of all bodies with which we come in con- tact. When any body is brought in contact with the skin, we feel that it is hard or soft, hot or cold, rough or smooth. This power is distributed throughout the external integument and is dependent upon the sensory filaments of nerves ramifying its tissue. This sensibility varies in acuteness in different parts of the body; thus, the extremities of the fingers are more sensitive than the general surface of the arms or legs; and the tongue, lips, and the orifices of the mucous passages are more sensitive than the general integument. All impres- sions applied to the surface of the body excite the sense of feeling, or what is commonly called sensibility, while if the integument and nerve filaments are injured the sense of pain is produced, which differs entirely from ordinary sensation. MOTION AND SENSATION. 89 The power of motion is resident in any portion of the body where muscular tissue exists, and it is dependant upon the contractibility of the muscular fibres; but this motion cannot take place without the agency of the nervous system. The stimulus which causes muscular action is transmitted to the muscles by the nerve filaments, which is demonstrated by the fact that if the nerves supplying a muscle are divided or seriously injured, the part becomes at once incapable of all voluntary movement. The nerves that thus produce muscu- lar contraction are spoken of as excitable nerves. Many of these, however, act upon other organs beside the muscles ; thus a nerve transmitted to a gland, when irritated, produces an increased secretion of that gland, while one supplying capillary blood-vessels would cause congestion. In these cases the influence is transmitted directly by the nerve to the organ which is called into activity. Sensation has been shown to be situated in the gray mat- ter in the interior of the spinal cord. The stimulus that excites it is transmitted along the sensory nerves, through the posterior root of the cord as previously mentioned, while motion is located in the exterior white portion of the cord, and is transmitted from thence to the parts to be acted upon by the filaments of the anterior roots of the cord. As the filaments are joined together in a common sheath, division of a nerve invariably destroys both the motion and sensation of the parts to which the divided nerve is distributed. This sup- ply of motory and sensitive filaments to the various tissues of the body, and their connection with the spinal cord as a nerve centre, gives motion and sensation without the direct intervention of the brain, either in receiving the impressions or directing the motions. This action of the spinal cord is described as reflex action, and governs many of the func tions of the human body as it does all those of many of the lower forms of animal life. As examples of reflex action, we may mention the following : When food is taken into the mouth, the mucous mem- brane is irritated by its presence, and acts upon the sensitive filaments of nerves, and these convey the impression to the 90 HOW DO WE LIVE? nerve centre, which sends a telegraphic communication along other nerves to the salivary glands. These are thus stimu- lated to action, when they secrete the saliva that is neces- sary to commence the process of digestion. In the same manner, when food enters the stomach, the mucous membrane of that organ is irritated and the impression is conveyed along one set of nerves, when again a telegraphic message is sent out along other branches of nerves, and these cause the mus- cles of the stomach to contract and also excite' the secretion of the gastric juice. In the same manner, the peristaltic action of the intestines is produced, and the liver and the pan- creas made to supply their secretions. Through the same agency, the various tissues of the body are irritated by the carbonic acid thrown off from them, and the irritation is conveyed to the brain and cord, from which messages are sent to the stomach and small intestine, thus causing the sensations of hunger and thirst, as previously mentioned. When an injury is impinged upon any portion of the body, the impression is made upon sensitive filaments of nerves. These convey the impression to the spinal cord and brain, where the sense of pain is produced and the impulse is conveyed along a motor nerve, which causes a motion of the muscles and parts in the vicinity of the injury. Again, in walking, or in any of the voluntary motions of the body, the impulse directing the motion originates in the brain, and travels along a motor nerve to the muscular fibres connected with the part to be moved. These are thus made to contract, and the motion is produced. When the ordinary motions of walking are once established, it is claimed that the pressure of the foot upon the ground produces a stimulus to the sensitive nerves, which is conveyed through the pos- terior root to the spinal cord, and from here the impulse is returned along the motor nerves to the lower extremities, and thus the motions of walking are kept up, independently of the direct control of the will. This is demonstrated by the fact that a person after starting to go to a certain place, may have his mind pre-occupied by other thoughts, and yet he will walk along unconsciously, and even pass his place of AUTOMATIC MOTION. 91 destination if the mind is not recalled, so as to bring the auto- matic motions again under the control of the will. The same principle applies to the automatic action of the hand, which, when once put in motion, may continue while the mind is occupied in an entirely different direction. It may, therefore, be stated, in brief, that the spinal cord is alone concerned in the performance of all those move- ments, which are primarily automatic; and that the will, which carries into action the determination of the intellect, has no direct power over the muscles which execute its man- dates, but operates through the automatic mechanism pre- sided over by the spinal cord. As illustrating the relations between the will and the automatic movements, Dr. W. B. Carpenter, in his "Mental Physiology," writes as follows : "Thus, then, the relation between the Automatic activity of the body, and the Volitional direction by which it is util- ized and directed, may be compared to the locomotive power of a horse under the guidance and control of a skillful rider. It is not the rider's whip or spur that furnishes the power, but the nerves and muscles of the horse ; and when these have been exhausted, no further action can be gotten out of them by the sharpest stimulation. But the rate and direction of the movement are determined by the Will of the rider, who impresses his mandates on the well trained steed with as much readiness and certainty as if he were acting on his own limbs. Now and then, it is true, some unusual excitement calls forth the essential independence of the equine nature ; the horse takes the bit between his teeth and runs away with the rider, and it is for a time uncertain whether the inde- pendent energy of the one, or the controlling power of the other, will obtain the mastery. This is just what we see in those spasms and convulsions which occur without loss of consciousness, and in which the muscles which we are accus- tomed to regard as 'voluntary' are called into violent con-* traction, in spite of the strongest volitional resistance'. On the other hand, the horse will quietly find his way home, whilst his rider, wrapt in a profound reverie, entirely ceases to 92 HOW DO WE LIVE? guide him ; just as our legs carry us along a course that habit has made familiar, while our mind is engaged only on its own operations, and our will is altogether in abeyance. And, to complete the parallel, the process by which a horse is taught any unusual performance-as when in training for the circus or the stage-entirely corresponds with that by which we ' train ' our automatic mechanism to any novel action: the result desired by the master being indicated to the learner, every effort that tends to produce it being encouraged and fixed by repetition, and every unsuitable action being repressed; until the entire sequence comes to be automatically executed at the first touch of the suggesting spring which expresses the directing will." As we ascend in the scale of animal life, we find the ner- vous system becomes more complicated, until its highest de- velopment is reached in man, with a large cerebrum super- added to the spinal cord, which is the fundamental and essen- tial part. It is this portion of brain that gives the predomi- nance of intellect over instinct, and it has been demonstrated that it is much larger in civilized than in uncivilized races. Although this rule applies to the different races, it does not always do so in individual cases. Thus a person may have a large cerebral development that has never been improved by education, while another, with a much smaller but better trained brain, will possess superior intelligence. The cerebrum is the organ of three functions: Feeling, including emotion, Will or volition, and Thought or intellect, which taken together constitute what is commonly called the Mind. All feelings, or emotions, are impressions made upon, or shocks received by the cerebrum and communicated by it to other portions of the body which give them expression. They are entirely independent of the will and thought, though they cannot be produced without the action of both, as all feeling carries with it the germs of the other two factors of the mind. The Will controls all voluntary movements and actions; and yet such movements originate in Feeling and are guided by Intellect; thus showing that the three factors of mind are VOLITION. 93 intimately dependent upon each other. On this subject, Prof. Alex. Bain, in "Mind and Body," writes as follows: "In the Will altogether I reckon up three elements; two primitive, instructive, or primordial, and the third a process of education or acquirement. "The first primordial element is called Spontaneous Energy, or Surplus Activity of the system, or the disposition of the moving organs to come into operation of themselves previous to, and apart from the stimulation of the senses or the feelings, the activity being increased when such stimula- tion occurs in the primitive spontaneity. I think there is evi- dence to show that the profuse activity attendant on health, nourishment, youth, and a peculiar temperament called the active temperament, springs in a very great degree from in- herent active power, with no purpose at first, but merely to expend itself; and that such activity gradually comes under the guidance of the feelings and purposes of the animal. It is the surplus power of the system discharging itself without waiting for the promptings of sensation. In the course of ed- ucation the spontaneity is so linked with our feelings as to be an instrument of our well being, in promoting pleasures and removing pains. The voice by mere spontaneity sends forth sounds, the ear controls and directs them into melody, and the wants of the system generally make them useful in other ways. •• Mere spontaneity, however, would not give us all that we find in the impulses of the Will. Being the overflow of vital power, it would show itself only whenever and wherever there is such an overflow. We want a kind of activity that shall start forth at anytime when pleasure is to be secured, or pain to be banished, and that shall be directed to the very points where these effects can be commanded. " For such a power we must refer to the great fundamen- tal law of Pleasure and Pain-the law that connects pleasure with increase of vital power, pain with the diminution of vital power. This law we may look upon as in many respects the foundation, the main-stay of our being; it is the principle 94 HOW DO WE LIVE? of self-conservation-the self-regulating, self-acting impulse of the animal system. When anyhow we come into a mood of joyful elation, the physical state corresponding is an exalta- tion of vital energy to the muscles, the organic functions, one or other, or both; and that exaltation is an increase of the ac- tivity that is bringing the pleasure. The first act of masticat- ing a morsel of food develops a pleasurable feeling to the conscious mind, and a concurrent stimulus of heightened ac- tivity to the body; the heightened activity vents itself in the parts actually moving at the time-the masticating organs, the cheeks, jaw, and tongue-which in consequence, proceed with redoubled vigor, the pleasure thus feeding itself. In that connection we have, as I believe, the deepest foundation of the will. On the other hand, if, in the course of energetic move- ments of mastication, a false step occurs, the teeth embracing by mistake the skin of the lip or the tongue, there is mentally a smart of pain, and physically, I think, a destruction of ner- vous power through the shock, and the destruction of power is at once and directly a cessation of the active currents im- pelling the mouth and the jaws. Such I conceive to be the ground-work of Volition, great- ly, but never entirely, overlaid in mature life by a large su- perstructure of acquired connection between feelings and spe- cific movements. Without some such foundation I see no way of beginning the work of voluntary acquisition, nothing to make our movements relevant to our state of feeling at the time; moreover it is the check that is always ready to step in and supersede our acquired habits. At any moment a burst of pleasure will raise our energies, a shock of pain (not being an acute exciting smart) will depress them; in the one case the cause of the pleasure, if our over-activity, will be main- tained with increase; in the other case the energies are ar- rested, and if they are causing the pain, it will cease with them. The bursting out of a cheerful light in a dark labyrinth spurs us on without our going through the formality of what we call a resolution of the will; while a course leading us to darkness, strangeness, and uncertainty will be arrested by the mere sink- ing away of our energies before we can even begin to deliberate. THOUGHT AND SENSATION 95 Our course in life from first to last, although most at first, is trial and error, groping and feeling our way, acting somehow, and judging of the result; and the general tendency of the law in question is to sustain us when we are in a good track, to turn off the steam when we are in a bad track." Thought or intellect is the crowning function of the cere- brum, and is composed of a number of faculties, such as mem- ory, reason, judgment, imagination, conception., &c. Just how thought is produced we are unable to explain, though sev- eral theories have been advanced to account for it. It is claimed by some that all mental efforts result from a series of explosions that take place in the ultimate nerve cells of the brain. Be this as it may, it is certain that there is as much loss of tissue after mental, as after muscular effort; and it is easily demonstrated that the material eliminated after con- tinued mental labor is the product of combustion of nerve tissue. A number of ganglia are situated at the base of the cerebrum, which are known to receive sensations through the special nerves that connect them with the organs of the special senses, as the eye, ear, nose, and tongue and throat. These ganglia taken together are spoken of as the Sensorium, and it is through their connection with the upper part of the cerebrum, that much of our knowledge is obtained. Yet any of these ganglia, through the agency of their special organs may receive impres- sions without communicating them to the cerebrum. This may be illustrated by reference to a simple one-the eye.. While walking in a crowded street the cerebrum may be occupied, and yet the eye through the sensorium sees obstacles in the way, and we avoid them without being conscious of it. This fact and others equally interesting, have led to the belief that the cerebrum has an automatic action which is of- ten unconscious. As illustrating this, a circumstance which occurs to almost every one may be mentioned. .We try to recall some name or circumstance, but cannot. The more we try the farther we get from it, till finally we discontinue our efforts. After a time, when our conscious thoughts are upon something else, or often when we have almost fallen asleep, 96 HOW DO WE LIVE? that which we had tried in vain to recall comes suddenly to mind, Prof. W. B. Carpenter believes that in such cases, the cerebrum has continued to think on the subject unconsciously, and when it has at last worked it out the sensation is con- veyed to the sensorium, and rises above consciousness. Though these are merely suppositions, there are numerous circumstances which go to indicate the possibility that they may have some foundation in fact. And yet, if they were positively proven we would be far from being able to explain the mysteries connected with the functions of the cerebrum, which constitute the Mind. The cerebellum, or lesser brain, has long been considered the special organ for the regulation and co-ordination of mus- cular movements. Without some such governing power we would be unable to move more than a single muscle at a time; while as it is, entirely different sets of muscles are moved sim- ultaneously, with the most perfect regularity and harmony. Dr. Ferrier, of England, has, however, added an important discovery to our previous knowledge of the functions of this part of the brain. In his experiments on locating the func- tions of the brain, he arrived at the unexpected conclusion that the cerebellum is the ganglionic centre of the motor nerves of the eye, as all the movements of the eye-ball were produced at will by stimulating different portions of this organ. The medulla oblongata is the connecting link between the brain and the spinal cord. It gives off the pneumogastric ganglion, which is the point of origin of the nerve of the same name that supplies the lungs and stomach. This part of the brain, therefore, presides over the function of respiration. The movements of respiration, though they can be controlled for a short time, are not voluntary, but are constantly kept up without our volition or consciousness. They are reflex in character and take place through the medulla. The accumulation of carbonic acid in the pulmonary ves- sels and air-cells of the lungs causes an irritation that is trans- mitted by the pneumogastric nerve to the medulla, and is thence conveyed along the motor nerves to the muscles of ACTION OF GREAT SYMPATHETIC. 97 respiration. These muscles then act in producing an expan- sion of the thorax. Although this action is kept up con- stantly day and night it is unperceived by the consciousness. Whenever the volition directs any muscular motion, the stimulus, originating in the cerebrum, must pass through the medulla to reach the cord. Thus we find that the combined functions of the several sections of the brain and spinal cord play an important part in the phenomena of life, and yet these are not complete without the action of the great sympathetic nerve. The branches of the great sympathetic nerve are dis- tributed to the organs over which the will has no immediate control, as the intestines, kidneys, heart, liver, etc. They are essential to all forms of animal life, and are consequently spoken of as the nerves of vegetative life. The ganglia of this nerve are connected; first, with each other; second, with the cerebro-spinal system, and third, with the internal vis- cera of the body, thus forming a complex and delicate ner- vous communication between the two great systems of nerves and the several organs. This system of nerves is endowed with sensibility and the power of exciting motion, but in a less degree than the cerebro-spinal system. When irritation is applied to any part supplied by this nerve, the sensation is slow to manifest itself, and it may be several hours before there is any direct manifestation of the effect of the stimulus. This is demonstrated by the fact that inflammations of the internal organs are very rarely established until several hours after the application of the exciting cause. The sympathetic has also been demonstrated to have close connection with the muscles of the Special senses. The movements of the iris in the eye, which cause the contraction or dilation of the pupil, do not take place instantaneously, but after an appreciable interval of time after a sudden pas- sage from a brilliantly lighted room into a dark one, or visa versa. The actions of the deeper seated muscles of the ear which control the "drum" are also in a measure controlled by the sympathetic nerve. 98 HOW DO WE LIVE? The filaments of this nerve also play an important part in the circulation. By their action, they cause contraction of the organic muscular fibres of the arteries, and thus carry the blood along, and at the same time regulate the resistance of the vessels so that the blood does not pass too rapidly through them. When the nerve is irritated, the vessels are contracted, but when from any cause its action is diminished or suspended, the vessels are dilated, the circulation is in- creased and the nutritive changes which should go on in the tissues are thereby arrested. In this way we have congested conditions of the internal organs following diseases that have in some way suspended the action of the sympathetic nerve in any of the internal organs. Certain forms of reflex action are also dependant entirely or in part upon the sympathetic nerve. The convulsions of young children are often known to be due to intestinal irrita- tion, which is conveyed through the sympathetic nerve to the cerebro-spinal system, and through that to the muscles in- volved in the paroxysm. The nausea of early pregnancy is in the same way produced by the irritation of the branches of the sympathetic that supply the uterine mucous mem- brane. Mental and moral impressions received through the special senses, will often disturb the motion of the heart and arrest the process of digestion, through the impressions con- veyed to the sympathetic nerve from the cerebro-spinal system. The mutual action of the digestive, circulatory, urinary, and generative organs result from the connection established by the sympathetic ganglia and their nerves. In short, the sympathetic nerve may be regarded as the connecting link between the organs of nutrition and the general nervous sys- tem, and it is as essential to the vegetative life of man as the brain is to the mental activities. REPRODUCTION. After considering the methods by which life is sustained in the individual, we come now to the consideration of the life of the species. Although it would, appear that the REPRODUCTION. 99 changes we have been describing result in maintaining the structures of the body in an unaltered condition, yet such is not the case. 711656 changes are progressive as well as momentary, and the vital properties of the organs of every individual animal eventually undergo such changes as to render them incapable of properly performing their original functions. This impairment of function must of necessity bring the life of the individual to an end at some definite time, and hence provision is made by which all living organ- isms are enabled to reproduce their kind. This process is known as reproduction, or generation, and requires two sets of organs, each of which develops a peculiar product of its own, capable of uniting with the other so as to produce a new individual. These two sets of organs differ essentially from each other, and in the higher animals belong to two different individuals, and are called the male and female organs of generation. The female organs produce a small cellular body called the germ, or egg, while the male supplies the fecundating element, which is known as the spermatozoa. The spermatozoa penetrates the shell of the germ, or egg, and the union of the two elements results in changes in the contents of the egg, which ultimately develop a living animal. In the human being, the egg undergoes a certain process of development in the ovaries, and from thence passes into the uterus. If in its passage from the ovaries, it is met by the spermatozoa before it makes its exit from the womb, the spermatozoa penetrates the egg and the womb closes and retains it in its interior. As soon as this union takes place, new activities are created, and the egg undergoes a series of changes, till at the end of nine months the living child is expelled from the womb. The contents of the egg is a colorless albuminoid sub- stance with minute oily granules scattered through it. Im- bedded in its contents, is found a single cell, which is called the germinative vesicle. It is the union of the spermatozoa with this vesicle that constitutes the beginning of vital activ- ity in the >egg. The contents of the egg after impregnation 100 HOW DO WE LIVE? is closely analogous to the substance that scientists have des- cribed as protoplasm, and which constitutes the matter from which life originates. The changes which this egg undergoes in the womb, and the various stages of foetal development, closely correspond with the gradual evolution which is mani- fest in tracing life from its lowest forms to the higher animals. This fact is used as an argument in favor of the theory of evolution as set forth by Darwin, Haeckel and others, and is strengthened by many other facts connected with the com- parative variations in the anatomical structures of man and the lower animals. There is nothing in the theory of evolution, when it is properly understood, to shock the feeling of the most devout believers in the theory of creation as set forth by Moses. It simply claims that all forms of life had their beginning in one or more primary low forms, and that from these beginnings all the higher orders of life have developed by a gradual pro- cess of evolution, and the survival of the fittest. During the development of the child in-utero, it derives its nutrition from the mother, and in the latter months of uterine life its physical and mental conditions are largely in- fluenced by those of the mother. This would indicate the importance, for the well-being of the offspring, of the mother surrounding herself with such conditions as would be most conducive toward producing favorable impressions upon her- self. As the mother lives during this time, so will the child be born, and too much importance cannot be attached to the influence of these pre-natal impressions on the future well- being of the child. At the birth of a child a change takes place in the cir- culation of the blood. Up till this time the placenta, or after-birth, which is closely adherent to the uterine wall, has acted as the organ for purifying the blood. Though it derives its blood from the uterus, it carries on a circulation of its own and is connected with the child through the vessels of the umbilical cord. As there is no air, the lungs take no part in the foetal nutrition. With the first cry of the infant, after its expulsion from the womb, a change takes plase in the REPRODUCTION. 101 circulation, corresponding to the new environments. The lungs begin to fill with air and the blood passes through them to be purified, in the same manner as heretofore described for the adult. The child is then supplied with nutrition from the mother in such a form as to give rapid growth of tissues; and it continues to derive its nourishment from this source until the digestive apparatus is sufficiently developed to prepare it for the digestion of other foods. As the child grows, the various organs and tissues gain increased strength, and by a progressive development, the organs attain the size and con- sistency that finally enable them to perform perfect functions. Thus from the two simple elements of generation a per- fectly developed human being is evolved, who is subject to all the conditions heretofore referred to as controlling individual life, and who in turn is capable of supplying one of the ele- ments, or factors, for the evolution of a similar being. CHAPTER III. WHAT SHALL WE EAT? As we have seen in the preceding chapter, the human body is composed of a number of elementary substances which exist in its interior, in the form of compounds that have been described as proximate principles. In order that the vital phenomena may be properly maintained, these sub- stances are constantly undergoing such changes as render them unfit for further use in the economy. They are then thrown off as effete material and their place must be supplied from without the body. This is done through the agency of food, which undergoes the process of digestion, as previously described, before it is prepared for the nutrition of the tissues. We, therefore, include under the general title of food all those substances, whether solid or liquid, that are necessary to sus- tain the body in a normal condition. Foods are divided into two general classes, namely: the hydro-carbons, and nitro- genous, which correspond to the second and third classes of proximate principles previously mentioned. The hydro-carbons are those foods that contain carbon in combination with oxygen and hydrogen. They serve prin- ciply to keep up animal heat, and they include all starches, sugars and fats. The nitrogenous, or, as they are sometimes called, albuminoid foods, contain nitrogen in addition to car- bon, oxygen and hydrogen, and are the substances that go to build up tissues. THE TERIOD OF GROWTH. 103 Water, which belongs to the proximate principles of the first-class, is contained in nearly all articles of food, and is also taken in its pure state, while the earthy matters that go to make up the bones, and are found in the fluids of the body, are usually contained in sufficient quantities in the nitrogenous articles of food. For the proper consideration of the question of food, in health, we must divide human life into three periods: first the period of growth; second, the period of interchange, and third, the period of decay. THE PERIOD OF GROWTH. The period of growth begins with ''he birth of the child, and continues until all the organs and parts of the body are fully developed-usually till the eighteenth, or twenty-first year. During this time several changes of food are necessary, and much of the future happiness or misery of the individual depends on the quantity and quality of food during this period of life. As the nitrogenous articles of food are necessary for the growth of the organized tissue, and as a continual waste is going on in the body from the time the first breath is drawn until life ceases, the supply of these principles must be greater than the waste, or no growth can take place. It is, there- fore a self-evident fact, that during the period of growth, the nitrogenous food must be supplied in much greater quanti- ties than are required at any other period of life. The milk of a healthy woman-the natural food of infants-contains about 4 per cent, of nitrogenous matter, which is a large excess, proportionately, over the amount necessary for the food of the adult; while of the fatty material there is but 3 per cent, and of sugar 4 1-2 per cent. Infants under six months of age, should have no other food but milk, and if possible, mother's milk. Every mother should, however, pay sufficient attention to her own diet to be able to furnish wholesome food for her child. After six WHAT SHALL WE EAT? 104 months, or when teething commences, farinaceous food may be given in small quantities. At this time, the parotid glands secrete a considerable amount of saliva, and there is also an increase in the quantity of the gastric and intestinal juices, thus showing that nature is preparing the digestive apparatus for the reception of other foods. Even now, however, great care is necessary in selecting the food, which must still con- sist largely of milk, The best food with which to commence feeding a child after milk, is broth, or beef tea, pure at first, but afterward thickened with a little tapioca or arrow-root. Then chicken soup, made with a little cream and sugar, baked flour, biscuit- powder, &c., may be given in turn, to secure a necessary change. Milk must, however, constitute the principal and es- sential nutriment till after the eye-teeth are cut. For the first six or eight months infants should be fed once in every two hours; and from that age till the second year of life about once in three hours. The diet of childhood, or the period from two to fourteen years of age, requires close attention. During this period chil- dren, if healthy, should have no wine, beer, coffee, strong tea, or other exciting drink; and their food should consist of well- cooked succulent meats, without sauces or condiments, eggs, plenty of farinaceous puddings, mealy potatoes, carrots, spinach, beans, rice, bread, fresh butter, oat-meal porridge, baked apples, and milk. Children should have four meals a day, but care should be taken that they do not overload their stomachs. Between puberty and full growth, the young people are large eaters. The various kinds of food should be bounteous- ly supplied, but the nitrates and inorganic salts as contained in meats, beans, peas, lentils, &c., should be proportionately larger, in consequence of the rapid growth that takes place during this period. Many popular fallacies are rooted in the public mind con- cerning the question of food. Supported by the bombastic and unscientific utterances of those who hold themselves up FALLACIES CONCERNING FOOD. 105 as public teachers, these fallacies have greatly retarded the advancement of knowledge, and have left their impress upon the physical organization of our race. They affect the child from the moment of birth till it is old enough to think and act for itself; and if it lives, they too often entail upon it deformity and disease. Now let us ascertain what these fallacies are, and how they affect the child. i. The child is kept from the breast two or three days after birth, and in the meantime dosed with molasses, herb tea and castor oil. This invarably deranges the sensitive di- gestive apparatus, and often leaves the child incapable of digesting even milk; prevents it from acquiring the habit of nursing, and allows the breasts of the mother to become hardened so that the milk cannot be properly secreted. Then the child fails to obtain the nourishment it requires, and suffers from inanition which lays the foundation for innumerable in- fantile disorders. 2. After confinement, the woman is usually kept on a diet of toast and tea or similar non-nutritous foods, for a week or ten days. This was supposed necessary at a time when preg- nancy and parturition were regarded as deranged conditions, and low diet was believed essential to prevent fever. As a re- sult of this treatment, the secretion of milk was often scanty, and in order to increase it, ale or beer was usually ordered Thus the child was deprived of its proper nutriment from the first, and when it obtained a sufficient quantity, the quality was impaired through the beverages taken by the mother. 3. Children are often weaned too soon, and without other cause than the convenience of the mother. In other cases, nursing is continued even when the mother is incapable of supplying wholesome milk. 4. When the mother is unable to supply the milk for her child, cow's milk is substituted, and is usually diluted by add- ing two parts of water to one of milk. It is then carelessly heated and given to the child. In the majority of cases the milk thus prepared cannot properly nourish the child, while 106 WHAT SHALL WE EAT? the stomach is often injured by the varying degrees of tem- perature at which it is supplied to the helpless infant. Both of these errors are overlooked until almost complete in- anition has taken place, or the stomach and intentines have become seriously deranged. 5. Whenever the child cries or is restless, it is supposed that it requires food, which is many times forced upon it un- til the stomach rebels and rejects it as soon as swallowed. It must be apparent to everyone that these errors cannot but result disastrously. The various organs of the child be- come deranged; there is an evident lack of nutrition, and consequently, of growth; sleeplessness, which is never known in a healthy infant, is a constant disturbance; the evidence of actual starvation is manifested, and disease and death follow. In fact the great infant mortality which occurs in all our cities, is largely due to the ignorance manifested in the feeding of infants. It, therefore, becomes an important question to know how to feed infants, so as to avoid the evils that are constantly resulting from the continuance of these prevailing errors. Infant Feeding.-Nothing but a teaspoonful of water should be given to a newly born babe ; and it should be ap- plied to the breast as soon as the mother has had a short rest. True it does not get milk thus early, but it draws out a watery substance which stimulates the mucous surface of the intestinal tract, so as to excite a peristaltic action and thus cause the first motion of the bowels. It should after- ward be applied regularly to the breast, and at the proper time it will obtain the proper nourishment it requires. In order that the quality of the milk may not be deficient, the mother should not be confined to a low diet, but supplied with broths, soups, and such foods as will supply nitrogenous elements for the formation of the milk. Ale and beer should also, as a rule, be avoided by the mother, as they are calcu- lated to increase the watery portion of the milk, without sup- plying any of the nutritious elements. A child should not be weaned till it is a year old, if the mother is healthy, but after the sixth month it may have, in INFANT FEEDING. 107 addition to the mother's milk, pure broths and soups, free from vegetables, or an occasional piece of beef or mutton to suck. It may also have good cow's milk, after the sixth month, if it seems to require it. When a mother cannot nurse her child, from any cause, a wet-nurse is the next best thing for the child. In selecting a wet-nurse, care should be taken to ascertain that she is perfectly healthy and of good disposition. No nurse should be employed who has a child of her own to care for, as very few are able to supply food for two children, and, if it is attempted, both are likely to suffer. The next best thing is to have recourse to the use of cow's milk; and care must be taken not to add so much water that the proportions of the nutritive elements of the milk are largely reduced. This is often the case, and when the child appears to be having all it can drink, it is actually starving. In order to know how to prepare cow's milk for infant feeding it is important to understand the composition of that and human milk, and we subjoin the following analy- ses, which speak for themselves. Water. Nitrogenous. Butter. Sugar. Salts. Woman's Milk 88.9 3-9 2.6 4-3 O. I Cow's Milk 86.6 4.0 4.0 4-8 o.6 It will thus be seen that there is very little difference between human and cow's milk, and that reducing the latter with two-thirds, or even half water, materially lessens the proportion of nitrogenous elements, which the child requires for growth. If cow's milk is allowed to stand for an hour, and the cream is then removed from its surface, the addition of about 3 per cent, of water would make it about as near an ap- proach to human milk as we can secure without accurate chemical tests. For the first month of life, however, after the removal of the cream, one part of water may be added to four parts of milk, and this may be sweetened by a few grains of sugar-of-milk. After the first month it is best to 108 WHAT SHALL WE EAT? give the milk pure, or at most, with only a part of the cream removed. The temperature of the milk is another important ques- tion. If it was possible to always heat it to a uniform tem- perature, it would probably be best to do so ; but when it is hot at one time, cold at another, and boiling at a third, it is sure to injure the stomach of the child. It is therefore best to allow the milk to stand in a closed vessel, in the liv- ing room of the child, for an hour before using it, and then give it without heating. I have recommended this plan for many years, and have always found it to give better satis- faction than any other. Condensed milk, and the various prepared infant's foods, should be entirely avoided, as they are calculated to work harm, on account of containing more hydro-carbons than the infant's digestive apparatus is capable of digesting. After the sixth month the same general character of foods, as previously mentioned, should be used, and in the same order. It is wrong to feed children principally with potatoes, wheat bread and other starchy foods, as they do not produce growth, and cannot be used up in the body. Care should always be taken never to overload an in- fant's stomach. Feeding, with infants, is entirely automatic, but even when the cravings of hunger are satisfied, the pres- sure of the lips against the mother's nipple or an artificial one, will keep up the same reflex action. The child may thus continue to suck till the milk comes up from the stom- ach just as swallowed. If this is repeated often it will result in indigestion and distressing pains to the child. To avoid this the nipple should be removed from the mouth as soon as the child manifests any tendency to cease sucking. THE PERIOD OF INTERCHANGE. We come now to the second period of life, in which the work of nutrition is simply one of interchange. PERIOD OF INTERCHANGE. 109 This is the period of manhood-the prime of life-during which, if healthy, all the organs and tissues are fully devel- oped, and their functions perfect. Growth is complete, and the office of nutrition is to supply the material from which to repair the waste occasioned by destructive assimilation. As has already been stated, this is best done by selecting our food from the animal and vegetable kingdoms. We must remember, however, that "a little learning is a dangerous thing," and that fallacious teachings and imperfect knowl- edge, on this subject, .will lead to many evil consequences, that would be avoided by adhering to the good common sense suggested by the cravings of natural appetite. Weclaim that the generous intermixture of animal and vegetable foods, and the frequent changes met with on the tables of our well-to-do mechanics and farmers, will produce more power for mental as well as physical labor, than the best selected bill of fare of those who set themselves up as scientific teachers on this subject. If we enjoin upon the community the importance of a mixed diet, and of frequent change, we will have more bodily strength and mental vigor, than if we feed the mechanic on beef and potatoes alone, and the literary man on oysters, tripe, calves brains, and Graham bread. Among the fallacies that have prevailed, and still prevail in regard to diet, none is more absurd than that which ex- cludes animal food. A strictly vegetarian diet, even if selected with reference to its value for flesh-producing, will soon be followed by a marked diminution of the vital ener- gies of the system, and leave it liable to disease on the appli- cation of slight exciting causes. We have seen the truth of this statement demonstrated so frequently that we do not hesitate to pronounce it an established fact; and it is due more to the greater difficulty of digesting the nitrates when combined with starch, and the excess of the latter substance, than to the lack of nitrogenous elements in vegetable foods. For the benefit of those who have an unconquerable aver- sion for animal food, however, we append a table, published a few years ago in " The South Kensington Food Gallery," 110 WHAT SHALL WE EAT? which gives the relative values of our leading vegetables, as flesh producers. Equal supplies of nitrogen exist in the following quanti- ties of the vegetables named : i. Lentils, I lbs. 3 os. 2. Dried Peas and Beans, 1 " 5 " 3. Cocoa Nibs, 1 " 8 " 4. Dry Tea, 1 " n 5. Oatmeal, 1 " 13 " 6. Wheat Flour, 2 " 1 " 7. Dry Coffee, 2 " 1 " 8. Rye, 2 " 3 " 9. Barley, 2 " 6 " 10. Maize, 2 " 9 " 11. Buckwheat, 3 " 10 " 12. Bread, 3 " 13 " 13. Rice, 4 " 13 " 14. Cabbage, 10 " 6 " 15. Parsnips, 15 " 10 " 16. Turnips, 17 " 13 " 17. Potatoes, 20 " 13 " 18. Carrots, 31 " 4 " It has been claimed by many writers that brain-workers require to eat large quantities of phosphatic foods to supply the waste of the brain tissue, and on this hypothesis they have suggested special kinds of food, said to contain large propor- tions of phosphates. Those acquainted with the subject, how- ever, have clearly disproved this theory, or at least have dem- onstrated that the claims are too sweeping. Phosphorus, in minute proportions, is a necessary ingre- dient of a healthy body, and chemistry has demonstrated that it exists in larger proportions in the muscles than in the brain. It is discharged in considerable quantities with the urine, after severe mental labor, but it is also discharged in as large, and often larger, quantities, after severe physical labor. It is found, after moderate labor, in about equal quantities in the urine of the mechanic and farm laborer on the one hand, and in that of the lawyer, minister, scientist or doctor, on the other. On this subject, Dr. Thos, K. Chambers, of London, in his "Manual of Diet in Health and Disease," writes as follows: PHOSPHORUS IN FOOD. 111 "That dogmatic expression of Buchner's: 'No thinking without phosphorus' has gained an unhappy notoriety. Strictly taken it is a groundless assumption, for it is impossible for us to have any evidence that intellectual being may not exist joined to any form of matter, or quite independent of matter at all. We certainly do not know enough of the subject to lay down a negative statement. And if it be held to mean that the amount of phosphorus passing through the nervous system bears a proportion to the intensity of thought, it is simply a misstatement. A captive lion, tiger, leopard or hare, who can have wonderfully little to think about, assimilates and parts with a greater quantity of phosphorus than a professor of chemistry working hard in his laboratory; while a beaver, who always seem to be contriving something, excretes so little phosphorus, at least in his urine, that chemical analysis cannot detect it. All the physiologist is justified in stating is that for the mind to energize in a living body, that body must be kept up to a certain standard, and that for this con- tinuous renewal of life a supply of phosphatic salts is required. The same may be said with equal justice of water, fat, nitro- gen, chloride of sodium, oxygen, &c. The phosphates are wanted, indeed, but wanted by pinches, while water must be poured in by the pailfuls. One might go on thinking for weeks without phosphates, but, without water a few days and without oxygen a few minutes, would terminate the train of self consiousness. The practical points taught us by phy- siology are that for the integrity of thought the integrity of the nervous system is requisite; and for the integrity of the nervous system a due quantity of such food as contains diges- tible phosphatic salts. "For the intellectual direction of the nervous system it is at the same time essential that it should not be oppressed by physical and mechanical difficulties. The presence in the stomach or blood of imperfectly assimilated nutriment im- pedes its functions in close proportion to their amount; so that not only the chemical constituents, but the mode of adminis- tering food must come into the calculation. 112 WHAT SHALL WE EAT? "The most perfect regimen for the healthy exercise of thought is such that would be advised for a growing boy, fre- quent small supplies of easily soluble mixed food, so as to sup- ply the greatest quantity of nutriment without overloading the stomach or running the risk of generating morbid half as- similated products." The truth is that brain-workers require easily-digested foods, and those most easy of digestion usually abound in ni- trogen and have proportionately less of the hydro-carbons, while some of them contain large quantities of the phosphates. Tripe, oysters, soups and broths are, therefore, good foods for those who are performing severe mental labor, not because they are rich in phosphates, (for the first two are not) but be- cause they are so easily-digested that the blood is only di- verted from the brain a short time, during the digestive pro- cess. The various kinds of fish are certainly valuable as foods but careful analyses fail to discover that they are richer in phosphates than some of our meats, as has been claimed. Neither have we had any evidence that a fish diet results in better brain work, or that those who live largely on fish from infancy are particularly intellectual. If this were true the great fish-eating nations would have developed the greatest brain-workers, while, in fact, the contrary is the case. As soon as the digestion is completed an extra amount of blood goes to the brain, and thus the mental activity is greater than after the use of foods that require several hours for digestion. THE PERIOD OF DECAY After the age of fifty or fifty-five, the movements of nu- trition become less active, and both assimilation and destruc- tive assimilation are materially diminished. With an unim- paired constitution a person of this age will usually retain a natural amount of vigor, even on a diminished daily al- lowance of solid food. If the digestive organs are impaired, as is often the case, they are much more liable to have the de- structive assimilation exceed the assimilation, and thus the vital energies rapidly decline. During this period, the nitrates RELATIVE VALUES OF FOODS. 113 and hydro-carbons need to be supplied in such form as to render them easy of digestion. The food should be well-cooked and made as soft and tender as possible, so as to avoid the lia- bilty of its being swallowed without the thorough mastica- tion and insalivation, which in many cases cannot be per- formed by aged persons in consequence of defective teeth. As the effect of alcohol is to check the activity of destruc- tive assimilation, its moderate use by persons over 50 years of age will as a rule prove of great advantage. Those who per- sist in using their brains as before, and who are unable to sup- ply the waste by new material, will be specially benefited by the use of alcohol. Elderly persons as a rule require less sleep as age advances, and it sometimes occurs that they find it dif- ficult to sleep long after the usual time of going to bed. If such conditions are persistent a light meal accompanied by a glass of beer, ale or wine, before retiring, will often produce an inclination to sleep which will last through the night. This is easily explained from the fact that a portion of the blood is drawn from the brain to aid in the digestion of this late meal, and thus mental activity is diminished and sleep ensues. RELATIVE VALLES OF FOODS. Physiologists differ as regards the relative value of the different foods used by man. All agree, however, that, in a normal condition, the human body is best sustained by a supply of mixed foods, and in appending a brief description of the various articles, we simply endeavor to supply a popular demand for correct information on the subject. Inorganic Substances.-The inorganic constituents of the body are mainly supplied as component parts of animal and vegetable substances used as food. Water is an important constituent of all foods, and is contained in them in large quantities. It is an important ele- ment in the body, and is frequently taken in its natural state to satisfy the demands of the system. It is not usually classed as a force-producing food, yet it cannot be doubted that when other foods are deficient, it supplies a certain amount of force to the system. The celebrated fast of Dr. Tanner, to which 114 WHAT SHALL WE EAT. we will again refer, would seem to demonstrate this fact with- out question. The saline matters which include lime, magnesia, pot- ash, soda, iron, phosphorus and sulphur, are not required to be taken into the body in their own form, but exist in proper proportions in the foods as before stated. Common salt, how- ever, is sometimes required in excess of what is contained in food. Milk.-Milk occupies a first rank as an article of food. It contains all the elements necessary for the nutrition of the child, and is valuable at all periods of life. It is possible that it may disagree with some persons, but it will usually be found that the difficulty is more with the individual than the milk. EGGS.-Eggs may also be considered a natural food, as they contain all the elements necessary for the construction of the body. They are easily digested when eaten raw or lightly boiled ; but are difficult of digestion when hard-boiled, and then usually produce constipation. Animal Foods.-The flesh of animals contains exactly the same proximate principles that exist in the fleshy parts of the human body, and are therefore the best adapted for flesh- producing foods. They are usually classified as meat, poul- try, game, fish and shell-fish. Meat.-The meats employed by civilized man are derived from herbiverous animals, although the flesh of carniverous animals is also eaten in some countries. Beef and mutton are the two most nutritious foods that can be found, and a person can perform more physical or mental labor on a diet of these, than on a similar quantity of any other kind of food. Next in order would come veal and bacon. Lean beef contains over 19 per cent, of nitrogenous mat- ter, 3 1-2 of fats, or hydro-carbons, and over 5 per cent, of saline matter; while fat beef has 14.8, 29.8, and 4.4 per cent, of these substances, respectively. In lean mutton there is a trifle less of nitrogenous and saline substances, and a small excess of fatty matter, over those of beef. ANIMAL FOODS. 115 In selecting meat it is easy to determine the difference between good and bad. If it is of a pale pink color it is a sign of disease, and if of a deep purple tint it indicates that the animal has died without being slaughtered, or has suffered from some acute fever. Good meat should have a marbled appearance, from the presence of thin layers of fat among the fibres. It should be firm and elastic to the touch, and should have little or no odor, and what it has should not be disagreeable. When meat is wet and flabby, and when the fat looks like jelly it should not be used. All meats are best broiled or roasted, and beef and mut- ton should be under done. Veal, lamb, bacon and fat pork should, on the contrary be well cooked. Poultry and Game.-Next to flesh of animals, birds are the most important articles of food. All birds are in them- selves wholesome, but some of them are rendered poisonous by the foods they use. The flesh of the fowl is delicate in flavor, tender and easy of digestion. It possesses less stimulating qualities than the flesh of animals, and is consequently well adapted for invalids. The turkey is different in flavor from the fowl, and is also wholesome and nutritious food. The flavor of wild birds, usually included with game, as the par- tridge, woodcock, snipe, quail, &c., is fuller and stronger than that of poultry, and the flesh is richer in nitrogenous matter. They are all easily digested and each possesses a special flavor which renders them appetizing foods for inva- lids.. Young birds of all kinds are more delicate than old ones, and as a whole, they constitute valuable variations of food in the proper seasons. They are the more readily di- gested when broiled or roasted, and should never be used in any other form. They contain a much smaller proportion of fats than animal meats, and at the same time less nitrogen- ous and saline substances, with a considerable excess of water. Fish.-Fish is another important article of food, and the varieties are almost innumerable. They are less sub- stantial and less stimulating articles of nourishment than the 116 WHAT SHALL WE EAT? flesh of either quadrupeds or birds, and yet they are easily digested in consequence of the small amount of fatty matter they contain. Contrary to the claims of many writers, chemical examinations have proven that fish contains less saline matter than any form of animal food. This fact com- pletely upsets the theory that fish is a valuable brain food in consequence of the amount of phosphates contained in them. Shell-Fish.-Lobsters, crabs, shrimps, oysters, mussels, clams, scollops, &c., are used as food, and come under the head of shell-fish. They are less nutritious and more indi- gestible, as a rule, than any of the foods before mentioned. Though lobsters are used to a considerable extent, there are very few persons who can eat them without having their digestion disturbed. The oyster, which has been lauded by many as a brain food, only contains about 4 per cent, of nitrogenous mat- ter; a little over 2 1-2 per cent, of saline matter, of which only one-half of one per cent, is phosphatic ,while it contains over 80 per cent, of water. The nitrogenous matter is prin- cipally albumen, and for that reason a meal of raw oysters can easily be digested in about one hour. When eaten they only satisfy the appetite for a short time, and are consequently not substantial food upon which to perform much labor. They may be taken at times when rest after eating cannot be obtained, and when we do not have to wait long for a more substantial meal. When cooked in any form, the albumen is coagulated and they are thus rendered very indigestible. It is important that they should be fresh when eaten, as they will disturb the digestion if in the least tainted by decompo- sition. Clams rank about the same as oysters, and are best eaten raw; sometimes, however, a broth may be made from them, which is strongly impregnated with salt, that is often a valuable article of diet for one who has a weak stom- ach, or is in any way troubled with nausea. Such persons, however, should not eat the flesh of the clam. VEGETABLE FOODS. 117 Vegetable Foods.-A large number of vegetables are used as food, and these differ essentially in their component parts from animal substances. Those in common use are the farinaceous seeds, as wheat, oats, barley, rye, rice, Indian corn, &c.; the leguminous seeds, as lentils, peas and beans; and the tubers and roots, as the potato, artichoke, carrot, parsnip, beet and radish. These all contain nitrogenous and non-nitrogenous sub- stances, starch, fatty and mineral matters, while some of them also contain sugar. The grains themselves are rich in nitrogenous or flesh- producing substances, while the flour prepared from most of them contains less than half of what is found in the grain. This shows that bread made from fine flour is much less nutritious than that made from the entire grain after the outer shell is removed. The table on page i io represents the relative values of the principle vegetables, as flesh produc- ing foods. Those at the top are the richest in nitrogen, while the quantity decreases as we go down the list. Lentils, beans and peas contain more nitrogen than the meats, but the proportion of starch is so great, and their diges- tion so much more difficult, that they are far from being as good flesh producers. The quantities of starch and sugars (hydro-carbons) in vegetables, range from 15 to 88 per cent.; while some that contain but a small quantity, as the potato, which has only 20 per cent., have very little other material except water. These are all useful foods in keeping up animal heat and storing up fat in the body, and some of them rank high as flesh producers ; but careful examination of their texture and chemical compositions show that they are inferior to ani- mal foods for the general nutrition of the human body. Fruits.-Fruits, in their season, are agreeable and re- freshing articles of diet, but they possess very little value in nutrition. When used moderately they sometimes have a beneficial influence on account of the vegetable acids they contain. The seeds and skins of some fruits, when swallowed, 118 WHA T SHALL WE EA T? often cause serious injury to the digestive tract, and care should always be taken not to swallow them. DR. TANNER'S FAST.* Closely connected with the question of foods, is the im- portant one of how long life may be sustained without a sup- ply of nutrition. Various opinions have been entertained on this subject, but till the time of Dr. Tanner's fast it was almost universally believed that a person could not be de- prived of food for more than eight or ten days, without becom- ing insane or dying from starvation. Although many instan- ces of long abstinence from food were on record, they were not credited, and thus it was believed that Dr. Tanner's fast would end in failure. He did, however, succeed in going forty days without taking food of any kind, and for thirteen days he also abstained from water. He thus not only upset all the theories by fasting forty days ; but also confounded the doc- tors by the amount and character of the food he ate after the completion of the fast. No diluted milk in small quantities for him ; but instead, peaches, milk and watermelon. The nausea from which he suffered so constantly during the last few days of the fast, instead of being increased, as the doc- tors believed it would be as soon as he partook of food, was at once allayed, as he himself predicted. The authenticity of the fast cannot be questioned, as it was carefully conducted from the beginning, with the view of preventing all possibility of deception. Aside from this, however, the examinations of the blood and urine proved conclusively that no food had been taken. Had there been, the chemical analyses would have at once detected evidence of the fact in the urine. During the first twenty-four hours following the fast, it was almost impossible to satify his craving for food, and he ate something every hour. His bill of fare varied as follows: *For full account of this fast see " Forty Days Without Food." By Robert A. Gunn, M. D., New York . DR. TANNER'S FAST. 119 watermelon in large quantities, milk, apples, beef steak, which he chewed, swallowing only the juice at first, beef tea, potatoes stewed in milk, several beef steaks, Hungarian wine and English ale. Everything he ate tasted good to him, and he did not have the slightest evidence of nausea, or distress at the stomach. He claimed that everything was promptly digested and absorbed. At 11:30 A. M., August 8th, there was an action of the bowels, for the first time in forty-one days. It gave him no inconvenience, and of itself proved that no food had been taken. At noon, Aug. 8th, the doctor weighed 126 1-2 pounds, a gain of five pounds in twenty-four hours; and again at six o'clock, he turned the scales at 130 pounds, thus gain- ing eight and one-half pounds in thirty hours. He slept well during the night after leaving the hall, and on Sunday was as bright and cheerful as any of his attend- ants. He said he would be able to go out on Monday, and if necessary, would attend to business. He was much annoyed by the statement of some of the papers that he had been nourished by alcoholic vapor-baths, and wished to write a communication denying it. It is but just to say in regard to this statement, that he took no vapor bath at any time. He had on three occasions an old-fash- ioned " alcohol-sweat." An alcohol lamp was lighted, and placed un,der the chair on which the doctor sat, and a rubber blanket was wrapped around him to retain the heat, till per- spiration was produced. We will be much obliged to the scientists (?) who wrote the editorials for some of our leading (?) papers, if they will inform us how much nourishment Dr. Tanner could get by sitting ten minutes over a burning alcohol lamp. This statement was in keeping with many others emanating from the same sources, and had no influ- ence in determining public opinion as to the value of the fast or its genuineness. A review of the records of the fast gives us valuable sta- tistics which are arranged in tabular form for the convenience of the reader. WHA T SHALL WE EA T? 120 STATISTICAL TABLE OF THE FAST. Dk OKL 1 - 0c 0 C u Ok to D to 00' to to OKL to * 0 22d 22d to £ to Ok 0 oc- -4 TkL n - A) 0 5k 5 Op' i 2^ n ? & 0 J) Day of Fast. 122 12 122 1 125 1-2 130 128 127 1-2 126 1-2 126 1-2 132 135 I-2 136 1-2 136 135 I"2 135 134 133 J'2 I32 131 1-2 131 1-2 I30 1-2 129 3-4 136 1-4 133 141 3-4 136 1-4 139 3-4 I4I 1-2 143 LU Weight. 88 84 78 84 ioo IOO 9° 84 116 98 IOO 96 96 IOO 107 108 98 82 84 82 84 72 88 84 72 72 76 72 74 84 74 72 78 78 78 74 74 78 82 92 Highest. Pulse. 82 84 78 84 66 89 72 77 88 89 89 80 89 89 98 95 80 76 76 80 80 7° 85 72 72 67 74 72 74 84 74 72 78 78 78 74 74 78 82 82 Lowest. KO KO 99 99 i-5 98 2-5 99 98 4-5 98 1 5 99 98 3-5 98 1-2 98 1-2 98 4-5 98 3-4 98 1-2 98 1-2 98 2-5 99 i-5 98 99 1-2 91 4-5 1004-5 98 98 i-5 99 2-5 98 4-5 99 99 99 99 94 4-5 99 i-5 99 98 3-5 98 3-5 98 4-5 98 2-5 98 4-5 Highest. Temperature in F. Degrees. 99 98 3-5 98 1-2 98 1-2 98 4-5 98 3-4 98 1-2 98 1-2 99 2-5 98 i-5 98 99 1-2 97 4-5 1 00 4-5 97 1-2 98 98 98 98 1-5 98 1-2 98 98 2-5 98 98 3-5 99 98 3-5 98 98 4-5 ,98 2-5 98 4-5 98 2-5 98 3-5 99 99 i-5 98 2-5 99 98 4-5 99 i-5 98 3-4 82 Lowest. Lu Ln • Ln Ln .p. 4^ Ln • 4.* 04^ Ok O^Ln Ln Ln Ln Ln Ln Ok Ok 4^ Ok Ok Lu 4^ Lu 4^ Ok 4^ Ok Ok Ok Ok Respiration. 29 1-2 77 i-4 5i 46 1-2 47 1-2 5i 18 1-2 23 1-2 30 16 16 12 20 16 8 11 1-2 12 1-2 14 4 16 24 1-2 12 1-2 9 1-2 20 1-4 183-8 to Ln O OK Number of ounces of Water drank. 17 13 22 1-2 19 1-2 . 17 i-4 14 14 13 13 13 3-4 21 14 15 16 17 1-2 19 1-4 22 3-4 36 3-4 27 45 33 29 3° i-4 21 1-2 19 1-2 19 1-2 16 9 7-8 21 3-4 103-4 15 !-2 3 IO 1-2 14 1-2 23 1-2 15 3-4 7 9 1-2 Number of ounces of Urine voided. 79 78 00 OC • CO co^r co co to • to Ln 0 O 00 00 00 00 00 co 00 3 0 14 O O 4- OO^J 00 OC^J oc 00 n O O kO CC4- 00 00 4 to • Right Hand. Dynamo- meter in Kilos. • 00 00 00 00 00 0 Ln . ~ 0 O HHLnL 00 00 to Left Hand. Close of Fast, weight, 121 1-2 lbs.; pulse, 99; respiration, 19. DR. TANNER'S FAST. 121 It will thus be seen that the total loss of weight was 36 pounds; total amount of water drank, 681 7-8 ounces, or 42 5-8 pounds; total amount of urine voided, 738 3-4 ounces, or 46 3-16 pounds; highest pulse 116; lowest pulse 66; highest temperature, 100 4-5; lowest temperature, 974-5; while his muscular strength varied but slightly throughout. The question, " What will it prove ? " was so frequently asked from the very beginning of Dr. Tanner's wonderful fast, that a reference to it here would be incomplete without an at- tempt to answer it. In our opinion it has proved and disproved many things that the public and medical profession are not willing to admit. And besides it opened the door for a vast amount of study in the departments of physiology, psychology and hygiene. It is. impossible to calculate the benefits conferred upon humanity by the self-sacrifice to which Dr. Tanner subjected himself; and the most we can do is to suggest such benefits as appear to us, and to carefully compare the facts developed by this case, with the commonly accepted theories of physiology. The first conclusion we are forced to is, that the medical profession have yet much to learn, and that arrogant assump- tion which is so common in their ranks, should give place to a spirit of tolerant investigation of every new subject that pre- sents itself for their consideration. At first nearly all the prominent physicians throughout the country declared that a man could not fast forty days; that reported cases of such fasting were not authenticated, &c. Then when it became ap- parent that Dr. Tanner was likely to succeed, they said it proved nothing, that many such cases were on record, and they had been of no benefit to science. A man might fast forty days, they said, but his digestive organs would be so impaired, that as soon as he began to take food, inflammation of the stomach must set in, and death ensue. Some even de- clared that the mucous membrane of the stomach was already, or soon would be, destroyed by the action of the gastric juice, and death must necessarily follow. 122 WHAT SHALL WE EAT? In spite of these opinions, however, Dr. Tanner began to eat without any of the serious trouble predicted for him; but on the other hand everything turned out as he himself an- ticipated. He did not accept the teachings of the books, nor the authority of the so-called leading men of the profes- sion. On the contrary, he had experimented for himself, and was certain, from absolute knowledge, what he could do. So, instead of the unknown "irregular" doctor from Minneapolis learning from the medical scientists of the world, he has dem- onstrated that they were all in error, and must begin to study anew. Scoffs and jeers will not answer now. Facts must neces- sarily upset all theories, and those who gracefully acknowl- edge their errors and are willingto learn the truth, are the true scientists. We claim that this fast has added greatly to our knowl- edge of the management of certain kinds of diseases. First, it disproves the utility of administering food by injections into the rectum (lower bowel). This absurd practice has long been in vogue, and milk, beer,tea, brandy, &c., have been con- stantly administered in this way; and because the patient lived a few weeks, the conclusion was jumped at, at once, that the food thus introduced kept him alive. The truth of such cases, however, is that the patient lives on his own tissue, as Dr. Tanner did, and that food thus introduced often excites inflammation from which the patient dies. This has been the opinion of the writer for years, and he has both spoken and written against the practice. It has been the custom of the profession to insist upon food being taken by persons suffering from various forms of indigestion, and diseases of the stomach and bowels. Now, that it is proved that a person can live forty days without food, there need be no fear of starvation if a patient is directed to go some days without eating. This would give the diseased organs a chance to rest till nature corrected the difficulty, and then the functions could be normally performed, the same as if they had not been impaired. On this point Dr. Tanner DR. TANNENS FAST. 123 had made numerous experiments before he attempted a long fast, and demonstrated in his own person that fasting was the best treatment for all derangements of the digestive organs. With a general knowledge of the power of man to endure long fasts, persons who are shipwrecked or otherwise deprived of food, would live longer than they do at the present time, under the belief that they must die in ten or twelve days, and thus stand a much better chance of being rescued alive. Another fact of economic value is clearly proved by this protracted fast, viz: that as a rule a man eats too much. It is an unquestionable fact that the custom of eating three hearty meals a day, often gives the various organs of the body too much work to perform, as is proven by the large quanti- ties of material daily thrown off as excretions in health. If we could learn a lesson in this particular, much force that is now spent in getting rid of the excess of material taken into the body, might be saved and utilized for mental labor. It is a well known fact, that large eaters seldom have superior in- tellects. The most important fact proved by the fast, however, is the wonderful power of mind over matter. According to the materialistic idea, mind is simply a function of the brain; and it has been claimed, that to keep up this function, phosphates must be constantly supplied by the food. But this man had no such supply for forty days, and yet the mind remained as clear and active throughout as at the beginning, and through the power of the Will he was enabled to control the strongest appetites and to endure the greatest physical sufferings. The authorities say that mental weak- ness, and finally, complete insanity should have ensued; but here again they are wrong. This fact alone is of the greatest value, and points to a necessity for more careful psychologi- cal study. Dr. Tanner claims that it proves to him the im- mortality of the soul. Whether this be true or not it points to the probability of mind being in some way connected with some force outside, or independent of the simple physical structure of the brain. 124 WHAT SHALL WE EAT? The examination of the urine voided the first twenty-four hours after the fast, which shows that the quantity of urea thrown off was increased three-fold, is a sufficient refutation of the assertions that the fast was not honestly carried out. And when we add to this the wonderful gain in weight, in so short a time, (36 hours), we feel it useless to waste time in furnish- ing proofs that the doctor did abstain from food during forty days. A calculation of the physiological results of the fast gives us the following: Amount of urine voided, 738 fluid ounces; solid matter in urine, 32 ounces; which gives us 770 ounces thrown off by the kidneys. Take from this 682 ounces of water drank, and we still have 88 ounces actual waste from the kidneys. The total loss of weight was 26 pounds, or 419 ounces; now, if we deduct the 88 ounces lost by the kidneys, we have left 328 ounces, which must have been thrown off by respiration and perspiration, chiefly as carbonic acid and water. Three hundred and twenty-eight ounces in 40 days, would give us a little more than 8 ounces per day lost by the skin and lungs, which result is as perfect as could be obtained by any of the self-constituted scientific experts. Many of the results to be derived from this fast must be worked out by careful study of all the facts, and it is the height of presumption, to say that nothing is to be gained by science through it. It is not surprising that the profession have been slow to accept the lessons taught by Dr. Tanner. History but repeats itself when the learned ones try to discredit an innovation on time-honored theories. Morse was considerd crazy for at- tempting to establish the electric telegraph; Fields was pro- nounced a fool for attempting to lay an Atlantic cable; Har- vey was denounced by the medical profession for demonstrat- ing the circulation of the blood; and Morton was cast into prison for proving the value of ether as an agent to destroy the sense of pain during a surgical operation. Yet all these men lived to see their innovations adopted, and to confound their opponents with all their theories. DR. TANNER'S FAST. 125 In the same way, Dr. Tanner is opposed by those who have long taught a false physiology. But the lessons he will yet teach the world, as well as his memory, will live long after the chief of " regular" charlatanism shall have been for- gotten. The beverages commonly used by man, as tea, coffee, chocolate, cocoa, wine and beer, and the general effects of al- cohol, will be considered in the next chapter; while the special foods appropriate for use in certain diseases will be considered in the second part of this work, under the headings of the respective diseases. CHAPTER IV. STIMULATING BEVERAGES. Stimulants in some form have been used at all times and by all nations; and there are very few individuals who do not make daily use of some beverage that possesses more or less stimulating properties. Those in common use at the present day are usually divided into two classes, non-alcoholic, and alcoholic. NON-ALCOHOLIC STIMULANTS. The non-alcoholic stimulants, such as tea, coffee, cocoa, chocolate, &c., that are extensively used as beverages at the present day, were introduced into Europe and America at a comparatively recent date. Though derived from entirely different plants, and their uses originating in parts of the globe remote from each other, their physiological properties are found to be almost identical. It is estimated that nearly six hundred millions of persons on the globe are now daily using these substances in some form, and this enormous use can be accounted for in no other way than that they give rise to pleasurable stimulation. Tea.-Tea contains but a small quantity of nutritious matter, and in the way it is drank cannot contribute much to- ward the chemical changes going on in the body. TEA AND COFFEE. 127 It is a mild stimulant and astringent, and when not used too strong is a harmless and refreshing beverage. It is suffi- ciently stimulating to arouse the brain to activity and to ex- ert a reviving influence after bodily fatigue. When properly prepared and used in moderation, it does no harm to healthy adults, notwithstanding the assertions made by fanatics that it injures the health. When used very strong, however, it may cause nervous agitation, muscular tremors, a sense of prostration, and sleeplessness. It will also, in delicate per- sons, produce constipation. Sometimes it has a decidedly injurious effect on persons of a nervous temperament, and in these cases it should never be used. With others it does not seem to digest, but causes annoying eructations with which the tea may be tasted for several hours. There is no general rule to be laid down re- garding its use; though it might be dispensed with, altogether, more easily than any of the other beverages. It is safe to ad- vise its discontinuance whenever it causes irritation and con- tinued wakefulness, or disturbs digestion. Otherwise it is re- freshing, yet harmless. Tea should always be made by pouring boiling water on the leaves, and then covering the tea-pot with a large cap, thickly-padded, and made so as to completely cover it on the table. This retains the heat and aroma, and in ten minutes the tea is ready for use. Tea should never be boiled, nor should it be prepared long before use. In either event the aroma is lost, and the tannic acid it contains is extracted. Then the bitter of the tannin is tasted and we might as well drink an infusion of oak bark. COFFEE.-Coffee is native of Southern Abysinia, but it is cultivated in Arabia, Egypt, West Indies, Peru, Brazil, Java, Ceylon, and other warm countries. Coffee-beans are the seeds of the fruit of a small tree, called Coffea Arabica; and two seeds are found in each berry. As used in Europe and America the seeds, or beans, are roasted, and then ground for use. Coffee is a useful and favorite beverage. It is more stim- ulating and heating than tea, and instead of being followed by 5 TI MU LA TING BE VET A GES. 128 depression, decidedly increases the force and frequency of the pulse. Whether it can be classed as a food or not, it certain- ly has a decided food action, as it is capable of relieving the sensation of hunger, as well as fatigue. For this reason it is always supplied to soldiers in active service, as one of the principal rations. It produces wakefulness, and, therefore, should not be taken late at night. It is particularly desirable for breakfast, as it stimulates the heart's action, which is usually feeble in the morning. It is in consequence of this action on the heart, that it acts well as an antidote for opium poisoning, and also to arouse those suffering from the narcotic effect of alcohol. Persons living in miasmatic districtswill find coffee a re- liable anti-periodic, if they drink a strong cup-full before going out in the night or early morning air. Those who can eat but little breakfast will also find it a valuable substitute for food, and in the main, it does much more good than harm. Many persons cannot use coffee without its causing con- stipation and indigestion, while we occasionally meet with one in whom it will act freely as a laxative. Those who can drink it without observing any unpleasant effects, will find it an agreeable and valuable beverage. The only correct way to prepare coffee for use is by per- colation, as the delicate aroma is thus preserved, and the bitter of the tannin avoided. The improved French coffee-pot is the best for this purpose. Coffee should never be boiled, as all the best properties are lost by the process. COCOA AND Chocolate.-Cocoa and chocolate are pro- ducts of the cocoa palm. They are both used as beverages, but they contain much larger proportions of fatty and al- buminous matters than tea or coffee, and, therefore, come more properly under the title of foods. Their action is less stimulating than that of tea or coffee, and it is probably on this account that they are not so extensively used. Coca.-The inhabitants of South America gather the leaves of a shrub called Erythroxylon Coca, and prepare from them a beverage which is consumed in the same way as tea. ALCOHOLIC BEVERAGES. 129 coffee and cocoa. It has a powerful tonic effect upon the mus- cular system, and has, consequently, been used largely as a medicine in this country and Europe. It must not be con- founded, in consequence of similarity of name, with the cocoa so extensively used by us. ALCOHOLIC BEVERAGES. Under the general name of alcoholic beverages are in- cluded all those substances that owe their stimulating effects to the alcohol they contain. It is therefore, important that we should consider the effects of alcohol on the system, before referring to the respective values of the several beverages containing it. The alcohol controversy has for many years occupied a large share of public attention, and to all appearance is as far from a settlement to-day, as ever. Two classes of persons have been instrumental in keeping up this controversy-tem- perance fanatics on the one side, and those interested i: the manufacture and sale of alcoholic beverages on the other- and thousands of well meaning people have taken the respect- ive sides, without being familiar with the real issues involved. Temperance people claim that alcohol, in any form, is always injurious, and that it should not be used under any pretext; while the manufacturer and vender claim that they have the same right to deal in it, that they have to deal in any other article of commerce. These two classes cannot be expected to change their views, and therefore they will continue to wage a useless war against each other, and each crusade will leave the question just where it was before. Such epidemics as the Total Abstinence crusade of 1874, and the Excise epidemic of 1877, are sure to be followed by a reaction which will not only profit the liquor dealers in the end, but also prove most disastrous to public morals. The only true solution of this temperance question will be a scientific, and not an emotional one. When scientific men turn their attention to the subject, and the people are 130 BTIMULA TIA G BE VERA GES. made to understand the true position of alcohol, some impor- tant results may be achieved. Then neither fanaticism, or self-interest, may sway en- lightened public opinion, and laws can be enacted to regulate the traffic in alcohol, which will do injustice to no one, and which can be carried out without causing us to blush for the civilization and intelligence of the legislators of the nine- teenth century. Everybody admits that alcohol in large doses is a poison- ous agent. Those who are the best able to judge-we mean the medical profession-with but few exceptions, recognize it as a useful medicine, under certain conditions, in bofh large and small doses; while many of the most careful observers claim, that if it is not a food, it has a decided food action. Now, before this controversy can be settled, the public mind must be satisfied regarding the medicinal and food actions of alcohol. This done, no one will defend its exces- sive use as a beverage, and no obstacles will stand in the way of the proper enforcement of rational excise laws. It is not our intention to dwell upon the chemical compo- sition of alcohol or the method of its production. It is enough for our purpose to know that it is a chemical com- pound containing four equivalents of carbon, six of hydrogen, and two of oxygen, and forms the basis of all spirituous and malt liquors. In small quantities it has been considered a stimulant, and in large doses a narcotic. Its history is con- temporaneous with that of civilization, and it has been used in some form by nearly all nations of which we have any knowledge. Why this wide spread use of alcohol ? Because it has seemed to supply a want that has been felt by the entire human family-a desire for stimulants in some form. This desire exists among civilized and uncivilized races, all over the world. Some take to opium, some to hasheesh, some to tobacco, and others to alcohol. In the Popular Science Monthly, for June 1872, the editor writes as follows, on this subject: THE THEORY OF STIMULATION. 131 " The craving for stimulation and for stimulants, in one or another of their innumerable forms, is not a local, unusual, arbitrary, or statutory thing, but a rooted and universal pas- sion of human nature. * * * * It is this deep basis of the propensity of human nature that gives to the sub- ject its mystery and perplexity. "The rationale of stimulation is indeed not so puzzling. Food builds up and maintains the vital activity of the whole animate creation in its working state, but that is not enough for man. He leads a life of high and complex feeling, subject to wide fluctuations, while his intellect furnishes him with the means of influencing his emotional states. He therefore seeks those agencies which act to arouse pleasurable emotion, and these are stimulants. Capable of appreciating the immediate pleasure, but incapable of realizing, adequately, the distant pain, the habit is formed, and use runs into abuse. "What, then, is to be done? Here logic is soon at fault, for the headlong reformer, who fixes his attention on some special phase of evil, and would eradicate it, root and branch, is soon found to be himself involved in something not very unlike what he so zealously condemns-he, too, is an object of reformatory solicitude. One thunders against the whole tribe of alcoholic stimulants, from ethereal wine to acrid whiskey, and never touches, tastes, or handles them-the pipe will do for him. Another counter-blasts tobacco-content with abundance of strong coffee. Another decries all these together, inspired by the stimulus of concentrated potions of tea. Still another ingests perhaps only vegetables and water, and fulminates from the pulpit or platform against all these gross material indulgences, yet is lifted into the seventh heaven of enjoyment by the stimulating incense of flattery and applause which comes up from admiring auditors, and without which life would be ' flat, stale, and unprofitable.' Others get from music, pictures, theatres, fashion, novels, newspapers, or travel, a quieter form of excitement, which, though often running into dissipation, is less harmful than ordinary narcotic stimulants. How far the ball-room, the political campaign, or the religious revival, may be the 132 STIMULATING BEVERAGES. equivalent of a drunken spree, we will not pretend to say, but that they are all marked by a common character-stimu- lation of pleasurable feeling, carried to a pitch of excitement that ends in reaction more or less exhausting-is not to be denied." These are facts no one can gainsay, and when we speak of the use and abuse of alcohol, we must not forget that it is only one of the many stimulants that are used and abused every day. The man who seeks pleasure from alcoholic stimulants is often denied pleasures that would make alcohol unnecessary could he but enjoy them. Now, let us propose to the temperance fanatics, to take away from the human family all the luxuries that make life enjoyable, and that are unnecessary for its maintenance, and see how many would sacrifice these and continue their fight. See if each one would not have some special luxury or enjoyment that he would cling to as tenaciously as the moderate drinker does to alcohol. We are not defending the use of alcohol as a beverage, but wish it to be understood that so long as our social condi- tions remain as they are, nothing we can say or do will influ- ence the desire for alcoholic stimulants. Then our aim should be to investigate the subject, with a desire to ascertain the exact truth, to be just and charitable to all, and to strive to so improve mankind that the sale of alcohol can be controlled by a wise legislation, that will pro- tect alike the rights of the individual, the community, the state and the nation. In order that we may obtain a correct knowledge of the alcohol question, it is important that we should study it from a neutral standpoint, and not start out with a fixed opinion and the full determination to prove that we are right. In order to do this satisfactorily, we must consider alcohol as a food, a medicine and a poison. ALCOHOL AS A Food.-Does alcohol possess any food properties? This is a question concerning which much diver- sity of opinion has existed, even among professional men. ALCOHOL AS A FOOD. Experimenters have arrived at different conclusions regarding it, and when they have published the results of their investi- gations the public have been at a loss to know which to be- lieve. Dr. B. W. Richardson, of London, who has published a little work on alcohol, (thousands of copies of which are in the hands of the public) makes the following statement: "Alcohol cannot, by any ingenuity of excuse for it, be classed among the foods of man. It neither supplies matter for construction nor heat. On the contrary, it injures con- struction and it reduces temperature." On the other hand Dr. Brunton, a leading medical au- thority, of England says : " It (alcohol) undergoes combustion in the body, main- tains or increases the bodily weight, and prolongs life on an in- sufficient diet." Now, what are the real facts of this question. Many years ago Liebig classed alcohol among heat-producing foods, such as starch, sugar and fat, because it contained carbon and hydrogen, which, by the aid of oxygen, undergo a process of combustion within the body and thus contribute in maintain- ing animal heat. This process necessitates the decomposition of the alcohol in the body, and if this change can be shown, the fact is established. About twenty years ago, three French chemists-Lalle- mand, Perrin and Duroy-conducted a series of experiments to prove that alcohol was not a food. They claimed their ex- periments proved that all alcohol taken into the system, left it unchanged, through the various secretions and excretions. Drs. Anstie, Dupre, Schulinus, Brunton, Binz and other ex- perimenters have since proved that the French chemists were wrong, and it is now recognized as an established scientific fact, that alcohol, given in small and moderate doses, is al- most wholly consumed within the organism, and only a trifling portion passes out of the body in the secretions. The French chemists, just referred to, and Dr. Richard- son evidently started out with the determination to decide the question against alcohol; and in all their experiments they 133 134 STIMULATING BEVERAGES. used large intoxicating doses that were actually poisonous. They never experimented by giving the moderate dose in which it has been proved by more careful investigation to act as a food. Then we may ask of what value are the conclu- sions drawn from such experiments. Aside from these direct experiments we have abundance of facts to prove that alcohol sustains life, and must, conse- quently, have a food action. Liebeg found that when labor- ing men drank a pint or two of beer a day, they needed much less bread. Dr. Hammond states in his "Physiological Re- searches," that having placed himself on a very insufficient al- lowance of food, he took daily with each meal half an ounce of alcohol, and under this regimen he found he gained rather than lost weight, and preserved, at the same time, the high- est mental and bodily vigor. Dr. Anstie mentions one case of a man 83 years of age, who took one bottle of gin per day, for twenty years, and dur- ing all that time he only ate one small finger-length of toasted bread a day. In another place the same author reports, that two female patients subsisted on nothing but alcohol for months. In another case a young man ate no solid food for five years, and for the last two subsisted on brandy and water. He kept his flesh and good spirits to the last, and died from valvular disease of the heart from which he had suffered be- fore his appetite failed. If time permitted we could quote thousands of cases from the leading medical authorities of all countries, to prove that alcohol has a decided food action, and every unbiased physi- cian of experience will testify to the same fact. When the nervous system is exhausted by long-continued mental application, pressing anxieties, or physical labor, there is no desire for food, and sleep is impossible. In such cases, a moderate amount of alcohol will give tone to the nerve cen- tres, and strengthen the whole system in the same manner as a good meal of nutritious food would do, if the stomach was not too much exhausted to receive it. This fact has been so often proven that no amount of denial can set it aside, and when such results follow the use of alcohol they must certainly ALCOHOL AS A FOOD. 135 be attributed to its food action. In many conditions the stomach cannot digest strong, rich, food, when some easily- digested food can readily be converted into nutriment. In the same way when exhaustion is so complete that no digestion can go on, alcohol is readily taken into the blood and thus supplies the place of food. During the decline of life the foou-action of alcohol is par- ticularly demonstrated. As before stated, in the discussion of foods, destructive as- similation usually exceeds assimilation at this period of life, while at the same time the quantity of food consumed is ma- terially lessened. Now, alcohol not only lessens the destruc- tive assimilation, but actually enables aged persons to perform more mental and physical labor than they can possibly per- form without it. On this subject Dr. Thos. K. Chambers writes as follows: " Alcohol calmly arrests the energies of the nervous system which would fret the tissues to decay, and would seriously weaken them, were not the wear and tear to be continuously replaced by new material. Now, with years, the replacement by nutrition is much diminished, and we, nevertheless, are apt to persist in using our brains as before. We shrink, rightly enough, from being shelved just when the rewards of our exertions are becoming due, and we do not care to rival the centuries of the olive or the yew, unless we can, like them, renew our age, and bear fruit unto the end. Here, then, alcohol steps in as a help in need, and it is strictly in accordance with the teachings of physi- ology to increase, as years increase upon us, the moderate quantity we had been taking previously. I do not write for habitual revellers and muzzy dram-drinkers (the sooner they become teetotallers the longer they will live), but for the temperate users of natural good things, and I am sure that they may reasonably obey the instinctive desire to take more and stronger wine as they grow in years." When taken in moderate quantities, with meals, alcohol stimulates the stomach, increases the flow of gastric juice, ac- celerates the appetite, and causes more food to be digested. The cares and anxieties of business, the ever-increasing 136 STIMULA TING BE VERA GES. desire to accumulate wealth, and endless mental and physi- cal toil so drain the nerve tissues of a large proportion of our American people, that some form of stimulant, with meals, seems absolutely necessary to promote digestion, and thus re- store the lagging energies. We again quote from Dr. Cham- bers: " A healthy man who gets the worst of it in any way, whose intellectual or muscular energy goes down under the pressure of work demanded, gets the worst of it in a less de- gree, by the aid of strong drink. Give it him when ready to perish from the drain on his nerve tissues, and his life is saved. The laborer when his limbs are stiff with his day's toil, and the brain-worker, who still more acutely feels the wear and tear of bread-winning, are not wasting the money they earn, which they spend on a fair ration of beer or wine at their even- ing meal." Alcohol as a Medicine.-If alcohol is itself a food, or has a food action (which we believe is fully proven), we can readily understand how it may be used to advantage as a med- icine. In all cases of shock and fainting, something is required to stimulate the heart's action, and re-establish the lagging circulation. There is no fact in medicine so surely demon- strated by repeated experiment than that alcohol will promptly relieve these, conditions, even when taken in small doses. When depletion was the rule in the treatment of inflam- mation of the lungs, more than half of those who took the disease died. As soon as alcoholic stimulants were used to support the system, but a small percentage of the cases proved fatal; and it is now generally recognized that alco- hol is the sheet anchor in the treatment of this disease. So in consumption, the moderate use of alcohol will greatly retard the development of the disease, and thus often pro- long the life of the patient for months, and even years. At the beginning of a severe cold the equivalent of half an ounce of alcohol, taken hot, on retiring, will often break up the cold before morning. ALCOHOL AS A MEDICINE. In low forms of fever the daily use of alcohol is often the only thing that can be relied upon to sustain the vital ener- gies till the crisis is past and the digestive organs can again perform their functions in the process of nutrition. Alcohol is also one of our best remedies for the relief of pain. In cases of neuralgia, or severe nervous head- ache, an ounce of alcohol will often give prompt and com' plete relief, after all other remedies have failed. If this fails, however, a repetition of the dose will do harm instead of good. In thus speaking of the use of alcohol as food and medi- cine, we have no desire to be understood as advocating its continuous use as a beverage. We simply aim to prove that it has a place which cannot be filled by anything else, and that when used properly, it may prove a blessing instead of a curse. When we speak of the use of alcohol, we do not mean that it is to be used in its pure state at any time, but in the form of some of the beverages that owe their stimulating properties to the alcohol they contain. The alcoholic beverages in common use are divided into spirits, wines and beers. Spirits.-All spirits are produced by distilling fermented liquors, and the alcohol they contain is formed during the process of fermentation. The flavors of the various spirits vary according to the source from whence they are derived. Those in common use are brandy, rum, whiskey and gin. Brandy is produced by distilling wine, and its quality varies like that of the wine from which it is obtained. When first made, brandy contains about 50 per cent, of alcohol, but its strength decreases by soakage, when allowed to stand in a cask, so that good brandy should not contain more than 42 per cent, of alcohol. It is colorless at first, but soon acquires a slightly amber tint from the tannic acid of the casks ; and all dark brandies are artificially colored. When a pure stimulant is required for faintness, exhaus- tion, diarrhoea, spasms, &c., brandy is one of the best forms in which it can be given. Burnt brandy is sometimes valuable 137 138 5 TIMULA TING BE VERA GES. when nausea is present, and will often be retained on the stomach when nothing else cAn be. Rum is the product of distilled molasses and the skim- mings from the sugar boilers. After distillation it is colored with burnt sugar. It improves greatly with age, and it pos- sesses a flavor which is preferred by many before that of any other spirits. It contains about the same amount of alcohol as brandy and may be used for the same purposes. Whiskey is usually made from the distillation of malted barley, though other grains are also employed in its manu- facture. It is about the same strength as brandy and rum, and also improves with age. It may also be used in any case where a pure stimulant is indicated, many persons preferring it to other stimulants. Giu is derived from the distillation of unmalted grain, which is rectified and flavored with juniper berries. It con- tains about 30 per cent, of alcohol. On account of the juniper berries it contains, it has a marked action on the kidneys, and it is used as a stimulant when such action is desirable. Although these spirits are used indiscriminately in America, they originated in different countries, and were pro- duced for the alcohol they contain. Brandy originated in France; whiskey in Great Britain ; rum in the West Indies ; and gin in Holland. Other spirits are manufactured in other parts of the world, even among savages, and used for their stimulating effects. Wines.-Wines are principally derived from the fer- mented juice of the grape, though other fruits are sometimes used in the manufacture of domestic wines. These latter, however, are not of sufficient importance to require special notice. Stimulating beverages under the name of wines have been known by all nations and in all periods of the world's history, and have been used as well as abused from the earliest times of which we have any record, down to the present day. WINES. 139 All wines contain alcohol, sugar, vegetable acids, and some of them contain tannin, derived from the skin of the grapes. The quantity of alcohol varies from 5 to 25 per cent, in the different kinds of wine. The light wines, or those containing under 15 per cent, of alcohol are the best for ordinary use. Clarets are among the best dinner wines. They are light, agreeable and refreshing, and, when pure, contain from 8 to 20 per cent, of alcohol, according to the brand. When used at dinner they stimulate the appetite and aid digestion, and there is hardly any condition of system with which they are likely to disagree. The Bordeaux white wines are less astringent than the Clarets, and are preferred by many, as a dinner wine, for that reason. Burgundy, red and white wines, are richer, fuller-bodied, and more delicately flavored wines than Claret, and are spe- cially valuable in conditions of general debility from poverty of the blood. German wines, commonly spoken of as Rhine and Hun- garian wines, are preferred by many to the French wines. They contain about the same proportions of alcohol, but are rather more acid. Many prefer them for table use, but this is simply a matter of taste. Champagnes contain from 10 to 13 per cent, of alcohol, and are classed as sparkling and still, sweet and dry.' They are usually described as volatile stimulants, because of the rapidity of their action on the system. Their effects are also more transitory than those of other alcoholic beverages. They are useful when prompt action is required in cases of exhaustion, and are also valuable in aiding digestion after a hearty evening meal. In many cases of irritable stomach after a prolonged illness, and even in obstinate vomiting from any cause, champagnes afford prompt relief. Where stimu- lants are required in cases of protracted illness, they are often preferable to any other wine. 140 STIMULATING BEVERAGES. Among the leading brands of champagne, The " G. H. Mmm " takes first rank, as an agreeable and refreshing bever- age, that can always be relied upon for its purity and the uniformity of its stimulating properties. Port and Sherry are among the stronger wines that may be used to advantage after dinner. They contain from 16 to 25 per cent, of alcohol, and must therefore be taken in smaller quantities than the other wines mentioned. Beers.-Beer is a beverage that has been long used all over the world, for its nutritive and stimulating properties. It is made from fermented infusions of malt, flavored with hops. The strength of the various brands of ale and beer varies materi- ally. They contain from 2 to 9 per cent, of alcohol, besides the hydro-carbons and bitter principles. For this reason they are tonic and nutritive as well as stimulating. The light beers increase the appetite and promote diges- tion, while the heavier ones aid in producing sleep after pro-' tracted labor. In persons who are anaemic and debilitated, beer is often the best form in which alcohol can be taken with advantage, but persons who are inclined to biliousness cannot use them long without injury. Lager beer, which is now so extensively used in America, contains from 3 to 6 per cent, of alcohol. It is classed among the lighter beers, the moderate use of which, even by .the healthy, can do no harm. Its extensive use has done much to diminish the consumption of the stronger alcoholic liquors in this country, and in that way its introduction has proved a blessing. In recommending these several alcoholic beverages, we refer to their proper use, and not their abuse; and a careful examination of the history of their production and the neces- sities of man, compels us to assert our belief, that more injury than good would follow, if mankind was entirely deprived of the use of these stimulants. The question has another side, however, which we must now consider. ALCOHOL AS A POISON. 141 Alcohol as a Poison.-As powerful as its proper use may be for good, the results that follow the abuse of alcohol are so terrible, that we have reason to seriously consider the advisability of recommending it in many cases where it might seem to be required. To children under fifteen years of age alcohol should never be given, excepting in the prostration following severe sickness, and then only in very small quantities. At this period of life it is certain to disturb the digestion, and poison the system by arresting destructive assimilation. This allows a large quantity of effete material to accumulate, and thus the foundation is laid for serious glandular and other diseases. When stimulants are used before the age of maturity, aside from the immediate evil effects, the persons are liable to become addicted to their use, and thus lay the foundation for habitual drinkers. Dram drinking, early and late, paralyzes the nerve cen- tres, causes diseases of the kidneys and liver, completely des- troys digestion, and invariably leads in the end to chronic alcoholism and premature death. When large quantities of alcohol are taken during or after a meal, instead of aiding digestion it separates the pep- sin from the gastric juice, and thus completely arrests diges- tion, and causes immediate distress. If this is continued for a short time the function of the stomach is seriously inter- fered with. When it is taken before the day's labor begins it does absolute harm. "Both body and mind will be incapaci- tated, the life shortened and all the keenest joys taken out of what remains." Of the moral effects of the abuse of alcohol we shall not attempt to write. That it inflicts untold misery upon thou- sands besides the victims themselves we all admit ; and that this state of affairs needs to be righted is equally true. How can this evil be remedied ? Certainly not by the sweeping denunciations of the temperance fanatics on the one hand, or by the excise laws of monopolists on the other. We must go deeper into the question than has yet been done, STIMULA TING BE VERA GES. 142 and ascertain, if possible, the causes that lead to intemper- ance and how they can be removed. A complete revolution cannot be brought about in a day, and neither fanaticism nor legislation will evolve this alcohol controversy out of the labyrinth of perplexing issues that sur- rounds it. In order to have this question properly settled we must not be influenced by a public sentiment against alcohol that is based on false deductions and mis-statements of facts. We must show what is the true position of alcohol, and de- mand that the rights of the many shall not be infringed upon by legislation, for the presumed benefit of the few who are morally weak. Let the people'learn through public discus- sions and scientific experiments that alcohol is both a medi- cine and a food, and that many persons who do a large amount of mental or physical work, find its daily use an abso- lute necessity. Let it be known that fanatics on the temper- ance question are not competent authorities, and before you ac- cept their statements as true, read the scientific side of the question. Learn that only about 9 per cent of the crime committed is the result of intemperance, instead of three- fourths as is usually asserted. In many prisons 21 per cent, of the inmates have been occasionally intoxicated, but the same may be true of members of churches. Instead of crime being largely due to intemperance, both are results of the evils of our social condition, and if we ever succeed in staying either, we must go to the very bottom of our social superstructure to find the cause. Instead of spending our energies in fighting the liquor traffic, let us strive to improve the condition of the poorer classes; provide forthem more comfortable homes by regu- lating the building of tenement houses by just legislation; se- cure for them places for social gatherings and cheap and in- structive amusements; engage singers and speakers to amuse and instruct them, instead of temperance lecturers; create among them a desire to appear well in all public places; so change our educational system that all children shall receive a good physical and moral education as a basis for intellectual THE ALCOHOL CONTROVERSY. 143 training. We would suggest that every tenement house should be provided with a public reception room, and play-room - the latter on the top of the house - which should be furnished and cared for by the owner of the building. Do these things and temperance fanaticism would have nothing to harp on, and humanity would be made purer and better. The would-be reformer, who has a comfortable home, and drinks the best of wines at his own table, does not know what he asks when he calls for the closure of those resorts where the laboring classes congregate and indulge in the use of stimulants. Let him visit the average tenement house of our great cities and learn the real condition in which a large proportion of our people live. Let him there see four, five, six, or more of a family crowded into two or three small rooms, without light or ventilation. Here they wash, cook, eat and sleep, and after the work of the day there is little of cheer or comfort to be had in such a place. The women and children have no social life, and the men only that which they obtain in the saloon or beer garden-the only places where they can go for a short time to forget the hardships of bread-winning at starvation prices. When we thus understand the real conditions of life among the masses of the poorer people, we can readily see how impossible it is to effect reforms by legislation. We can also understand the great necessity of establishing conditions that will supply the social stimulus which can alone banish the excessive use of alcohol. Do you say that such changes cannot be effected? We admit they cannot at once; but, we affirm that neither moral suasion nor legislation can ever settle this question, till the social condition of the masses is so improved that they can find pleasure and enjoyment, and a little freedom from the cares and trials of life, without seeking them in the grog-shops of to-day, or in the frequent potions of alcoholic beverages. Then let us commence this reform at once, as by so doing we can arouse all the finer and nobler feelings of those for whom we set to work, and a marked improvement can be made in the condition even of the present generation. Then, 144 STIMULATING BEVERAGES. by a gradual evolution each generation would be better than the proceeding one, till higher aims and purer enjoyments would fully supply that universal desire for pleasurable stimu- lation, that thousands under existing conditions can only find by drinking alcohol. But how can the present difficulty be adjusted? Laws are constantly being enacted to quiet the excitement of the time, but no permanent improvement has, as yet, been made. The great trouble has been, and is, that we have too many laws, and too much government. In spite of the cry of "infringement on State rights," we believe this whole question should be regulated by the gen- eral government, and entirely freed from the influence of local politics. The following rules should be laid down and in- forced: First: Heavy penalties should be attached to the sale of im- pure liquors, the use of which at the present time occa- sions so much mischief. Second: Strong liquors should be sold in sealed packages, with a government seal attached, and never allowed to be used on the premises. Third: The license should be low, and only granted to those who can provide accommodations for the comfort of the public. Fourth: A large portion of the excise money should go to the local government, to be spent in improving the social conditions of the masses. Fifth: The public should be instructed regarding the true value as well as the abuse of stimulants, and then they would be prepared to act rationally concerning them. However imperfectly we have presented these thoughts, we are convinced that all who think seriously on this impor- tant question will agree with us in the main. No individual or class of individuals, can judge the matter from their own narrow standpoint; but all must deal with it in a spirit of candor, justice and charity. When we learn that intemperance is largely the result of an unsatisfied yearning for a higher and purer social condition; when we learn to forget pride of place and power, and stretch out our hands in kindness to our less fortunate brothers; when we realize that we must reach the masses by appealing to their social natures; and when we are all willing to talk less and do more for the improvement of humanity, this alco- hol controversy and many other vexed questions will settle down to their own true position, which will be found to cor- respond with the fixed laws of nature. THE ALCOHOL CONTROVERSY. 145 CHAPTER V. HOW TO KEEP WELL. It is not enough that we live, but that we are well; and we owe it to ourselves and the future of our race, to do every thing in our power to improve our physical condition, and thus lay a sure foundation for perfect health and happiness. With all the advances that have been made by modern civilization, it is to be regretted that so little has been learned by the people, concerning the structure and func- tions of the human body, and the laws that govern health and prevent disease. Until a comparatively recent period, even physicians have only concerned themselves with the sick, and have considered every attempt to enlighten the public regarding the laws of health, as an infringement on their rights. That day is now happily passed, and the peo- ple have awakened to a due appreciation of the importance of a knowledge of themselves, and are endeavoring to learn "how to keep well." That they may do this satisfactorily they must first be able to answer the questions "How are we made?" "How do we live ?" and "What shall we eat?" Then they are pre- pared to understand the importance of adopting such rules of life as are best calculated to keep the various organs of the PHYSICAL DEVELOPMENT. 147 body in such condition as will enable them to perform their normal functions. There are so many conditions essential to good health, over which we have direct control, that it is impossible to determine which is of the greatest importance. In fact, health is dependent upon all of them, and, therefore, we can- not give precedence to any one. For the sake of convenience, we may divide the subject as follows: Physical development and exercise, cleanliness and bathing, clothing, rest and sleep, sewage and drainage, air and ventilation, and occupations. PHYSICAL DEVELOPMENT. A proper physical development is one of the first essen- tials of health. With a weak and undeveloped body the normal performance of functions is impossible, and without functional activity health cannot exist. It, therefore, becomes our duty to see to it that our children have every opportunity for physical training that is necessary to the proper develop- ment of their bodies. In early childhood the natural desire to play and romp will usually supply all the exercise that is necessary; but after a time the restraint of the school room and the inclem- ency of the weather prevent that degree of muscular activity that is requisite to health. This is particularly true with children brought up,in the city, as whatever exercise they have is confined to walking, which is only sufficient for the muscles of the legs. The importance of muscular motion is readily explained and understood. Every muscular contraction increases the circulation of the blood in a part, so that a fuller supply of pure blood is carried to it, and the impure blood is rapidly removed. The increased amount of blood thus carried causes the muscles to grow and thus adds to their strength. When exercise is general and not excessive, the same result follows in all the muscles and tissues. Thus growth is favored by 148 HOW TO KEEP WELL. proper exercise, and after that is complete, strength and vigor are imparted to the body. As an example of the importance of use to produce muscular vigor, we may men- tion the old and familiar illustration of the arm of the black- smith, which becomes large and powerful through constant use. On the other hand, when an arm is carried in a sling for a short time, it becomes smaller and weaker than its fellow. Without a due amount of muscular motion in the volun- tary muscles, the circulation of the blood would be very im- perfect and growth would be impossible. When this motion is but moderately kept up there is a corresponding lack of vigor, which is incapable of imparting perfect health. Therefore, the importance of exercise dr training becomes apparent to all. With the object of providing means for physical develop- ment many appliances have been devised, and these have been productive of good from the fact that they combine pleasure with exercise. The public gymnasiums are filled with every variety of contrivance for effecting muscular movements, but many of them are calculated to overtax the muscles, and thus do harm instead of good. Rowing, which is a pleasing and healthful exercise in itself, has been carried to such an extent as to prove too severe on the general muscular system. The same is equally true with base ball and cricket, sports that are in themselves healthful, but frequently overdone for the average growing boy. Home Gymnastics.-The best results in the way of proper physical development are obtained by the simple con- trivances designed for home use. With these, children of both sexes can begin moderate exercise early enough to in- sure health. The "Pocket Gymnasium," which consists of rubber tubes of various sizes, arranged with handles, is the most simple contrivance in use. The movements employed in GYMNASTICS. 149 using it are many and graceful, and are adapted for the old and young, of both sexes, and in all degrees of muscular development. An invalid may exercise moderately in this Fig- 3^- way and thus hasten the restoration of health. Fig. 36 rep- resents some movements practiced with the Pocket Gymna- sium, but illustrations of every variety of motion are printed on a sheet that accompanies the apparatus. The Home Gymnasium as represented below in Figure 37, is another convenient and valuable apparatus. It is sup- 37- ported by two strong screw-hooks in the ceiling, about eigh- teen inches apart, and screwed five inches into the joist. It can also be used out of doors, on a framework such as is used for swings. The straps are made of the strongest linen, the rings are of bent wood and perfectly smooth, while the 150 HOW TO KEEP WELL. stirrups are of iron. The rings and stirrups can be easily fixed to any height, or both can be removed for the insertion of the trapeze bar. A seat is also arranged for the stirrups, which converts it into a swing. The exercises that can be per- formed on this apparatus are varied, and are certain to impart vigor, not only to the muscles of the extremities, but also to the digestive and respiratory organs. Figs. 38 and 39 represent another form of parlor exercise, which possesses many advantages. Fig. 38 admits of a large Fig. 3^. Fig. 39' variety of movements with the back to the machine; while Fig. 39 gives all the motions of rowing. The degree of exer- cise is regulated by the weights attached to the end of the rope that passes over the pulley, fastened to the door or win- dow casing. Some one of these appliances should be in every family, and should be used daily by growing children, and by all per- sons of sedentary habits. It must be remembered, however, that these forms of ex- ercise are not to take the place of proper out-door sports and recreations, but are to be employed as auxiliaries in securing physical strength and vigor. CLEANLINESS AND BA THING. 151 Walking, running, fishing, boating, shooting, base ball, cricket, and in fact, every variety of out door sport, impart health and vigor to those who take part in them. Every ex- ercise or occupation that causes general muscular activity should be encouraged for both boys and girls, men and women; for the most important factor of nutrition-the cir- culation of the blood-is largely dependent upon the move- ments given to the blood by muscular motion. Even persons who are occupied with work of various kinds, eight or ten hours a day, often need exercise to bring unused muscles into action, and many occupations are so sedentary that general exercise is essential to health. The competitions now so common in athletic clubs often lead to too severe muscular effort, which may frequently do great injury. The object of exercise is not to see how much physical effort may be endured, but to regulate the amount of activity so as to make it conducive to the healthy perform- ance of normal functions. Therefore, severe strain in any form should be avoided. CLEANLINESS AND BATHING. The importance of cleanliness cannot be over-estimated. It promotes health, improves personal appearance and pre- vents causes for offense to others. The intimate relation that exists between cleanliness and health, must, therefore, receive that attention which its importance demands. The skin is constantly throwing off, by the means of in- sensible perspiration, a considerable amount of material that would be injurious to health if retained in the system. Un- der the influence of bodily exertion and extreme heat, this perspiration is increased so as to be apparent in the form of globules of water, which hold, the effete material in solution. This secretion exudes through the minute openings in the skin, commonly called pores, which form the outlets for the sweat glands and sebaceous follicles. The sweat glands not only aid in removing effete material, but also provide moisture 152 HOW TO KEEP WELL. to keep the skin cool and regulate the heat of the body. The sebaceous follicles secrete a substance which acts as a natural oil to the hair and skin. Both these sets of glands are active in health, and many times the material thrown off by them has a strong odor, which is very offensive if not removed. When from any cause the action of the skin is impaired, the lungs, intestines and kidneys are called upon to do extra work in carrying off the waste products of the body. These organs, however, cannot always do this, and thus effete ma- terial accumulates and produces disease. To guard against such results the pores of the skin should be kept free and open by frequent bathing. It must not be understood that it is alone the dirt that settles on the skin that is to be removed. A fine scurf is being constantly shed from the skin, while the sebaceous matter or oil, spreads over its surface and becomes rancid, and to this is added the impurities of the perspiration. It is even more important that these wastes of animal tissues are removed, than the inorganic dirt with which we come in contact. Personal cleanliness is maintained by means of frequent bathing, of which a variety of methods may be employed. The Sponge Bath.-The morning sponge bath, is one which all can employ with little trouble. The free use of soap and water with a sponge or cloth, every morning, is a sure method of cleansing the skin, and at the same time it serves as a good tonic to the circulation. The water should be used as cold as it can be borne with comfort, but nervous persons should be careful that it is warm enough to prevent shock. After the bath the skin should be thoroughly and briskly rubbed with a moderately coarse towel. This gives a sense of warmth to the skin that is refreshing and invigorating to the whole system. The Hot Water Bath.-Hot water baths are better adapted for cleanliness than the cold, but they should not be used frequently, as they relax the system and produce a feel- ing of depression. They should be taken on going to bed, when they often promote sleep, by drawing a considerable amount of blood to the surface, thus relieving the brain and BA THING. 153 internal organs. Bathing the feet in hot water is especially beneficial at night, to relieve congestion of the head and in- duce sleep. The hot sitz-bath is also beneficial in many in- stances where a full hot bath is not desirable. In fact, no house is completely furnished without a tub specially arranged for taking sitz-baths. In bathing for cleanliness soap is an important part of the bath. The alkali it contains is necessary to the proper re- moval of the oily secretion of the skin, but at the same time it is important that a soap containing only a moderate quantity of alkali should be used. The strongly alkaline soaps leave the skin dry and harsh, and sometimes even excite an irrita- tion that may extend to inflammation. For special purposes, as congestions of internal organs, and impaired circulation, irritants, such as mustard, capsicum, &c., may be added to the hot water bath, to stimulate the superficial circulation. When it is specially desirable to stimulate the circulation of the skin for the relief of gout and rheumatism, or to strengthen weak limbs, various kinds of washing gloves, pads, belts or brushes, may be employed with advantage. Any of these can be used wet in place of the sponge, or dry after the bath to produce friction, and in either case they will give a feeling of natural vigor to the nervous system. Sea Bathing.-Sea-bathing is usually a great luxury to those in health, and frequently serves to restore the health and vigor of persons who have become debilitated from any cause. Persons who can swim add the advantages to be de- rived from well-regulated muscular movements to those of the bath. Surf bathing is preferable to still water, particularly for those who do not swim. The dashing of the waves and the continued motion of the bather stimulate the circulation in the skin and afford muscular activity. A weak person should not bathe when feeling exhausted, nor should any one continue to bathe if they are always chilled on going into the water. The least chilliness while bathing should indicate the necessity of leaving the water, and in such cases a little stimulant is always desirable. 154 HOW TO KEEP WELL. The following rules should always be observed by bathers: First: Do not bathe for at least three hours after a full meal. Second: Never bathe while perspiring profusely. Third: Never go into the water feeling cold, for the bath will still further reduce the temperature. Fourth: Always leave the water while you feel invigor- ated. Fifth: Delicate persons should not bathe longer than five minutes. Sixth: It is best for all to leave the water after fifteen or twenty minutes. Seventh: The body should be quickly rubbed after the bath. River Bathing.-Bathing in fresh water is not so invig- orating as sea-bathing, but is healthful and enjoyable in hot weather. It is important to keep the body entirely covered while in the water, and thorough friction should be applied after the bath to establish a reaction. Persons are more apt to take cold after fresh than after salt water baths. The Hot Air Bath.-The most common form of hot air bath is that known as the Turkish bath. A person sits in a hot air chamber with the temperature ranging from no to 180 degrees Fahr., till free perspiration is produced. Then the entire body is thoroughly shampooed with warm water and soap, and afterward showered. During the showering the water is gradually cooled until it is as cold as it can be borne. The body is then rubbed dry and the bath is complete. After such a bath a person should remain quiet for at least half an hour. This mode of bathing is very refreshing to many per- sons, and it is certainly one of the most effective methods of thoroughly cleansing the skin. Such a bath will promptly relieve a severe cold, and is valuable in many forms of skin diseases. Of late years, how- ever, many persons have made a hobby of it, and have claimed BA THING. 155 that it would cure all diseases without medicine. Its daily use has been indiscriminately recommended for the strong and the weak, for the healthy and the sickly, for the fat and the lean, and it has thus often done harm instead of good. A Turkish bath once or twice a week may be used with advantage by any one in good health, but oftener than this it may do harm. In acute rheumatism it will often give prompt relief, but if it does not do so after the second or third bath, it will do no good. It will also be found valuable in re- ducing flesh, if taken every alternate day. A modification of the Turkish bath may be used in its stead. It consists of a large air-tight box which incloses the entire body, except the head. A gas jet, or alcohol lamp, is lighted, and the air in the box is thus heated to the required temperature to produce free perspiration. The body may then be rubbed dry, or treated the same as in the regular Turkish bath. It is more comfortable to have the head wet with cold water occasionally, while in the box, and this pre- caution should not be neglected. Various medicines may be burnt in this box after the air is heated, and we thus have the various vapor baths some- times recommended in the treatment of skin diseases. A home substitute for this is easily improvi ed, by sitting on a chair under which is placed a burning alcohol lamp, and then surrounding the body, except the head, with a rubber or some other blanket. The blanket will retain the heated air, and perspiration will soon follow. When it is desirable to secure an action of the skin in sickness this plan is often adopted, and is usually spoken of as an " alcohol sweat." Steam Baths.-In steam baths, steam is substituted for hot air. In the Russian bath the bather sits or reclines in a chamber into which steam is being constantly carried. When perspiration is produced the same process as that in the Turkish bath is employed. A steam box has also been employed so as to apply the steam to the entire body, except the head. These steam HOW TO KEEP WELL. 156 baths are not as desirable as the hot air ones, and are conse- quently not so much used. CLOTHING AND MODES OF DRESS. The first and most important objects of clothing are to protect the skin from external injury, and the entire body from the vicissitudes of heat and cold, to which it is subject. For these purposes the kind of material is of more import- ance than the quantity. Thick woolen underclothing should be worn next to the skin, by young and old of both sexes, during the winter. In the early fall and late spring, a thinner wool, as merino, maybe substituted, while in the warm sum- mer months muslin or cotton gauze, are more comfortable. Next to these a sufficient amount of clothing to retain the heat of the body is essential in winter, while the lightest gar- ments that will satisfy the demands of society should be worn in summer. Outer garments that may be put on or laid aside as occasion requires, should always be on hand during cold weather. Children, particularly, should be well protected by warm and comfortable clothing ; and it must be remembered that young children and aged persons require more clothing than those in the prime of life. It is better that the head is not too warmly covered, when the hair is abundant, but warmth is necessary for a bald head in cold w'eather. In clothing the feet, thin Lisle thread stockings and low shoes are best in summer. In winter the shoes should be strong and thick, so as to keep the feet perfectly dry, and the stockings should be such as are the most comfortable to the wearer. Many wear woolen stockings, while others cannot do so on account of the excessive perspiration they occasion. As a rule thick cotton stockings are preferable even for winter wear. The thin shoes worn by women make it almost impossi- ble to keep the feet dry and warm, and consequently they often suffer severely for their indiscretion in this direction. WOMAN'S DRESS. 157 In ordinary circumstances it is best not to wrap up the head and neck when going out on a cold day. If this is done at one time and neglected at another, which is apt to be the case, it is liable to result in repeated colds. For this reason it is best to become accustomed to the exposure of those parts from the early winter. Clothing for the night is of much importance. Persons in good health should always wear night dresses made of muslin. Children and aged persons, and those afflicted with rheumatism should wear a woolen dress over the muslin. The same clothing should never be used at night that is worn during the day. It is best to sleep between cotton sheets, and have enough woolen blankets over these to give the proper warmth; while some cotton spread over the blankets aids in keeping the heat in and the cold out. As a rule boys and men are dressed in a manner that affords both comfort and health, while all the errors and folly of dress have been committed by that part of the human family that is looked upon as the weaker sex. We would not be just to ourselves, or our readers, if we did not speak plainly concerning the false modes of dress common among women, and point out the evils to which they give rise. Woman's Dress.-It may truthfully be said that woman's dress, "from the crown of the head to the soles of the feet " is a continued series of mistakes and absurdities. Many women object to wearing proper underclothing in winter, because it interferes with their dressing for parties and balls, according to the custom of Fashion. This often leads to the taking of colds, which develop chronic catarrhal and bronchial difficulties, if they do not lead to serious diseases of the lungs. Again, it is usually impossible to persuade women that they need to wear thick shoes to prevent them from con- tracting colds. They prefer a thin shoe that will neither protect against cold nor wet, so long as they imagine that their feet appear smaller or more handsome. Then, again, 158 HOW TO KEEP WELL. the heel is worn nearly in the middle of the sole of the shoe, and is so high and slender that it often requires no small de- gree of skill to be able to walk at all. This disturbs the natural equilibrium of the body by changing the direction of its axis, and thus becomes an important factor in developing many of the uterine displacements so common at the present day. The quantity of false hair that is piled upon the head, under the delusion that it adds to their personal beauty, is often the cause of many of the distressing headaches from which fashionable women suffer. Then the bonnet, or hat, is frequently insufficient to protect the head from the influences of the cold to which they are exposed. These are small matters to them, however, so long as they are following the prevailing fashion. Through the false notions that have been inculcated into the minds of women regarding the shape of the body, the use of corsets has become almost universal in all grades of society and conditions of life. A small waist is considered a special mark of grace and beauty, and in order to secure it girls are put into corsets and tightly laced, before they are properly developed. This causes unnatural compression of the lower, or false ribs, the various organs of the body are crowded out of place, and proper respiration and digestion are rendered impossible. This same process of lacing is continued through life, and thus many of the natural functions of the body are seriously and permanently impaired. As illustrating the evils that follow tight lacing, we wish the reader to examine the difference in the appearance of the thorax and waist in Figs. 40 and 41. Fig. 40 represents the natural outline of a per- fectly formed woman, the ribs occupying their normal posi- tions and representing the general shape of a cone with the base downward. Fig. 41, on the other hand, represents the unnatural shape produced by tight lacing. The lower ribs are pressed in, from their natural positions, so that what is naturally the largest part of the thorax is made the smallest. It can thus be readily seen that the various internal organs TIGHT LACING. 159 must necessarily be forced out of position in consequence of this change of shape. Fig. 4i- Fig. 40. Many women, however, insist that, though they wear corsets, they do not lace, and consequently are not in- jured. Even if this is in a measure true, the corsets still do harm. During respiration the ribs are raised at the sides so as to increase the lateral diameter of the thorax, and when a stiff corset presses them closely this motion is prevented, even though the corset is not tightly laced. In proof of this, it is only necessary for a woman, who claims she does not lace, to lay aside her corset for a few weeks and then attempt to put it on again. She will find that if it meets, it does so with difficulty, and that she does not breathe with ease. HOW TO KEEP WELL. 160 To insure the health of women, corsets should never be worn, at any period of life, or under any circumstances, and the sooner they learn that a slender waist is ungraceful as well as unhealthy, the better it will be for their comfort and happiness. In addition to tight lacing, the custom of wearing a num- ber of heavy skirts fastened around the waist, and dragging upon the hips and abdomen, is another cause of serious trouble. The weight thus borne presses the abdominal mus- cles, interferes with their normal motion and impairs the functional activities of the abdominal and pelvic organs. Proper Dress for Women.-When we condemn the usual method in which women dress, it is important that we should point out such means as would be more conducive to health, than those we condemn. In this particular, we could hardly go far astray, for most any method adopted would be prefer- able to the one now in vogue. Instead of the corset, girls and women should wear a snugly fitting waist, without bones, such as is usually called a corset-cover. Around the waist of this garment, buttons may be placed at proper distances apart, to which the waist bands of the skirts should be fastened, without being bound tightly around the body. This gives proper support to the skirts, by distributing their weight over the shoulders and back, and at the same time does not press the ribs so as to interfere with natural respiration. It cannot be tightly drawn and thus the several organs are not likely to be forced from their normal positions. For the heavy outside skirts, sus- penders, similar to those employed by men, should be used to relieve the weight from the hips and abdomen. Undercloth- ing, appropriate for the season of the year, should also be worn regularly, and when heavier clothing is put on, it should not be changed on every slight elevation of temperature. This mode of dress, when adopted with children, will prevent deformity and impaired functional activity. Even those who have practiced tight lacing all their lives, will derive great benefit from this mode of dress; and REST AND SLEEP. 161 will soon find a marked change in the general shape and size of their waists. It not unfrequently happens, however, that when those accustomed to the corset, cease to wear it, they will at first feel a weakness of all the muscles of the thorax and back. This is likely to lead them to believe that they cannot possi- bly support themselves without it. As soon as the muscles of the body have had time to strengthen, by their normal action, this condition passes off, and if they are candid they will admit that they are greatly benefitted by the change. This style of dress does not necessitate any departure from the usual forms of the outer garments, and the general shape of the body is more in harmony with nature, and much more graceful in appearance than the slender waist, as con- trasted with the broad bust and still broader hips, now so commonly seen. REST AND SLEEP. After all severe mental and physical labor a feeling of weariness and exhaustion supervenes. This feeling indicates that too great demands have been made on the tissues, and that the waste resulting from continued activity is becoming greater than the supply of new material. If we disregard this warning and continue our work, the results are not as satisfactory as before, and beyond a certain point, no amount of will power can enable us to continue either mental or physical effort. This fact is sufficient to indicate the im- portance of rest, to give the over-taxed parts of our bodies a chance to recuperate ; and it is always best to discontinue labor when the feeling of exhaustion comes over us. After every period of labor a period of rest is desirable. It may be that a few minutes relaxation from work is all that is necessary, or we may require that complete repose that can only be obtained by sleep. The activity of the nervous system having become ex- hausted by over work, the supply of blood to the brain is greatly decreased, and sleep consequently ensues. During 162 HOW TO KEEP WELL. sleep respiration and circulation are diminished, and con- sequently less blood is carried to the extremities. On the other hand, the blood that leaves the other parts of the body go to the chief organs of vegetative life, and hence the diges- tive organs are largely supplied with blood. This augments, the quantity of the digestive juices, and promotes the ab- sorption of the nutritious elements of the food; while at the same time the condition of rest prevents the destruction of tissue. In this way the various organs and parts of the body are recuperated during sleep, and prepared for renewed ac- tivities. It will thus be seen that sleep is a wise provision of nature for regulating the waste and supply necessary for the continuous evolution of the forces of life; and that a proper amount of it is necessary for health. Children, in whom the supply must exceed the waste, require a large amount of sleep. Infants under three months, of age, if healthy, sleep three-fourths of the time; and all children under fourteen years of age should sleep not less than ten hours. From that age to maturity, all persons are healthier if they sleep long and soundly. During the period of interchange, or the prime of life, the majority of people require eight hours sleep, though many persons accustom themselves to do with much less. Alfred the Great, king of England, divided his day into three parts,, and devoted eight hours to business, eight hours to study,, and eight hours to sleep and recreation. Physicians, law- yers, and literary men, as a rule, habituate themselves to do- with very little sleep, but after a time it cannot fail to tell upon their general health. Aged persons, as a rule, require but little sleep. This, is due to the fact that the process of destructive assimila- tion is less active at this period of life, and consequently the same amount of repair is not required to build up the tissues. The time for sleep is during the night, and it is always, best to form the habit of going to bed early and rising early. This is, however, impossible for many persons, and those EES7' AND SLEEP. 163 who are obliged to work late into the night, should make up for it by sleeping during the morning hours. The main point is to sleep enough to completely recuperate the ex- hausted energies of the system. Long continued muscular effort will always be followed by a desire to sleep, from the fact that an extra amount of blood must be supplied to the muscles to admit of the in- creased work. On the other hand long continued mental activity produces an increased flow of blood to the brain, which must necessarily cause a condition of wakefulness. Again, after a full meal, the process of digestion demands that an increased supply of blood should go to the stomach and intestine. This diminishes the quantity of blood in the brain and the desire for sleep after eating is produced. It will thus be seen that it is a diminution of cerebral circulation which causes sleep, and not sleep that diminishes the flow of blood to the brain as has been claimed by some writers. When from any cause insomnia occurs, it has been the custom of physicians to prescribe some remedy that would diminish the frequency of the heart's action, and thus lessen the quantity of blood to the brain. Instead of this it is much better to establish some physiological process to accomplish this end. With brain workers, a brisk walk of half an hour's duration, or the same time spent in exercise on the "Home Gymnasium," will often so change the flow of blood as to produce a quiet and refreshing sleep. If this fails, a light meal accompanied by a glass of wine or beer before retiring, will be found to answer the purpose better than medicine. Physical labor often exhausts the system to such a degree that an unusual demand for nutrition is created. In this condition a person cannot sleep, but if food is taken, sleep is promptly induced. These facts conclusively disprove the old idea, that it is unhealthy to eat before going to bed. Of course if nutriment is not required and no reason for taking food exists, it may do harm, but it is always better to take food before retiring than to go to bed hungry. 164 HOW TO KEEP WELL. Alcoholic beverages, when taken in considerable quanti- ties stimulate circulation in the brain^and thus prevent sleep till reaction takes place. Sleep that is thus produced is un- natural and is not refreshing. Tea and coffee taken with the evening meal, or before bed time, always produce enough brain stimulus to prevent sleep. They may occasionally be used for this purpose when some special work is to be per- formed; but if continued any length of time they will eventu- ally do harm. It is always a safe rule, however, to entirely avoid the use of all kinds of beverages in the evening, that have a tendency to occasion wakefulness. It is always best for those who work hard to yield to the natural desire to sleep, after eating a hearty meal. A sleep of half an hour after dinner, not only aids perfect digestion, but gives new life and vigor to the system. When digestion is impaired and there is a torpid action of the liver, sleep does not refresh the system, and a person, even after a long sleep, feels languid and dull. In such cases the digestion must be so improved that the tissue wastes may be replaced, before sleep will bring the needed refreshment. During sleep a good supply of fresh air should be ad- mitted to the room, and in cold weather a proper amount of bed clothing must be supplied to prevent the lowering of the temperature of the body. Young persons should not sleep with old people, nor healthy persons with those who are suffering from any form of disease. In fact, under the most favorable conditions, the general tone and vigor of the system is best maintained by sleeping alone. CONDITION OF DWELLINGS. No fact has been more clearly demonstrated than that the health of a family depends largely on the condition of their dwelling. With personal cleanliness, proper sewage and drainage, good ventilation and abundant supply of sun- light, we are certain to escape many of the diseases so pre- valent where these requirements of health do not exist. CONDITION OF DWELLINGS. 165 As few people can control the location of houses, and the amount of ground that surrounds them, it would be use- less to occupy space in discussing the importance of these subjects. It is enough to say that when possible the houses should be roomy, and surrounded by a plot of ground, so that windows could open directly into every room, thus securing an abundance of fresh air and light. This is possible in the country and in country towns, but in cities we must make the best of conditions as we find them. There should, however, be some law regulating the building of tenement houses. The ground on which they are built should be of sufficient size to admit of building on the four sides so as to leave a large open court yard in the centre. The building should be narrow so as to admit of no dark inside rooms for living pur- pose, and rigid rules should be enforced regarding the sewage and drainage. The premises should be carefully inspected once a week so as to insure that attention to cleanliness that is requisite to guard against preventable diseases. Sewage and Drainage.-The question of sewage is an important one, not alone for the health of the family, but also that of the community. In towns and cities the matter is in the hands of the corporate authorities, and it is only neces- sary for the house-holders to learn the importance of proper sewage, to compel property owners to provide this means of preventing disease. Waste pipes and closets should be fre- quently examined so as to be sure that no sewer gas es- capes through them into the house; and each closet should be provided with a separate tank large enough to insure a constant supply of water for the use of the closet. From the main sewer pipe in the basement of the house, a good sized pipe should be carried to the roof to allow of the escape of all sewer gas before it can pass through all the pipes in the house. In the country, where there is no regular system of sewers, great care is necessary to prevent the accumulation of waste animal and vegetable matter, the decomposition of which so often gives rise to disease. The old method of 166 /IOW TO KEEP WELL. digging cess-pools in the ground near a dwelling, and allow- ing all sewage material to accumulate for a year or more, not only tends to poison the air, but also the wells and streams in the neighborhood. It is also a common custom in the coun- try to throw all slops and swill on the surface of the ground near the house. Decomposition attacks much of this waste material and thus we have another exciting cause of dis- ease. Often when attempts at sewage are made in inland towns the sewers are emptied into some lake, running stream or stagnant pond. In either case serious injury to health is lia- ble to follow. If a lake or running stream is thus contami- nated, the source of the water supply of many towns may be poisoned to such a degree as to seriously impair the health of the inhabitants. If sewage is poured into a stagnant pool, a decomposition soon takes place and poisons the atmosphere of the entire neighborhood. To prevent these evils all sewage matter should be col- lected in metal tanks and removed during the night, to where they can be made available for fertilizing purposes. With proper care the earth-closet must prove of great value to re- place the privy. After use a layer of fine earth is thrown into the receiver and acts as a good disinfectant. The con- tents of the receiver can also be removed at night and utilized. In damp, low-lying districts, where so-called miasmatic diseases prevail, thorough drainage adds greatly to the health of the community. This is particularly essential if any stag- nant water is lying near a dwelling. Air and Ventilation.-A constant supply of fresh air is in the highest degree essential to health. Without it the lungs cannot supply to the blood the oxygen necessary for its purification, and all the tissues and organs of the body suf- fer in consequence. In short, pure atmospheric air is an ab- solute necessity for perfect nutrition, and all available means of supplying it should be adopted in every house. In densely-inhabited cities, and in occupied rooms the atmosphere is never found in its natural purity. The emana- 167 AIR AND VENTILATION. tions from the body, which are constantly going on, vitiate it in various ways. The carbonic acid thrown off by the lungs, and the effete material from the skin, poison the air while at the same time the oxygen is being consumed by respiration. The smoke and other emanations from factories of various kinds also have a tendency to contaminate the air with nox- ious products. The germs from decomposing animal and vegetable matter, also impregnate the air, and thus become potent causes of disease. In cities these impurities are more harmful in summer than at any other season, and largely on that account do we find more disease, and greater mortality during warm weather. Thus the necessity of country air during the summer months, which must give strength and health to those who are forced to breathe the vitiated air of the cities for the greater part of the year. In closed rooms, where the air does not have free ingress, the oxygen is soon exhausted by even one or two persons, and the air becomes loaded with the exhalations from the skin, and over-charged with carbonic acid given off by the lungs. In a short time this vitiated air must be breathed again, and it then fails to supply the oxygen for the support of the vital functions, and also poisons the body by again carrying impurities into the blood. In order to avoid these evils the most perfect cleanliness of our streets and houses must be enforced, and proper ventila- tion must be secured for our living rooms and places of public resort. All houses should have windows front and rear, and the rooms should communicate so that by opening the windows a free draught of air maybe made to pass through all the rooms. Every room should be provided with openings for the ingress and egress of air, and care should be taken to regulate the temperature of the room, so that it can neither be made too hot by neglect of ventilation, nor too cold by over ventila- tion. When the air of a room is not over-heated the impure air settles to the floor, as it is heavier than the pure atmospheric 168 HOW TO KEEP WELL. air. This points to the necessity of having openings on a level with the floor for the egress of the impure air, while the pure air should be admitted from above. When the air of a room is heated, the carbonic acid expands and thus becomes lighter. It then ascends to the ceiling and carries the other impurities with it. To insure the best ventilation at all times, then, openings on a level with the floor and close to the ceil- ing are desirable for the egress of impure air, while the pure air should be introduced into the room a little above the heads of the occupants. In order to establish a current of air for spontaneous ven- tilation, the temperature of the room must be higher or lower than that of the out-door atmosphere. Thus in summer the air of the house is cooler than that of out-doors, and when the windows are open ventilation is usually secured. In the win- ter the heating of the house raises the temperature above that of the outside air, and when the ventilators are open the cold air enters readily. It will therefore be seen that the heating of houses constitutes an important part of ventilation. The open fire-place, made large enough to radiate suffi- cient heat for warming the room, is one of the best methods of heating and ventilating that can be employed. The heat is thrown out into the room, while at the same time a draught is created which causes a constant current of air to be carried up the chimney. This carries the impure air out of the room and creates a vacuum for fresh air, which is constantly pour- ing in. Even when other methods of heating are adopted, an open grate fire will always serve as a valuable means of ventilation. In seasons when a fire is not required, a gas jet burning in an open fire-place will establish a current of air which affords a sure method of removing impure air from a room. When stoves are employed for heating they should be constructed with an open front and a good draught, so as to resemble, as nearly as possible, a fire-place. Heated air introduced into a room through pipes leading from a furnace affords a good means of warming a house, pro- vided the air thus heated enters the room above the heads of AIR AND VENTILATION. 169 the occupants. This air enters with sufficient force to crowd the impure air out of the room through the proper ventila- tors. near the floor and ceiling, and the room is thus kept warm at the same time that ventilation is secured. The steam heaters situated in a room for the purpose of heating the air by radiation requires some method for supply- ing cold air from the outside, with sufficient force to carry off the impure air. In the absence of any method of ventilation other than the doors and windows of an ordinary dwelling, an open grate, as before mentioned, insures the best ventilation. In the absence of this, the doors admit some pure air whenever they are opened, while the air is carried out under the doors. The lowering of the upper sash of the window, also aids the proper ventilation. Sleeping rooms can be ventilated by lowering the upper sash of the window a short distance and leaving the door opened a few inches. With this arrangement a draught is established which is likely to keep the air pure and whole- some. The bed should be so situated that the current of air will not pass directly over the sleeper. In public halls, the lamps and gas jets should be outside of the hall, and so arranged that the light will be transmitted through plates of glass. The importance of this is ap- parent when it is known that a burning gas jet, or lamp consumes a large amount of oxygen, and produces a corres- spondingly increased amount of carbonic acid, which hastens the deterioration of the air in the room. The temperature of a living room should not, as a rule be over 70 degrees Fahr., and a sleeping room not more than 60, or 65 degrees; and every house should be provided with one or more thermometers, by which the temperature can be regulated. Travelling in tightly closed cars, even on very cold days, should always be avoided, as the air in a crowded car soon becomes vitiated and tends to impair the health of those who continue to breathe it. 170 HOW TO KEEP WELL. When any contagious disease is present in a house, or when a severe infectious disease prevails as an epidemic, it is desirable to use means to keep the air of a room free from the infection. If the disease is in the house, the windows should be open to admit fresh air, and the doors should be left open and covered with sheets tacked all around, except at one side which can be raised to admit of entrance and exit. The sheets are then kept dampened with a solution of carbolic acid, containing five grains of the acid to the ounce of water. The sheet thus wet filters the air and destroys the germs that might otherwise escape from the sick room. The windows may be similarly protected with the view of preventing in- fected air from without entering the house. OCCUPATIONS. Occupations have an important bearing on health, and a careful examination of the subject will surprise many persons who believe themselves well informed. It is usual to speak of out-door occupations as the most healthful, while in fact the reverse of this is true, at least so far as longevity is concerned. From carefully collected sta- tistics it appears that farmers, who manage their farms with- out performing hard labor, live longer than any other class of persons. Next in order come clergymen, lawyers, physicians and professors; and following these we have musicians, editors, architects, merchants, financiers and capitalists; while butchers, pedlers, drovers, teamsters, &c., are the shortest lived. In a word, it may be stated that the most intelligent and those devoted to brain work, live longer, as a rule, than those who perform severe physical labor. This is due to the fact that hard labor exhausts the energies of the body without affording proper rest and recreation, while exposure to the vicissitudes of the weather causes conditions that tend to develop disease. On the other hand, active mental labor, varied by proper muscular exercise, keeps up a nervous activ- ity that is constantly imparting renewed vitality to every part and organ of the body, and thus tends to keep the body OCCUPA PIONS. 171 young and to prolong life. Men and women who do not use their brains to any extent, invariably grow old rapidly and do not live as long as brain workers. Of the trades those that call the largest number of mus- cles into action, if not accompanied by too much exposure, are the healthiest; while those that confine the workers to one position, with only a few muscles active are the most unhealthy. Thus carpenters, coopers and blacksmiths are usually healthy, while tailors, shoemakers, jewellers and en- gravers, are unhealthy and short lived. It may be laid down as a general rule that all persons who perform labor requiring extensive and continued muscular effort, should have an abundance of rest, as well as such recreations as will agreeably occupy the mind. Those follow- ing trades that necessitate sedentary habits, or the use of only a few of the muscles, should devote a part of each day to ex- ercising those muscles that are not active during labor. Brain workers, again, require an abundance of exercise, so as to keep up a proper circulation throughout the body, and to impart vigor to the natural actions of the various organs. Some kinds of occupation are in themselves injurious to health, and should be entirely avoided by the weakly, and only engaged in by the robust for short intervals at a time. Working in foundries or near any intense heat, is apt to pro- duce free perspiration, which is suddenly checked in air at any ordinary temperature, and thus results in colds, rheumatism, &c. Working in damp places and with wet feet also develops similar conditions. In many factories the air is impregnated with noxious vapors, or gases, the inhalation of which is in- jurious to health. In such places persons should not work more than two or three hours a day, while the balance of the time should be spent where the atmosphere is pure, and in obtaining the proper exercise, recreation and sleep. In all occupations, however, we believe that a proper ob- servance of the rules of health we have here laid down will result in a great improvement in the health of the masses of the people, and a marked increase of the longevity of our race. CHAPTER VI EDUCATION OF THE SEXES. Much has recently been said and written concerning the education of the sexes. Opinions have been freely expressed for and against their co-education. Some have assumed that girls are incapacitated by nature to follow the same methods of education as boys. Others declare that the physical func- tions of woman render it impossible for her to attain the same degree of mental development as man. On the one hand, the liberal-minded are calling for more extended facilities for the higher education of woman; on the other, thousands rush forth to close the doors of our universities and colleges against the intrusive tread of our sisters and daughters. Thus it is that a war of sex is being waged on the question of education, not alone in our own country, but also in the leading countries of Europe-a war that has been an unequal one, because the custom of ages past has given to man every encouragement and facility for the highest possible degree of mental develop- ment, while it has said to woman, " thus far shall thou go and no farther"-a war that will continue to be an unequal one, till the masses of the people are made to see the absurdities of the prevailing notions concerning the education of the sexes, and to understand the methods by which their truer and higher education may be accomplished. OUR PRESENT SYSTEM OF EDUCATION. 173 With the view of presenting the subject in a systematic manner we shall consider it under the following heads: First: Our present system of education and its defects. Second: The rational education of the sexes. Third: The physiological differences of the sexes. Fourth: The future relation of the sexes under a rational system of education. These are questions of vital importance to the well-being of our race-questions that demand candid and fearless discus- sion; and it becomes our duty to present them in their true light, even at the risk of being considered indelicate by those who intrench themselves behind the walls of false modesty and fulsome sentimentality. We do not claim as original many of the points here referred to, and our only excuse for presenting them shall be the hope that a candid reiteration of them may be instrumental in causing a few to think more earnestly concerning the important question of education than they have heretofore done. OUR PRESENT SYSTEM OF EDUCATION, AND ITS DEFECTS Parents usually begin the education of their children by lying to them. This is a severe accusation and yet it cannot be denied. No sooner does a child begin to recognize different objects, and to lisp forth the prattling words that give expression to its dawning thoughts than it plies those around with childish questions, which often puzzle the wisest to answer. Parents not only reply falsely to the innocent questions, but they also deceive their children in numerous ways. They promise them sweetmeats and toys as inducements to make them do some- thing, and then fail to give the promised rewards; punishment is often threatened and not inflicted, and absurd nursery tales and superstitious notions are repeated so frequently that the child becomes filled with wonder and awe. As the child- ish mind expands it begins to discover the numerous decep- tions that have been practiced upon it, and soon learns to EDUCATION OF THE SEXES. 174 practice deception in turn. For this it is so often severely pun- ished, that its disposition becomes soured, so to speak, and the bent of its moral education is thus misdirected in the early dawn of intellectual life. In this way parents are too often responsible for the lying, deceptions and temper manifested by their children, and which are so difficult to correct after having been inculcated into their infant minds. Babyhood is scarcely passed when the question of sex en- ters into every thought for the future training of the child. Perchance a boy is allowed to romp and play in the fields, gar- den, streets, or in any place where he can find room to run and jump, to laugh and shout, to roll and tumble with the na- tural freedom of childhood, but a girl is decked out with white dresses and a profusion of ribbons from the time she is two or three years of age, and every childish impulse of her nature is dampened by being constantly reminded that she will soil her dress, or that she must not do this or that because it will make her too like a boy and unlady-like. Thus child- ren are forced into womanhood without tasting the sweet freedom of childhood; thus girls are led to think that their brothers are entirely different beings from themselves, and yet they are so often fascinated with boyish sports and frolics, that they wish themselves boys, that they might be permitted to enjoy them. On first entering school and being subjected to school discipline girls usually learn more readily than boys. They are more accustomed to indoor restraint, and do not grow res- tive and discontented under it as boys do. If not too closely confined, however, boys soon become used to the school- room, and for a time the boy and girl stand side by side in their several classes. A change soon comes. The boy is informed that he must be the architect of his own future, that he must prepare himself for some particular vocation in life by which he can earn a livelihood, and to this end his studies are shaped. If he goes to a trade he is instructed in its various branches by competent mechanics till he has mastered it fully. If he is to become a merchant or banker, he enters a store or counting- house, and remains till he has mastered every detail of the business. If he aspires to the learned professions he goes from the common-school to the academy and university, and after- ward to the theological seminary, law-school or medical col- lege, till he has fully mastered the intricacies of the profession of his choice. His teachers, as a rule, are able, earnest, prac- tical men, who have been selected on account of their special fitness for the positions they occupy. But what is the course laid down for the girl during all this time? She is early re- minded that her chief aim in life is to get a husband. Her education is often completed at fourteen or fifteen, she is en- gaged at seventeen, and at eighteen she is married and settled for life. As a rule, if her education extends beyond the common- school, it is continued in the young ladies' seminary or fashion- able boarding-school. In these institutions she must receive instructions in music, whether she has any liking for it or not; she may learn a little bad French and worse German and Spanish, and is almost certain to acquire absurd notions of anatomy and physiology, and such other branches of science as are claimed to be taught. In addition to these subjects she is taught how to make a graceful courtesy; how to fold her hands in that easy position assumed by the kangaroo when in the attitude of listening; how to manage the long train of her dress most gracefully, in a crowded room; how to eat without appearing vulgar; how to decline a second portion of meat or bread without appearing to want it, and how to rise from the table with a smile on her face, and the declaration that she could not eat another mouthful, when, in fact, she had eaten so little that she feels faint and hungry. These ac- complishments once acquired the young lady's education is completed, and at the age of seventeen or eighteen she is brought out by her wily mamma. Then follows a season of frivolity-balls, parties, opera and theatre are patronized, night after night, till she becomes intoxicated and bewildered by the maze of fashion, and the gaudy display of wealth. If she is a reputed heiress, her dear mamma has no trouble in find- ing a suitable match for her during her first winter in society; if not she must go to Saratoga, Long Branch, or some other OUR PRESENT SYSTEM OF EDUCATION. 175 EDUCATION OF THE SEXES. 176 fashionable watering place in the summer, that she and her mamma may use all their arts to catch a husband. It matters not that they are crowded into a little room, eight by ten, during the hottest days of July and August; it matters not that they must re-arrange their toilets four or five times a day, so long as there is a chance to find a husband amid the dancers or promenaders of the night. Well, a husband found! what then? Too often mutual disappointment, discontent, premature decay and a life-time of misery. In all our cities and larger towns, childrens' parties have become established institutions, and preparations for them enter largely into the education of the young. The simple attendance of an afternoon dancing-class might be more ben- eficial to most children, than otherwise; but when they are surrounded by the glare and excitement of midnight parties; when they are decked out in all the ridiculous paraphernalia of their elder brothers and sisters; when the rest that nature demands for them is denied, they become bewildered and ex- cited, their sensitive nervous organizations become deranged, physical development is arrested, physiological functions per- verted, and chorea and a chain of other maladies are almost sure to follow. But their education would be incomplete without these scenes to fit them for polite society, and it mat- ters not what consequences may follow, this branch of their education must not be neglected. Then come all the frivolities and absurdities of dress. Ig- norant of the natural shape of the human body, and of the laws of human development, mothers dress their daughters as though they were stuffed dolls. They are early taught that it is graceful to have a small foot and a slender waist, and to attain these requisites of female beauty the feet are incased in small boots and their waists in tightly-drawn corsets, till their natural development is arrested, their thoracic, abdominal and pelvic organs forced from their natural positions, and their various functions materially perverted. Thus it is that the natural shape of the body is so altered as to become a de- formity that will remain through life, and that must in the nature of things permanently derange normal functions. This OUR PRESENT SYSTEM OF EDUCATION. 177 is the kind of education our girls receive to fit them for the re- sponsible duties of life, and yet we look blindly on and make no efforts at reform. How apparent are the defects of this system of education, and how fearful are the consequences it entails upon hu- manity. Our girls grow up without physical development, and are taught to believe, that they have no mission in life, but to please the opposite sex. Their school education is conducted after a certain form that must invariably be adhered to regard- less of the special capabilities of the students. Their educa- tion must be completed at eighteen, while boys are rarely, if ever, expected to graduate before twenty-one. They are subjected to the discipline of school and to the excitement of fashionable life without having the least opportunity for physical exercise, while at the same time they are dressed in such a manner that respiration and other functions are hardly possible. Some few break down in school, and many are obliged to forgo the pleasures of a fashionable season on account of failing health. But it is after marriage that the worst evils become apparent. With almost all, maternity is attended with great suffering, and with some it is impossible. A chain of female maladies are sure to follow and life loses its charms and becomes a burden. But alas, these evils are too often aggravated by the un- natural desire of young women to shirk the responsibilities of maternity. They cannot, at first, sacrifice society for off- spring, and they are inclined to consider it a disgrace to have a large family; consequently abortion is frequently resorted to, and it does not fail to leave its moral and physical blight upon our country. Of all the evils for which our present system of. education is responsible-and they are many-this one crime of abortion stands out boldly and prominently above them all. It entails upon our American women miserable lives and premature deaths; it retards our national growth; it gives us puny off- spring; it is sapping the life-blood of our Republic, and if 178 EDUCATION OF THE SEXES. continued for three generations without the influx of foreign population, our boasted America would crumble into dust be- neath the weight of this single vice. This is no exaggerated picture we are drawing. It is so- ber, candid truth, that can be verified by every physician of experience, throughout the length and breadth of our land. Go and ask members of the medical profession what makes girls so weak and puny, and they will answer you: "the want of physical exercise." Go and ask them what makes young women weakly and sick after puberty, and they will tell you : " the perversion of normal functions of the body by tight, lac- ing and other violations of natural laws;" Go and ask them why girls break down at school and in society, and the answer comes, "their physical education was neglected, their bodies deformed by improper dressing, they do not have proper food, and the time that boys spend in play they spend in ar- ranging their toilets." Again ask them why American women suffer so much from disease, and you are told that, "through life they have so violated the laws of nature, that they must now suffer the consequences of their folly, ignorance and crime." But, you say, there are many exceptions to what you affirm. True, there are exceptions, for it would be pitiable, indeed, if there were not. Many instances do occur where mothers exercise common sense in dressing their daughters, and where girls have ample opportunity for a fair amount of physical development. Such girls usually grow to be healthy women, capable of acquiring as high a degree of men- tal development as boys, and fitted toperform the various du- ties of life without sickness and suffering. If, however, they should aim at a higher degree of education than is usually ac- corded to girls, they meet with many obstacles; they are shunned by their own sex, laughed at by men, and often pro- nounced eccentric or insane. Our system of education is far from what it should be, even for boys. The moral and physical development of our children are rarely if ever considered; and the compulsory routine of the school-room is often productive of much harm to children, whose physical development has been neglected. OUR PRESENT SYSTEM OF EDUCATION. 179 But we can hope for nothing better so long as the ma- chinery of our school-system remains as at present. In all our large cities, the members of the Boards of Education are too often ward politicians who obtain their positions as rewards for services rendered to their party, without having the least qualification for such an office. They, in turn, appoint A. B. and C., to vacancies in our schools, on the recommendation of their political friends, and thus it is that political influence is all that is necessary to get a position as a teacher. With it the most incompetent are appointed to and retained in many of our schools; without it the most finished scholar, and the most experienced teacher can hardly obtain a hearing. Our normal schools practice a system of cramming, en- tirely inadequate to fit men or women for the responsible du- ties of teachers, and the systems of school disclipine they teach are too arbitrary and entirely uncalculated to give the proper physical, moral, or mental training necessary for the proper development of the young. Too many of our teachers care nothing for their work, and only follow it till something better turns up. Inexper- ienced boys and girls are intrusted with the care of our children in school, before they are themselves fit to leave a teacher's side. With such, school hours are dull and tedious, and when over, amusements, dress and frivolity occupy their time, and personal improvement, in many instances, is never thought of. We do not mean to say that all our public school teachers are such as we have described. We have many sincere, hard- working men and women, whose hearts are wholly in their work, but they are so few in comparison, that they are often lost sight of; and, being no better paid than idlers and pleas- ure-seekers, they are often obliged to seek more remunerative occupations. In our colleges and universities, provided for the higher education of boys, the teachers, as a rule, are competent and earnest workers, but not so those to whom the education of girls are intrusted. What people have been pleased to call the finishing of a young ladies' education, is, to a great extent, EDUCATION OF THE SEXES. left to itself. Any one can teach young ladies, and young ladies'seminaries and boarding schools spring into existence by the hundreds every year. And who are the teachers? Unsuc- cessful or superannuated ministers, the wives and daughters of bankrupt merchants, and ladies who wish to add to their income, through the means of the money obtained from their pupils. We do not find fault with these efforts to obtain a live- lihood, but do affirm that the large majority of schools for young ladies, conducted by such persons, do not and cannot give to our girls a wholesome training, and, consequently, should not be patronized. We have thus briefly sketched the most prominent fea- tures of the present system of education, and, doubt not, that its defects, and the numerous evils to which it gives rise, have long been apparent to every one who has hoped for the im- provement of the race. 180 THE RATIONAL EDUCATION OF THE SEXES. The evils to which we have referred can only be remedied by the adoption of a more rational system of education-a sys- tem more in accordance with the laws of nature-a system that shall aim at a higher intellectual development than has as yet been attained. We cannot at once adopt such a system, but we can set to work reforming existing defects and abuses, and in that way lay a sure foundation for the ra- tional education of those who are now infants, and for suc- ceeding generations. The proper time to begin the education of a child is dur- ing its early infancy. We cannot conceive of a more helpless thing than a newly born babe. It can breathe, utter a feeble cry, and is possessed of a slight degree of automatic motion; but morally and intellectually has not commenced to live. With proper nourishment and care it begins to grow, and after a few months we notice the gradual dawning of intellect- ual life. Though feeble, at first, this new life is strengthened day after day, and soon every word and action of those around THE RATIONAL EDUCATION OF THE SEXES. 181 are impressed upon that infant mind, which is influenced to a very great extent by these first impressions. How important, then, that parents should guard this formative period of men- tal life, and surround their children only with such things as would produce good impressions. Wrangling and contention, and the slightest show of temper should be carefully guarded against before even very young children, and when they be- gin to talk, and ask innocent questions, they should never be put off with a cross word or with an untruthful answer. Never tell a lie to a child if you do not wish to make it a liar. When you cannot answer its questions, tell it so, and talk to it in a rational way; do not teach it idle and absurb superstitions when young, that it will be likely to reject when older; do not teach it to do right for the sake of reward, or the fear of punishment, and do not punish it for imitating even the vices of others; but rather remember that a child develops by imita- tion, and if you would lay the proper foundation for its moral education let your own lives be above reproach. In short, you must yourselves be always everything you would have your child be, for every child deri/es the bent of its moral life from the example of those around it. Before passing from this point we must enter a protest against the pernicious influence of deceiving children with so many falsehoods concerning Santa Claus, and the presents he brings them at Christmas and New Year. They naturally expect many things they do not get, and all kinds of false- hoods are told as reasons for their getting as much as other children ; and when they at last discover the deception, they not infrequently remind their parents of the untruths they uttered, and make that a defense for their own falsehoods. Next to the moral comes the physical education of chil- dren; and in early childhood we cannot do better than to allow a child to follow its own instincts in this direction. It is as natural for a child to play as for a lamb to frisk in the fields, and this play is necessary for the proper physical devel- opment of girls as well as boys. Then, leave them both free to play together from their earliest childhood-avoid every article of dress that would in the least prevent the natural 182 EDUCATION OF THE SEXES. motions of the body-impose no restraint upon the one that you would not upon the other, and above all do not subject them to school discipline too soon. Plenty of play, fresh air, wholesome food, and proper rest, are far more important than books for children under ten years of age. With these their physical development is insured and the foundation of a rational education is laid. It is a mistaken idea that a child should be well advanced in school before the age of ten; for such advancement is sure to be at the expense of its physical development. Most of a child's early education results from observation. Every new object it sees has special interest for it, and every answer given to its childish questions forms a part of its education. Thus, while attaining a physical development, mental growth goes on through the perceptive faculties, and a child often learns more in this way than in the school room. When their school life begins let their advantages be equal, give them more time for play than for study and the same kind of exercise for one as for the other. As soon as they are capable of understanding it they should have in- structions in anatomy and physiology; let them be thor- oughly instructed regarding the structure of their own bodies, the functions of their various organs, and the hygienic laws that will enable them to preserve health and prevent disease. Abolish tight lacing, and all other unnatural modes of dress; and have boys and girls enter the lists for a higher education, and go through our colleges and universities side by side. Let there be no distinction on account of sex, and make both feel that they should be self-dependent and entitled to such positions in life as they are qualified to fill. To accomplish this much to be desired end, we must have earnest, competent teachers in all our schools and colleges- teachers who know how to instruct pupils physically as well as mentally-and they should be paid as well, or even better, than any other profession or trade. This co-education of the sexes-morally, physically and mentally-commencing with infancy and extending through life, we believe to be more rational and better calculated to THE PHYSIOLOGICAL DIFFERENCES OF THE SEXES. 183 improve the condition of mankind than any improvement of a system based on the assumed inferiority of woman. THE PHYSIOLOGICAL DIFFERENCES OF THE SEXES. The advocates of the co-education of the sexes have fre- quently been met of late, with the assertion that, in conse- quence of the physiological differences of the sexes there are differences in mind, and must be in education. To prove this, many absurd opinions have been expressed, many false doc- trines have been advanced, and many erroneous conclusions have been drawn; and, therefore, it is of the highest import- ance to the discussion of our subject that we should carefully examine this. division of it with the view of arriving at a rational conclusion. At the outset we are confronted with the opinions of Dr. Clark, of Boston, and Dr. Maudsley, of London, both of whom affirm that the menstrual function in woman unfits her, for several days in each month, for mental or physical labor; and that continued labor during that period is productive of harm. They further say, that the development from girlhood to womanhood takes place after puberty, that menstruation is an abnormal condition, which causes a drain upon the sys- tem, and that shattered health is sure to follow when this law of periodicity is not obeyed. It does seem surprising that these men should take such positions, and more surprising that so many are willing to accept them as true. That sexual development takes place after puberty is one of the most absurd assertions ever uttered. The very appearance of the menstrual flow is an evi- dence of development, for no flow can take place until the ovaries and uterus are fully developed, and as soon as it does the girl is capable of becoming a mother. This period, in- stead of being the commencement, marks the completion of sexual development, for in both sexes this development is a gradual one from infancy to puberty. 184 EDUCATION OF THE SEXES. In the Poptilar Science Monthly, lor July, is to be found a valuable article entitled, "The Genesis of Woman," by Dr. Ely Van de Walker, from which I extract the following, bear- ing on this subject. He says : " Young women become objects of parental or medical solicitude at a period when it will have but little influence on the perfection or imperfection of their sexual life. By the keenness of the vision directed to this period of woman's genesis, they are blinded to all the years of formative child- hood. Perfect function is an expression of perfect organs. Women do not reach the inception of ovarian life with organs, in an infantile condition. During the years of childhood structural evolution goes on, and ends in the climax of func- tion. It naturally follows, that during the period of struct- ural development are sown the seeds of ovariafl ill health." At the close of this article Dr. Van de Walker arrives at the following conclusions: First: "That sex, structurally and functionally, from infancy to puberty, is in a state of slow and progressive evo- lution." Second; "That the time occupied in the establishment of ovulation is not the true crisis in the development of women." Third: "That under value has been given to simple ovarian growth and function as a factor in the development of womanly mental and structural peculiarities." Fourth: "That in a state of health the inception of the ovarian function is never paroxysmal, or sudden." Fifth: "That perfect structural development is followed by perfect function, and that the reverse of this is true;" and lastly- "That early diseased ovulation is mainly the result of physical, moral, and hygienic faults of the true crisis of woman-that of formative childhood-rather than of the period of puberty. Then he adds: "With these facts before us, is it not legitimate to assume that the puberic period in woman's life has been over-estimated in its direct influence upon her health PHYSIOLOGICAL DIFFERENCES OF THE SEXES. 185 at that and subsequent periods? Instead of curtailing her opportunities for work and study, by throwing around her re- straints, and, as it were, creating a disability out of a natural function, transfer the attention and anxiety now lavished upon her, to a period when all that makes woman in the best and noblest sense is in the process of elaboration; for it is during this time of rapid structural change that the future good or bad health of woman is determined. Let healthy ovulation be the natural outcome of a healthy childhood, and the function will obey its law of periodicity year by year, and all this time the young woman is as able to sustain uninter- rupted physical and intellectual work as the young man. I do not wish to be understood as saying that at puberty, or at any other period of woman's life, the laws of health may be violated with impunity, but that a law of health is no more binding upon the young woman than upon the young man; that really there is no such thing as one law for women and another for men. But the law of the woman is not the law of the child. The woman must follow those laws of health that keep her healthy; the child must be trained to obey those which will insure health in the woman. If I am right in trac- ing ovarian functional derangement mainly to the structural crisis, it is evident that the child must be an object of careful attention. It is not my purpose to mention the causes which will vitiate the development of the child. I desire to direct attention to this period as one full of danger to the future woman. Lest I be accused of ascribing too many of the dis- asters to which the functional health of woman is liable to the period of childhood, I will say that women, and all the func- tions peculiar to their sex, are liable to the accidents of dis- ease at any time; but, if we accept the evidence of the intel- ligent people, who have the opportunity of observing large numbers of young women in schools and colleges, the .early period of sexual function is not so liable to disease as when women are called upon to perform some of the higher duties of their being, later in life. * * * * My ajm has been, to fix, if possible, the actual value of the puberic age of woman as a crisis, so that there may be no factitious EDUCATION OF THE SEXES. 186 bar to her progress to either a higher education, or to her training for any of the skilled labors suited to her strength." This question of development need hardly be argued further, for the positions taken by Dr. Van de Walker are the only rational ones that can be entertained in the light of modern physiology, and besides we have abundant proof on every hand to establish their truth. Although Dr. Clark, in speaking of the menstrual func- tion, frequently refers to it as an abnormal condition, we can hardly think he means to be understood in that way. Men- struation is as much a normal function as is digestion or res- piration, and where natural laws have not been violated it is established with as perfect immunity from pain and suffering. Why should a woman suffer during the performance of a na- tural function? Why should she be an invalid one quarter of her time, as asserted by Maudsley. Certainly not on account of the tyranny of her organization, but on account of the tyranny of our modern civilization. Among the poorer classes of Scotland, Germany, Ireland, and other European countries, where girls are obliged to work in the fields the same as boys, the menstrual function is es- tablished without necessitating any change of life. It regularly appears while they continue their work without intermission, and though subjected to the same physical labor as men, all forms of uterine diseases are to them unknown. Even in our own country we find among the poorer classes many women who work hard, year after year, without an hour's rest during their menstrual periods, and they do not suffer in health by so doing. These woman do not suffer, because their physical devel- opment was not interfered with, by unnatural dress and false modes of life, during their formative years from infancy to puberty. But there are those who are willing to acknowledge that the menstrual function is normal and may be perfectly healthy, and that physical labor does not derange it; yet they adhere to the belief that in consequence of that function women PHYSIOLOGICAL DIFFERENCES OF THE SEXES. 187 differ from men in their modes of thought. They even say that this difference is noticed in early childhood, and as an instance of it quote the passion little girls have for dolls. We need not tell anyone who has studied the habits of children that the supposed difference does not exist. Give a little girl her choice between out-door sports and the most beauti- ful dolls, and see how soon the dolls are forgotten; observe how she deserts her doll for the rougher toys of her brother, and then say, if you can, that the instinct of her sex makes her fond of dolls. Examine the brain of a woman by the most careful exam- ination to which we can subject it, and you cannot detect the slightest difference between it and the brain of man, except- ing that in size it is proportionate to the body, which is smaller than man's on account of the lack of physical exercise to favor development. Now, if the brain in both sexes is the same, and if thought is a function of the brain as is now generally believed by scientists, the methods of thought must, in the main, be sim- ilar. It is true that it is influenced by education and the sur- roundings of every day life, but there is no more difference in the methods of thought in the two sexes than there is in those of two individuals of the same sex. If woman has not thought as deeply as man, it is not because she is incapable of doing so, but because she has not had the opportunity of preparing herself for so doing. Whenever she has had a chance, or when she has had the courage to win her way in spite of opposition and disadvantage, she has proven herself equal to her brothers. In the field of literature, on the stage, on the rostrum, and in the medical profession, she has won golden opinions from an exacting world, and in all of these we will defy the most acute critic to point out wherein her methods, or the results obtained, differ from those of man. What has been the verdict of the colleges where woman is admitted on an equality with man? That female students are as regular in attendance and as proficient in their studies as males. And this, too, at a time when the way is just EDUCATION OF THE SEXES. 188 beginning to be opened up to them, and when they have not had equal advantages of an early physical education. It has been our own fortune to instruct medical students for over ten years, and during that time we have lectured to mixed classes and to both sexes separately; and we have al- ways found women to be as regular in their attendance on lectures, as earnest students, as careful observers, and as prompt in answering questions as men. We have found them graduating with as high honors and becoming as successful practitioners as any in the land. Ah! but what about the array of facts brought forward by Dr. Clark relative to the injurious effects of this higher educa- tion upon girls? Would you enforce your system in the face of so much that disproves your theories ? These are ques- tions we often hear. We would answer them by saying that Dr. Clark relates a few cases of failing health in ambitious girls at school, and then jumps at the conclusion that over study, continued dur- ing the menstrual period, was the sole cause of the trouble. We would ask him to inquire more particularly into the previous history of those cases; to ascertain how they were cared for and dressed before the age of puberty, how they were fed while prosecuting their studies, and what was the shape of the thorax of each. And, in by far the largest number, we are confident that the trouble would be directly traceable to errors in the physical education during the formative years, and to the want of proper food and exercise during their school lives We are confident that a measurement of their waists would prove us to be correct, and we would find them with the lower ribs so compressed that the thoracic cavity, instead of repre- senting a cone with the base downward, would resemble two cones with their bases joined. We have been frequently called upon to prescribe for girls whose health began to fail while attending school, and in every instance we have found a cause for their failing health, entirely independent of their school life. We could relate hun- dreds of instances, similar to those related by Dr. Clark; but PHYSIOLOGICAL DIFFERENCES OF THE SEXES. 189 in which we have found imperfect physical development, de- formities of the thorax, improper dressing and unwholesome food, operating to produce the derangement, and not the men- tal tax caused by pursuing the higher branches of education. On the other hand do we not see thousands of cases of amenor- rhea, dysmenorrhea, menorrhagia, and other female maladies, among girls and women who have never spent a day of their lives in study. We could give you numerous instances, that have come under our own observation, of young men who have broken down in health, during or immediately after their college course, but would you accept these few cases as any argument in favor of such a modification of our college system as would give to each student one quarter of the time for ab- solute rest? Would you accept them as an argument against a higher education ? Of course you would not. For an opinion on this matter do not go to teachers, many of whom are themselves extremely ignorant, but rather go to the medical profession. They will tell you that very few of our American women escape the consequences of the errors of their early training; but they will also tell you that the best educated arc, as a rule, the healthiest; they will tell you that thousands suffer and die from ennui for every one that breaks down at college. Go where you will, - examine this question from every possible stand-point, and you can find no evidence to prove that there is sex in mind or in education. All the differences that do exist result from false usages of society; from the de- sire of our American mothers to worship at the shrine of fashion, upon whose altars they have for generations placed their daughters as willing sacrifices. Let us hope, however, that the earnest efforts that are being put forth for the higher education of women may result in the better understanding of the necessities of the formative years of childhood, and that the next generation may be so improved that everyone shall be willing to acknowledge that science and education know no sex, race or color. 190 EDUCATION OF THE SEXES. THE FUTURE RELATION OF THE SEXES UNDER A RATIONAL SYS- TEM OF EDUCATION. The importance of this subject cannot be too highly- estimated, for we cannot afford to adopt any system of edu- cation that will interfere with the proper relation of the sexes. Some oppose the higher education of women on the ground that they must unsex themselves by the methods they must adopt to attain it-others say that the office of maternity must prevent them from ever putting their knowl- edge to practical account, and consequently their time has been thrown away-others again are fearful that society will be disorganized and that a continual warfare of the sexes must result. How groundless are such fears, and how little is the in- fluence of education upon mankind understood by those who entertain them. If the system of early moral and physical education to which we have referred, was universally adopted, and that followed by a rational co-education in school and college, men and women would more fully understand their true re- lations toward each other, and be more careful of fulfilling the laws of their being. Under such a system of education woman would not be so dependent on man for protection and support; but, possessed of a healthy physical and mental or- ganization, she would stand by his side as an equal in the fullest sense of the term. Every road to distinction and honor would be open to her, not because of her sex but because she was human, and she would be eligible to any position in life she was qualified to fill. There would be no such thing as man's rights or woman's rights, but human rights would be everywhere recognized as the only true prin- ciple for the government of the world. What would be right for man would be right for woman, and what would be wrong for woman to do would also be wrong for man to do. Woman would be recognized as a rational, thinking being-she would neither be a toy, a slave, nor a shrined goddess around whose altars the idle drones of society are wont to worship; but a. FUTURE RELATION OF THE SEXES. 191 companion, a friend, a helpmate, and a safe adviser to man. There would be no rivalry between the sexes. There would be plenty of room for both, and each individual would select such vocation as their abilities and tastes fitted them to fill. All women would not aim to be lawyers and doctors no more than all men do at the present time; nor could we expect that all women would pursue the higher education-men and women would still be found for every position in life, but labor of every kind would be paid for in proportion as it was well or poorly done, without regard to the sex of the oper- ator. Under such a system, what would be the status of the marriage question ? Marriage would cease to be a matter of convenience-women, being educated and independent, would no longer marry for a home or for society-the unhappy mar- riages, disappointments, misery, and subsequent divorces, now so common, would be unknown ; and happiness would take the place of misery, sickness would give way to health, and a vigorous, noble progeny would be ours, instead of the puny, idle and undeveloped beings who are destined to suc- ceed us on the stage of life. Do you ask how these changes, are to come about? We answer, by educating the sexes to- gether. Do you object to this ? If so, you object to that which is best calculated to accomplish the objects of our being-the highest possible development of our race. When boys and girls are educated together they can each see the qualities of the other, and those of like tastes, will naturally attract each other. Through long years they have opportunities of carefully watching each others physical and mental development, and similar qualities of mind will gravitate together and culminate in that true marriage des- cribed by Theodore Parker, as "a continually falling in love."' Such a marriage would not be the "marry in haste and repent at leisure" kind, so common at the present time, but a union of two halves to make one perfect whole. Neither would be complete without the other, while together they become the embodiment of all that makes life worth living. Such a marriage would recognize neither as superior to the otherv 192 EDUCATION OF THE SEXES. but both as equals, who would labor side by side in whatever fields they found most suited to their desires and ability. But some will say that such a life is incompatible with maternity, and that those who wish to be mothers cannot enter upon it. They will tell you that woman is of necessity an invalid during the entire period of utero-gestation and for several weeks afterward, and consequently debarred from labor of any kind. This is true at the present time, but it is the result of our modern civilization, and not in accordance with the laws of nature. Child-bearing is as much a natural function as any function of the body, and when healthy it should be free from pain and sickness. Under the system of education we havesuggested maternityand natural work would not be incompatible, and the agonizing pains of childbirth would be unknown. Go and ask the untutored savage if we are not correct, and then aid in the work of redeeming woman from the unnatural physical condition civilization has imposed upon her. Under this system society would have no idlers. Every man and woman would have an aim in life; true and noble friendships could exist between the sexes without fear of the imputation of wrong doing from slanderous tongues; and every human form would bear the stamp of that nobility that comes from earnest honest toil. Fathers and mothers would be better fitted to rear their children. Surrounded by a healthy moral atmosphere from their earliest infancy, and guarded in their physical develop- ment, children would grow up free from many of the evil influences of to-day, and crime, insanity, and all forms of dis- ease would soon be unknown. All this would not unsex woman, nor rob her of a single womanly charm. On the contrary, health, education, and equality would add to her charms and grace a hundred fold, While she would win preferment, and retain it for her ability alone; she would still be loved and cherished as a mother, sister and wife; and she, in her turn, would love a father, brother or husband, with all the ardor of her being. FUTURE RELATION OF THE SEXES. 193 The feeling we call love is natural to the sexes, and that system of education that leaves it free to find a resting place in its proper soil must eventually redeem mankind from the follies and crimes that beset our generation. All this may appear like an Utopian dream when we contemplate society as it is; and yet, if we set to work we may have the satisfaction of knowing that our children will reap some of the rewards of our good works. By our exam- ples we can inspire the rising generation with high hopes and noble ambitions, and then, in imagination, we can draw aside the curtain that veils the future from the present; and look- ing into that far distant future we can see-what ?-a beauti- ful tableau merging from behind a cloud. It grows clearer and clearer, till now we can see its very outline. It is a pyramid. On its base we read the words, "moral and physi- cal culture," just above that, "intellectual development," on the next line we can see "the equality of the sexes," and higher still, "free thought." On the top of the pyramid stand a male and a female figure, side by side. With one arm they encircle each others waists while they hold high above their heads a lamp of dazzling brilliancy. As we grow ac- customed to the sight we can read in golden letters, "the light of science illuminates the world." We drop the curtain, and with hearts aglow with emotion we exclaim, "if we can aid in laying the foundation stone of that pyramid, we shall not have lived in vain." CHAPTER VIL HEREDITY. A careful review of the question of natural heritage can- not fail to call up for our earnest consideration many subjects of absorbing interest, concerning which many false opinions are entertained. That little thought has been bestowed upon this subject is evident from the erroneous notions that are en- tertained concerning it by many persons well informed on other subjects. This, however, is not to be wondered at, when we remember that from our earliest childhood we have been taught to believe that our physical structure, our infirmities, our traits of character, and our modes of thought are all inherited from our ancestors, and that, do what we will, we are totally una- ble to free ourselves from the tyranny of our organizations. It is true that both animals and vegetables inherit the pe- culiarities of their species; that mankind inherits material or- ganisms that distinguish the human being, and that certain peculiarities of race are due to natural heritage. It is also true that children often bear the likeness of the family to which they belong, in a striking degree, but when we come to speak of the hereditary transmission of special diseases, such as insanity, consumption, scrofula, cancer, &c., we have many reasons to believe that the influence of heredity in pro- ducing them has been largely over estimated. REDUNDANT FINGERS. 195 The common idea regarding the hereditary transmission of disease, is that such diseases, when they exist in a parent, are transmitted to the offspring, and though they may lie dormant for years, they must sooner or later become active, and develop the disease just as it was in the parent. It is further claimed that the seeds of the disease may pass through one or more generations, and then appear in the same form as it had done in the remote ancestor. The sooner the public mind is disabused of this belief, the better it will be for the health of thousands who may have had relatives die from such diseases ' as are commonly con- sidered hereditary. We shall not attempt to discuss the question minutely, for its importance demands more careful study than we have yet had time to give to it. We shall, however, mention a few facts that have come under our observation and give the de- ductions we have drawn from them. The presence of redundant fingers in the male members of certain families has always been quoted as an evidence of the unfailing law of heredity, and the casual observer would be inclined to accept this evidence as an indisputable part of the traditional history of a family. We find, however, that in all such cases, the presence of the finger on the husband, or the knowledge on the part of the expectant mother, that such a deformity is a family mark, produces such a strong mental impression as to effect the unborn child. In other words, these redundant fingers are in reality mothers' marks, which in some mysterious way are produced through the influence of mental impressions upon the mother during the period of utero-gestation. In proof of this we will mention one of a number of cases. A young man was born with a redundant finger on each hand, as had been the case with every male member of the family for generations. He and one of his brothers had the fingers removed during childhood, and their hands presented no evidence of ever having been deformed. This young man left home and married. His first child, a boy, was born without HEREDITY. 196 the redundant fingers, and his mother, who was visiting him, expressed great surprise that such should be the case. The mother of the child had never heard the family history till now, and, consequently, no mental impression had been made upon her concerning it. When she again became pregnant, she thought a great deal on the subject, and became im- pressed that the second child, if a boy, would be born with the family mark, and the child was so born. An inquiry about other children born to mothers who knew the family history, proved that all the male children had the redundant fingers. Now, if this mark was due to hereditary transmis- sion, why did not the first child of the woman, who knew nothing of the family have the extra fingers ; or, having had one child without them, why should the second one be so marked. We contend that the mental impression was the immediate factor in producing this mark, and that in the same manner all the other cases were produced. In another case a woman had two perfectly formed boys, before she knew that her husband was web-footed; but she became aware of this fact before her third child was born, and that one had toes like the father. She informed us that all through her pregnancy she was impressed with the idea that the child would be marked by the webbed-feet. Here again we would ask, if this condition was due to heredity, in- stead of to the mental impressions, why were the first two not marked in the same way. How mental impressions made on the mother effect the child in the womb, we cannot explain, but it is a well-estab- lished fact that such impressions do frequently mark infants in all kinds of ways, that can be traced without a doubt to some strong mental emotion. Now, if we admit the possibility of mothers' marks being produced in the method described, may it not also be true, in a measure, that family likenesses are also due to the influence of the mind of the mother on the development of the foetus. It may often be observed that ex- pectant mothers have a great longing that the child should look like the father, or some member of the family, and after the child grows somewhat, the likeness is found to exist. INHERITED CONDITIONS. 197 If certain family peculiarities may thus be produced with- out the direct influence of the law of heredity, may not other conditions, that have been supposed to be hereditary, be produced by other causes and surroundings. As we have pre- viously seen in the preceding chapters, the human body is made up of a number of compounds, called proximateprinciples, and these must exist in certain proportions, to constitute health. To keep up these proportions proper food must be taken, and assimilation must go on. A person whose vital energy, or force, is fully up to the normal standard may be exposed to every variety of exciting causes of disease, and be proof against attack; but if the vital powers are lowered from any cause,disease may be induced on the application of an exciting cause. The absence of proximate principles in the body does not constitute disease, but merely causes a weakened condi- tion of system, and we can always take it for granted that whenever such weakness exists there is a deficiency of some of the proximate principles in the body. Now, ifparents are weak and debilitated, particularly at the time of conception, or during utero-gestation, the proximate principles that are de- ficient in them will be deficient in the child. This is particu- larly true in the case of mothers who are weakly during the period of pregnancy, as the child is supplied with its nourish- ment from the elements existing in the mother. Such defi- ciencies are abnormal, and must leave the child with a corre- spondingly low degree of vitality. If the mother nurses the child, she is still unable to furnish it with the elements neces- sary to supply the deficiency that exists at birth, and thus the child is in a condition to be attacked by any disease. When it grows older it receives the same kind of food as the parents do, and it may be that it does not yet receive the ele- ments of strength. Now such a child, born of a weakly mother, and surrounded by exactly the same. conditions may develop consumption, cancer, rheumatism or any other dis- ease, on the application of the exciting cause. The mother being exposed to the exciting causes of disease may develop some of them before the child. The mother and child, 198 HEREDITY. partaking of the same food, exposed to the same influences, and, in fact, subject to the same environments throughout, con tract the same disease, and this is used to prove that the dis- ease is transmitted from parent to offspring. Several mem- bers of the same family, for similar reasons, may be affected in this way, but that does not prove that disease per se has been transmitted to all of them directly from the parents or grandparents. Our position may be briefly stated in a few words. Parents of low vitality impart a similar condition of system to their children. The parents contract certain diseases, and possibly die from them; and the children, living in the same house, eating the same food, exposed to the same vicissitudes of weather, are likely to contract the same diseases. If at any period of life, however, the children change their environ- ments, they may become strong and robust, and be forever free from the diseases from which their parents suffered. The term scrofula is a convenient word with which to cover up the ignorance of the profession, and to keep up the belief that some poison has been transmitted from parent to offspring. The conditions commonly described as scrofula are nothing more than evidences of bad nutrition. The destructive assimilation has been impeded from some cause, or the nutriment has not been sufficient, and the lymphatics, make an effort to remove the effete material. The lymphatic glands thus often become engorged and inflamed, in conse- quence of the increased labor they are called upon to perform, and this condition is called scrofula, which is made to mean some loathsome disease transmitted from generation to gen- eration. Diseases of the bones, hip-joint disease, spinal curva- tures, discharges from the ears, old ulcers, cancer, &c., which have long been considered hereditary, and of a scrofulous nature, are now universally admitted to be due to some direct exciting cause, entirely independent of transmission from parents. Even consumption is not influenced by heredity as much as has been supposed. Children of consumptive parents, who have been removed from the surroundings of the INSANITY. 199 family, often grow robust and escape the disease, while many contract it, in whose families no such disease had ever ex- isted. What we have just said applies with equal force to dis- orders of the brain and mind. If natural heritage, as for- merly taught, was true, we could never have had any devel- opment. The low forms of life would have gone on repro- ducing fac-similies of themselves for all time. Evolution would have been impossible, and the higher orders of animals would never have existed. Then we must admit that the surroundings and circumstances have fully as much to do with every individual and condition in life, as the influences inherited from ancestors. According to the old idea of heredity, a child ofEnglish- speaking parents should inherit a condition of brain that would cause it to speak English, no matter what its surround- ings, when it began to talk. But the truth is, such a child living in a foreign country will speak the language it hears the most, and may not be able to utter a single word of English. In regard to the question of insanity, we do not hesitate to affirm that the widespread belief in the heredity of the disorder, has done more to fill our lunatic asylums than all other causes put together. One case in point, will serve to illustrate. A wealthy gentleman's wife became insane at the birth of her first child, when she was about nineteen years of age; and had been in an asylum for about twenty-five years. Her mother and grandmother had both gone insane before her, under the same circumstances, and at about the same age, and the knowledge of this worried her, till she, too, suf- fered the same fate. The gentleman devoted himself to the child born under such trying circumstances, and brought her up to believe that her mother died while she was an infant. This girl married at the age of eighteen, and when her first child was born, her father watched with fear and trembling for the development of the dread disorder that had blighted the lives of her maternal ancestors. No untoward symptom presented itself and she was soon well and happy. In about HEREDITY. two years a second child was born, and still she was well, and never thought or dreamed of having any trouble with the brain. A little more than three years later her father was taken sick, and when told that he could not live, he called his daughter to him and related to her the story of her mother and her family history. She was much affected by what she heard, and her father's death added to her sorrows. She recovered, however, and a year later she was again preg- nant. At this time the conviction settled upon her that she too would become insane at the birth of this child. Although she was a sensible woman, no amount of reasoning made any impression upon her mind; and after the birth of her child she was attacked with acute mania, from which she had not re- covered when we last heard of her, at which time she had been insane six years. Her constant cry before the birth of her child was, " insanity is in our family; they have all suf- fered from it and I cannot escape." Every slight pain in the head was magnified into an aggravated symptom of the ap- proaching disorder, and it was impossible to counteract the fatal mental impression made upon her by the belief in the old dogma that insanity runs in families. If we examine the statistics of asylums, and trace the histories of their inmates, we will find that a large majority of those said to be suffering from hereditary insanity, were haunted for months or years with the fear of losing their reason, simply because they knew that some members of their families had been insane. Without this exciting cause, they might have gone through life entirely free from any mental derangement. On the other hand, statistics prove that in a large num- ber of cases of insanity, no family history can be traced that shows the existence of the disease in any of the ancestors, and that sufficient exciting causes can always be found to ac- count for all the cases that are met with. Whatever the result of investigation may be in the future concerning the influence of heredity in producing disease, we may safely lay it down as a rule that even if children do inherit tendencies to disease from their parents, proper 200 MENTAL IMPRESSIONS. 201 attention to the mode of life and a complete change of envir- onments will, in a large number of cases, ward off any ten- dency to disease. It is important to keep all knowledge of so-called hereditary diseases from the younger members of the family in which they have been found to exist, as the mental impressions in such cases do much to develop the conditions favorable to the manifestation of this class of dis- orders. From what we have already said concerning the effect of mental impressions on enceinte women, the import- ance of their surrounding themselves with the most agreeable influences, and avoiding as much as possible all causes of ex- citement are apparent. We owe it to our children that they should be born well, and the general health and mental con- dition of the expectant mother have been shown to have more influence upon the future of the child, than any hereditary taint that may have existed in the family, two or three gen- erations back. It is, therefore, imperative that we should give more at- tention to this important subject than we have done hereto- fore, and if by so doing we can tn any way better the condi- tion of humanity, we will feel that we have accomplished some good, even though we may take positions that may be pronounced unscientific by those who look on only one side of the question. CHAPTER VIII. THE WAR OF THE PATHIES. History proves that in medicine, as in religion, a cruel and relentless war has ever been waged against those who have dared to oppose the commonly accepted dogmas. The experience of thousands of earnest seekers after truth, in the present generation, will clearly demonstrate that this war is still being waged with all the rancor and bitterness that party prejudice and ignorant intolerance can engender. This war is being waged now and here, on the soil of our own free Republican America. It is a war of despotism against freedom-of bigotry against toleration-and of mouldy dogmatism as opposed to free investigation in medical science. We may trace the history of medicine far back into the misty realms of fable and mythology, and follow its course from that down through the ages to the present day, and we will find opposing schools bitterly contending with each other, regarding the merit of their respective teachings. Every new discovery, every innovation on the commonly ac- cepted ideas, has met with persistent opposition from the estab- lished physicians. Up to the close of the eighteenth century, the healing art was founded on empiricism and sustained by the blind faith with which the people accepted every dogma of the physician as absolute truth. THE ALLOPATHISTS. 203 Up to a very recent period, disease was looked upon as an entity or demon that could only be driven out by the most heroic treatment. Depletion was the only course thought of as at all capable of effecting a cure of any disease; but in the course of time a change came. Depletion gave way to simpler medication, and to this was added a supporting and nourish- ing regimen. With a more correct knowledge of physiology came a better understanding of the nature of diseases. What was once regarded as an entity is now recognized as deranged function; and instructions regarding the proper mode of life are considered as important as the administration of medi- cine. Yet, in spite of all that has been done; in spite of all the improvements that have been made in the science of med- icine, much remains to be accomplished, as can be seen by ex- amining into the present status of the profession. The professional mind is not settled on fixed principles. Different theories exist in regard to the nature and cure of disease, and separate schools or sects are founded on the dif- ferent theories. A few individuals often claim the right to make a code for the government of their sect; and intolerance and bigotry are manifested on every hand. The allopathists, till recently, have prided themselves on their ancient origin and built their faith on the theories and discoveries of centuries ago. The innovations of new schools made it necessary forthem to change their modes of practice, till now many of them are willing to accept what is good from all sources. They have made great progress, they have aided largely in the advancement of medical science; they have a rich literature, and possess a high degree of culture. Yet with an astonishing amount of assurance, they arrogate to them- selves all the knowledge, all the rights, and all the privileges of the profession. They recognize none as physicians who do not agree with them; they ostracize all who do not sub- scribe to their code of ethics; in short they aim to wield des- potic sway by the enforcement of laws as absolute and un- bearable as those wl* h which Draco attempted to govern Athens. 204 THE WAR OF THE PATHIES. The homceopathist discards everything connected with the past history of medicine as being entirely false, and claims to have discovered a new law of cure, and a new system of therapeutics. He finds that "like cures like," and that medi- cines to be effectual must be given in infinitesimal doses, and he proves the correctness of the theory by producing any dis- ease, or the symptoms of any disease, at will. He entirely dis- regards the causes of disease and treats symptoms only. For every symptom he has a specific remedy in which he has im- plicit faith. He marvels that any one can practice medicine and not be a homoeopath, and confidently asserts that his system will yet supersede all others. The eclectic claims to select the good from all schools, and to give the broadest liberty of thought and action to every physician; but many of those of the present day who claim to be eclectic know nothing of the true meaning of the term. Although the school was started as a protest against intolerance, many of its adherants are to-day as sectarian and intolerant, as any in the land. It has enriched our materia medica by the addition of a large number of vegetable reme- dies; it has done much to banish depletion and to inaugurate a supporting treatment instead. The hydropath finds in water a panacea for every ill. He washes out disease, and washes in health, and when he finds water inadequate, Graham bread is brought to the rescue. The electropath attributes all diseases to obstructions in what he is pleased to call the circulation of the nervous fluid, and as these obstructions can only be rectified by electricity, his battery is all powerful in his hands to cure every form of disease, and to remove from the system all poisonous drugs that may have accumulated during years of unnecessary me- dication. The magnetist claims the power of relieving pain and banishing disease by the simple touch of the hand. That these theories cannot all be true is evident, but that each may possess some truth is probable. It, therefore, becomes our duty, as candid investigators, to glean from all MEDICAL INTOLERANCE. 205 sources that which scientific investigation proves to be cor- rect, and to reject everything that is injurious or empirical. No school or sect has a right to arrogate to itself all knowl- edge, nor have we a right to unqualifiedly condemn every- thing we do not accept as our own belief. There is much that is good in the allopathic school and it becomes ours by inheritance. The homoeopaths reformed the abuses of over medication, inaugurated the administration of pleasant medi- cine, and taught the profession the value of direct medication by using one remedy at a time; and it is our right and privi- lege to benefit by the lessons they have taught, without em- bracing their exclusive theories. Water we know to be invaluable both in health and disease, and we can call it to our aid whenever, in our judgment, it is required, without being obliged to wash and splash and boil our patients as we do soiled linen. Electricity, with its acknowledged value as a curative agent, is ours to use whenever we deem it neces- sary, but we must not abuse it by driving lightning through everyone we meet. And magnetism is a gift we can and do all use to a certain extent, with decided advantage, and it is our duty to study its nature and action, so as to understand its real value as a curative agent, and not to discredit it by making claims that cannot be substantiated. Instead of each physician selecting from these various isms whatever good they contain, and using it for the benefit of his patient, we find that special dogmas are still taught to the exclusion of truth; and the various schools are arrayed against each other as if in mortal combat. The allopathic school, which is the oldest and most powerful, is still doing everything in its power to crush out every one who does not subscribe to its teachings. It denounces as "irregular" the most enlightened adherents of the other schools, and has ever been active in keeping up a continual warfare against all medical progress. With but few exceptions, its members adhere to the use of the old remedies, and they denounce every new therapeutic agent that is not introduced by themselves. Yearly attempts are being made to effect medical legislation and create a privileged class in medicine, to the exclusion of THE WAR OF THE PATHIES. 206 the others; but fortunately, such legislation is hardly likely ta be secured in America. Following the example of the old school, the other sects in medicine, in self-defense, claim for themselves superior knowledge and better results in the treatment of diseases, and each strives to convince the public that their's is the best method. The true physician discards all schools, and selects his remedies and method of treatment from all sources that promise relief to his patients; and it is only by such a course that the best interests of the profession and the public can be advanced. Let the people become more enlightened with regard to the structures and functions of their own bodies; let them understand that all the advances that have been made in medicine have come from those outside of the schools; let them remember, that freedom of thought and action can alone result in advancement in any department of science; and they will soon awaken to the knowledge of the fact that the true physician is he who knows no allopathy, homoeopathy, hydropathy, or any other exclusive dogma of theory and practice. When the public ceases to ask the physician what school he belongs to, and employs him solely on account of his ability to prevent or cure disease, the war of the pathies will cease forever. That such will be the future of medicine we firmly believe, and then we can hope to see the medical profession advance with the scientific development of the times, till the proscriptiveness of the past shall have been forgotten; till the history of sectarian schools shall only be regarded as so many events or epochs to mark the pro- gress of medicine; till the faith which has so long mystified the people with regard to medicine shall be removed; till prophylactics are discovered for every disease; and, till dis- ease and suffering are banished through the superior knowl- edge of the people. Such is the future we have dreamed of for the medical profession, and though we may not see it in our day, all true REFERENCES. 207 physicians may aid in hastening its coming, by doing all they can to elevate the literary standard of the profession, by in- structing the people in a knowledge of themselves, and by worshiping at no other shrine than that of Science. Books of Reference. Anatomy, Descriptive and Surgical. By Henry Gray, F. R. S. Human Physiology. . By John C. Dalton, M. D. Mental Physiology. By Wm. B. Carpenter, M. D. Mind and Body. By Alex. Bain, LL. D. Foods. By Edward Smith, M. D., F. R. S. Manual of Diet in Health and Disease. By Thomas K. Chambers, M. D. Popular Physiology. By R. T. Trail, M. D. Popular Science Monthly. PART SECOND. ILLS AND THEIR REMEDIES. INTROD UCTIOJN. It is not the purpose of this work to enter into discussions regarding the exact nature of the exciting causes that produce certain diseases, about which differences of opinion exist; nor is it designed to be an elaborate text-book for the minute description of the various changes the tissues of the body un- dergo in different diseases. It will simply aim to give a brief description of the several diseases, the symptoms by which they may be recognized, and the means best adapted for their prevention and cure. Technicalities will be avoided as much as possible, and the treatment recommended will be the most approved, and we believe the most successful known to the profession at the present day. We shall first consider constitutional diseases, in which are included malarial and other fevers, miasmatic diseases, erup- tive fevers, rheumatism and gout. Next in order will come the disorders of the respective organs or systems, which will be considered in the following rotation: first, diseases of the digestive apparatus; second, diseases of the circulatory ap- paratus; third, diseases of the respiratory organs; fourth, diseases of the genito-urinary organs, and fifth, diseases of the nervous system. 212 INTRODUCTION. Following these, departments will be devoted to the functions and diseases peculiar to women, and to the acci- dents and diseases usually classed under the title of surgery. Under the latter department we shall include inflamma- tion and its sequences, wounds, tumors, diseases and in- juries of the skin, vision and its defects, hearing and its dis- orders, and such other ills as have not been described under diseases of the respective organs. In many of the surgical diseases and accidents to which we are all liable, it is often important to know what should be done, even though we ourselves, may be unable to do it. Then, when a surgeon is consulted, we are enabled to de- termine between the competent and incompetent, and thus save time and suffering in the treatment to be adopted. Be- sides a knowledge of what is required for the cure of a disease, or the correction of a deformity will frequently determine a patient or his friends to consult a surgeon. These are our only reasons for speaking of the treatment of surgical cases, and we are convinced that the information here given will often lead patients to seek advice in time to prevent suffering and deformity. General Diseases; or Diseases Affecting the Blood and Particular Organs and Regions. CHAPTER I. FEVERS. The term fever has been applied to all that class of dis- eases in which there is a general disturbance of the nervous functions and more or less derangement of the various organs of the body. In addition to these irregularities of function, there is present increased heat, frequent pulse, disinclination for food, and general languor in the patient. In the ma- jority of cases all these symptoms are present at one time, but it sometimes happens that one or more of them may be absent. The increased action of the pulse and the hot skin, however, are the most constant symptoms in all febrile dis- turbances. Fevers have usually been divided into idiopathic and sym- tomatic; the first arising without any obvious local cause, while the second is dependent upon some kind of local irrita- tion such as inflammation, arising from some severe injury to a part or organ. The causes that tend to produce fevers are numerous, but all of them have in some way a direct influence in changing the character of the fluids of the body, so as to render them unfit for the nutrition of tissues. In the idiopathic fevers, the 214 FEVERS. material which causes these changes is introduced from with- out, while in the symptomatic fevers they are generated with- in the body, and carried into the circulation of the blood. Stages of Fever.-During the progress of a fever, four distinct stages are recognized: first, the initiatory, or forming stage; second, the cold stage; third, the hot stage; fourth, the sweating stage or period of decline. During the initiatory stage the patient feels a languor and listlessness, with a general depression of the mental and bodily powers. This feeling continues until the patient be- gins to think he is "not well." The circulation of the blood becomes deficient; coldness of the extremities and dryness of the skin manifest themselves; the appetite is impaired; there is pain in the back and head; there is marked restlessness, particularly during the night; general soreness and lameness of the muscles often extending over the whole body, is com- plained of; and the patient expresses himself as feeling an ach- ing of "all his bones." Finally, a chilly sensation is noticed even when sitting in a warm room. These symptoms con- tinue until the beginning of the second stage, and the dura- tion of the first stage depends upon the degree of natural vi- tality of the system, and the intensity of the morbific mater- ial that has been introduced in the blood to act as the exit- ing cause of the disorder. In the second' stage the depression of the nervous sys- tem becomes so great that the circulation of the blood is materially interfered with. Congestion of the internal organs takes place and the blood is to a great extent imper- fectly oxygenated. When this condition is reached, decided rigors or chills occur, which may be accompanied by occa- sional flashes of heat over the body with still more severe rigors following. In this case, the pulse is frequent, small and depressed. The face is pale and the finger nails blue. Nausea and vomiting are also met with, as symptoms of this stage, in some forms of fever. The duration of this stage varies in different individuals. In some cases the symptoms will continue only a few minutes, while in others they may INTERMITTENT FEVER. 215 last for hours. When the sensation of cold and other symp- toms begin to subside, the third stage is soon ushered in. The hot stage is marked by a gradual return of the blood to the surface. The cheeks become flushed, the veins are distended, and the general depression of the nervous system, which was before manifest, entirely disappears. The extremi- ties first become warm, but finally the heat of the entire body becomes intense, and almost unbearable. The pulse increases in frequency and will often range to 100 and 150 beats a minute; and in some cases there is a great tendency of the blood to the brain, when the head becomes hot, and delirium frequently occurs. During this stage digestion is arrested, there is a loathing of food, and in some cases there is more or less nausea. There is usually a great thirst and a morbid demand for water, which can be given in considerable quanti- ties without harm. The duration of the third stage varies, very materially, according to the character of the fever, which will be spec- ially mentioned in considering the respective febrile condi- tions. The fourth, or period of decline, supervenes upon the gradual cessation of the febrile symptoms. The surface of the skin has diminished in heat and begins to assume a moist and soft condition. The pulse is less frequent, soft and com- pressible; the patient becomes quieter; and finally there is a secretion from the skin, kidneys and bowels. This condition indicates that the blood has in a measure been freed from the morbid matter which caused the disease, and the patient will in most cases be considered convalescent. INTERMITTENT FEVER. Intermittent fever, commonly spoken of as fever and ague, chills and fever, or chills, belongs to those fevers that are' spoken of as malarial. It is found to occur in regions where there is low-lying, damp ground, and where the earth is being turned up during hot weather. It is generally 216 FEVERS. believed to be produced by the inhalation of the exhalations from decomposing vegetable matter, which is described as marsh miasm, or malaria. Some contend that so-called malaria is a gaseous pro- duct of decomposing vegetables, while others believe it to be a vegetable fungus that finds its way into the blood. So far as practical results are concerned, it does not matter which of these theories is correct. It is enough for our purpose to know that vegetable matter, water and heat, are essential for the production of the disease. In dry sea- sons, when the dead vegetable substances are not frequently moistened and then dried by the sun, and in very wet seasons when the marshes and low-lying grounds are constantly covered with water, intermittent fevers do not prevail. On the other hand where the season is hot, and we have frequent rains, the constant evaporations of the moisture carry the products of the vegetable decomposition into the atmosphere, and thus numerous cases of fever and ague occur. Intermittent fever is so called from the fact that all the stages of fever will occur, as heretofore described, and be followed by an interval of apparent health. When this inter- val has passed the several stages of the fever are again mani- fested. From the beginning of the cold stage to the end of the sweating stage is called a paroxysm, and the interval between the paroxysms is called the intermission. Some- times the paroxysms recur every twenty-four hours, when the fever is said to be of the quotidian type; again the revolution may not occur till the end of forty-eight hours, when it is called the tertian; and when seventy-two hours are required for the return of the paroxysm it is spoken of as the quartan form of the disease. SYMPTOMS.-For several days before the development of intermittent fever the patient feels languid and depressed, and has no disposition to exercise. There is a torpid condi- tion of the kidneys and bowels, the appetite is poor, and the digestion impaired. These symptoms may last several days, and constitute the initiatory stage. INTERMITTENT FEVER. 217 A sense of chilliness running down the back afid extend- ing to the extremities, and a desire to yawn and stretch mark the beginning of the second, or cold stage. Pain in the back and head then follows, and a sensation as if cold water was being poured down the back, is experienced. The pulse becomes small, irritable and frequent; the skin becomes cold and assumes the appearance commonly called "goose-flesh;" the nails and lips become blue; the teeth chatter; and at last the whole body will shake. Though the sense of cold is very great, it is not relieved by being near the hottest fire. Dur- ing this stage the nervous system is irritated. The patient is easily annoyed, neuralgic pains are felt in different parts of the body, and a sense of suffocation accompanies the breath- ing. These symptoms may last only a few minutes or may continue for two or three hours. They begin to subside gradually, and finally give place to a few moments of rest and comfort. The hot stage next develops, and it is usually the case that when the cold stage is of short duration the hot stage will be severe, and when the cold one is severe, the hot period is of short duration. The respiration now becomes more free and regular; the pulse is stronger and fuller though less fre- quent; the skin becomes dry and harsh, and its heat is greatly increased; and a general febrile condition is manifested, the temperature at times rising to 106 or 107 degrees. The mouth is dry, the tongue parched, and sometimes presenting a dry, red appearance, while at other times it is coated with a white or yellowish-brown fur. This stage may last only about an hour, or it may continue almost to the time for the next paroxysm. The sweating stage is marked by an amelioration of all the symptoms of the third stage, and the appearance of profuse perspiration and increased urinary secretion. The pulse as- sumes its normal condition, and in a short time the patient seems entirely well. If the paroxysms are not broken up by appropriate remedies, after a period of intermission, varying in duration 218 FEVERS. with the type of the disease, the above symptoms will re- appear in the same order, but usually with increased severity. Treatment.-The treatment of intermittent fever may be divided into the palliative and curative. The palliative is that which is employed during the paroxysm, and necessarily varies according to the stage of the disease; while the cura- tive or radical treatment is that which is adopted with a view of preventing a recurrence of the paroxysms. During the first stage of depression and languor, it is im- portant to use some remedy to overcome the torpid condition of the bowels which is usually present. For this purpose, the Compound Podophyllin pill*f is the best remedy that can be used. One of these pills taken at bed-time, for two or three nights in succession, will overcome the torpid condition of the bowels, and in some instances may have a tendency to remove the general languor of the patient, thus preventing an attack of chills. If it does not do this, it prepares the patient for the other remedies which are to be given at a later period. During the cold stage we can do little but endeavor to make the patient comfortable. Where the symptoms are severe, however, an application of mustard to the spine, and a hot foot bath may be serviceable. Some stimulant can also be given with advantage, and where alcohol is not desirable, from io to 20 drops of the Fluid Extract of Prickly Ash berries may be given in warm water every hour, during the continu- ance of the cold stage. The hot stage requires but little treatment. Bathing the surface of the body with tepid water or dilute alcohol may afford material relief by shortening the paroxysm. When the temperature is high and the hot stage of long duration, the Fluid Extract of Gelsemium (yellow jessamine) given in *Before using any of the remedies recommended, the reader should refer to Part III. of this work, where a description of the properties, uses, actions and doses of the various medicines will be briefly given. + See Page 860. INTERMITTENT FEVER. 219 three drop doses every half hour, will materially shorten the duration of this stage. This remedy may be continued until the frequency of the pulse and the heat of the skin begin to diminish. As the sweating stage indicates the breaking up of the paroxysm, it becomes time to consider the treatment which will most certainly prevent its return. In spite of all that has been said to the contrary, we know of no remedy that can equal Quinine for this purpose, and it should be adminis- tered in sufficient quantities to completely counteract the influences that produce the disease. When first administered it should be given in ten grain doses, every four hours, until the time for the recurrence of the paroxysm has passed. After that it should be continued in five grain doses, three or four times a day, for about a week. Then it may be discontinued for about five days, and the last named dose administered for two days. It should be so continued, two days in the week for three or four weeks, to guard against a possibility of the recurrence of the paroxysm on the seventh, fourteenth or twenty-first day, as is often the case. Should a ringing in the ears be produced, the size of the dose should be dimin- ished, and the quantity given to children should depend upon their age.p Quinine may be taken in the form of powder, pill or solu- tion, but to avoid the bitter taste, the quantity required for a dose should be put in capsules, which can be readily swal- lowed without appreciating the taste. As it is important to aid in the elimination of the mala- rial poison from the system, the kidneys and bowels should be kept free. In this disease, the Nitrate of Potash (saltpetre) has not only a beneficial action on the kidneys, but is also considered a valuable anti-periodic. It may be given as fol- lows : Nitrate of Potash, one-half ounce; water, six ounces. Mix, and give one tablespoonful three times a day. For the bowels, the Podophyllin pill, before referred to, should be fBy referring to Part III., the respective doses for children of all ages can be readily estimated, from the table for that purpose. 220 FEVERS. given every night until the bowels have a tendency to move more than once a day; and after that it may be given every second or third night, as required. After this treatment has been followed out it almost invariably breaks up a tendency to the recurrence of the paroxysm of fever and ague. If a person continues to live in a so-called malarial dis- trict, and thus remains exposed to the exciting cause of the disease, he may have a recurrence of it at any time. To guard against this it is important to keep up the action of the kidneys and bowels, and to avoid the night air as much as possible. If obliged to go out in the night, a cup of strong coffee before doing, so will help to ward off the disease.* As preventive measures, all low-lying swampy grounds should be well drained and the grass kept cut and carried off, or burned if not fit for use. REMITTENT FEVER. Remittent fever, commonly called bilious fever, is sup- posed to be due to the influence of miasm introduced into the blood, the same as in fever and ague. It occurs in the same localities, but is more commonly met with toward the end of the summer or the beginning of autumn. It is often seen that persons who suffer from intermittent fever during the summer, will have an attack of remittent fever later in the season. This would indicate that at first the natural vitality of the system throws off some of the morbid matter after each paroxysm of ague, and the patient seems well till the poison again accumulates, and more must be thrown off to keep up the natural actions of the body. When the vitality of the system is lowered, by these paroxysms of fever, or any other cause, and the person continues to be exposed to the influence of miasm, the disease takes firmer hold and thus we have remittent fever. SYMPTOMS.-The initiatory stage is attended with the same general languor as previously described, which lasts for several days. The appetite is poor; there is a bitter taste in * See Page 359. REMITTENT EE VER. 221 the mouth; a feeling of nausea, which sometimes extends to vomiting, is almost constantly present; the bowels are con- stipated; the skin is dry, and there is pain in the head, back and limbs. A decided chill or rigor usually ushers in the second stage, though sometimes the chill is very slight. Alternate chills and flashes of heat continue for a couple of hours, which is the usual duration of the cold stage. Just before the hot stage vomiting often occurs, and as the vomited matter seems to contain large quantities of bile, the term, bilious fever has been applied to this disorder. The hot stage presents the usual symptoms of the same stage of intermittent fever. It, however, continues for about twenty-four hours, when the heat diminishes, the skin be- comes moist, and the patient feels much relieved. This con- dition only lasts for a short time, and is again followed by the febrile symptoms. The cessation of the fever is called the re- mission, and it usually occurs once in twenty-four hours. If the fever is not checked within seven or eight days it may assume a typhoid type, and becomes a protracted con- tinued fever. Or, the patient's strength having become greatly exhausted, he may sink into an unconscious condition, in which he dies. Treatment-One of the first indications in the treat- ment of remittent fever is to quiet the irritation of the stom- ach and to excite the action of the bowels. To accomplish the first object, a mustard paste may be applied over the re- gion of the stomach, and allowed to remain for twenty min- utes or half an hour, with a view of producing counter irrita- tion; and drop doses of the Fluid Extract of Nux Vomica in a teaspoonful of water may be given internally every half hour till five or six doses have been taken. Should the nausea and vomiting still continue, it may be necessary to give a thirty grain dose of Compound Lobelia powder in a wine-glassful of warm water every fifteen or twenty minutes until free vomit- ing is produced. This removes the bile and all irritating mat- ter from the stomach and produces very little depression of the system. After this, the Compound Podophyllin pill*maybe * See P"ge 360. 222 FEVERS. given at bed time, and repeated every night as required. To control the fever, the Fluid Extract ofVeratrum Viride prepared from the green root should be given in two drop doses every hour until moisture of the skin begins to appear. In the ad- ministration of this remedy it is best to add 40 drops to 20 teaspoonfulls of water, and give of this mixture a teaspoonful at a dose. Should the nausea return, discontinue the Veratrum. Aside from this the same general treatment should be adopted as has been recommended in intermittent fever. Twenty grain doses of Quinine can be given every four hours during the continuance of the fever with great advan- tage, as it will frequently cause a rapid reduction of tempera- ture. After a few doses have been given in this way it maybe continued in five grain doses every four hours in conjunction with the Fluid Extract ofVeratrum Viride during the continu- ance of the fever. When the fever begins to abate and there is evidence of severe prostration, the Fluid Extract of Nux Vomica and Phosphoric Acid should be substituted for the Quinine. These remedies are best given in the following form: Fluid Extract of Nux Vomica, 1 dram; Dilute Phosphoric Acid one half ounce; water, enough to make three ounces. Of this give one tea-spoonful in a little water about every three hours. Whenever a fever of this kind continues for a longer period than six or seven days it is never safe to attempt home treat- ment, but the most competent physician to be had should be sent for to take charge of the case. TYPHOID FEVER. Typhoid fever is an acute febrile disease, supposed to be due to the poisonous products of certain forms of decompos- ing animal matter. It is, consequently, often found to affect a number of people in the same locality, all of whom may have been poisoned from the same source. In consequence of the inflammation and ulceration of numerous glands in the intes- tines, it is sometimes called enteric fever. If left to itself it lasts from four to six weeks, and leaves the patient very much prostrated, though in the majority of cases it ends in convalescence. When death occurs, it is due either to the TYPHOID FEVER. 223 great prostration caused by the fever, or to perforation of the intestines from the ulceration of the glands. Remittent and other fevers often assume the low form of prostration characteristic of this fever, and are then said to have run into typhoid, or assumed typhoid characteristics. Although many consider it a contagious disease, it can- not be properly classed as such, and if proper care is taken in keeping the sick room wholesome, and removing the emana- tions from the patient, the chances of contracting the disease from one already suffering from it, are very slight indeed. SYMPTOMS.-This disease has the usual stages of devel- opment which belong to all fevers. It is characterized by a gradual and insidious commencement; dull headache, which is followed by stupor and delirium, picking at the bed-cloth- ing, and low mutterings even during sleep. The tongue is red and slimy, but is sometimes covered with a thick brown fur, which becomes dry and causes the surface of the tongue to be marked by deep fissures or cracks. The abdomen is full and distended, giving a hollow sound when tapped gently with the finger; there is tenderness on pressure, particularly along the groins; the bowels maybe constipated at first, but diarrhea usually sets in, and remains a constant symptom. About the tenth or twelfth day an eruption occurs, which shows itself in the form of isolated, slightly elevated, rose- colored spots, that disappear on pressure, and come on in successive crops. These, however, are sometimes absent, The temperature ranges from 100 to 104 degrees, but in severe cases it sometimes reaches 106 degrees. Toward the last a fetid accumulation forms around the teeth, and the entire mucous surface of the mouth is dry and parched. The bowels and bladder sometimes act involuntarily, while at other times the urine is retained and causes great distention of the blad- der with the accompanying distress. After the fever subsides the patient is greatly prostrated, and a long time is required to restore the vitality of the system. Treatment.-To control the fever at the commencement of the disease the following should be given: Fluid Extract 224 FEVERS. of Veratrum Viride, 15 drops; Fluid Extract of Aconite root, 10 drops; water, 4 ounces. Mix, and give one tea- spoonful every hour, till the pulse is diminished and the heat of the skin reduced. When the pulse is weak the Vera- trum should be omitted and the Aconite used alone. The sponge bath used daily will also aid in keeping down the temperature and making the patient comfortable. During the first few days the Eclectic Compound Podo- phyllin pills may be given. One pill night and morning will have a good effect in aiding the removal of morbid accumu- lations, without acting as a cathartic. Quinine in 20 grain doses, every four or five hours, is also important in reducing the temperature and cutting short the disease. If this course of treatment is adopted early, the disease can often be arrested before more serious complica- tions set in. When distention and tenderness of the abdomen are developed, the intestinal ulcerations are certainly progress- ing. Now tincture of iodine and carbolic acid may be used to advantage, in the following form : Compound Tincture of Iodine, 2 drams, Carbolic Acid, (95 per cent.) I dram; water, 3 ounces. Mix, and give a tea- spoonful three times a day largely diluted with water. Warm fomentations of hops sprinkled with Spirit of Tur- pentine should be applied to the abdomen, and covered with oiled-silk, to retain the heat; and these should be changed every two or three hours. The diet should be confined almost entirely to milk, of which from two to four ounces should be given about every three hours. When there is a tendency to nausea a table- spoonful of lime water added to a gobletful of milk, will serve a good purpose. When the prostration is great, egg- nog made with brandy should be given freely at regular intervals, and in such proportions that not more than half an ounce of brandy is taken at a time. When the fever subsides, the greatest care is necessary to build up the vitality of the patient. In addition to the TYPHUS FEVER. 225 milk and brandy, beef 'essence can now be given with advan- tage, several times a day. Great benefit is also derived from the use of a nerve tonic, the following being one of the best: Sulphate of Strychnine, one grain; Dilute Muriatic Acid, three drops; water, four ounces. Mix, and give one teaspoon- ful three or four times a day. When complications arise no patient should be left with- out the daily attendance of an experienced physician. TYPHUS FEVER. Typhus fever is a highly contagious disease, of a specific character. It arises where a large number of poorly fed per- sons are crowded together in close apartments, without ven- tilation. It often prevails in sea-port towns and in crowded ships, and has hence been called ship-fever. It comes as an epidemic and invariably prevails to a considerable extent after a famine. It develops suddenly, lasts from ten to twenty-one days, and frequently terminates fatally. It is sel- dom met with, excepting in isolated cases, in sections where proper attention is given to personal hygiene, ventilation and general cleanliness of dwellings. Symptoms.-The patient is dull and heavy for two or three days, and complains of being greatly fatigued. He suffers with severe headache, and is restless and wakeful at night. Great prostration occurs during the first few days and the patient is obliged to go to bed. The face becomes flushed; the eyes become blood-shot; wakefulness is present from the start; the mind is dull and confused; and by the end of the first week delirium ensues. The tongue is at first covered with a yellowish-white fur, which soon becomes dry and brown; the bowels are constipated; and a copious rash appears on the skin about the sixth or eighth day, which dis- appears upon pressure at first, but soon becomes permanent. The delirium continues low and wandering and finally termi- nates in coma. 226 FEVERS. Treatment.-Attention should be given from the outset of the disease to keeping up the strength of the patient. The diet should consist of milk, eggs, animal broths, and some good wine. As the prostration becomes marked, half an ounce of good whiskey or brandy should be given every two or three hours. Here, again, the large doses of Quinine serve a good purpose, and twenty grains may be given morning and evening. The fever is controlled by the following mixture: Fluid Extract of Veratrum Viride, I dram; Fluid Extract of Gelsemium, 2 drams, water, 4 ounces. Mix, and give one teaspoonful every hour. After six or eight doses are given, it may be omitted for two or three hours, and commenced again if the fever is still high. The tepid sponge bath can be used once or twice in twenty-four hours with advantage. In many cases great benefit is derived from the cold water pack. As this is a contagious disease, the patient should be isolated as soon as the case is diagnosed. Many complications arise, after the first week or ten days of the disease, that can only be properly treated by the phy- sician who is at hand to observe the symptoms as they develop. RELAPSING FEVER. Relapsing fever is an acute contagious disease, which rarely occurs except as an epidemic, and only attacks those who are poorly fed or debilitated from previous sickness. It is characterized by a paroxysm of fever, which lasts about six or seven days, and then entirely disappears. After four or five days a relapse occurs, and the febrile paroxysm again shows itself, and runs the same course as the first. It is sup- posed to be caused by the presence of a minute parasite in the blood. SYMPTOMS.-This disease comes on suddenly, and the febrile condition manifests itself almost as soon as the pains in the head and limbs. After the disease develops, grind- RELAPSING FEVER. 227 ing, piercing pains are felt in all the muscles, which are increased by motion. Wakefulness and loss of appetite are usually present, and the fever is of a remittent character. The tongue is moist and white; there is a marked tenderness over the region of the stomach; nausea and vomiting are often persistent; the liver and spleen are enlarged; a jaun- diced condition of the skin is frequently present; and there is no eruption. On the sixth or seventh day a free perspiration occurs, and the fever terminates. After a remission of four or five days a relapse occurs, and the symptoms recur as before. At the end of this paroxysm convalescence generally ensues, but sometimes a third or fourth relapse takes place. This fever seldom terminates fatally. Treatment.-In this disease Quinine is of little value, while Carbolic Acid has proved a reliable remedy. Two drops of the Pure Carbolic Acid, well mixed in a tablespoonful of pure Glycerine, should be given three or four times a day, and continued after the remission occurs. Gelsemium can be used to control the fever and relieve the pain in the head, while Black Cohosh is valuable for the muscular pains. These remedies may be given in combination, as follows: Fluid Extract of Gelsemium, io drams; Fluid Extract of Black Cohosh, one-half ounce; water, enough to make 3 ounces. Mix, and give one teaspoonful every hour, while awake. If a slight fullness of the head is felt the dose should be reduced one-half. This must be discontinued as soon as the fever has subsided. When the pain is severe, and sleep is impossible, 15 or 20 drops of Laudanum, or the eighth of a grain of Morphine, may be given at bed time, but should not be repeated. During the remission good nutritious food should be given, the Carbolic Acid should be continued, and some pre- paration of Iron should be added to enrich the blood. For this purpose the tonic known as Dialyzed Iron may be given in doses of 15 drops in water, four times a day. In some cases there is a tendency to the occurrence of chills followed by flashes of heat. In such cases Quinine FEVERS. 228 should be given during the remission, in 5 grain doses, three or four times a day. YELLOW FEVER. Yellow fever is an infectious disease which occurs only in hot latitudes. It frequently occurs as an epidemic in the southern cities of the United States, and an occasional case is met with in northern seaport towns. It is believed to be due to some poisonous germ which can only exist where the temperature is above 72 degrees. For this reason cold weather always cuts short an epidemic. Decomposing animal and vegetable matters, imperfect drain- age, crowding together of many people in poorly ventilated quarters, and personal uncleanliness, are essential for the development of the germ. SYMPTOMS.-In from one to three days after exposure to the influence of the germs, the patient complains of impaired appetite, general languor, headache, and ' muscular pains. These symptoms continue for two or three days, when a chill occurs and is followed by fever. In some cases, however, a severe chill or rigor is felt without the slightest warning, often while a person is at work and feeling as well as usual, and this is immediately followed by the fever. The fever rises rapidly and is at its worst at the end of the first or second day, with a temperature ranging from 103 to 105 degrees. The face is flushed and wears an anxious look; the eyes are bright, wa- tery and injected with blood; the head aches severely; the temples throb; there are general muscular pains,which are very severe in the back and loins. The tongue is heavily coated and is red at the tip and along the edges, and the breath has a diffused cadaverous odor, which is noticeable from the onset of the disease. The upper part of the abdomen is tender to the touch; the stomach is irritable, and food and drink are usually rejected with painful retching. The bowels are con- stipated, though sometimes a diarrhea occurs, and the urine is scanty, and in severe cases, suppressed. At first the vomited matter is simply particles of food, mucus and bile, but in a YELLOW FEVER. 229 short time it becomes chocolate colored. In some cases a slightly yellowish condition of the skin appears early in the disease. In mild cases a slight remission of the fever occurs on the second or third day, and in severe ones it may not show itself till the sixth day. This remission is only of a few hours dur- ation, and when the fever returns it attains its maximum on the second day. Delirium now sets in, and is often violent. The skin becomes very yellow and vomiting is persistent, and the matter vomited is of a dark brown color. It is the color of the skin that has given the name Yellow Fever to the dis- ease, while the color of the vomited matter has given it the name of Black Vomit. When the black vomit occurs the case is usually hopeless. Treatment.-Thorough cleanliness and general hygienic rules should be enforced, not only in the houses but also throughout a city where yellow fever prevails. All patients should be isolated, and care should be taken to disinfect all emanations from the person, and to remove them as soon as possible. These precautions will prevent the spread of the disease. When the first symptoms appear one Compound Podo- phyllin pill should be taken every night, so as to overcome the torpid action of the liver and act on the bowels. For the nausea, half drop doses of Pure Carbolic Acid, in water, are ser- viceable, and lime water should also be given with milk. Chopped ice taken into the mouth, and small pieces swallowed, will also aid in relieving the irritable stomach. The Fluid Ex- tract of Gelsemium, in 20 drop doses, every half hour, till three or four doses are taken, will often greatly control the fever, and at the same time relieve the muscular pains. A mustard paste applied over the stomach, and along the whole length of the spine and retained for half an hour will aid in relieving the irritability. Champagne is also valuable in re- lieving the nausea and vomiting. An old-fashioned alcohol sweat, as described on page 155, is often of the greatest im- portance in speedily inducing a copious perspiration; and thus FEVERS. 230 enabling the skin to become active in throwing off impurities. After a sweat of this kind the patient must be placed in bed and warmly covered. Opium does not serve a good purpose, and should not be used. When the remission takes place large doses of Quinine (20 grains) should be given every two or three hours, if the stomach can retain it. This tends to prevent the develop- ment of the third stage, which usually terminates fatally. Stimulants are also desirable from the commencement, and when the nausea is severe, champagne may be substituted for other stimulants. Should the black vomit occur, the most experienced phy- sician, at the bed side of the sufferer, is often at a loss to know what to do, and the majority of cases prove fatal. The treat- ment previously suggested, however, will often break up the disease, and prevent the occurrence of the "black vomit." DENGUE. Dengue is an acute fever that is rarely met with except in warm climates. It is supposed to be due to some specific poison, and in its character resembles relapsing fever. It prevails as an epidemic, is very painful, of short duration, and rarely proves fatal. On account of the character of the pains it is called " break-bone fever" and neuralgic fever. Symptoms.-This fever comes on in a few hours after ex- posure. While walking the patient is seized with intense pain in the head, back and joints. The affected joints swell rapidly, the face and neck become very red, and a painful stiffness of the muscles occurs. The tongue is coated, and a burning pain in the stomach occurs, which is soon followed by nausea and bilious vomiting. The disease shows itself at once, and reaches its height in twenty-four hours. The temperature is 105 or 107 degrees, the pulse very frequent, breathing rapid, and the skin dry and hot. Mental confusion and even delirium are also sometimes present; an eruption shows itself, which resembles a slight scarlatina rash. After two or three days duration the fever abates suddenly, and we often have profuse DENGUE. 231 perspiration, diarrhea, and bleeding from the nose. At this time the eruption disappears, and the febrile symptoms gen- erally intermit for two or three days. After this period of freedom from fever another paroxysm sets in similar to the first. The eruption also reappears with the fever. It is brighter than before, and begins on the palms of the hands, and the soles of the feet, and is often accom- panied by intense itching. The joints are but slightly affected during the second stage, but there is still muscular soreness. This stage lasts from a few hours to three or four days, and when it ends the eruption terminates by desquamation. Persons who have suffered from this disease are usually very much prostrated, and require several months to regain their former strength. Treatment-A free emetic on the onset of this disease gives great relief. For this purpose the Compound Lobelia powder is the best. It may be given in 30 grain doses, in a wine glassful of warm water, repeated every 15 or 20 minutes till vomiting is produced. After the emetic has done its work, a Compound Podophyllin pill, should be given night and morning till a free action of the bowels is produced. Full doses of the Gelsemium and Black Cohosh are also indicated here, and can be given as follows: Fluid Extract of Gelse- mium, 3 drams; Fluid Extract of Black Cohosh, one-half ounce; water, 4 ounces. Mix, and give a teaspoonful every two hours. Opium is recommended by some, but should not be used unless the above mixture fails. In that case, a one grain Opium pill may be taken once in six or eight hours, or in its stead, 15 to 20 drops of Laudanum. After the fever, good beef essence and wine, should be used to strengthen the system. Quinine in 3 grain doses 3 times a day, and Dialyzed Iron in 15 drop doses, in water, 3 or 4 times a day, will also be essential in restoring the system to its natural vigor. CHAPTER II. ERUPTIVE FEVERS. Eruptive fevers constitute a class of diseases caused by specific contagion. Each disease is supposed to have a spe- cific poison that gains access to the blood, and there ferments so as to generate a large amount of the same virus, which the system attempts to get rid ofby throwing it upon thesurface in the form of an eruption. The influence of the poison on the system causes a fever to develop, which runs a certain course like other febrile diseases. It is claimed that when a person has once had any of these fevers, the first attack gives immunity against a second. How far this may be true we will not attempt to discuss, but it is an established fact that there are many exceptions to this rule. It may be that but few persons are exposed more than once in a life time to the contagion when the system is in a condition to be affected by the disease. It is certainly true that one individual is rarely attacked by any of the acute diseases more than once, and yet we do not claim that all SMALL-POX, OR VARIOLA. 233 diseases give protection against subsequent attacks. We can only suggest this idea, and allow our readers to think of it for themselves, as space will not allow us to discuss the question. VARIOLA, OR SMALL-POX. Small-pox is a contagious disease that is more dreaded than any other on account of the character of the eruption and the disfigurement it occasions. It is caused by direct exposure to the effluvia arising from the small-pox patient during the pustular period, or from the excrementitious matter thrown off during the progress of the disease. We believe it may also be developed anew in filthy, poorly ven- tilated and crowded houses during the seasons of the year when fires are necessary, and the rooms are closed against the introduction of pure air. At all events, such conditions materially aid in its development. SYMPTOMS.-After exposure to the contagion, from ten to thirteen days elapse before any special indication of the disease is observed, excepting a general listlessness. About this time a sudden and violent chill occurs. Sometimes sev- eral chills occur in succession, with flashes of heat interven- ing. The fever sets in at once and continues high until the eruption occurs, at the end of the second or beginning of the third day, though in some cases it does not show itself till the fourth or fifth day. During this time there is great thirst, no appetite, nausea and vomiting are persistent, and the bowels are constipated. There is intense pain in the back, which extends down the hips, thighs and legs, headache is also severe, and sometimes confusion of mind, or well defined delirium supervenes. The eruption first shows itself on the forehead, about the eyes and mouth, and on the scalp, and afterwards extends to the body and extremities. When it begins on the second or third day, the disease is apt to be severe, the pustules occur- ring close together and running into each other thus produc- ing what is commonly called confluent small-pox. If the 234 ERUPTIVE FEVERS. eruption is delayed till the fourth or fifth day it is likely to be mild, and is then called discrete small-pox. A red point that can be removed on pressure, first shows itself. It is slightly elevated, hard, and movable under the finger. On the second day of the eruption the red points assume the ap- pearance of a medium sized pimple, and on the following day a small vesicle is seen on the summit of the pimple, with a clear fluid underneath. The size of these vesicles increase for the next day or two, and on the fifth day of the eruption, and eighth of the disease, they attain their full size. At this time the fluid is milky and purulent, and the top of the vesicle becomes depressed so as to form a hollow. After the eruption has first appeared the febrile symptoms diminish, and the severe pain in the head and back are greatly relieved, but about the seventh day, the fever again sets in and continues for several days. By the ninth day the sup- puration is at its height, and the bases of the vesicles are more rounded and of a red color, while the surrounding skin is swollen. The head and face thus become greatly swollen and disfigured in severe cases, and the broken vesicles cause the putrid secretion to spread over the surface thus developing a distressing condition. The chills and fever of this stage are due to the suppuration and re-absorption of the poison. It is often severe and again develops the pains in the head and back Delirium is present, and often assumes the form of acute mania, which necessitates the constant watching of the patient. The pustules begin to dry about the eleventh day, and as they do so the redness and swelling of the skin begin to di- minish. Great itching accompanies the drying, and falling off of the eruption, and when the parts are irritated by scratch- ing, fresh inflammation may set in, which sometimes assumes the form of erysipelas. When the suppuration has been severe, or when the ves- icle has been ruptured too soon, the skin is marked by the de- pressions characteristic of the disease. After the disease the skin is red and tender for a long time, and the hair usually falls out. TRE A TMENT OF SMALL-POX. 235 VARIOLOID. The term varioloid has been applied to mild cases of small-pox that occur after vaccination. The disease in no way differs from true small-pox, except in the mildness of the symptoms; and this condition is recognized in all eruptive fevers, some persons suffering severely, while others have them so mild as to be hardly disturbed by them. TREATMENT OF SMALL-POX. Small-pox has a regular course to run, and cannot be cut short. In many cases, however, the severity of the disease may be modified by the use of the appropriate remedies. It is first important to isolate the patient so as to prevent the spread of the disease. Sheets should be fastened over the doors, and kept wet with a five per cent, solution of Carbolic Acid; and the sick room should be disinfected with Carbolic Acid as soon as possible. Before the eruption appears the treatment should be the same as recommended for the first stages of the other fevers. If we have reason to suspect small-pox, about two drops of Carbolic Acid, largely diluted with water, may be given three or four times a day. When the fever sets in the following may be used: Fluid Extract of Veratrum Viride, I dram; Fluid Extract of Golden Seal, 3 drams; water, 3 and one-half ounces. Mix, and give one teaspoonful every hour. This will keep down the fever, and at the same time quiet the irritation of the stomach, If the pain is severe, one grain of Opium in pill form, or from 15 to 20 drops of Laudanum, must be given once in five or six hours. The same treatment must be continued after the eruption appears, but the dose of the mixture may be reduced to half a teaspoonful. ER UP TIVE FE VERS. 236 The warm water sponge bath used with Castile soap should be applied two or three times a day, and where the eruption is severe, immersion in a warm bath will prove beneficial. After the surface is thoroughly cleansed one of the best applications to prevent pitting is a mixture of one ounce of Fluid Extract of Golden Seal, and five ounces of Glycerine. This should be applied all over the surface with a large camel's hair brush, after the sponge bath has been used. If this treatment is followed out, and the pustules are not irritated by scratching, there will be but little pitting of the skin. Attention must be given to the nutrition of the patient from the commencement of the disease, but especially during the period of maturation. Milk, eggs, broths, raw oysters, and beef essence may constitute the diet, but something should be given four or five times a day. During maturation, stimulants are needed, and an ounce of good brandy or whiskey should be given three or four times a day. After the desquamation is completed all the clothing should be destroyed, and the room thoroughly disinfected by Carbolic Acid, and left open for two or three weeks before be- ing occupied again. As loathsome as this disease is, it is not a fatal disease, and is less to be dreaded than many of the eruptive fevers VACCINATION. The question of preventing small-pox is one that has long occupied public attention; and so great has been the dread of the disease that the people were willing to adopt any measure that was claimed to be a prophylactic against it. For this reason the practice of vaccination has been accepted without question, and till a very recent time no one 237 thought of saying a word against its value as a preventive of small-pox. Vaccinating infants before the age of two months very often leads to dangerous results. The upper part of the arm is generally selected upon which to perform the oper- ation, but in some countries, especially in France, the operation is performed upon the leg. We have not the space to enter into a lengthy discussion of the question regarding the effects of vaccination here, but will simply state that if the same time and money that has been spent on it had been applied in improving the hygienic condition of the people, which can alone prevent the ravages of small-pox, we would be more free from all diseases to-day than we are.* VARICELLA, OR CHICKEN-POX. VARICELLA, OR CHICKEN-POX. Chicken-pox is a mild febrile disease accompanied by a vesiculai* eruption. It is believed to be caused by an inde- pendent specific virus, and occurs as an epidemic, isolated cases being rare. It is seldom seen in persons over ten or twelve years of age. Symptoms.-There is no fever noticeable in this disease till after the eruption appears. Then there is a slight rise of temperature, which is accompanied by thirst and constipa- tion. The eruption begins as a red elevated spot which soon develops into a vesicle. These appear first on the trunk, and then extend to the extremities, while a few are seen on the forehead and scalp. The disease declines after the second day, and the vesicles dry up and fall off in from three to five days. The eyes are irritated during the disease, but it is not true that they suffer any permanent injury from it, as is popularly believed. * For a concise statement of the facts concerning vaccination, the reader is referred to a little work on this subject, written by Prof. Robert A, Gunn, M. D, 238 ERUPTIVE FEVERS. Treatment.-The only thing to be done in this disease is to keep the child out of the way of taking cold, and to give an Eclectic Compound Podophyllin pill, night and morning, to overcome the constipation. Only three or four days are necessary for complete convalescence to take place. RUBEOLA, OR MEASLES. Measles is a contagious eruptive fever, that runs its course in about two weeks. The mucous membrane of the bronchial tubes and air-cells of the lungs, are considerably congested and catarrhal symptoms prevail. It is due to a specific poison which prevails in all parts of the world It is communicated by immediate contact with the sick, or it may be carried long distances in clothing. It occurs in wide spread epidemics, and in solitary cases; and is especially a disease of childhood. When adults take the disease the symptoms are usually more severe than with children. Symptoms.-The usual symptoms of the initial stage of fevers in general are present, and show themselves about ten days after exposure. They last about four days and termi- nate in a chill which is followed by the fever. For a day or two before the chill, symptoms of catarrh and a slight cough are present, and these increase as the fever progresses. Sneezing, obstruction of the nose, with increased secretion and discharge, watering and redness of the eyes, and hoarse- ness, are constant symptoms before the eruption appears, and might of themselves determine the character of the disease. Sometimes the pain in the back and head is so severe that it suggests the possibility of small-pox. The eruption first appears on the face, neck and breast, then on the trunk and extremities. It is irregularly ovoid in shape, raised above the surrounding skin, of a red color, and feels slightly rough. The single points often run together and form large blotches. It requires from one to three days for the eruptions to fully appear. It then remains red for a couple of days and then begins to disappear. By the seventh or ninth day it is entirely gone. During the development of RUBEOLA, OR MEASLES. 239 the eruption the fever is high, but subsides as soon as it is well out. In cases where the eruption is tardy in making its appearance the fever is more severe, and the patient suffers severely. The bronchial irritation is increased with the ap- pearance of the eruption, and the breathing becomes diffi- cult. The ordinary measles is not a severe disease, but some- times it assumes a malignant type, in which the eruption may not appear in periods ranging from five to twelve days. In these cases the nervous system is greatly prostrated after the excitement of the first day or two, and delirium, and even coma may set in. Sometimes the eruption recedes after it has appeared. This always increases the fever and the bronchial irritation and is a troublesome complication; while in the severe forms of the disease serious results may follow if the eruption is not speedily brought to the surface again. Chronic congestion of the bronchial tubes and larynx often remains as a sequence of measles, and thus a distressing cough is kept up. This condition may in time lead to con- sumption if not arrested. Treatment.-In measles a tepid sponge-bath should be given twice a day, and a hot foot-bath in the evening. Fluid Extract of Veratrum Viride may be given to control the fever. Twenty drops should be put into half a goblet of water, and a teaspoonful given from the goblet every hour. The Fluid Extract of Pleurisy Root may also be given to favor the development of the eruption. Twenty drops in a wine-glass full of hot water, three or four times a day, will prove valuable throughout the disease. When the bronchial irritation is great, warm fomenta- tions of hops should be applied to the chest, and the vapor of tar water should be inhaled. When the cough is trouble- some the following mixture may be used: Fluid Extract of Lobelia, I dram; Fluid Extract of Pleurisy Root, 2 drams; Sulphate of Morphine, I grain ; water enough to make 4 ounces. Mix, and give one teaspoonful every two hours. 240 ERUPTIVE FEVERS. Care must be taken to protect the patient against draughts of air, during and after the disease. The clothing should be warm and the bowels, kidneys and skin kept in action. The Eclectic Compound Podophyllin pill will regu- late the bowels, the Pleurisy Root continued as directed will keep up the action of the skin, and a half teaspoonful of Sweet Spirit of Nitre, in water, two or three times a day, will act well on the kidneys. « In the severe forms of the disease when there is marked depression, Quinine should be given in from 3 to 5 grain doses, three or four times a day. If this causes ringing in the ears it should be discontinued, and in its stead 10 grains of Sulphite of Soda may be given, in water, three times a day. When delirium begins to appear and the fever is high, the following can be used with advantage: Fluid Extract of Belladonna, 20 drops; water 4 ounces. Mix, and give a tea- spoonful every hour till the fever is reduced, and then con- tinue it once in two hours. Good nutritious food, such as broths, milk, wine-whey, &c., should be given from the start, and continued till con- valescence is fully established. SCARLATINA, OR SCARLET FEVER. Scarlet fever may properly be classed as a disease of childhood. It is an acute, infectious disease, and is propo- gated by a peculiar specific poison, which is communicated by inhaling the exhalation of a person suffering from the disease or by contact with the clothing. It may also be transmitted long distances by adhering to various substances and has been known to be extensively spread by distribution of milk from a neighborhood where the disease prevails. Adults sel- dom suffer from it, or if they do it is usually mild. It may be communicated at any period of the disease from the appear- ance of the initial to the terminal symptoms. When persons are enjoying perfect health, and there is no indication of the vital powers being lowered in any way, they are not susceptible to the influence of the poison, and SCARLATINA, OR SCARLET FEVER. 241 hence it often occurs that one or two members of a family may be affected by the disease, while others may escape en- tirely. SYMPTOMS.-Usually six or eight days after exposure the disease is ushered in with severe chills, especially in adults. In children, one or more convulsions may manifest themselves, or severe vomiting, followed by prostration, may occur as the initial symptom, instead of the chill. The skin is hot and dry; the throat has a burning sensation, and on examination the mucous membrane is seen to be red and swollen; the tongue is coated with a thick, yellow fur; and the mouth is dry and parched. The eruption makes its ap- pearance in the course of from twelve to thirty-six hours, and first shows itself on the neck and upper part of the chest, then on the cheeks and forehead, and within a few hours it spreads over the entire body. In severe cases, it may not be well out until the third or fourth day. In milder cases it shows itself in patches of a pale rose red color which rapidly becomes brighter. These patches are distinct and surrounded by a normal skin. When the eruption is slow in making its appearance the patches run together, so that the whole sur- face becomes of an intense scarlet hue. The thick coating of the tongue with a delicate layer of superficial membrane falls off about the fourth day, leaving the surface raw and dotted with swollen follicles which gives it the appearance of a strawberry, from which it is called the "strawberry tongue." The appetite is lost; the bowels sometimes constipated and sometimes relaxed even to diarrhea; the urine is scanty and high colored, and contains more or less blood and a constitu- ent of the blood called albumen. If a small portion of the urine is put into a spoon and boiled, it will leave a deposit of coagulated albumen resembling the white of an egg slightly boiled. When the eruption has reached its height it remains for twelve or twenty-four hours and then gradually disap- pears, and in the mild cases it is entirely gone in from two to four days; but in severe cases the time for its disappearance may vary from three to seven days. As the eruption recedes desquamation of the skin takes place, first in the form of 242 ERUPTIVE FEVERS. minute scurf, and finally by the shedding of large scales. When this occurs the fever declines, the pains cease, the tongue becomes moist, the appetite returns, the urine passes more freely and in about ten or twelve days after the begin- ning of the symptoms, the patient is well. In the mild forms of this disease the throat is but slightly affected, but in the severer cases the tonsils and the whole mucous membrane of the throat are very much inflamed and swollen, and the glands of the neck are extensively involved, even to the formation of abcesses. When the throat affection is severe the eruption is often slight, and the reverse of this is also true. In cases where severe kidney complications de- velop there is violent headache, disorder of vision, muscular twitching and convulsions, the eye lids and legs are swollen, and the urine becomes very scanty. The temperature is below normal and the pulse is very small, rapid and feeble. These symptoms usually develop during the third week, or during the scaling period, and as they begin to disappear the urine flows more abundantly, but its cloudy appearance which indicates the presence of albumen may continue for weeks after the disease has entirely disappeared. Sometimes the severer cases prove fatal in twenty-four hours, and where severe convulsions are followed by continued loss of con- sciousness, we may generally expect an unfavorable termina- tion. Relapses after this disease are common, and sometimes two or three months may pass before the patient is entirely restored to health. Treatment.-The main objects to be attained in the treatment of this disease are to keep down the fever and to promote the appearance of the eruption. In the mild form of the disease, the tepid sponge-bath, applied two or three times a day, will be serviceable in keeping down the fever and making the patient comfortable. Its advantages may be increased by adding to the quart of water about a table- spoonful of common baking soda which thus renders the water alkaline. For internal use the following may be found of great advantage: Fluid Extract of Belladonna, io drops; SCARLET FEVER. 243 Fluid Extract of Aconite Root, 8 drops; water, 4 ounces. Mix, and give one teaspoonful every hour until the eruption appears and the fever abates. Warm drinks, such as Chamo- mile tea, or even a hot whiskey sling, may also be used to advantage in promoting the eruption. As soon as this appears the fever is greatly diminished, and it may be only necessary to continue the alkaline sponge bath without the other remedies. For the inflammation of the throat a simple gargle made as follows will be useful: Vinegar, 1 ounce; Honey, one-half ounce; Borax, 30 grains; water, enough to make 4 ounces. The throat should be gargled with this mixture three or four times a day, or if the patient is too young to gargle, it should be applied with a fine brush to the inflamed surfaces. A stimulating application to the skin around the throat will also be valuable, and for this pur- pose, equal parts of Spirit of Turpentine and Sweet Oil, ap- plied on a piece of flannel, and changed every hour or two, is one of the best that can be used. After the disease subsides a dry flannel may be fastened around the throat and worn for some time. « In the severer forms of scarlet fever where the febrile action is high and where there is a marked irritation of tho nervous system, we can best control the disease by the fol- lowing : Fluid Extract of Gelsemium, I dram; Fluid Extract of Viratrum Viride, 15 drops; water, 3 ounces. Mix, and give a teaspoonful every hour. When the quantity of urine voided is scanty, the following mixture will promote its flow: Acetate of Potash, 2 drams; water, 6 ounces. Mix, and give a tablespoonful two or three times a day. When the inflam- mation of the throat is severe it should be gargled with the following solution: Carbolic Acid, 30 grains; Glycerine, I ■ounce; water, 3 ounces. Mix, and use as a gargle three or four times a day. A fomentation of hops applied to the neck as hot as can be borne, and covered first with oiled-silk and then with two or three thicknesses of flannel, should be ap- plied, and changed every two or three hours. Inflammations of the eye and ear sometimes occur during the progress of the disease, and these should receive attention at the time, 244 ERUPTIVE FEVERS. as should also the complications of the kidneys. The treat- ment of these conditions will be considered in the subsequent chapters of this work. In all such severe cases, no family should be without a competent physician, who can watch the progress of the case and meet complications as they appear. In all cases of scarlet fever, great benefit is derived by annointing the entire body with Vaseline, three or four times a day. ERYSIPELAS. Erysipelas is a febrile disease characterized by extensive local inflammation of the skin. It is divided into two classes commonly called idiopathic and traumatic. The former arises spontaneously, while the latter always attacks open wounds. This disease is usually classed as contagious, from the fact that it often prevails extensively in hospitals, and sometimes appears as a distinct epidemic. Yet we often meet with cases where it seems to be due to the influence of cold, checking the action of the skin in persons whose diges- tion is impaired, or whose blood is impoverished. Such cases occur singly and are not contagious. The entire thickness of the skin is involved in the inflammation and it usually begins at a circumscribed point, then spreads in different directions. Symptoms.-Like other fevers, erysipelas is ushered in by a chill, though sometimes it may be very slight. • The chill is followed by fever, which is accompanied by headache, nausea, loss of appetite, and vomiting of bile. Some of the glands of the neck become swollen and tender before the eruption appears. A sensation of intense heat is felt in that part of the skin where the eruption first shows itself. Fol- lowing this a few red spots may appear close together, which soon run into each other and then spread over a considerable surface. The inflamed skin is thick, raised .above the sur- rounding surface, presents a glossy appearance, and is sensi- tive to the touch. The color is first red, but gradually assumes a purple hue. When it occurs in the loose tissues, such as the eyelids, the swelling is very great, but the pain is not as severe as when the integument is tightly drawn over ERYSIPELAS. 245 the parts. Sometimes the exudation of the fluid portion of the blood is so great that little blisters rise all over the af- fected surface. The inflammation reaches its highest point on the second or third day, when it gradually begins to recede, and on the fourth, fifth or sixth days, the inflamed parts have assumed a yellowish hue. It usually occurs, how- ever, that when the inflammation has reached its height at the point where it commenced, it will spread to the adjacent skin before recession begins. Formation of abcesses some- times takes place in the skin or superficial glands. The entire skin peels off over the whole surface that has been inflamed, and where the scalp is involved the hair also drops out, but is quickly reproduced. It is more frequently met with in the face and scalp, and the swelling of the parts is so severe as to produce great disfigurement. Sometimes the inflammation extends from the skin to the mucous surface of the nose and mouth, and may thus spread to the upper part of the nasal cavities, and from its close proximity cause in- flammation of the membranes of the brain. In some cases the inflammation may leave one part of the body and attack another entirely remote, and after it has attained its height there, it may again pass to another distant point in the same way. These cases, however, are unusual. The disease rarely lasts longer than six or seven days, although in exceptional cases it may continue for several days longer. It often de- velops as a complication during convalescence from other serious diseases, and when such is the case, it usually proves fatal. When it attacks wounds it is more severe, and great care must be taken to prevent its being transmitted to other wounded surfaces, through the influences of the atmosphere or by the person dressing the wounds. Treatment.-In mild cases of erysipelas, one Compound Podophyllin pill,*given every night at bedtime, keeps the bowels in a laxative condition, and should usually be em- ployed. As a local application the following is the least objectionable and most serviceable we have used: Carbolic Acid, 15 grains; Vaseline, I ounce. Mix, and apply thor- oughly over the inflamed surfaces three or four times a day. * See page 360. 246 ERUPTIVE FEVERS. This excludes the air and is believed to destroy the parasite which is now supposed to be the cause of the disease. When the case is more severe and the inflammation is high, the Fluid Extract of Viratrum Viride should be given in two drop doses every hour until the fever is controlled. In addi- tion to this, io drops of the common Tincture of Iron should be given four times a day. This is best taken mixed with a wine-glassful of water and sucked through a glass tube. After the fever has subsided, Quinine may be given in five grain doses, three times a day, for a week or ten days. A strong solution of Nitrate of Silver, and Mineral Acids have been recommended to apply to the healthy skin surrounding the inflamed surfaces, to prevent the spread of inflammation; but such applications rarely do any good and often produce ugly sores which are soon attacked by the disease, and for these reasons should not be used. From the beginning of the dis- ease particular attention should be paid to the nourishment of the patient. If the stomach is irritable, milk, with a table- spoonful of lime water to the gobletful, may be given several times a day, and following this, animal broths, soft boiled eggs, eggs beaten up with sherry wine, and other stimulants should be given at regular intervals. In traumatic erysipelas the wound should be thorough- ly cleansed with a solution of Carbolic Acid, and subse- quently dressed with the Antiseptic dressings as described in the chapter on wounds in the surgical department. In fact if wounds are always dressed in this way traumatic erysipelas need never occur. CHAPTER III. MIASMATIC DISEASES. Under the general name of Miasmatic diseases some writ- ers have classed all those epidemics that are not communi- cated from one person to another by direct contagion, but are due to the presence of minute organisms, or specific poisons, which permeate the atmosphere. These diseases travel from one section of the globe to another, usually along the avenues of commerce, but sometimes they pass over an entire conti- nent and appear in another in a very short period of time. When they break out in filthy localities new centers for the development of the poison are thus created, and those in- haling the new poison may be more exposed than those re- mote from it. As a rule, however, these diseases are not con- tagious in the proper acceptation of the term. INFLUENZA, OR EPIDEMIC CATARRH Influenza is acontinued fever which occurs in wide-spread epidemics, and is supposed to be due to a minute organism floating in the atmosphere. It is characterized by catarrh of 248 MIASMATIC DISEASES. the respiratory organs, which extends to the digestive tract; by a general condition of debility and serious nervous symp- toms. It prevails in all climates and under all conditions of soil, and often extends from one country to another until its ravages spread over both hemispheres. It is similar to the epizootic which sometimes prevails so extensively among horses. It cannot be communicated from one person to the other, as it depends entirely upon the minute organism in the atmosphere. The disease has no regular period of incubation. It sometimes seems to develop immediately after exposure, while in other cases it may not manifest itself for several days. It produces a great thickening of the mucous membrane of the nose, pharynx, larnyx, trachea and bronchial tubes, and inflammation of the lungs themselves often occurs as a compli- cation. SYMPTOMS.-The disease is ushered in by a feeling of chilliness alternating with flashes of heat, or by a decided chill, which is at once followed by fever. As a rule the fever is slight, but in some cases it may be very severe. It is remit- tent in character, the remissions usually occuring in'the morn- ing. The fever is accompanied by a severe frontal headache which extends into the eyes, and all the symptoms of acute catarrh manifest themselves. There is a sense of heat, dry- ness and obstruction of the nose, that is soon followed by an increased flow of the mucus and sometimes by bleeding; the eyes are bloodshot and watery; the throat feels hot, dry and irritated and the mucous membrane of the mouth, tongue, and back of the throat is thickened and inflamed. In a short time an annoying cough begins, which is soon followed by a secretion. Before this begins the patient is constantly sneezing, but this diminishes with the increase of the secretion. When the in- flammation extends deeper into the respiratory organs, diffi- culty of breathing occurs, sharp cutting pains are felt in the side, and the expectoration is mixed with blood. In the milder cases, the catarrhal symptoms reach their height on the third or fourth day, and then decline and disappear entirely a few days later. In cases where the disease extends into the respi- ratory organs the mucous membrane of the oesophagus, stomach INFLUENZA. OR EPIDEMIC CATARRH. 249 and intestines also becomes affected. This destroys the appe- tite, causes nausea and vomiting, with pain in the stomach re- sembling colic. Sometimes these symptoms are accompanied by diarrhea, and again by obstinate constipation, while the urine is scanty and high-colored. From the onset of the dis- ease the patient is depressed and weak, and finds it difficult to perform mental work; the muscles are sore andstiff; and darting pains run along the course of the nerves. The severe frontal headache is, however, one of the most distressing symptoms,and this is usually attended by vertigo. At the termination of the fever we sometimes have profuse sweating, diarrhea, or bleed- ing from the nose-symptoms that may prove critical. The inflammation of the bronchial tubes may continue for some time after the disease has subsided, and the great nervous prostration may retard the convalescence of the patient. It is not a fatal disease, and when death does occur it is more often due to the complications that arise than to the disease itself. Treatment.-At the beginning of the disease 15 grains of Quinine may be given at a dose, with advantage, and this can be repeated once or twice a day until the fever subsides. With a view of controlling the fever and relieving the dis- tressing pain in the head, the following may be found valua- ble: Fluid Extract of Aconite Root, 10 drops; Fluid Extract of Gelsemium, 2 drams; Water, enough to make 4 ounces. Mix, and give a teaspoonful every hour until the symptoms are relieved. It is important to promote free perspiration, and for this purpose the feet should be bathed in mustard water as hot as can be borne, after which the patient should be warm- ly covered in bed. A small wineglassful of Boneset tea should then be given warm, every half hour, until four or five doses are taken. By this time nausea and vomiting may be pro- duced which will be followed by profuse perspiration and a marked modification of the symptoms. The Boneset tea is made by pouring a pint of boiling water upon an ounce of ground Boneset, and allowing it to stand till cooled; and after it is settled the tea is poured off and heated for use. The severe catarrhal symptoms may also be relieved by the 2*0 MIASMATIC DISEASES. following: Carbolic Acid, 2 drams; Aqua Ammonia, 2 drams. Mix in a wide-mouthed bottle, and then pack into the bottle enough cotton-batten to absorb the mixture. The bottle is then corked for use. When the cork is removed, the bottle may be held under the nostrils and the fumes inhaled until they can be felt penetrating the upper portion of the nasal passages. This will often afford immediate relief. Quiet in the house, good nutritious diet, and the moderate use of stim- ulants will also prove advantageous. HAY FEVER. Hay fever is a catarrhal condition affecting the air pas- sages. It occurs in different persons at different periods of the year, but usually affects each individual at about the same time each year, and we have known cases where it would re- cur on the same day of the month every year. It is claimed by some to be due to the emanations from new mown hay; others believe it to be produced by the pollen of rye, barley, wheat, oats and grasses; and others still advocate the theory of a specific poison, similar in its nature to the germs that give rise to the other diseases of this class; while Dr. George M. Beard advances the theory that all persons subject to it have, in themselves, some peculiar condition of the nervous system, which may be developed or excited so as to produce the disease during periods of intense heat, or the application of dust, or the pollen of grains and grasses, to the mucous surfaces of the air passages. Which of these may be the cor- rect theory yet remains to be proved, so for the present we must content ourselves with considering what is known of the disease. Those who are subject to hay-fever are great sufferers for periods ranging from four to five days, to three months, if they remain in the locality where they are attacked by the disease; and without change of locality it is apt to be more severe every year. Although it is not a fatal disease, and leaves no evidence of its presence after the season has passed HAY FEVER. 251 it may develop chronic inflammation of the bronchial tubes, or asthma; and in some cases it may give rise to partial deafness. SYMPTOMS.-The disease develops in two forms-the catarrhal and asthmatic-some persons being affected with but one of the forms, while others have the symptoms of both. The Catarrhal form of the disease is sometimes preceded by a feeling of lassitude, loss of appetite, furred tongue, and diarrhea, though in some cases constipation may be present. In other cases there is an itching sensation of the eyes, nose, and behind the palate, while the person is enjoying usual health, and these symptoms are immediately followed by a watery discharge from the nose and an incessant sneezing. The eyes become blood-shot and watery, and the mucous surfaces of the nasal cavities become so inflamed and swollen that breathing can only be carried on through the mouth. At this stage the sneezing is less persistent and sometimes ceases altogether. The secretion soon changes to a thicker con- sistency and becomes yellow, or reddish from being mixed with blood. The mucous surfaces of the nose, eyes and throat, are hot ar.d dry, and have a burning feeling, with shooting pains extending through the eyes and front part of the forehead. The hearing is defective and a sense of pain and fullness is felt in the ears. The asthmatic form sometimes follows the catarrhal symptoms, and in other cases comes on suddenly without any catarrhal condition developing. The mucous surfaces of the larynx and bronchial tubes become inflamed and greatly swollen; a hoarse, croupy cough develops; and the difficulty of breathing, common to asthma, rapidly follows. In this condition the patient cannot lie down, and he becomes pale and exhausted and covered with a cold sweat, in his efforts to breathe. Sometimes these symptoms are relieved, but do not disappear until the disease is over. Chronic bronchial inflam- mation or congestion of the lungs may remain for several months after the hay-fever has entirely disappeared. 252 MIASMATIC DISEASES. Treatment.-The surest way to obtain relief from this dis- tressing disease is an immediate change of residence. Sea- air and the air of mountainous regions will usually prevent an attack and also promptly arrest the disease after it has developed. The Catskills, Adirondacks and White Moun- tains are favorite resorts for hay-fever patients. Medicines of every variety have been given without af- fording much relief. Before the onset of the disease and for a few days after it develops, inhaling the fumes of equal parts of Carbolic Acid and Hartshorne, as previously des- cribed on page 250 will often prove highly beneficial. Quinine, in five grain doses three times a day, has also been recommended for use a week before the time for the appear- ance of the symptoms. After the disease has set in we have found the following a valuable local application: Carbolic Acid, 20 grains; Honey, I ounce; watery I ounce. Mix, and add one tablespoonful to one and a half ounces of warm water, and inject with a catarrhal syringe through the pos- terior nares (behind the soft palate) so as to force the injec- tion out of the nostrils. We have also found prompt relief, in many cases, from half dram doses of Chlor-Anodyne.* This dose may be repeated two or three times a day. Ten grain doses of Iodide of Potassium given four times a day, will usually act more favorably in reducing the inflammation, than any of the internal remedies. Astringent powders to the mucous surfaces rarely do good, and sometimes cause irri- tation. PERTUSSIS, OR WHOOPING COUGH. Whooping cough is too well known to require any lengthy description. It is essentially a disease of childhood, but is sometimes met with in adults. It is due t'o a specific poison and invariably occurs as an epidemic; and while it may appear to be directly communicated from one child to another, it is an established fact that the condition of the *For ingredients of Chlor-anodyne see article under that title in Part III. PER.TUSSIS, OR WHOOPING COUGH. 253 atmosphere is the principal means by which it is spread. It has been demonstrated that irritation of the anterior branch of the nerve called the "superior laryngeal nerve produces relaxation of the diaphragm, spasm of the glottis and a con- vulsive expiration." These are the conditions presented in whooping cough, and it has been concluded that the specific poison that produces the disease, when carried into the res- piratory organs, stimulates the filaments of this nerve and thus causes the paroxysm of coughing. The disease itself is not fatal excepting in infants where the action of the heart may be suspended by the efforts of coughing, or exhaustion occurs from loss of sleep or vomiting. Complications, how- ever, arise during the progress of the disease which may result in death. When not complicated it continues from seven to ten weeks, although a spasmodic cough may remain for some time longer. Symptoms.-Whooping-cough may be divided into three stages, namely the catarrhal, the spasmodic, and the ter- minal. The first stage shows itself like an ordinary catarrh, accompanied by a slight fever which is less marked at night. A feeling of general languor and loss of appetite is also present, and a slight cough gradually develops. Several days may elapse before particular attention is given to these symptoms, and the disease may not be well marked before the expiration of three or four weeks. After two or three weeks, the cough becomes more persistent and is spasmodic in character. The patient takes a forcible inspiration, and the expiration occurs as a succession of short, rapid efforts to empty the lungs. It is these short respiratory motions that produce the cough. When the cough increases the larynx becomes more contracted and the whoop is produced by the forcible inspiration that follows the cough. From five to twenty days mark the duration of the ordinary catarrhal symptoms with the slight cough, while the more severe cough accompanied by the whoop, will continue from three to five weeks; and during this time a mucus secretion is raised after the cough, which sometimes assumes a yellowish ap- pearance. It is sometimes difficult to raise this expectoration 254 MIASMATIC DISEASES.. and the child vomits before the air passages are free. The continuance of the paroxysm varies from a few seconds to a few minutes, and they may recur on an average of once an hour or once in ten minutes. The frequent vomiting occasioned by paroxysms often causes the patient to lose flesh by pre- venting the retention of food in the stomach. Anything that has a tendency to produce an irritation of the stomach of the mucous surfaces of the air passages, or seeing others in the act of coughing, will excite the paroxysm. A child usually turns pale and seizes some object for support as soon as it begins to feel the paroxysm approach. In some cases inflammation of the bronchial tubes, pneumonia, and even con- sumption may follow as complications of whooping-cough. When such inflammation extends into the smaller branches of the bronchial tubes the blood is not properly oxygenated, and thus brain complications occur which terminate in con- vulsions and water on the brain. These, however, are only among the graver symptoms of the disease. After seven or eight weeks the paroxysms become less frequent and less severe, the febrile symptoms subside, vomiting ceases and the child gradually recovers its wonted strength and vigor, when serious complications are not developed. Treatment.-So far as we can determine the treatment of whooping-cough has only resulted in a palliation of the symptoms. The various cough mixtures, so long in use to promote expectoration, are really of no value, excepting so far as the opium they contain has a tendency to control the paroxysms. In the early stages of the disease the inhalation of a Carbolic Acid spray, produced by an atomizer* will fre- quently control the severity of the inflammation. For this purpose five drops of the 95 per cent. Carbolic Acid may be added to the ounce of tepid water, and inhaled from the atomizer for five minutes at a time. This should be repeated three or four times a day. For internal use we have always been pleased with the following: Fluid Extract of Bella- donna, 10 drops; Fluid Extract of Lobelia, 30 drops; water, *For description of Atomizers, and how to use them, see article on Catarrh. PAROTIDITIS, OR MUMPS. 255 4 ounces. Mix, and give a teaspoonful every hour, to a child under four years of age. For older patients the dose may be doubled. From five to eight grains of Quinine given at the onset, even to very young children, will often arrest the dis- ease, and larger doses may be given to children over five years of age. If decided improvement is not noticed after the first dose, it should not be continued. Fluid Extract of Black Cohosh given in from two to five drop doses, four or five times a day, is an old but really valu- able remedy for any stage of the disease. In the spasmodic stage the following will prove valuable : Bromide of Sodium, 2 drams; water, 3 ounces. Mix, and give one teaspoonful four or five times a day. Opium is also a valuable agent to control the spasm, but it should be given with caution, and then only at bed time. It is best given in the form of Paregoric, and in doses ranging from five to twenty drops. The patient should have nutritious food, frequent tepid or warm baths, and proper protection against exposure to damp and cold. Change of air is always beneficial and in many instances will cure the disease in a few days. PAROTIDITIS, OR MUMPS. Mumps is an inflammation of the parotid gland, pro- duced by a specific miasm. It usually occurs as an epidemic, and children from four to fifteen years of age are the most liable to it. Little is known of its cause, further than that from five to twenty days after exposure the swelling is de- veloped. It is sometimes confined to one side of the neck, while in other cases both sides are involved. SYMPTOMS.-The ordinary symptoms that precede all fevers are noticed in this disease. Chilliness and vomiting occur and these are followred by fever. In from twelve to thirty-six hours after the fever sets in a sharp pain is felt below the ear, which sometimes extends into the ear and throat. A swelling soon appears which extends rapidly in 256 MISAMATIC DISEASES. every direction till it attains a large size. With the beginning of the swelling the jaw becomes stiff, and its motion causes pain. The swelling often extends to other glands in the neck and even to those under the arm; and difficulty of swallow- ing and breathing is sometimes the result. The swelling reaches its height in from three to six days, then remains unchanged for one or two days, and has entirely subsided by the tenth or twelfth day. Sometimes the inflammation runs so high that suppura- tion takes place, and the gland breaks and discharges, or has to be opened with a knife. Treatment.-The fever may be allayed by Aconite given as follows: Fluid Extract of Aconite Root, io drops; water, 4 ounces. Mix, and give one teaspoonful every hour. A hot fomentation of hops applied to the neck every hour or two will also afford relief. Among the more recent methods of treatment the very best results have been obtained from the. following: Fluid Extract of Jaborandi, I dram; Simple Syrup, 2 ounces. Mix, and give a teaspoonful every half hour till free secretions of the saliva and perspiration are pro- duced. When the skin is hot and dry the tepid sponge bath should be used; and if the bowels are constipated one Ec- lectic Compound Podophyllin *pill should be given every night. CEREBRO-SPINAL MENINGITIS, OR SPOTTED FEVER. Cerebro-spinal meningitis is an infectious fever that occurs as a wide spread epidemic, over which local condi- tions seem to exert little or no influence. The specific miasm or germ must be present, and then bad hygienic con- ditions will undoubtedly favor its development and the spread of the disease. It is called spotted fever from the character of the erup* tion, and is also spoken of as cerebro-spinal fever. This last name would be the most appropriate one, as it could then be readily distinguished from the inflammation of the membranes of the brain and spinal cord, that may occur from some local * See page 360. CEEEBEO-SPINAL MENINGITIS. 257 injury or known cause, and which we shall refer to else- where. SYMPTOMS.-The common form of the disease begins abruptly with general lassitude and muscular pains; and these are followed by a chill, severe headache, nausea and vomiting, vertigo, and a feeling of great prostration. The muscles of the neck and back become more painful and rigid, and those of the extremities assume the same character. The head is drawn back and the spine is curved, by the severe muscular contractions. The skin about the neck and face becomes very sensitive, but the intense pain in the head is the most prominent symptom. There is great mental excitement at first, amounting sometimes to active delirium, but this soon gives place to depression, and a tendency to sleep. The face is sunken and pale, and the features are pinched and indicate suffering; there is spasmodic muscular twitchings of different sets of muscles; there is at first an intolerance of light and sound, which is soon followed by par- tial deafness and indifference to light; the appetite is entirely lost; vomiting is common; and constipation, which is present at first, gives place to diarrhea, with involuntary evacua- tions. Eruptions of various kinds appear on the body, during the progress of the disease, though they do not occur in some epidemics. The disease reaches its height in from three to six days, and may end in recovery or death. If the termina- tion is likely to be favorable the patient can easily be aroused; but if profound stupor sets in death is almost cer- tain to follow. In severe cases the patient is stricken down suddenly and complete collapse occurs in a few hours. The skin be- comes blue and cold, unconsciousness supervenes after a very brief period of delirium, and the blood settles in blotches on various parts of the body. These cases are invariably fatal, and death may occur in a few hours, or a few days. In some cases bleeding from the nose, gums, and even from the skin takes place early; and if great prostration and 258 MIASMATIC DISEASES. coma follow these symptoms, death will occur in three or four days. In other cases muscular pains, stiffness of the neck and spine, severe headache, nausea and vomiting, without fever, manifest themselves for two or three days, and then pass off without the development of the other symptoms. Treatment.-Experience has taught the profession that opium is the best remedy for the first stage of this disease. It should be given in doses large enough to control the mus- cular contractions and the severe pain. Sulphate of Morphine, in one-fourth grain doses, may be given every 3 hours till the symptoms are relieved, and in severe cases a half-grain dose should be given on the start. Hot water should be applied to the spine every two or three hours. Fluid Extract of Gelsem- ium in three-drop doses, should be given every half-hour during the delirium. As soon as the symptoms of depression show themselves these remedies should be discontinued and attention should be directed to supporting the system. Now, five grains of Quinine can be given three times a day with ad- vantage; and when the skin is cold and clammy, five drops of the Spirit of Turpentine, in a teaspoonful of glycerine, should be given three or four times- a day. Hot water to the spine continued at this time will prove of great advantage in has- tening recovery. If constipation is present an Eclectic Compound Podophyllin Pill night and morning should not be omitted. A good nutritious diet is essential from the begin- ning of the disease, and beef-essence, animal broths, eggs, and milk should be given every three hours, till convalescence is established. Stimulants are desirable during the stage of depression, but they must be discontinued if they produce any excitement. DIPHTHERIA. Diphtheria is a specific disease that first attacks the throat and then produces poisoning of the general system, which is accompanied by the usual fever. It owes its origin to some specific poison the nature of which is not known, an.d DIPHTHERIA. 259 although it is primarily an infectious disease, it seems to take on more of the characteristics of contagion than any other disease of this class. It sometimes prevails as an extensive epidemic, and again it may be developed in some locality from imperfect sewerage and drainage. Symptoms.-For three or four days before the develop- ment of the disease the patient is dull, languid, fretful and sleepless, has a great desire to drink, and an impaired appetite. These feelings are followed by chilliness, or a decided chill with headache, backache and sometimes severe pains in the various muscles. Following this, fever sets in, sometimes slight, though often quite acute, and accompanied by the ar- rest of the secretions of the skin, kidneys, and bowels. Some- times there may be heat and irritation in the throat from the manifestation of the first symptoms, but usually the patient does not complain of the throat until after the fever is well developed, while even then the pain is not severe. On exam- ining the throat the surfaces are found to be somewhat swol- len, and may present either a red or livid appearance. At some points ashen gray spots may be seen upon the mucous membrane. These are small at first and appear in clusters closely grouped together. As the disease advances these patches become more marked and the points from which the gray matter exudes more numerous. They finally coalesce, and thus cover a considerable surface with the peculiar ashen gray exudation which is characteristic of the disease. After two or three days the patches of exudation may be removed or are thrown off themselves, when a free secretion may occur from the underlying surfaces. The saliva becomes thick and tenacious and requires frequent attempts at removal. After the exudation has peeled off, the surfaces are raw and remain so for sometime. In some cases the surfaces now become stiff and irritable, and every attempt at deglutition or even res- piration causes severe pain. The swelling extends into the nasal cavities and downward into the pharynx as far as the epiglottis. In other cases the secretion from the raw surfaces commences on the second or third day, and more or less ul- ceration takes place. In this condition the muscles of the 260 MIASMATIC DISEASES throat are relaxed, the tissues are filled with a watery exuda- tion from the blood, and paralysis of the throat results, which renders it impossible to swallow. When the pharynx is in- volved the usual symptoms of croup are developed. When the inflammation and exudation extend to the larynx, the complication is a serious one, and unless promptly relieved will terminate fatally in 48 hours. Many cases are described as diphtheria in which there is severe pain in the throat as the first symptom, but experience has demonstrated that most of these cases are simply inflama- mation of the tonsils with non-specific ulceration of their sur- faces. The great depression of the system and dryness of the throat, and the greyish-white exudation presented in the first examination are the common characteristics of a genuine case of diphtheria; and whatever pain is present in the throat, is developed later in the disease as the result of more extended inflammation. In severe cases the several glands of the neck become enlarged in sympathy with the extensive local in- flammation. Treatment.-There is probably no disease that we are called upon to treat, in which a greater diversity of opinion prevails, than is met with in the treatment of diphtheria. An attempt to describe these various methods of treatment would only confuse the reader, and we shall, therefore, confine our- selves entirely to that which has proved the most successful in our hands. Nutritous and stimulating food must be given from the very commencement of the disease. Beef essence, milk, eggs, wine whey, and good brandy or whiskey, should be alter- nated so that the patient receives something stimulating or nourishing every two or three hours. With a view of controlling the fever and eliminating the poison, the following should be given to children from two to six years of age: Fluid Extract of Viratrum Viride, (green root) 15 drops; water, 4 ounces. Mix, and give one teaspoonful every half hour until the skin becomes moist or slight nausea is pro- duced. When either of these conditions develop, the remedy DIPHTHERIA. 261 should be discontinued until the skin again becomes hot, when it should be repeated in the same way. For older persons, from one to three drops of the Viratrum maybe given every hour with the same object in view. This may be continued at all times when there is any indication of fever. As an application for the throat pure Carbolic Acid is the best that can be used, and it should be applied with a long slender piece of pine wood, which can be whittled down, and smoothed at one end for the purpose. This is dipped into the pure Carbolic Acid, where it is held for a moment until it has absorbed some of the acid. The tongue is then depressed and the ulcerated parts on the throat are gently touched with the end of the stick that had previously been dipped in the acid. By this means the caustic effect of the acid is obtained on the ul- cerated surface without any possibility of its extending to the healthy tissues. This may be repeated once or twice a day for two or three days, by which time the exudation may be entirely removed and the inflammation much reduced. A non-specific raw surface is thus left that will soon heal over. At the same time a gargle of five drops of Carbolic Acid (95 per cent.) to an ounce of warm water, may be used three or four times a day. Some of the same solution may be injected into the nasal cavities with a small syringe. Aside from this being a valuable application in any inflammation, if the theory of general poisoning from the throat is the correct one, we suc- ceed in destroying the germs of the disease that are deposited there, by our first strong application. As soon as the fever subsides and the throat is cleared of the exudation the period of prostration begins. Here Quinine, in from 2 to 5 grain doses, according to age, may be given three or four times a day. If there is any evidence of paralysis of the throat, the Faradic current of electricity may be applied ad- vantageously. If the patient is slow to recover his usual health and the nervous system seems prostrated, the fol- lowing will be of advantage: Sulphate of Strychnia, 1 grain; Dilute Muriatic Acid, 3 or 4 drops; Dilute Phosphoric Acid, one-half ounce; Water, enough to make 4 ounces. Mix, and give one teaspoonful 262 MIASMATIC DISEASES. three times a day. Children under five years of age should not take more than 20 drops of this mixture, while those over that age may take half a teaspoonful at a dose. CHOLERA. Cholera is an infectious disease propagated by a minute organism, or germ, but requiring conditions of filth for its de- velopment. It is not contagious as is demonstrated by the fact that physicians and nurses are no more liable to take the disease than other persons in the locality where it prevails. During all cholera epidemics, it has been noticed that the healthy and robust escape; while those whose nervous ener- gies have been lowered by intemperance, improper nourish- ment, bad air, fear of contracting the disease, or previous ill- ness, are the persons generally attacked. In fact the same is true regarding the liability to contract all contagious and in- fectious diseases. SYMPTOMS.-All cases of cholera are preceded by an at- tack resembling a simple but copious diarrhea, or by vomit- ing and purging with griping pains, like cholera morbus. These conditions may continue a day or two before other symptoms develop. The disease itself is ushered in by chilli- ness, with great anxiety and alarm. The evacuations are fluid, and grayish, like rice-water or whey. They are very profuse, and are passed with great force. The patient feels cold and becomes rapidly prostrated after two or three evacu- ations. If vomiting had not already occurred on the start, it soon begins. The ordinary contents of the stomach are first thrown off, then some bilious matter, and finally the rice- water discharges that characterize the disease. There is in- tense thirst, but all fluids are ejected as soon as swallowed; the tongue is cold, sticky and white; the countenance is con- tracted, the nose pinched, the eyes staring, the skin assumes a leaden hue; and the breathing is difficult, and sometimes accompanied by hiccough. Cramps occur in different parts of the body, but are more severe in the calves of the legs than CHOLERA. 263 elsewhere. The skin becomes cold and is covered with a clammy perspiration, while the fingers, nose and lips are blue. The eyes are now sunken, and surrounded by dark rings; the breath is cold; the voice weak and husky, and the urine al- most entirely suppressed. Even in this prostrated condition the patient, retains his mental faculties, and when aroused will answer intelligently all questions put to him. Death may occur in three or four hours, but the usual time is from twelve to forty-eight hours after the beginning of the symptoms. When reaction takes place the surface of the body be- comes gradually warmer, the cheeks become slightly flushed, the countenance takes on a more natural appearance, respira- tion is more easy and free, the urine begins to flow, and the passages from the bowels begin to assume a natural appear- ance. From three or four days to a couple of weeks may be necessary to restore the health. Sometimes, instead of con- valescence progressing favorably, the usual symptoms of typhoid fever develop and continue for weeks. After this, re- covery may take place, or profound stupor may set in from which the patient never awakens. Treatment-When cholera prevails the slightest diarrhea should not be neglected. Acids, morphine, chloroform, &c., have been recommended for controlling the diarrhea and chol- era morbus that precede the disease. Too little is known about the treatment of cholera, even by the most experienced physicians, to warrant home treat- ment. Those exposed to the infection may take with advan- tage, on the appearance of any diarrheal condition, half a tea- spoonful of Chlor-anodyne,* every half hour, till relieved, or till five or six doses are taken. If the symptoms are not promptly relieved this dose should be doubled. At the same time boiled milk, soft-boiled eggs, and animal broths should constitute the diet, and solid foods should be avoided. A large mustard paste over the ¥ For formula, see Chlor-anodyne, in Part III, of this work. MIASMATIC DISEASES. 264 stomach may also prove serviceable in allaying the vomiting. Carbonic acid water and acidulated drinks may also be used for this purpose, and are usually enjoyed by the patient. These measures will often arrest the diarrhea and cholera morbus that constitute the first stage of cholera; but should they fail to do so, no time should be lost in sending for the family physician. A friend from West Florida, who has passed through sev- eral cholera epidemics, and had the disease three times him- self, informed us a few years ago, that any case of cholera could be arrested by taking a good alcohol " sweat" at the onset of the disease. If the symptoms still continued, the "sweat" was repeated. He said that he had seen many cases cured in this way after they had been given up by the doctors. Such a treatment must necessarily relieve the stomach and bowels, by increasing the action of the skin; while it must at the same time keep up the heat of the body. CHAPTER IV. DISORDERS OF NUTRITION. Under the general classification of disorders of nutrition are included all those abnormal constitutional conditions that are primarily developed in consequence of some derange- ment of the process of nutrition. Whatever part of the nu- tritive apparatus may be at fault the general result is a dis- turbance of the process of assimilation, or that of destructive assimilation. In the former there is a deficiency of some proximate principle that is not supplied by the nutritive pro- cess, and hence there must be corresponding disorder of the tissues requiring that particular substance; while in the latter, some material, that should have been thrown off,'accumulates in the system and produces disturbance of the normal con- dition of some of the tissues. The principal disorders of this class are scrofula, rickets, rheumatism, gout, and diabetes, each of which will be briefly described. SCROFULA. The word scrofula has long been used as a convenient term with which the doctors could cover up their ignorance. The disorder known as scrofula is characterized by enlargement 266 DISORDERS OF NUTRITION. of the lymphatic glands, various blotches on the skin, and a general bloodless condition. It is claimed by many to be hereditary, and to be the cause of a great variety of disorders, which are really due to special causes. It is true that children who are born of mothers who were unhealthy during the period of utero-gestation, may have these conditions developed, as may also any person whose gen- eral health is affected by bad air, poor food, crowded rooms, or other unwholesome hygienic conditions. When abnormal conditions exist in the various tissues, or when the eliminatives fail to perform their functions properly, the lymphatic vessels and glands are the first to suffer from enlargement or inflammation. But even these may be only slightly affected till a period involving some decided change in the system arrives. In infants who have been imperfectly nourished, the period of teething causes an activity of the various organs, and nature makes an effort to get rid of some of the impurities. In consequence of this, various eruptions appear that are at once pronounced scrofulous and hereditary. Another change takes place in the body about the age of pu- berty, and eruptions may appear or glandular enlargements be- gin to manifest themselves. In both these cases if the condi- tions could be entirely changed and proper attention given to the nutrition of the body no after effects are likely to de- velop that could in any way be considered as an inherited dis- ease. Symptoms.-Some patients suffering from the derange- ment commonly called scrofula have a clear white and trans- parent skin through which the veins show clearly; fine soft hair; bright eyes with pupils dilated; flabby muscles; in fact all the appearances met with in a person who has been deprived of food for a long time. Other persons may be inclined to be fleshy, but have a puffy appearance which indicates the ab- sence of normal fatty tissue; their muscles are weak and re- laxed; and all the movements are slow and heavy. Both of these conditions are due entirely to imperfect nutrition, and the systems of such persons must, therefore, be weak and unable to SCROFULA. 267 establish any vital action. Consequently, if they should re- ceive a wound or bruise, there is not sufficient vitality to re- pair the injury, and hence the healing process is often greatly retarded. When the glands become enlarged, they sometimes in- flame, break and discharge pus freely, and often several of them take on this condition in succession. Treatment.-Surround the patient with the best hygienic conditions possible. Give a generous supply of nutritious food, and if the nursing mother is weak and anemic the child should be taken from the breast and fed artificially. Tincture of Iron in io drop doses may be given with' advantage, three times a day, largely diluted in water. Any good bitter tonic will be advantageous, and should be employed for some time. The following will be found serviceable: Fluid Extract of Hydrastis Canadensis, 4 drams; Fluid Extract of Nux Vomica, I dram; Glycerine, I ounce; water, enough to make 6 ounces. Mix and give one teaspoonful three times a day, before eating. Children under three years of age should not have more than 20 drops at a dose. When sores, abscesses, &c., occur in weakly persons they must be treated as laid down in the department of surgery. An entire change of climate, diet, and habits, will often do more to restore a so-called scrofulous person to health, than all else beside.* RICKETS. Rickets is a disease of childhood, in which nutrition is so disordered that the material necessary for hardening the bones is not supplied. This leaves the bones undeveloped, and they are, consequently, incapable of supporting the body. Symptoms.-The child suffering from this disease is seen to waste away in flesh; there is vomiting and diarrhea, and the passages are acid, and of a light color. All the symptoms of a low continued fever are present, for some considerable time. Finally, the extremities of the long bones become thickened, and when the child begins to walk the bones yield to the *See page 359. DISORDERS OF NUTRITION. 268 weight of the body. Thus we find the long bones of the legs become bent, and the spine curved by the weight they are called upon to support. Treatment.-Good food, gopd air, proper bathing and warm clothing are the most i mportant features in the treat- ment of rickets. Everything that will improve the general condition of the child should be resorted to. With a view of enriching the blood and supplying material for the bones, the tonic known as syrup of Lacto-Phosphate of Iron should be persistently employed, in teaspoonful doses three times a day. RHEUMATISM. Rheumatism is an inflammatory disease affecting the fibrous tissues that surround the large joints. It also affects the ligaments, tendons, and sometimes the muscles, especially the heart. This inflammation differs from the ordinary in- flammation of other tissues, and may, therefore, be classed as a specific one peculiar to this disease. Rheumatism does not occur excepting in persons who have an excess of lithic acid in the blood, and is, therefore, classed as a constitutional disease. This excess of lithic acid is due to a deranged condition of the digestive organs, and thus we have impaired nutrition acting as the predisposing cause of the disease. When this predisposition exists, ex- posure to cold or damp acts as an exciting cause of the in- flammation. Rheumatism is divided into the acute and chronic forms, but the terms "rheumatic fever," and " articular "rheumatism are often applied to the acute variety. Symptoms.-For some time before an attack of acute rheumatism evidences of indigestion are present; the appetite is impaired, the tongue coated, and the bowels are constipated. Then there may be muscular soreness, neuralgic pains, and stiffness and soreness, of some of the joints for several days, when a chill occurs, which is at once followed by fever; or a RHEUMATISM. 269 number of chills may come on in succession, with flashes of heat between. In some cases the chill may occur abrupt- ly without the premonitory symptoms. The joints soon become painful, hot, swollen, red, and sensitive to the slightest pressure; while the head aches and sleep is im-. possible. The inflammation may begin in one joint, but in from twelve to twenty-four hours others are affected, and the pain and swelling are relieved in those first attacked. In a week or ten days all the large joints, as the ankle, knee,, shoulder, elbow, wrist and hip, may be affected, and usually- in the order in which they are named. After the disease has; left one joint it may return again with greater severity thap before. The inflammation may also attack the heart and prove serious. When the spine is affected the body cannot be moved in any direction, or even breathing performed without great pain, and this particular form of the disease is called. lumbago, The fever as a rule does not run high, and its termina-. tion is gradual; although in rare cases a very high fever may- develop which is liable to be followed by delirium and stupor As soon as the joints are inflamed, sweating begins, and is one of the characteristics of the disease. The urine is scanty, high colored and strongly acid, as is also the perspiration. The symptoms of chronic rheumatism differ somewhat from those of the acute form. The pain is limited to the joints affected, and does not travel from one to another. There is no redness or swelling; pain is increased on motion, and when changes in temperature occur, or during damp weather. The joints are stiff, and produce a creaking noise when moved; and muscular pains are sometimes present. These are caused by the disease extending to the sheaths of the tendons of the muscles, and are not rheumatic in them- selves. Sometimes deposits take place in the joints, and change their structure so as to render a cure impossible, Treatment.-The treatment of rheumatism has received a large share of attention from the profession, and different rem-, edies have been lauded as almost specifics for the disease. 270 DISORDERS OF NUTRITION. Salicin, prepared from the brook Willow, is, perhaps, the best remedy known for persons who have robust constitutions. It should be given in 15 or 20 grain doses every three hours for two or three days, by which time it will almost certainly control the disease. We have given it in cases where great reduction of both the pain and fever took place within twelve hours, and it controlled the attack completely in three days. This is the usual action of the drug, and its use should be persisted in till the favorable change takes place. Some use 20 or 30 grains of Salicylic Acid every three or four hours, instead of the Salicin, and its action is similar. Its use, however, often causes irritation of the stomach and de- pression of the heart's action, neither of which will be pro- duced by the Salicin. Before this treatment is commenced a Compound Podophyllin pill*should be given night and morning, till a free action of the bowels is produced. This prepares the stomach for the other medicine, and improves digestion. In some cases, particularly if the patient is anemic, this treatment may be modified with advantage. After regulating the bowels, give the following: Nitrate of Potash, one-h^lf ounce; Water, 6 ounces. Mix, and give a tablespoonful after each meal. In addition to this, 5 drops of the Tincture of the Chloride of Iron, three or four times a day, will be of great advantage. This remedy should be mixed in one-third of a goblet of water, which can then be taken through a glass, tube. The juice of three or four lemons a day, will also prove valuable. Vegetable acids are changed in the stomach so as to produce a similar effect to that of Bicarbonate of Soda. Thus, the administration of lemons is not a contradiction of the theory that the blood is acid in this disease. Quiet of the affected joints is essential. Warm fomenta- tions will also prove grateful to the patient, and give relief. In the severest cases, a fly blister will often promptly arrest the pain and cause sleep. It should be applied over the in- flamed joint, and made sufficiently large to cover the side of the joint involved. It should be left on at least four or five hours, * See page 360. RHEUMATISM. 271 and when the blister is well raised it may be clipped with a pair of scissors, and then dressed with a flax-seed meal poul- tice. This is not painful as is generally believed, and the re- lief it gives is often magical. Proper attention must be given to diet. An entire ab- stinence from food will cut off the supply of the excess of acid, and thus greatly shorten the duration of the disease. Meats of all kinds should be avoided, and vegetables, fruits, oysters, fish, and light broths substituted. This attention to diet should continue long after the attack has passed. In chronic rheumatism the Brazilian remedy called Manaca is deserving of faithful trial. We have successfully treated a number of patients with it, and believe it will be found of great value in many cases of this kind. It should be given in io drop doses of the Fluid Extract, four times a day at first, and then gradually increased to 30 drops at a dose. The Compound Podophyllin pills*should be used to regulate the bowels. We have also had good results from the following: Fluid Extract of Black Cohosh, 1 ounce; Fluid Extract of Colchicum seeds, 4 drams; Glycerine, 2 ounces; water, enough to make 6 ounces. Mix, and give a teaspoonful three times a day, after eating. Turkish baths will also be found valuable in the treatment of this form of rheumatism, as will also the water from sulphur springs, when drank freely three or four times a day.f The proper use of the Faradic battery will also prove a valuable aid in treatment, while the Galvanic current maybe used to promote the absorption of deposits in the joints. For the treatment of rheumatic complications of the heart the reader is referred to the chapter on diseases of that organ. GOUT. Gout is a constitutional disease closely allied to rheuma- tism, and yet presenting many points different from it. Like rheumatism it is largely dependent upon deranged digestion, which causes an increase of the lithic acid in the blood. It is * See page 360. + See page 359. 272 DISORDERS OF NUTRITION. claimed by many of the old writers that gout is a hereditary disease; but we believe a more careful study of the subject will demonstrate that its presence in different generations of fami- lies is due more to the local surroundings and the character of the food than to heredity. Many attribute gout to high living, continued use of wines, and to various excesses, but it can be shown that persons in the lower walks of life, who can indulge in none of these excesses, are also liable to it. Men suffer more than women, and those in middle life are more frequently affected than the young or the old. It occurs more in the winter season than at any other period of the year. The attacks may be avoided by a timely change of residence to a warmer climate before the winter sets in. Symptoms.-Gout may develop either as an acute or a chronic affection. In the acute form we sometimes have head- ache, nausea, coated tongue, constipation, and a yellowness of the tongue and eyes. These symptoms are accompanied by restlessness, irritability, despondency at one time and high spirits at another. Shivering, rise of temperature and sweat- ing may also occur. In some cases, however, none of these symptoms are present. The disease itself begins with a sense of uneasiness in the ball of the great toe, which continues to increase until an acute pain is felt, and this condition usually shows itself toward morning. On examination, the seat of the pain will be found red, hot and swollen, and so sensitive that the slightest touch will greatly increase the suffering. The muscles of the legs oftentimes contract suddenly, and the veins become swollen, and it is difficult for the patient to find any position that affords relief. The urine is very acid, deep red in color, dense, and deposits a brick-dust sediment. After several hours of pain the severe symptoms abate, the skin be- comes moist and a general sense of relief is experienced. If absolute quiet is enforced and the foot is elevated, considerable relief is obtained, but when evening again approaches, the pain becomes severe and passes through the joint, causing another night of suffering. If the disease is allowed to take its- course this may continue for ten or twelve days or even longer. Toward the end of the paroxysm, the redness and tenderness. GOUT. 273 subside, but the ankle and foot remain stiff and unwieldy for some time. The patient suffering from gout is much depressed at each attack, but when it is over he quickly regains his usual health. The paroxysms may occur every few weeks or two or three years may intervene. A subsequent attack of the disease may affect the same joint or may extend to others. With each new attack, other joints are liable to be in- volved and the inflammation may finally extend from the joints of the foot to those of the knee or hip. The paroxysms become less severe as their frequency increases, but they are apt to last longer with each attack. In chronic gout the joints of the feet are more generally involved and the symptoms are less violent than in the acute form; the disturbance of digestion is present at all times and is manifested by flatulence, acidity of the stomach, pain through the regions of the stomach and liver, piles, constipation and in some cases diarrhea, and a heavily coated tongue and fetid breath. The paroxysms develop slowly and deposits around the joints take place and increase according to the duration of the attack. The joints become hard, distorted, and the arti- cular functions are interfered with. Sometimes the deposits in the joints, acting as foreign bodies, excite an inflamma- tion that may often extend to ulceration. The urine is pale, of low specific gravity and contains albumen. During the progress of the disease, various internal organs are affected with pain, and the popular terms of "gout in the stomach," "gout in the head," gout in the kidneys," &c., have beep ap- plied. These symptoms are in reality due to the limy de- generation of the blood-vessels supplying these organs, which are not themselves affected by the imflammatory condition known as gout. A person who has once suffered from gout, or who has ever seen it in others can hardly be mistaken as to its symptoms. Treatment.-In the treatment of gout we must consider what means are best adapted for the relief of the paroxysms, and then ascertain what is best to prevent their return. The 274 DISORDERS OF NUTRITION, question of diet is an important one, and must be considered at the start. If practicable, entire abstinence from food for several days would ensure the best results, but as few per- sons are willing to adopt this plan they should abstain entirely from animal foods, and confine themselves exclusively to vege- table diet. Stimulants of all kinds should be avoided and every effort made to regulate the diet. To relieve constipation, a Compound Podophyllin pill*should be taken every night at bed-time, and half a teaspoonful of bi-carbonate of soda may be taken in water, once or twice a day, to relieve the acidity of the stomach. When flatulency is excessive a teaspoonful of pure glycerine taken immediately after eating will be found of great advantage. Of the specific remedies for this disease, Colchicum is one of the oldest, and at the same time one of the best that can be used. During the attack the wine of Colchicum may be given in teaspoonful doses three times a day, and the dose gradually increased until there is a tendency to looseness of the bowels. Among the more recent remedies, Salicin is the best. It can be given in 15 grain doses every four hours until the pain subsides. This remedy acts here in the same manner as it does in rheumatism in producing rapid reduction of the inflammation, thus allaying the severity of the symptoms, which it will often do after a few doses are taken. As a rule local remedies are of little value. In some cases, however, where swelling is great, a warm fomentation of hops applied fresh every hour will afford great relief. The foot should be elevated and kept entirely free from motion. The adoption of this treatment will prevent the disease from extending beyond two or three days, and in some cases it may be controlled in twenty-four hours. After the paroxysm has passed, attention must still be paid to the diet so as to prevent a recurrence of the trouble. Foods should be selected that are easily digested, and a vege- table diet with fruits should still be adhered to. Proper ex- ercise should be had daily, in the open air if possible; but if this is impracticable, exercise with the Home Gymnasium should be kept up daily. Flannel should be worn next to the skin throughout the greater portion of the year, cold bathing *See page 360. SCURVY. 275 should be avoided; the bowels, kidneys, and skin should be kept active so as to keep up proper elimination. If the patient appears weak and debilitated some good tonic should be ad- ministered. For agreeableness of taste and reliability of ac- tion, we believe the preparation of Elixir of Calisaya, Iron and Strychnia, to be the best that can be used. It may be given in teaspoonful doses after each meal, and continued un- til the general strength of the pat'ent is improved. SCURVY. Scurvy is a disease caused by an impoverished condition of the blood, that results in a transudation of that fluid and the formation of large "black and blue" patches on the skin. It is produced by the continued use of salt meats and fish, without fresh meat or vegetables, and is hence often found to prevail among sailors, soldiers, and men working in lumber camps and mines. Those having a debilitated constitution suffer from the disease sooner than the strong and robust, but no one can be kept long on a salty diet without suffering from it. SYMPTOMS.-The person about to suffer from scurvy gradually becomes paler than natural and tires more easily after physical or mental labor. The muscles of the back and legs become sore; the patient grows very sensitive to cold; the mind is despondent; and there is a general feeling of lan- guor and depression. The eyes are sunken, the lips thin and blue, the skin assumes a sallow and mottled appearance with discolored spots, scattered over it, and the weight of the body is reduced. These symptoms may be present for one or two weeks, or they may continue for three or four months. The first symptom of the scurvy itself is manifested in the gums. They become swollen, painful to the touch, bleed on the slightest irritation; and finally large portions slough off and leave the teeth loose and bare. The patient has now grown very weak, and the slightest exertion causes palpita- tion of the heart and difficulty of breathing. Fever develops, but it is symptomatic, instead of a part of the disease. The 276 DISORDERS OF NUTRITION. spots that were at first but slight discolorations are now filled with extravasated blood, and the slightest bruise is followed by an extensive settling of blood under the skin. The skin sometimes ulcerates and is then covered with extensive sores, and these often bleed freely. Bleeding also takes place from the mouth, nose, stomach and bowels. The urine is scanty and in severe cases contains albumen. Treatment.-It is easier to prevent this disease than to cure it when once produced. Cabbage, onions, potatoes, beans and other vegetables, used with salt meats, will pre- vent the derangement of nutrition that causes scurvy. Even when the first symptoms of the disease begin to appear the free use of vegetables will arrest its development. Fresh meats should also be substituted for salt meats, when this is possible. The free use of lime-juice is also valuable aS a pre- ventive and a remedy. To control the tendency to bleeding, io drops of Fluid Extract of Ergot may be given every three hours; while Dialyzed Iron, given in 15 drop doses, four times a day, will act well as a tonic. When there is fever, Quinine should be used instead of the Iron, and here it is best given in solution, as follows; Sulphate of Quinine, 1 dram; Dilute Sulphuric Acid, I dram; water, 6 ounces. Mix, and give a tablespoonful four times a day. In this mixture we not only have the benefit of the Quinine, but the Sulphuric Acid acts as a tonic and also tends to control the bleeding. An ounce of good whiskey should also be given, three or four times a day. When ulcerations of the skin are present they must be treated as recommended under the article on the treatment of ulcers. CHAPTER V. DISEASES FROM SPECIFIC POISONS. Aside from the general constitutional diseases heretofore described as being caused by the introduction into the sys- tem of poisonous germs, we have diseases that owe their origin to the direct introduction of a specific poison, peculiar to themselves, which must be carried through the skin and deposited in the loose underlying tissue, or come in contact with a raw surface, or with a delicate mucous membrane. When the poison is once introduced it propagates itself and after a time develops a disease identical with that from which it was derived. Local changes take place at the point where the poison is first applied, and after a time the quantity of the poison is increased. It is then absorbed into the system and causes constitutional disturbances, often of a serious character. In this class of diseases we include Hydrophobia, Glanders, Specific Symptomatic Fevers, from stings of poisonous insects and bites of serpents, and Syphilis. HYDROPHOBIA. Hydrophobia is a word of Greek origin, and means "fear of water." The term was first used to indicate the disease DISEASES FROM SPECIFIC POISONS. 278 communicated to man by the bite of a rabid dog, at a time when the fear of water was believed to be a leading symptom of rabies, and it has become so identified with the disorder that the name is still retained. Many have questioned the existence of such a disease, communicated by inoculation from a rabid dog, and there has been much controversy on the subject which space will not permit us to review. After a careful study of the entire ques- tion, however, we do not hesitate to draw the following con- clusions : First: That there is such a disease as genuine hydro- phobia, resulting from the bites of rabid animals. Second: That the origin of the disease and the nature of the poison are, as yet, entirely unknown. Third: That genuine hydrophobia in man is very rare. Fourth: That most of the cases reported are simply nervous conditions developed through fear. It is important for the proper understanding of this sub- ject, that we should know something of the symptoms of the disease in the dog; and, therefore, we shall state them briefly. Symptoms of Rabies in Dogs.-The early symptoms of rabies are sometimes obscure, but in the greater number of cases sullenness, fidgetiness, and continued shifting of pos- ture are the most prominent. For several hours the dog may be seen to retreat to his bed or to some dark corner. He shows no disposition to bite; is curled up with his face between his paws; and answers laggardly when called. He at length becomes fidgety, is constantly changing his posi- tion, and gazes steadily for a moment at a time, at the differ- ent persons he is familiar with. The appetite fails; he swal- lows bits of thread, straw, wood, hair, &c., and may vomit once or twice during the early period of the disease. Delirium soon shows itself. After a momentary quiet a rabid dog will start up, and with ferocity depicted on its countenance, plunge with a savage howl to the end of his chain. Then comes a moment's pause, when the eyes close and the head HYDROPHOBIA. 279 droops, but he springs up again as violently as before. There is a slight increase of saliva in the mouth, but the stories told of mad dogs being covered with froth are fabulous. A dog in a fit may froth at the mouth, but not a rabid dog. The saliva soon decreases and becomes thick and adhesive. Thirst now comes on, and the dog will lap water till the jaw and tongue are paralyzed, when he will often plunge his head and even his entire body into the water. The delirium in- creases about the third day and he bites at everything within reach. He leaves home, if loose, and remains away for hours. If confined he makes a peculiar bark and howl, but if at large he makes no noise. He trots in a straightforward course, and will turn to avoid obstacles. He will seldom go out of his way to attack any object, but will do so if annoyed. A naturally savage dog, however, may attack all animals or persons he sees. He soon becomes exhausted, moves with a tottering gait, his head is bent to the ground, his mouth is open, his tongue protrudes, and his tail is drawn between his legs. Finally paralysis ensues, first of the hind quarters, and finally of the whole body, which is soon followed by death. The ordinary duration of the disease is from four to six days, but it may sometimes extend to ten days. So far as is known the disease is always communicated by a rabid dog biting others, and the time for the disease to develop is from two to six weeks. A careful observance of these symptoms would soon con- vince the public that many dogs now pronounced rabid every year, have none of the symptoms of rabies. Were this understood, the element of fear would have less to do in developing hydrophobic symptoms in persons bitten by non- rabid dogs. Symptoms of Hydrophobia.-After a person has been bitten by a rabid animal, there is an absence of all immediate symptoms. The wound heals kindly and no evidence of any trouble manifests itself till the sixth or seventh week, about which time the first intimation of the disease shows itself. DISEASES FROM SPECIFIC POISONS. 280 This period of incubation or latency varies considerably; T>ut it is seldom less than forty days or more than six months. The symptoms that usher in the disease are spoken of as general and special. The general symptoms are undue heat of the body, uneasiness and restlessness, loss of appetite, alternate chills and flashes of heat, and sore throat; then active fever with nausea, vomiting, headache and excitement. These symptoms are soon followed by those of a special character. The scar of the bite becomes irritated, and an itching painful sensation is felt, which sometimes extends along the course of the nerves. The scar becomes red, swollen and inflamed, and often ulcerates, discharging a thin unhealthy pus. The accompanying pain often takes on the character of chronic rheumatism. If the patient is a child, he becomes more shy; if older, he is depressed, lonely, anxious, and manifests a degree of listlessness that passes into a vacant stare, regardless of surrounding objects. Great anxiety is manifested regarding the bite, a sense of weight and pressure is felt upon the chest; the sleep is disturbed and broken by the patient suddenly starting up with frightful dreams. A sense of despondency and gloom settles on the mind, there is a sighing and oppression of breathing, with unusual deep inspirations, and a rough husky voice. A sense of languor and lassitude, with great weakness and heaviness follows, with some slight convulsive twitchings about the face and extremities. These symptoms may continue from a few hours to eight or ten days, before the stage of irritation sets in. This stage is ushered in with stiffness of the muscles of the throat, jaw, and root of the tongue, pains in the stomach, chilliness and drowsiness. All attempts at swallowing be- come difficult and occasion severe paroxysms, hence the great dread of fluids and the subsequent dryness of the mouth and throat, with distressing, burning thirst, that cannot be quenched. The spasm extends to the muscles of the larynx, inducing hurried respiration and a sense of suffocation. The voice is changed and hoarse, the secretions of the mouth and HYDROPHOBIA. 281 throat become viscid, and can only be expelled with diffi- culty, causing a hawking and barking noise in the effort. The convulsive spasms afterwards involve the muscles of the general system, thus inducing convulsions resembling epi- lepsy and tetanus. There is flatulency, vomiting of bile, and frequent urination which soon betomes involuntary. The senses are abnormally acute, and the mind becomes greatly agitated. A fear of even the best friends, and indescribable despair take hold of the patient, sleep is impossible, and finally a rabid impulse is developed, which sometimes causes an inclination to bite. As the disease progresses the parox- ysms increase both in frequency and violence. This stage lasts from twenty-four to forty-eight hours. The paralytic stage marks the last moments of the dis- ease. It is marked by rapid depression and nervous exhaus- tion, intermission of the paroxysms, incoherency and delirium. The pulse becomes small, quick and irregular; the skin is covered with a clammy sweat; the eyes are dull and sunken; the pupils large; the mouth remains open; the saliva runs out, or passes back into the throat, causing a gurgling noise and choking. Death takes place at this time either from exhaustion, or by suffocation during one of the convulsive attacks. These are the symptoms that attend a true case of hydrophobia, but fortunately they are rare. They are ob- served with considerable uniformity in young children and in those who have heard nothing of th-e disease, and in these cases the difficulty of swallowing is not associated with the fear of water. When similar symptoms are developed without change in the scar of the bite, or before the fortieth day, or after six months from receiving the bite, the case may be set down as a spurious one, caused by fear. Treatment.-The treatment of this disease is not satis- factory, and, as far as known, when a true case of hydropho- bia occurs, it is almost certain to prove fatal. As soon as a person is bitten with a rabid dog the wound should be well 282 DISEASES FROM SPECIFIC POISONS. sucked out, and touched with pure Carbolic Acid, to prevent the poison from entering the system. It is always safest to have the tissue around the wound cut out with the actual Galvanic cautery. This prevents the poison from getting into the blood, and thus the disease is stopped. Hot air baths are also said to be good for such cases, and may sometimes give marked relief. No medicine, so far as we know, has yet been found that exerts the slightest influence in the way of curing ■the disease. GLANDERS. Horses and mules often suffer from a disease of the mucous membranes of the nose, attended with violent inflam- mation and a profuse discharge of thick, fetid matter. The salivary glands are extensively involved, and it is hence called glanders. It soon affects the whole system, and though it often arises spontaneously in half-starved and over- worked animals, it is both contagious and infectious. This disease is often transmitted to man from the affected animals, and has also been known to be communicated from ■one individual to another. SYMPTOMS.-Soon after inoculation the patient com- plains of languor and pains in the head, back and limbs. A ■chilly sensation alternating with flashes of heat is next felt, the joints become stiff and sore, the appetite is impaired, the stomach is irritable, bowels are constipated, and sleepless- ness supervenes. These symptoms continue for from thirty- six to forty-eight hours, and are then followed by a severe rigor, followed by violent fever and profuse perspiration. The pulse now becomes quick and unsteady, the tongue dry and covered with a brownish fur, and the general symptoms of typhoid fever become manifest. A severe inflammation of the mucous membrane of the nose also develops, which is followed by a free viscid and fetid discharge. Prostration comes on rapidly, an offensive odor is given off from the entire body, and profound stupor GLANDERS. 283 sets in about the eighth or tenth day, and death usually takes place within three weeks, and sometimes as early as the eighth day. Treatment.-Care should always be taken to protect cuts and sores from contact with the saliva of animals at all times, and particularly when they are diseased. If contact should be had with the secretions from an animal suffering with the glanders, the part should be thoroughly cleansed with a solu- tion of Carbolic Acid, 5 drops to the ounce of water; and if there is an abraded surface, it should first be cleansed and then thoroughly cauterized with the pure 95 per cent. Car- bolic Acid. The acid is best applied with a pine stick. For the general treatment we must depend on remedies that will support the vital strength of the system. Qui- nine may be given in 10 grain doses every three or four hours, and an ounce of brandy every two hours will also be required. The nose should be frequently syringed with a solution of 3 drops of Carbolic Acid to the ounce of warm water. The diet should be nutritious and bounteous, the ventila- tion of the sick room should be scrupulously attended to, and when possible a change of air is desirable. POISONOUS INSECT WOUNDS. There are various kinds of insects that secrete a poison which can be thrown into the puncture made by the sting. When a person is stung by these insects, a sharp, hot, itching pain is felt at the seat of the wound, and after a few moments the part becomes swollen and the elevation usually pre- sents a white appearance. Sometimes the sting is left in the wound, and then the inflammation is more severe. If a per- son is stung by a large number of bees or hornets, at one time, the symptoms are often so severe as to be followed by death. The bite of the mosquito is also very annoying and to many persons extremely poisonous. 284 DISEASES FROM SPECIFIC POISONS. Various kinds of spiders inflict bites that become greatly inflamed, and sometimes cause a general febrile condition of the system. The bite of the scorpion is usually severe, and may often produce constitutional disturbance as well as local inflamma- tion. Treatment.-Wounds inflicted by stinging insects should be carefully examined so as to detect the presence of the sting in the wound. Various applications are recommended to relieve the irritation. Among these, Spirit of Camphor, Vinegar, Hartshorn, and salt water have been recommended. About the best thing for this purpose is a solution of io drops of Carbolic Acid to the ounce of Sweet Olive Oil. In severe cases a warm application of hops may be applied with advan- tage. The same application will be found valuable in the bites of all poisonous insects. If the oil is objectionable, io drops of the Acid may be mixed with an ounce of Alcohol, in place of the oil, and applied to the surface. If the bites are severe, as those inflicted by the scorpion or spider often are, they should be cauterized with the strong Carbolic Acid, and then have applied to them a hot poultice to reduce the in- flammation. Brandy may also be given to keep up the strength, and if there is much fever, two drops of the Fluid Extract of Veratrum Viride can be given with advantage, every two hours. WOUNDS OF VENOMOUS SERPENTS. Poisonous serpents are found in different parts of the world, and they are often liable to inflict wounds on man, and at the same time inject into the wounds thus made, a small quantity of poisonous matter, that may soon develop serious symptoms in the victim of the bite. As a rule, bites of poisonous serpents are attended by excessive pain at the seat of the wound, which is speedily followed by inflammation and swelling. Depression of the system soon occurs as a result of the absorption of the poison. SYPHILIS. 285 The patient looks pale, is nauseated, shows a tendency to swoon, has clammy sweats and coldness of the body. Breathing then becomes oppressed, the mind wanders, or furious ^delirium develops, which soon results in death. Treatment.-As soon as a wound of this kind is inflicted, it should be placed to the mouth and sucked for several min- utes, with the view of thus removing the poison. If the patient cannot do this some one should do it for him, and unless there is a raw surface in the mouth, no harm can come of it. The wound should then be thoroughly cauterized with the pure Carbolic Acid, and a large flaxseed meal poultice should be applied afterward. It may be safer to have all the tissue surrounding the wound removed by means of the Gal- vanic cautery, but this can rarely be done in time to prevent the poisoning of the general system. In spite of all that has been said about various remedies for the cure of these poisonous bites, none has yet been found to take the place of alcohol. As soon as a bite is inflicted whiskey should be freely administered and continued for several days, till the effect of the poison is overcome. Then io or 15 grains of Quinine should be given three times, a day, and nutritious food should be administered to build up the strength. When alcohol fails the case is invariably hope- less. Syphilis is a disease that is supposed to originate from impure coitus. It first appears as a local sore on the genitals, the poison of which assumes a specific character, and is capa- ble of producing a similar sore on a healthy person. After a certain time the poison of the sore is absorbed into the gen- eral system and poisons the blood. The local sore is spoken of as primary syphilis or chancre, and the poisoning of the blood is generally spoken of as secondary or constitutional syphilis. The . disease has been known among all nations, and from the earliest time of which we have any record; and much diversity of opinion has always prevailed in regard to its origin. It is enough for our purpose, however, to know SYPHILIS. 286 DISEASES FROM SPECIFIC POISONS. that it is propagated by contagion, and that the poison must come in contact with an abraded surface, or a delicate mucous membrane. Many authorities claim that there are two poisons capable of producing sores on the genitals, but that only one of these can develop constitutional syphilis. We believe, however, that we have abundant evidence to prove that both these poisons have a common origin, and that the conditions presented are due to special circumstances. We further believe that constitutional syphilis may be produced by either, and at all events it is best to err on the safe side and to treat all venereal sores as though they might produce constitutional syphilis. Chancre.-The term chancre is used to designate the primary local sore of syphilis, and as these sores take on widely differing appearances, they are usually described as the indurated, or hard chancre; the non-indurated, or soft chancre; and the superficial erosion. Though they may occur on any part of the body to which the poison is applied, they are rarely met with excepting on the genital organs. After exposure to the contagion, a period varying from five or six days to six weeks may elapse before the local sore develops; and the longer the period between the exposure and the development of the sore, the more likely will the sore be to produce constitutional syphilis. The hard chancre develops in a small circular or oval shaped pimple. A small vesicle appears on the top which ruptures and leaves a slight excavation in the center of the sore. It secretes but little and has a tendency to heal rapidly. The underlying surface is hard or indurated and this condition remains after the pimple has disappeared. This form of sore does not develop until from three to six weeks after the exposure. When the local sore first appears as a pustule, and then ruptures, leaving an open ulcer underneath that discharges freely and is inclined to spread, the condition is spoken of as soft chancre The surrounding tissue is not hard at first, and other similar sores are likely to develop near it. It does not heal so rapidly as the hard chancre and presents CHANCRE. 287 more the appearance of an ordinary ulcer. In some cases the surrounding tissues become hardened, and when the ulcer heals the hardness remains the same as in the hard chancre. Sometimes the delicate mucous membrane is chafed, and presents an irritated condition for a few days with the surface glued over with a clear serous secretion. This condition is often so slight as to escape the notice of the patient, and even when it is noticed it rarely awakens any apprehension, as a little attention to cleanliness for two or three days will cause it to disappear entirely. Yet, with- out any other local irritation or sore, constitutional syphillis. may be developed, and this fact has given the name super- ficial erosions to such conditions of the mucous membrane. Sometimes severe inflammation may supervene upon any of these local conditions, and thus occasion extensive ulcerations of the surrounding parts. Treatment of Chancre.-No sore of the genitals should be neglected. The objects to be attained in the treatment of chancre are, first, to cure the local sore, and second, to pre- vent the poison from entering the system. As soon as a chancre is seen it should be cauterized with a 95 per cent, solution of Carbolic Acid. To do this, the sore should be well cleansed and the acid applied with a sharp pine stick, or the end of a match. The moisture of the sore should first be absorbed by a piece of dry cotton, and then the point of the stick, completely saturated with the acid, should be ap- plied to every point of the sore and the underlying indura- tion until the whole surface presents a white appearance. The cotton should be at hand to prevent the acid from running over the healthy tissue, and for this purpose the part must be thor- oughly dried as fast as is necessary. The Carbolic Acid thus applied destroys all specific and septic poisons on the start, and thus converts the sore into a simple ulceration. At a subsequent dressing the following will be found advantageous: Carbolic Acid, (95 per cent.) 20 drops; Glycerine, 2 ounces; Rose Water, 2 ounces. Mix, and apply to the sore with a small piece of surgeons lint. The lint should be placed over the sore, and in such a way as to prevent it from coming- 288 DISEASES FROM SPECIFIC POISONS. in contact with the surrounding parts. This dressing may be applied twice a day, and if a tendency to heal is not manifest- ed, in two or three days, the part must be again cauterized with the acid as before described. The utmost cleanliness should be observed, and the parts washed thoroughly before each dressing. With a view of preventing constitutional syphilis, such general treatment is adopted as will tend to eliminate the poison before it affects the system. If the patient is strong and robust, the following may be used with advantage: Iodide of Potassium, 4 drams; Fluid Extract of Poke Root, I ounce; Compound Syrup of Stillingia, 5 ounces. Mix, and give one teaspoonful three times a day, after eating. If the patient is weak and debilitated it is best to begin the treat- ment with the administration of some good tonic. The Elixir of Iron, Quinine and Strychnia, may be used to advantage. It should be given in teaspoonful doses, three times a day, after meals. The tonic should be continued for a couple of weeks, and then the Iodide of Potassium mixture just des- cribed should be given in its place for the same space of time. To be on the safe side, these remedies should be al- ternated in this way and continued for about three months. If no constitutional symptoms develop by that time the pa- tient may be considered safe. Constitutional Syphilis.-After the primary sore has disappeared there is an interval during which there is no evi- dence of the existence of any disease, but after variable periods of time the poison becomes active, and gives rise to various complications of the skin, mucous membrane, the covering of the bones, and other portions of the body. These conditions are described as secondary, general or constitutional syphilis. According to the observations of various investigators, the period of incubation varies from 25 to 120 days, but in the majority of cases the constitutional symptoms show them- selves in from 40 to 50 days after the first appearance of the primary sore. When the person is debilitated from any cause, and the vital powers considerably lowered, the period of CONSTITUTIONAL SYPHILIS. 289 incubation is short, while the strong and robust naturally resist the poison, and a long time elapses before the constitutional symptoms are developed. When a proper treatment is resorted to early, the appearance of the constitutional symptoms is gen- erally retarded, if not entirely prevented. We can usually con- sider our patient safe from general syphilis after three months have elapsed, and after six months we can be positively assured that constitutional syphilis will not develop. Among the secondary symptoms are enumerated various affections of the skin, spoken of as syphilitic eruptions; ulceration of the mu- cous membranes; falling out of the hair; ulcerations at the roots of the nails; enlargement of the lymphatic glands, es- pecially of the neck. Gummy tumors also form under the skin, and the periosteum and bones become involved in in- flammation and ulceration. These latter are usually spoken of as tertiary symptoms. The constitutional symptoms of syphilis appear with much more regularity than is usually supposed. A patient who has been subjected to no treatment for primary syphilis will, as a rule, be attacked by the following symptoms within three months, viz: first, a feeling of lassitude with headache, and occasional darting pains in different parts of the body, loss of appetite, and more or less febrile symp- toms ; second, irritation of the throat, which is soon fol- lowed by enlargement of the soft palate, characteristic in- flammation and marked soreness of the throat; third, cuta- neous eruptions in the form of scaly blotches, pimples, or cop- per-colored spots, that first make their appearance on the breast and arms, and afterward over the whole body; fourth, enlargement of the glands of the groin and neck; fifth, the appearance of whitish patches and superficial ulcerations upon the mucous membrane of the mouth, and pustules of the scalp. All these symptoms do not appear in one person, but may oc- cur in one case and be absent in another. This is undoubtedly due to the constitution of the patient, the hygienic surround- ings and the treatment given for the primary disease. Some- times the secondary symptoms show themselves before the sore has disappeared. In such cases the healing of the primary 290 DISEASES FROM SPECIFIC POISONS; sore has been protracted beyond the period of three weeks. Some of the secondary symptoms, particularly the mucous membrane eruptions, may disappear without treatment and again show themselves the same as before. When such is the case the interval of time between the disappearance of the eruption and Its re-appearance is brief, and if a year passes without a re-appearance of any such eruptions, the patient may be considered safe from another attack. Treatment of Constitutional Syphilis.-The treatment of constitutional syphilis may properly be divided into hygienic, tonic, and alterative, and each of these should receive due attention. Upon the hygienic condition of the patient much of our success in the treatment of syphilis depends. Syphilitic patients should have a generous diet of the most nutritious kind of food. Without this the vital powers are reduced, the disease is permitted to make greater progress, and a long time is necessary to overcome the effects of the virus. The functions of the skin should be kept regular by means of fre- quent bathing. The Turkish or sulphur vapor bath will be found of great value in these cases. The bowels should be kept free and soluble by taking one Compound Podophyllin pill,*every night at bed time. Flannel should be worn next to the skin and changed frequently; the room occupied by the patient should be well ventilated; daily exercise should be taken, but not to fatigue; sudden changes of temperature and exposure to a damp or chilly atmosphere should be avoided; and the mind should be occupied in reading or by the society of friends. Careful observance of these rules will help in all cases of syphilis. Tonics constitute an important class of remedies in this disease. The general health of syphilitic patientsis usually below the normal standard, and the best thing to be done is to give such remedies as will certainly restore the vital powers. These are always at hand and consist of vegetable tonics, Quinine, Iron and Cod Liver Oil. Iron will always be found serviceable when general debility exists. A good combination is had in the form of Saccharine Carbonate of * See page 360. SYPHILIS. 291 Iron and Manganese. This preparation makes a pill mass which may be divided into 3 or 4 grain pills. From one to three of these pills may be given three times a day, and con- tinued until a general improvement of the health is percepti- ble. In place of the pills, the same remedies may be given in the following form : Carbonate of Iron, 2 drams; Carbonate of Manganese, 2 drams; Tincture of Colombo, 4 ounces; Simple Syrup, 4 ounces. Mix, and give a teaspoonful three times a day, after meals. The bottle should be well shaken before administering the dose, as a sediment settles to the bottom. Sometimes cases are met with where there seems to be marked febrile symptoms at regular intervals. In such cases Quinine may be found the most serviceable remedy that can be used; and it should be given in 5 grain doses three or four times a day. Again, we often meet with cases in which these remedies fail to accomplish any satisfactory results, but a marked improvement is observed after the use of Cod-Liver Oil. If the patient gives evidence of nervous prostration, Strychnia and Phosphorus are the remedies to be employed. These may be given in combination in the form of the Strychnia and Phosphorus pills, one of which may be given after each meal. After building up the general health of the patient by means of hygienic influences and tonics, specific treatment may then be resorted to, but in no case should the tonics be so long omitted as to endanger again relapsing into a state of general debility. The alterative treatment can be used from the first in strong robust patients, but not until the general health is improved in weak and debilitated ones. These remedies an- tagonize the influence of the specific poison in the system, but if continued too long they may impoverish the blood. When such results become apparent they should be discon- tinued, and the patient placed on the tonic treatment just described. The remedy most commonly used as an anti- syphilitic is Iodide of Potassium, and it may be given alone or combined with other remedies. The following is a valuable form of administering it: Iodide of Potassium, 4 drams; Fluid Extract of Poke Root, 1 ounce; Compound Syrup of 292 DISEASES FROM SPECIFIC POISONS. Stillingia, 5 ounces. Mix, and give a teaspoonful three times a day, after meals. Sometimes a change in the form of the mixture is desirable, so that after the above has been taken for a few weeks it may be replaced by the following: Iodide of Potassium, I dram; Muriate of Ammonia, 1 dram; Com- pound Tincture of Cinchona, 4 ounces. Mix, and give a tablespoonful three times a day, after meals.* It is always best to commence treatment for constitu- tional syphilis as soon as the local sore is discovered, and to continue it for about three months. If at the end of that time no general symptoms manifest themselves, the treatment may be discontinued without any danger to the patient. If general symptoms have developed, the treatment is not to be discontinued for from three to six months after all syphilitic symptoms have disappeared. Under ordinary circumstances it is best to continue the use of the alterative remedies for one or two weeks, and then to use the tonics for the same period of time. This alternation of the remedies will be found the most successful in the treatment of this disease. Syphilitic Buboes.-Sometimes, after the development of the primary syphilitic sore, the glands of the groin become swollen and enlarged, and this abnormal action frequently extends to the formation of abscesses. This glandular en- largement is due to the absorption of the virus, and it is an intermediate condition between primary and constitutional syphilis. The term bubo has been applied to these enlarged glands. It will often happen that a number of the glands of the groin will be considerably enlarged, though but one or two may go on to suppuration. These enlargements usually appear at the end of the first week or ten days after the development of pus in the chancre, though it may come on at any time during the existence of the primary sore, or a week or two after it has healed. The nature of the bubo may be recognized by its gradual development, and the distinct evidence of the enlargement of more than one gland; while it may be distinguished from rupture in not being pushed downward with every effort at coughing. * See page 359. BUBOES. Treatment of Buboes.-If the buboes are painful the patient should be kept as quiet as possible, and at the onset cold applications to the part will be found serviceable. The local application of equal parts of Iodine and Fluid Extract of Poke Root, will be found valuable in preventing the in- flammation. This mixture should be applied two or three times a day, with a small brush, and if the inflammation be- comes severe, the part should be wet with the following pre- paration: Muriate of Ammonia, I dram; Alcohol, I ounce; water, 5 ounces. Mix, and apply three or four times a day by saturating a piece of lint with the mixture, and laying it over the bubo. If this does not control the inflammation, a hot linseed meal poultice should be applied and changed every couple of hours until the bubo has become soft. This indi- cates the formation of pus which should be relieved. As soon as this is present, the bubo should be opened freely. If a surgeon is not at hand the poulticing should be continued until it opens of its own accord. After the pus is discharged the cavity should be washed out two or three times a day by injecting into it a solution of Carbolic Acid (95 per cent.) containing 5 grains to the ounce of water. The sore should then be dressed as described under the head of antiseptic dressings. 293 CHAPTER VI. DISEASES OF THE DIGESTIVE SYSTEM. The importance of the function of digestion to the health of the general system cannot be over-estimated; and the reader should carefully study what was said in the first and second chapters of Part I., regarding the structure and func- tions of the various organs forming the digestive apparatus. This will prepare him to understand the various departures from the normal condition, that will be described here as dis- eases of the digestive system. We will first consider the de- rangements that affect the mouth, and follow with those affecting the several parts of the alimentary canal. Then we shall take up the diseases of the accessory organs, as the liver, pancreas, and spleen, and such parts of the abdominal contents as may be connected with these organs. STOMATITIS. Stomatitis is the term used to designate an inflammation of the mucous membrane of the mouth. There are several varieties of the disease, which are known as simple, aphthous, ulcerative, and parasitic. STOMA TITIS. 295 Simple stomatitis is usually caused by local irritants, as tobacco, condiments and hot drinks; but it is sometimes the continuation of a catarrhal inflammation affecting the stomach and oesophagus. The aphthous form of the disease is common to early life, but may occur at all ages. Feeble and delicate children, who live under bad hygienic conditions, are liable to it. It is usually dependent on disorders of the stomach and bowels, and often follows a prolonged diarrhea. The ulcerative form may develop from a simple stomatitis in persons whose vital energies are depressed from any cause; and the parasitic form is due to the irritation caused by the lodgment of a parasite in the mouth. Symptoms.-In simple inflammation of the mouth, the muc.ous membrane becomes dry, rough, swollen, and of a dark red color. After a few hours the flow of the saliva is largely increased, and the taste is perverted or entirely destroyed by the foulness of the secretion. Every movement of the lips or tongue causes considerable pain, as does also hot or cold fluids when taken into the mouth. The aphthous form of the disease is characterized by a grayish or yellowish white exudation, which appears in small round or oval-shaped patches. These soon run together and form large sized patches on the inside of the cheeks and lips, and on the roof of the mouth. This exudation is thrown off in two or three days, and a raw, ulcerated surface is left underneath, that requires a week or two to heal. The pain is often severe in this form of inflammation, the salivary glands are enlarged and sensitive on pressure, there is more or less fever, especially in children, and the digestive organs become impaired. This condition is aphtha and is popularly known as thrush. In many cases where aphthae occurs in children of feeble constitutions, whitish, curd-like masses are seen on the palate, tongue, cheeks and lips. These are produced by the growth 296 DISEASES OF THE DIGESTIVE SYSTEM. of parasites deposited on the inflamed surfaces, and when they become detached the disease is extended along the entire alimentary canal, from swallowing the parasitic mass. When thus extended diarrhea often sets in and the curd-like masses are seen in the passages; while the verge of the anus presents the same condition as the mouth. It is this form of aphthae that is commonly called "sprew." In some cases the inflammation extends to the formation of large ulcerated patches, that become excessively painful and difficult to heal. Treatment.-In the treatment of inflammations of the mouth too much attention cannot be given to diet. Acids of all kinds, sweets and condiments must be avoided. Fluids must neither be too hot nor too cold when taken into the mouth, and in severe cases solid foods should be avoided till the severity of the symptoms subsides. If the disease is due to inflammation or ulceration of the stomach, or to dyspepsia, these conditions must be treated as indicated in the articles on those diseases. The surfaces of the ulcers should be cleansed with pled- gets of lint, and then touched with a pine stick, saturated in pure Carbolic Acid. As soon as touched with the Acid the surfaces must be dried with the lint to prevent injury to the surrounding tissues. After this the mouth must be thor- oughly washed several times a day, with the following: Car- bolic Acid (95 per cent.), 1 dram; Glycerine, 2 ounces; water, 6 ounces. Half a teaspoonful of this mixture, should be diluted in water, and given internally three or four times a day in the aphthous form of the disease. This will destroy the germs or parasites that are thrown from the surfaces and pass into the stomach, and will at the same time allay the gastric irritation. Chlorate of Potash is also a valuable remedy in all forms of this disease, when given in 15 grain doses three times a day. The dose for children must be in proportion to the age. If the patient is debilitated, from 2 to 5 grains of Quinine should be given every four hours. INFLAMMATION OF THE TONGUE. 297 INFLAMMATION OF THE TONGUE. Glossitis is the term applied to inflammation of the tongue. It may be confined to the mucous membrane or may extend to the body of the tongue itself. When the mucous membrane is alone involved, the inflammation may result from the contact of hot liquids, or other local injuries. The deeper seated inflammation may also be caused by local injur- ies, but it more frequently results as a complication of erysip- elas, small-pox, typhoid fever and blood poisoning. Symptoms.-Inflammation of the tongue is marked by? swelling and redness, which is soon followed by peeling off of part of the mucous membrane. Taste is impaired, pain is felt when anything hot or cold is taken into the mouth, and the flow of saliva is increased. When the tongue itself is involved the pain is very great, and the swelling of the organ may extend to such a degree as to endanger life by interfering with respiration and deglutition. In these cases, the glands of the neck are also considerably swollen. After inflamma- tion has continued for a time, there is a severe chill, followed by fever, which usually indicates the formation of pus. Treatment.-In the simple superficial inflammation of the tongue the mouth may be washed with -a weak solution of Carbolic Acid, (5 grains to the ounce of water), and all sub- stances that might produce irritation when taken into the mouth should be avoided. When the inflammation is more deeply seated, mustard plasters may be applied under the angles of the jaw, water as hot as can be borne should be held in the mouth, and a stronger solution of Carbolic Acid (10 grains to the ounce of water) can be used as a wash with advantage. If the tongue becomes greatly swollen a physi- cian should make two or three incisions with a view of re- lieving the congestion and thus preventing suppuration. The deep seated throbbing pain indicates the formation of pus, and when this is present a free incision should be made in the tongue to allow the pus to escape. This prevents further destruction of tissue and the symptomatic fever. To control the fever the following may be given: Fluid Extract of 298 DISEASES OF THE DIGESTIVE SYSTEM. Aconite Root, 10 drops; Fluid Extract of Veratrum Viride, 15 drops; water, 4 ounces. Mix, and give one teaspoonful every hour. If this does not completely control the fever, we give in addition 20 grains of Quinine night and morning. A free incision will invariably prevent the extensive swelling which so often obstructs respiration, and at the same time enables the patient to take proper nourishment. In addition to milk, beef essence and eggs, alcoholic stimulants must be given in all severe cases. INFLAMMATION OF THE (ESOPHAGUS. The canal leading from the mouth to the stomach is sometimes the seat of an inflammation. The condition is technically called oesophagitis, and is popularly known as catarrh of the oesophagus. The disease may be acute or chronic, and often takes on an ulcerated character. It is sometimes produced by contact with irritants in the same way as inflammation of the mouth or tongue is occasioned, and it may occur as a complication of scarlet fever, small- pox, or diphtheria. SYMPTOMS.-In the acute form of this disease swallowing is always accompanied by pain, though in the chronic condi- tion pain may not be noticed excepting \Vhen hot foods are taken. If ulceration is present along the canal, food, when swallowed, passes to that point and is there forced back by a spasmodic contraction of the oesophagus, caused by the irri- tation of the food coming in contact with the ulcerated sur- face. In the chronic condition a considerable quantity of tenacious mucus rises in the throat, and is then thrown off. When these symptoms are present, pressure carried along the neck, just behind the wind-pipe, will cause a pain in the oesophagus. Treatment.-Solid foods must be avoided as much as pos- sible, so as to prevent the irritation of the inflamed surfaces during the act of swallowing. A tablespoonful of weak solu- tion of Carbolic Acid (5 drops to the ounce of water) should STRICTURE OF THE (ESOPHAGUS. 299 be swallowed slowly, three or four times a day, and the Aconite and Veratrum recommended in the inflammation of the tongue, should be used when fever is present. Mustard plasters along the sides of the neck will also be found service- able. The most important thing, however, is to give the stomach as much rest as possible. STRICTURE OF THE (ESOPHAGUS. By stricture of the oesophagus we mean a narrowing of this canal. This condition may result as a sequence of inflam- mation and by the contraction of scars formed by the heal- ing of ulcers. Fibroid, and other tumors, may also develop in the canal and thus produce obstruction. Lodgment of foreign bodies and the contraction of the muscles of the oesophagus, caused by irritation of the mucous surface, may also temporarily obstruct the passage. Symptoms.-The first symptom of stricture of the oesoph- agus is a sense of obstruction to the passage of food which the patient distinctly feels at a certain point. At first, re- peated attempts at swallowing are necessary to carry the food through the constriction, and then considerable water must be used before this can be accomplished. The seat of the obstruction can generally be indicated by the patient, and a pressure at this point will produce a cough and difficult breathing. As the obstruction increases, hunger and thirst are constantly present, and the body becomes emaciated. When these symptoms come on suddenly we can usually ascertain the history of some injury inflicted upon the oesophagus. Spasmodic contraction of the oesophagus may tempor- arily occur when inflammation or ulceration is present; and when these conditions are relieved the spasms will disappear. It may also be associated with nervous disorders, which must be overcome before the spasm can be relieved. When the stricture is due to cancer of the oesophagus, the enlargement at the part continues to increase, darting 300 DISEASES OF THE DIGESTIVE SYSTEM. pains extend from it in every direction, and after a time a fetid mixture of pus and mucus is ejected. Treatment.-As soon as any obstruction in the oesopha- gus is recognized a competent surgeon should be consulted. His first duty would be to ascertain the cause of the obstruc- tion, after which he may adopt such surgical means as will be best calculated to afford relief. ACUTE GASTRITIS. Acute gastritis, or inflammation of the stomach, fre- quently occurs as the result of sudden atmospherical changes. It is more commonly produced, however, by swallowing liquids too hot or too cold, excessive eating, the use of con- diments, and the continued use of strong alcoholic drinks. Symptoms.-The first symptoms are loss of appetite, painful digestion, sleeplessness, and headache over the eyes, that is increased by light, or by sudden movements of the head. In some cases severe vertigo sets in, which may cause the patient to lose consciousness for a few seconds. There is a boring pain in the stomach which is increased by pressure; the tongue is enlarged, covered with a yellowish white coat- ing and marked on the sides by the indentations of the teeth; there is a bitter or putrid taste in the mouth, and food excites disgust; there is a great thirst and acid drinks are particu- larly desirable; a nausea soon comes on and is followed by vomiting, first of the alimentary substances, and finally of bilious matter. If the vomiting occurs after a hearty meal the amount vomited is excessive. The symptoms are aggra- vated by taking food into the stomach, as it cannot be properly digested, and this failure to digest the food results in decomposition, which is followed by a foul odor of the breath and the eructations of fetid gases. This causes heart- burn, and a distended condition of the stomach. In mild cases, little or no fever is present, but in the severer forms of the disease the fever runs high, and continues for several ACUTE GASTRITIS. 301 days. Such cases are usually spoken of as " gastric fever/ and may sometimes be mistaken for remittent fever. The disease usually lasts from four days to a week, but may be aborted by a free evacuation of the stomach or bowels. In some cases, a vesicular eruption appears on the body as the disease subsides, while in others there is profuse perspira- tion. It is sometimes spoken of as "acute catarrh of the stomach." Treatment.-Ordinary cases of acute inflammation of the stomach only require the quiet, secured by an entire absti- nence from food. If there is great distress and pain in the stomach, occasioned by the irritation of indigested articles of food, vomiting should be induced ,by swallowing draughts of hot mustard water or salt and water. After the contents of the stomach has been thrown off, food should not be taken till the symptoms subside. Vichy water may be drank freely to allay the thirst, and carbonic acid water, or lime water, may be employed to allay the continued nausea. One or two drops of Carbolic Acid, largely diluted in water, may also be given every three hours for the purpose of arresting fermenta- tion. A large mustard paste may be applied directly over the stomach and kept there for twenty minutes, or half an hour, or till the skin is well reddened. After the acute symptoms have passed the Fluid Extract of Nux Vomica will tone the stomach and improve the appetite. It may be given as fol- lows: Fluid Extract of Nux Vomica, 30 drops; water, 4 ounces. Mix, and give a teaspoonful every two or three hours. If the bowels are constipated and the tongue heavily coated, one Compound Podophyllin PilFshould be given at bedtime for several nights. When food is taken it should at first consist chiefly of milk and animal broths, and solid food should be avoided until the stomach has gained its natural tone. CHRONIC CATARRH OF THE STOMACH. Chronic catarrh of the stomach is the designation usually given to a long standing, or chronic inflammation of the * See page 360. 302 DISEASES OF THE DIGESTIVE SYSTEM. mucous membrane of that organ. The disease may succeed an acute inflammation or may be induced by long continued and excessive use of alcohol. Highly seasoned food, sauces, imperfect mastication of food, and over-feeding, tend to excite active congestion which may in time develop into in- flammation. SYMPTOMS.-Frequent attacks of acute inflammation of the stomach, with the severe symptoms attending that disor- der, will in time cause a condition in which the patient is never free from distress and uneasiness of the stomach. A feeling of weight and fullness, sometimes associated with pain, is felt after eating, and soreness that is increased by pressure extends over the entire region of the stomach. In some cases pain is relieved by taking food, while in others it is increased. There is a marked distention of the stomach immediately after eating which is caused by the formation of gases. This distention crowds the diaphragm against the heart and causes palpitation of the heart. In many cases the face is red and the head feels full, while headache and vertigo are present for an hour or two after taking food. Later in the disease vomiting takes place, although it is not present in all cases. The appetite is dimin- ished, and small quantities of food seem to satisfy hunger. Constipation and flatulency are usually present, although attacks of diarrhea sometimes occur. The nutrition of the body is impaired, the strength is diminished, and the various functions are sluggishly performed. The patient becomes melancholy and hypochondriacal, and is constantly thinking of his own condition. This disease may last for months or even years, the patient sometimes suffering severely and again remaining comparatively comfortable for a time. Treatment-In this, as in all other diseases of the stomach, special attention must be given to the diet. All articles that produce any unpleasant sensation should be omitted. Foods containing sugar, starch and fat are likely to decompose and cause an acid condition of the stomach, and should therefore be avoided. In commencing the treat- ment of these cases it is best to abstain from all kinds of food CHRONIC CATARRH OF THE STOMACH. 303 for twenty-four hours, drinking in the meantime a gobletful of hot water three or four times a day. The object of this is to free the stomach from its decomposing contents, and should the hot water produce nausea and free vomiting, all the better. When food is taken, the exclusive use of skim-milk for a few days will be found of great advantage. It may be taken in quantities of four or five ounces every three or four hours. Indeed the continuation of this diet, without medicine, will often do more to cure a case of chronic catarrh of the stomach than any other treatment that can be adopted. If it is kept up for a few weeks, and the symptoms of the disease have subsided, wheat bread, rice, and soft boiled eggs, may be gradually added. After this, lettuce, celery, spinach, tomatoes, cauliflower, etc , will form impor- tant articles of diet. During the milk treatment no medicine should be em- ployed, except something to keep the bowels relaxed, and for this purpose a Compound Podophyllin pill* may be taken every night, or every alternate night, as required. A glass of hot water drank every morning will also prove beneficial. In some instances good results may be obtained by ap- plying a mustard plaster over the stomach every day, for twenty minutes or half an hour until a decided irritation is produced. In other cases a Spanish Fly blister, as large as the hand, may be placed over the stomach and left there until a large blister is raised. The vesicles should then be clipped with a scissors and a poultice of linseed meal applied to increase the flow of serum. The blistering will often give great relief and the sore created is comparatively slight. Of the medicines used in this disease Arsenic is one of the best. It may be given in the form of Fowler's Solution in one or two drop doses, three times a day before meals, and may be continued with advantage for a month or six weeks. Should acid eructations or nausea be present, two drops of Carbolic Acid in a tablespoonful of Glycerine should be given after each meal. When the irritation has subsided to some extent tonics are needed, particularly when there is a lack of nerve power in the stomach. The following mixture will be * See page 360. 304 DISEASES OF THE DIGESTIVE SYSTEM. found serviceable: Fluid Extract of Nux Vomica, i dram; Fluid Extract of Golden Seal, 4 drams; Glycerine, 1 ounce; water, enough to make 4 ounces. Mix, and give one tea- spoonful before each meal and at bedtime. The Compound Podophyllin pills should be continued every night, with a view of overcoming the torpid condition of the liver and regulating the bowels. The custom of using Soda in these cases often does more harm than good, and should not be resorted to. DYSPEPSIA. Dyspepsia is a term applied to all conditions of imper- fect digestion that are not dependent on changes of structure in the digestive organs. The causes of dyspepsia are numer- ous, and the symptoms, consequently, vary greatly in differ- ent cases. The secretion from the mucous membrane may be scanty, or too profuse; the gastric juice may be deficient or excessive, or changed in quality; the muscular movements may be impaired; the pancreatic and intestinal juices may'be deficient in quantity and quality; or there may be an irritable or prostrated condition of the nervous system. SYMPTOMS.-A feeling of weight and tension in the region of the stomach, with a bad taste in the mouth, fetid breath, nausea which may extend to vomiting, heavily coated tongue, sometimes a disgust of food, unpleasant eruc- tations for several hours after eating, and alternating consti- pation and diarrhea, are the symptoms that indicate an excessive secretion of mucus. Continued irritation of the stomach, heartburn, both before and after eating, a feel- ing of soreness when the stomach is distended, and an annoy- ing contracted feeling when emptied, indicate a scanty mucus secretion. Irritation of the stomach, accompanied with slight pain and water-brash, or the rising of a sour liquid into the mouth, indicate an increased secretion of the gastric juice. DYSPEPSIA. 305 Distention of the stomach, with an uneasy sensation of fullness, the rumbling of gases, the absence of pain, a general sluggish condition of the system, and continued constipation, indicate impaired muscular action. A feeling of "goneness" in the stomach with distress after eating, and a great irritability that causes every thing to be rejected as soon as swallowed, indicate derangement of the nervous sys- tem. This may be due to disease of the spinal cord. From the deranged digestion that constitutes dyspepsia we necessarily have feeble and imperfect nutrition, and derangement, to some extent, of all the functions of the body. Loss of strength and flesh also ensue if the disease continues. The general symptoms of pain, burning, sensa- tion of soreness in the stomach, tenderness on pressure, dragging weight and tension, always indicate the presence of some form of indigestion. Treatment.-In the treatment of dyspepsia it is impor- tant to regulate the action of the bowels, to give tone to the muscular coats of the stomach, and to arrest the decomposi- tion of food. When distention of the stomach and acid eruc- tations are present, it is best to abstain from food entirely for twenty-four hours, as recommended in chronic catarrh of the stomach. Then a gobletful of hot water, drank two or three times a day will be found of decided advantage. With a view of giving tone to the muscular coat, the following mix- ture should be used: Sulphate of Strychnia, I grain; Dilute Muriatic Acid, 3 or 4 drops; water, 4 ounces. Mix, and give a teaspoonful three times a day, before eating. If the gases continue, a tablespoonful of pure Glycerine may often be given with advantage after a meal, or one or two drops of Carbolic Acid may be added. The Glycerine and Carbolic Acid both aid in preventing the decomposition of food in the stomach, while the Strychnia increases the peristaltic action and thus aids in the digestion. Acidity of the stomach and heartburn may be relieved by swallowing the juice of a lemon, and it is often a good practice to do this every morn- ing, half an hour before eating. After the Strychnia mixture 306 DISEASES OF THE DIGESTIVE SYSTEM. has been used for some time, the following may be substh tuted for it: Fluid Extract of Golden Seal, 2 drams; Fluid Extract of Prickly Ash Berries, 4 drams; water, enough to make 4 ounces. Mix, and give a teaspoonful three or four times a day. With a view of regulating the bowels, the Eclectic Compound Podophyllin Pill should be given night and morning, and continued until they move freely. If a pain is felt immediately after eating, particularly in the debilitated condition of the system, half an ounce of good whiskey will, usually give prompt relief. A larger quantity than this, however, will aggravate the difficulty by precipi- tating the pepsin of the gastric juice.* In most cases, some light table wine with the evening meal will be found beneficial, but it must not be taken to excess. When continued nausea is present, 5 grains of In- gluvin, given after each meal and at bedtime, will often give prompt relief. In temporary indigestion that comes on sud- denly and lasts for a few days, a teaspoonful of Wine of Pepsin may be given after each meal, but it should not be continued more than a week or ten days. Too much attention cannot be paid to the diet of dys- peptics. The patient should always note what articles of food disagree with him, and their use should be discon- tinued. Starches and sugars tend to produce gases, and should also be avoided. Raw oysters are easily digested and constitute a good article of food, but milk is the most important diet in dyspepsia. Food should be taken sparingly and at short intervals, so as to give the stomach as much rest as possible. In fact, in all cases of dyspepsia, as well as all other diseases of the stomach, we would have no difficulty in restoring the normal condition, if absolute rest and absti- nence from food could be obtained. In the celebrated fast of Dr. Tanner, it was positively demonstrated that a person could go forty days without food. He claimed, and we believe justly, that short fasts would result in the restoration of all deranged functions of the stomach. In attempting such a fast, water should be freely drank whenever any sensation of hunger occurs. Absolute * See page 358. NEURALGIA OF THE STOMACH. 307 rest is thus obtained for the stomach and inflammatory con- ditions are more easily controlled. If the Tanner fast proved nothing else, it certainly demonstrated the fact that people, as a rule, eat too much, and this is one of the most frequent causes of indigestion, and should always be guarded against. Intestinal Dyspepsia.-As only part of the process of digestion is completed in the stomach, that organ may be in a healthy condition and yet intestinal digestion may be im- paired. The abuse of cathartic medicines, the continued use of indigestible articles of food, and the irritating products of stomach dyspepsia, act in producing this disorder. Symptoms.-Although sufficient food is taken and no trouble is felt in the stomach, yet the patient is not properly nourished, as is manifest by loss of strength and energy, and continued constipation. When the bowels do move the feces are semi-fluid and irritating, the face is contracted and pinched, there is uneasiness about the navel, the skin is dry and harsh, the pulse frequent, the urine scanty, and the nervous system irritable. Treatment.-The same general line of treatment must be adopted as recommended in stomach dyspepsia. The liver and bowels must be kept active, and tone must be given to the muscular coats of the intestines. Rubbing and kneading the abdomen will aid greatly in giving tone to the abdominal organs, and thus aid in curing the disease. NEURALGIA OF THE STOMACH. Neuralgia of the stomach is severe pain induced by an irritation of the sensory nerves of that organ. The condition is due to some peculiar state of the nervous system, and prop- erly belongs to the class of nervous diseases. SYMPTOMS.-Neuralgia of the stomach is characterized by severe paroxysms of pain, that are felt most severely over the center of the stomach, just at the lower end of the breast DISEASES OF THE DIGESTIVE SYSTEM. 308 bone. From here the pain shoots out over the chest and abdo- men. The pain is not constant, but the paroxysms are some- times so severe as to cause profuse perspiration. Pressure neither increases nor diminishes it, and the attack may last from a few hours, to two or three days, or it may recur at intervals for months. In most cases the pulse is small, weak and irreg- ular, and severe palpitation of the heart, and hysteria are lia- ble to follow an attack of the disease. When the acute pain subsides eructations of gas and vomiting often occur. The function of digestion is, as a rule, rarely interfered with, and nutrition goes on without impairment. Treatment.-The best remedy for this disease is Gelsem- ium. The Fluid Extract prepared from the green root should be given, combined with some stimulant. The follow- ing combination is a good one for our purpose : Fluid Extract of Gelsemium (green root) 2 drams; Fluid Extract Prickly Ash Berries, 1 dram; water, enough to make 3 ounces. Mix, and give in teaspoonful doses, every half hour. If the case is severe two teaspoonfuls may be given at first, for two or three doses. This preparation should be discontinued as soon as relief is obtained, or when the eyelids begin to feel heavy. If this fails to give relief Chlor-Anodyne may be given in half tea- spoonful doses, every half hour. When the pain comes on at stated intervals 10 grains of Quinine every four hours will often prove serviceable. Hot fomentations of hops applied over the abdomen, and changed every two hours, will often relieve the pain, and induce sleep. If the disease continues long the bowels become constipated, and digestion is impaired; and these conditions must be treated as recommended under the heading of dyspepsia. ULCERATION OF THE STOMACH. Ulceration of the stomach is a condition in which there is a destruction and falling off of patches of the mucous mem- brane and portions of the other tissues that form the wall of the stomach. It is a condition frequently met with, especially in youth and middle life. Sometimes there may be one or two ULCERATION OF THE STOMACH. 309 large ulcers, while in other cases a number of smaller ones may be spread over the entire internal surface of the organ. The difficulty is usually occasioned by disturbances of the cir- culation of the blood in the stomach, and it is preceded by some form of inflammation, although in some cases it may be so slight as not to attract special attention. SYMPTOMS.-Pain, indigestion and vomiting are the first symptoms of this disease. The pain is located just below the extremity of the breast-bone, and extends from that, toward the right side, under the bony arch formed by the ribs, while it may sometimes extend to the left side and as far down as the navel. The pain is of a gnawing, burning character and passes from the front through to the back. Great tenderness is felt on pressure over the stomach, and also on the bones of the spine directly behind it. After a while there will be vomiting of blood, which is characteristic of this disease. Severe attacks of neuralgia of the stomach will also frequently take place, and these cause a general depression of the system. These attacks usually come on when undigested food remains in the stomach, or after exposure to cold, fatigue or mental anxiety. The pain is increased after taking food into the stomach, or within an hour or two after; and the more indigestible articles of food cause the greatest amount of pain, The disease is of a chronic character and may often continue from three to five or seven or ten years. Sometimes, in these long standing cases, a decided chill may occur which is followed by fever. This is due to some tendency to blood-poisoning caused by the absorption of pus from the ulcers. When properly treated the disease terminates in recovery. In some cases a large artery or vein may be eaten through by the process of ulcera- tion and thus fatal hemorrhage may occur. In other cases the ulcers may perforate the walls of the stomach and excite an inflammation which causes death, or the outlet of the stomach may be contracted and the cavity dilated so that starvation follows. Treatment.-Absolute rest for the stomach is the most important consideration in the treatment of this disease. To 310 DISEASES OF THE DIGESTIVE SYSTEM. secure this an entire abstinence from food as long as possible should be observed, and when food is taken it should consist solely of milk. Sugars and starches are always objectionable and should never be used in these cases. Four ounces of milk should be given every three hours, and if nausea or vomiting is present two teaspoonfuls of'Lime-water should be added to the milk. A gobletful of hot water, drank night and morning, will also be found serviceable in this disease. After the sev- erity of the symptoms have somewhat subsided, one drop of Fowler's Solution of Arsenic three times a day will give the best results. Subnitrate of Bismuth in io grain doses may also be given three times a day, with a view of allaying the ir- ritation. After a few weeks of exclusive milk diet, soft boiled eggs and broths may be added to the regimen; but great caution must be observed in abstaining for a long time from all indigestible articles of food, and all foods containing starch or sugar. If hemorrhage occurs, ice-bags should be applied over the stomach and small pieces of ice should be swallowed. Morphine, which is so generally recommended in these cases, should not be given, excepting to render the patient comfor- table in hopeless cases. CANCER OF THE STOMACH. Carcinoma, or as it is commonly called cancer, is a malig- nant disease that may attack any of the organs or tissues of the body. It properly comes under the head of surgery and will be fully considered in that department of this work. It sometimes attacks the stomach, and if it does it will cer- tainly prove fatal in from six months to a year and a half after the first development of the disease. SYMPTOMS.-The usual symptoms of dyspepsia are first noticed, but at an early period a pain occurs in the immediate region of the stomach, which is increased by food and by pres- sure. It is constant, acute, and of a burning, lancinating char- acter. The appetite diminishes, distress after eating becomes severe, and the regurgitation of acid liquids into the oeso- phagus and mouth take place. Soon a decided lump is felt in CANCER OF THE STOMACH. 311 the stomach, vomiting occurs after eating, and the matter vomited is acid and putrid. If the cancer is located near the entrance to the stomach, the food is ejected without entering that organ. Emaciation occurs and the countenance assumes a sallow and cadaverous appearance. The darting, shooting pains become more severe, and, finally, profuse vomiting of blood ensues. These cases rapidly develop in persons under forty years of age. Treatment.-The treatment of cancer of the stomach can only be palliative, as we have no means of reaching the mal- ignant growth and effecting its removal. All solid foods must be discontinued, and milk, soft boiled eggs and animal broths substituted. Drinking freely of hot water, or of weak hot tea, will add materially in relieving the burning pain. Sometimes it may be necessary to wash out the stomach once a day with the aid of the stomach pump, particularly if the cancer is lo- cated at the outlet of the stomach so as to prevent the pass- ing of food into the intestines. In the way of medicine the following will be found to serve an excellent purpose: Car- bolic Acid (95 per cent.) 20 drops; Compound Tincture of Iodine; 30 drops; Glycerine, 3 ounces. Mix, and give one teaspoonful in a wineglassful of water three times a day. It is claimed that Arsenic persistently employed will materially retard the development of the cancer of the stomach, and for this purpose, Fowler's Solution of Arsenic may be given in two-drop doses, three or four times a day. Care must be ob- served, however, to let an hour or more intervene between these two medicines. As the disease advances and the suf- fering of the patient becomes so severe as to be almost unen- durable, Morphine should be given by hypodermic injections often enough to allay the severity of the suffering. HEMORRHAGE OF THE STOMACH. Hemorrhage of the stomach is occasioned by a rupture of some of the blood-vessels of the stomach, or by rupture of a number of the capillaries during the process of severe inflam- mation. When a sufficient quantity of blood escapes to cause 312 DISEASES OF THE DIGESTIVE SYSTEM. nausea and vomiting, the condition is spoken of as hemateme- sis, or vomiting of blood. It is a sequence of other diseases, and is often met with in ulceration, and cancer of the stomach, and after severe inflammations. In some persons there is a weak condition of the various tissues of the body, accompanied by a disposition to profuse bleeding on the slightest irritation, and sometimes without any apparent cause. In such persons the bleeding may take place from the mucous surface of the stomach, and may give rise to vomiting of blood. Symptoms.-When there is bleeding of the stomach to any extent, the surface and extremities of the body are cold, and a sensation of warmth is felt in the stomach. A feeling of distention is next observed, and this is soon followed by faint- ness, nausea and vomiting of blood. If the bleeding is pro- fuse the patient may turn sick, faint and pallid, and the blood flows freely from the mouth and nose. If the blood is thrown off immediately, it is partly fluid and partly clotted; but if it has remained in the stomach any length of time it has a brownish-black appearance. These appearances of the blood make it easy to distinguish between this disorder and bleed- ing from the lungs, as in the latter the blood is frothy, and of a bright red color. Treatment.-If the patient is debilitated and has a ten- dency to the recurrences of hemorrhage, nutritious food should be bounteously supplied, and such remedies as will build up the general health should be resorted to. Cod-liver oil should be given three times a day, in conjunction with 15 drops of Dialyzed Iron. Quiet in the recumbent position must be enforced while the bleeding is going on, and small pieces of ice should be swallowed frequently. Ice bags over the stomach will also prove valuable; and cold Alum-whey, or Dilute Sulphuric Acid, will aid materially in controlling the bleeding. Half a gobletful of the former may be drank every ten or fifteen min- utes, while 20 drops of the latter, in a gobletful of water may be taken as frequently. If these remedies fail the physician DIARRHEA. 313 should give a hypodermic injection of five grains of Ergotin, and repeat the same at intervals till the bleeding is controlled. If fainting occurs stimulants should be given, or the fumes of Ammonia should be inhaled. If the fainting is prolonged three drops of Nitrite of Amyl should be placed on a hand- kerchief and held under the nose for a minute or two. This will certainly arouse the heart to action and restore the circu- lation. The Nitrite of Amyl can be obtained for this purpose, in small glass balls, which contain from three to five drops. One of these can be broken in the handkerchief when needed. To prevent a recurrence of the bleeding io drops of the Fluid Extract of Witch Hazel should be given in water three or four times a day, and continued for several weeks. In exceptional cases the patient may die from the great loss of blood, or from strangulation, caused by the blood enter- ing the wind-pipe, but the large majority of cases are amena- ble to treatment. DIARRHEA. Diarrhea is a word of Greek origin, and literally means, to flow through. It is applied to those conditions where fre- quent watery evacuations from the bowels occur as a result of inflammation or irritation of the intestinal tract. It often follows as a symptom of other diseases of the intestines, and as a sequence of general blood-poisoning from any cause. It also occurs from irritation of the intestinal canal, from imper- fect digestion, from want of tone of the intestines, from an increased secretion of bile, and from an increase of the mucus secreted in the intestinal canal. Symptoms.-Irritation, arising from acrid articles of food that cannot be digested, from the arrest of normal secretions, or from exposure to cold, occasions a diarrhea that presents the following symptoms: The actions of the bowels are fre- quent, copious and foul, and are sometimes preceded by grip- ing pains; the desire to go to stool is usually urgent; the tongue is heavily coated; there is loss of appetite and an 314 DISEASES OF THE DIGESTIVE SYSTEM. uneasy feeling of the stomach; a frequent tendency to head- ache; and a loss of strength if the diarrhea continues for a few days. This condition is not attended by febrile symp- toms. When digestion is imperfect the undigested food increases the peristaltic action of the intestines and thus causes the free evacuations. The discharges contain particles of undi- gested food; and pain is felt during the passages, which is usually accompanied, by a raw, sore feeling of the rectum. If the disease continues a marked loss of flesh is soon ob- served. In this condition the appetite is not impaired but is often excessive. When there is a lack of tone in the intestines the watery portion of the blood is poured into the intestinal canal from the relaxed bloodvessels, and thus the evacuations are copious and watery. The skin is pale and cool, the appetite is impaired, the urine light in color, and there is extreme debility. Bilious diarrhea is the name given to that form of the disease caused by an excessive secretion of bile. The pas- sages are at first, greenish-yellow, foul, and semi-solid in con- sistency, but they soon become watery and profuse. There is considerable griping pain during and after the passages, sore- ness on pressure along the right side of the abdomen, and sometimes considerable mucus mixed with the discharges. The tongue is coated, the mouth tastes bitter, the appetite is lost, the skin is dry and rough, and the urine is scanty and high colored. When the stools are gelatinous and semi-transparent, and contain but a small quantity of fecal matter, it indicates an excessive secretion of mucus. This condition is more frequently met with in children and old persons, and is usually called catarrhal diarrhea, It causes little disturbance at first, but after a time the appetite is lost, the strength fails, the skin becomes dry and harsh, and rapid loss of flesh takes place. Treatment.-Sometimes nature attemps to get rid of irri- tating substances in the bowels by causing a diarrhea. This DIARRHEA. 315 removes the cause of the irritation, and then it subsides with- out treatment. If there is much pain in this form of diarrhea, from one to two 'tablespoonfuls of Castor Oil should be given to aid in the removal of the irritating substances. To avoid the disagreeable taste of the oil, it should be taken in the soft elastic capsules. Although these capsules are large, they become moist and slippery as soon as placed in the mouth, and are swallowed more readily than an ordinary pill, while the capsule is dissolved almost as soon as it enters the stomach. If the diarrhea continues after the Castor Oil has operated, the. following may be used with great advantage: Tincture of Opium, Tincture of Ginger, Tincture of Rhubarb, Tincture of Capsicum, and Tincture of Camphor, of each 2 drams; Brandy, enough to make 2 ounces. Mix, and give a teaspoon- ful, in water, every half hour till relieved, or till four or five doses are taken. In the copious watery evacuations resulting from defi- cient tone of the intestines, the above mixture also serves the best purpose, as it combines stimulating and astringent remedies. In bilious diarrhea the Compound Syrup of Rhubarb and Potash should be given in teaspoonful doses, three times a day, with a Compound Podophyllin Pill* at bed time. These should be continued till the discharges assume a more healthy appearance. In the mucus diarrhea an ounce of Castor Oil may be given at first to remove the excess of mucus from the bowels. This should be followed by small doses of Podophyllin, pre- pared as follows: Podophyllin, 2 grains; Sugar of Milk, 18 grains. Mix thoroughly, and divide into twenty powders, and give one powder night and morning. In addition to this the Compound Syrup of Rhubarb and Potash may be given in teaspoonful doses, every three or four hours. In cases where any febrile symptoms manifest themselves the following must be given : Fluid Extract of Aconite, 10 drops, water, 4 ounces. Mix, and give one teaspoonful every hour or two, as required. * See page 360. 316 DISEASES OF THE DIGESTIVE SYSTEM. After the disease in any of its forms is under control, and there is general prostration of the system, two drop doses of Fluid Extract of Nux Vomica, three or four times a day, will speedily tone up the nervous system. An ounce of good whiskey or brandy may also be given once or twice a day. CHOLERA MORBUS. Cholera Morbus is an acute inflammation of the mucous membrane of the stomach and bowels, that is characterized by vomiting and purging. It occurs principally in the sum- mer and early fall, though it may develop, under certain cir- cumstances, at any time of the year. Sudden changes from cool to hot weather, or long continued heat act as predispos- ing causes of the disease; while unripe fruit and vegetables, or any other irritating substances taken into the stomach may cause an attack. Drinking freely of ice water when overheated, will also ^develop the disease. Symptoms.-A coated tongue and general languor of the system, accompanied with diarrhea and nausea, may be manifest for two or three days before cholera morbus sets in, but as a rule it comes on suddenly and violently. The patient is usually awakened from a sound sleep by a chill; and pain in the intestines, and nausea, vomiting and purging set in immediately afterward. The first evacuation from the stom- ach consists of partly digested food with mucus, and the first from the bowels is almost entirely ordinary feces. The matter discharged in both ways soon becomes watery, and of a green or yellowish color. In severe cases the discharges take on the rice-water character of those of genuine cholera. The discharges are profuse and numerous, and the patient becomes so weak, in a short time, that he can scarcely rise in bed. The weight of the body is greatly reduced, the face becomes blue and pinched, the skin is cold and covered with a clammy perspiration, the voice is husky, a terrible thirst is present, but all fluids are rejected as soon as swal- lowed. The urine is scanty and sometimes suspended, the CHOLERA INFANTUM. 317 heart's action is feeble, and cramps frequently affect the muscles of the calf and other parts of the extremities. The disease lasts from a few hours to two or more days, and sometimes a secondary fever sets in and may continue for a couple of weeks. The majority of cases recover under proper hygienic conditions and treatment, but occasionally a patient may die from collapse, or during the secondary fever. The disease is so characteristic that it is easily recognized, but the severer cases are sometimes mistaken for cholera, par- ticularly during a cholera season. Treatment.-In simple cases of this disease, the symptoms subside as soon as the irritating substances are thrown off. If they should continue, prompt methods of treatment should be adopted. Among the best remedies that can be used is the preparation known as Chlor-Anodyne. This should be given in half teaspoonful doses, in a little water, and re- peated every half hour till the symptoms are relieved. Should the first dose or two be rejected, it should be repeated at once. A large mustard paste should be applied over the entire abdomen, and allowed to remain till the sense of burn- ing is pretty severe. If the vomiting still continues, 2 drops of Carbolic Acid in an ounce of water will often act promptly. It may be repeated if necessary every half hour till three doses are taken. Cold champagne will sometimes remain on the stomach when nothing else will. When the vomiting is controlled the Chlor-Anodyne will speedily relieve the purging. In the extreme prostration that follows the severe form of this disease, the following will be found a valuable nerve tonic: Sulphate of Strychnia, I grain; Dilute Muriatic Acid, 2 or 3 drops; Dilute Phosphoric Acid, 4 drams; water, enough to make 4 ounces. Mix, and give one teaspoonful three or four times a day. CHOLERA INFANTUM. Cholera infantum is an acute inflammation of the stomach and intestines occurring in infancy, usually during the 318 DISEASES OF THE DIGESTIVE SYSTEM. teething period. It is characterized by vomiting, purging and more or less febrile excitement. It is popularly known by the name of "Summer Complaint," and occurs most fre- quently at the time when people begin to feed infants with other than mother's milk- Feeding infants with poor milk, condensed milk, starchy foods, such as potatoes and bread, and the stronger foods of adults, before the stomach and intestines are capable of digesting them, are among the most common causes of this disease; but bad ventilation, imperfect drainage, and the great heat of crowded cities are prominent factors in its develop- ment. Damp, low-lying and malarial localities also tend to produce it. It is most prevalent in the low-lying, poorly ventilated tenement house districts of large cities, and is less frequently met with in country districts, where infants have all the benefits of a bounteous supply of fresh milk and pure air. Symptoms.-In some cases the child seems restless, irri- table and feverish for two or three days before any trouble is noticed. Diarrhea then sets in, and is soon followed by vomiting. In other cases, slight diarrhea, with the usual symptoms of that disorder, may have existed for several weeks before any vomiting or fever is manifest. In other cases, the vomiting and purging commence suddenly, with- out any premonitory symptoms, while the child is appar- ently in the enjoyment of perfect health. The evacuations may at first contain some fecal matter but soon become watery. The stools often contain curds or undigested food, and present a greenish or greenish yellow color. Anything taken into the stomach is immediately vomited, and the continued retching is accompanied by vomiting of mucus or serous fluid which is often mixed with bile. In a few hours the eyes become sunken and partially closed, the lips are dry, cracked and bleeding, the body is much wasted, the countenance pallid, and sometimes red spots appear on the cheeks. Pain is felt at every motion of the bowels, and every attempt at vomiting. Tenderness is manifest on pressure around the margin of the abdomen, CHOLERA INFANTUM. 319 and a reddish rash is seen to spread over the buttocks, geni- tals and verge of the anus. The mind is torpid and the child lies in a stupid condition, entirely indifferent to every thing surrounding him. The skin becomes hot and dry, the pulse very rapid, and the cheeks may be flushed with fever. The discharges from the bowels may range from thirty to forty in twenty-four hours, but when so frequent only a small quantity of fluid is passed at a time. With proper care and treatment, the disease will ter- minate favorably in from two or three days to a week, although two or three weeks is often necessary for a complete recovery. In fatal cases the respiration becomes short and labored, and the child sinks into a stupor and may die in from one to three or four days after the commencement of the attack. Treatment.-The first consideration in the treatment of summer complaint should be the diet and hygienic condi- tions of the patient. Foods of all kinds, except milk, should be withheld. If the child is nursing it should not be fed oftener than every two to three hours. If fed with cow's milk, Lime water should be added in the proportion of one teaspoonful of Lime water to four tablespoonfuls of milk. Small pieces of ice may be placed in the child's mouth from time to time to allay the excessive thirst. The surface of the body should be bathed two or three times a day with a cold sponge bath which will effectually diminish the fever. Pure air is very essential, and if possible the child should be removed to the country. In the way of medicines, Aconite and Ipecac, are the most valuable in the first stages of the disease. To four ounces of water in a goblet, add two drops of Fluid Extract of Aconite Root. To another goblet containing 4 ounces of water, add 5 or 6 drops of Fluid Extract of Ipecac. These should be given every half-hour at first, and alternated so that a dose is taken every fifteen minutes. When the fever begins to subside a half-hour should intervene between the doses, thus giving each remedy once an hour. When the face is pale and the child appears languid, 3 or 4 drops of the 320 DISEASES OF THE DIGESTIVE SYSTEM. Fluid Extract of Nux Vomica should be added to the gob- let containing the Ipecac, and then continued until the nausea is controlled. In the ordinary acute cases of summer com- plaint this treatment, with the proper attention to diet and surroundings is all that is necessary to affect a cure. In cases where there is a marked irritation of the brain with great heat in the back of the head, 5 drops of Fluid Extract of Gelsemium should be mixed with five teaspoon- fuls of water, and of this a teaspoonful should be given every hour in place of the Ipecac.; and where the patient is dull and stupid the Fluid Extract of Belladonna in the same propor- tions and dose, should be used instead of either the Ipecac, or Gelsemium. In cases where the abdomen is swollen, the following may be given with advantage: Podophyllin, 1 grain; Sugar of Milk, 19 grains. Rub together thoroughly and divide into twenty powders. Give one of these powders three times a day. If the disease assumes an intermittent character, as manifested by an increase of the fever and other symptoms at different times, one grain of Quinine every three hours will frequently allay all the symptoms. In such cases the Quinine should be continued for several days. After the force of the disease is spent a few drops of good brandy in a small quantity of cold water will prove ser- viceable in giving tone to the stomach and general system. During convalescence the Nux Vomica mixture before recommended should be continued in teaspoonful doses every two or three hours. With a view of enriching the blood, the following may be found valuable: Tincture of Iron, 8 drops; Glycerine, 1 ounce. Mix, and give a teaspoonful three or four times a day. Opium, or any mixture containing it, does positive harm and should never be given in this disease. INTESTINAL CATARRH. Inflammation of the mucous membrane of the small in- testine may come on suddenly from exposure to cold, or from INTESTINAL CATARRH. 321 the irritation caused by particles of undigested food. The condition is called intestinal catarrh, or muco-enteritis. If the inflammation extends to the stomach it is called gastro- enteritis; if confined to the duodenum it is denominated catarrh of the duodenum or duodenitis; if to the ilium, it is called ileitis, to the colon, colitis, and when both these parts are involved, it is named ileo-colitis, a condition that is frequently spoken of as diarrhea, from one of the symp- toms; and when the inflammation is located in the cecum it is called typhlitis. SYMPTOMS.-In inflammation of the intestinal mucous membrane there is tenderness about the navel, a frequent desire to go to stool, which is accompanied by diarrhea, but the passages are small and do not relieve the desire to evacuate the bowels. Sometimes the desire will be great, and yet nothing passes when the effort is made. The stool is sometimes yellowish, thin and acrid, and at other times mixed with mucus. If the duodenum is the part affected, the pain is on the right side near the stomach, and the patient is constipated. The stomach is often involved and nausea and vomiting come on. If the cecum is principally involved the inflammation often extends to the large intestine, and severe tenesmus, or contraction of the muscles of the rectum, takes place with little or no evacuations. When a stool is passed it is some- times mixed with blood. In nearly all cases of this form of inflammation there is a general disturbance of the system. General languor is first felt and is soon followed by chilliness, and sometimes by a decided chill. Then a feverish condition sets in and the pain about the umbilicus, or at the seat of the inflammation becomes marked. The appetite is lost, the tongue is coated with a yellowish fur, and in severe cases the tip and edges are red and dry. In some cases the prostration of the system is great, and the symptoms of typhoid fever develop. Whenever these general constitutional symptoms mani- fest themselves the condition is easily recognized as being 322 DISEASES OF THE DIGESTIVE SYSTEM. distinct from diarrhea caused by irritation of the intestinal tract. Treatment.-Hot fomentations over the abdomen, and a hot foot-bath should be resorted to at once, to draw the blood from the inflamed part. To control the fever and allay the irritation, the following should be given: Fluid Extract of Aconite Root, io drops; Fluid Extract of Ipecac., 20 drops; water, 4 ounces. Mix, and give a teaspoonful every hour. An alcohol "sweat " continued till free perspir- ation is produced, will also prove of great advantage. With the view of relieving irritation and changing the character ot the passages from the bowels, we may give the Compound Syrup of Rhubarb and Potash, in teaspoonful doses, three or four times a day. If the pain is severe and tenesmus present one-eighth of a grain of Morphine may be given, at intervals of three or four hours. This treatment will usually control the inflammation in a few days; and should the diarrhea continue afterward, it may be treated by the astringent remedies described in the article on diarrhea. CHRONIC ENTERITIS, OR CHRONIC DIARRHEA. Chronic inflammation of the mucous membrane of the small intestine often remains after the acute inflammation subsides. It may also come on gradually during the continu- ance of an ordinary diarrhea. Persons going from a cool to a very warm climate often suffer from diarrhea, that gradually develops this condition, which is commonly called chronic diarrhea. This chronic inflammation may extend to the stomach, thus causing dyspepsia, or to the large intestine, in which case symptoms of dysentery are superadded. SYMPTOMS.-In chronic diarrhea the evacuations are fluid or semi-fluid, sometimes numerous, and again there may be but one or two during twenty-four hours. The color varies from a light clay-color to a dark brown. The passages are often mixed with mucus, pus, blood, and shreds of lymph CHRONIC DIARRHEA. 323 resembling membrane- The passages may seem almost normal tor a number oi days, and then again they take on the unhealthy character. There is general tenderness over the bowels. The appetite is impaired, the skin is dry and sallow, the patient is restless and nervous, sleeplessness is persistent, migratory pains are felt in the head, and the flesh and strength are greatly diminished. Fever of a remittent character sometimes sets in, and in severe and protracted cases the cheeks are flushed and night sweats occur. Treatment. In this disease the irritation of the mucous membrane is greatly relieved by establishing the action of the skin. The Turkish bath accomplishes this admirabiy, and one should be taken two or three times a week. If this cannot be had the Alcohol sweat may be substituted; and after the perspiration has been freely established the body should be rubbed down with warm water, and then thoroughly dried with a coarse towel. The kidneys should be acted on freely by the following: Acetate of Potash, 4 drams; water, 6 ounces. Mix, and give a tablespoonful three or four times a day. As the liver is usually torpid, the following should be used: Podophyllin, 2 grains; Sugar of Milk, 14 grains. Tritu- rate, and divide into sixteen powders. One of these should be given night and morning till the evacuations become more solid in consistency and more natural in color. In many cases counter irritation is necessary. Spirit of turpentine ap- plied over the abdomen, and covered with flannel wrung out of hot water, will answer a good purpose in many cases. At other times a mustard paste may be used with advantage. If febrile symptoms are present give the following: Fluid Extract of Aconite Root, 10 drops; water 4 ounces. Mix, and give a teaspoonful every one or two hours. Quinine in ten grain doses may also be given when fever is present, and good results follow its use. After the symptoms are modified, a good tonic effect can be produced on the diseased parts by the following: Fluid Extract of Nux Vomica, 30 drops, Fluid Extract of Prickly Ash berries. 3 drams. Mix, and give a teaspoonful three or four times a day. In some cases, after 324 DISEASES OF THE DIGESTIVE SYSTEM. the Podophyllin powders have acted, and the general irrita- tion has subsided, benefit is derived from the treatment laid down for diarrhea. Opium, however, should be avoided in this disease, as it tends to arrest the secretions, and thus re- tards the recovery of the patient. Attention must be given to the diet. Solid foods should not be taken, and animal broths, eggs, oysters, &c., should be used in preference to sugars, starches and fats. INFLAMMATION OF THE BOWELS. When inflammation involves all of the coats of the small intestine it is called enteritis. It is usually acute and some- times extends so as to involve the peritoneum. It may be developed by cold, and undigested articles of irritating foods, or it may follow as a complication of other diseases. SYMPTOMS.-Enteritis is first manifested by constipation and a tenderness around the umbilicus. This condition may be present for a day or two, before a chill or decided rigor oc- curs, which is followed by a fever. The fever runs high for two or three days, and the patient is greatly prostrated. The abdomen is now hard and distended, the pain is severe, and the slightest pressure causes great distress. The patient lies, on his back, and can only be slightly relieved from the pain by drawing up the legs. The constipation is persistent, and this is sufficient to distinguish it from muco-enteritis. Care must be taken not to mistake it for rupture or other mechani- cal obstruction of the bowels. The symptoms of these condi- tions will be described in the surgical department. Treatment.-Hot fomentations of hops, sprinkled with Spirit of Turpentine, should be applied to the abdomen as. hot as can be borne, and changed every two hours. The heat may be best retained by covering the fomentation with a large piece of oiled-silk. A one-grain Opium pill every three- hours will be found highly valuable in this disease, to allay the severity of the pain. The nausea, which is sometimes present, may be relieved by one or two drops of Carbolic INFLAMMATION OF THE BOWELS. 325 Acid, in a wineglassful of water. A teaspoonful of brandy with two or three drops of Chloroform will relieve hiccough, and reduce the distention of the bowels. When the fever is decided it should be controlled by the following: Fluid Extract of Aconite Root, io drops; Fluid Extract of Gelsemium, 30 drops; water, enough to make 4 ounces. Mix, and give a teaspoonful every hour. When the fever and irritation begin to subside the bowels should be moved by one ounce of Castor oil with ten drops of Spirit of Turpentine. This should be given in the morning. If this fails to move the bowels, a full enema of soap suds and sweet oil may be given to remove any obstruction in the lower bowel. Absolute quiet must be observed, and no food should be given unless the patient craves it, and then nothing but milk with Lime water should be allowed. While recovery is taking place, no solid food should be used, and every precaution should be taken to avoid exposure to cold, or undue exercise that might re-develop the disease. INFLAMMATION OF THE CECUM. Inflammation of the cecum, and the long worm-like ap- pendix attached to it, is technically denominated typhlitis. When the inflammation is developed in the loose tissue around the cecum, it is called perityphilits, which means inflamma- tion around the cecum. This disease is caused by the exten- tion of inflammation from the small intestine, by impaction with feces, and by the lodgment of irritating substances in the folds of its mucous membrane. Inflammation of the appen- dix of the cecum is usually caused by the lodgement of seeds of fruit in the opening into the appendix. Symptoms.-The first symptom of this disease is a dull deep-seated pain in the region of the right groin. This is soon followed by a sensation of weight, and constipation is generally present, unless there is also an inflammation of the small intestine, in which case diarrhea exists. The pain con- tinues to become more severe, spreads out into the groin, hip, 326 DISEASES OF THE DIGESTIVE SYSTEM. and testes, and is increased on pressure. The tongue is soon heavily coated, the skin is harsh and dry, and the pulse in- creased. In two or three days a tumor is felt low down in the right side of the abdomen, and this is sometimes followed by peritonitis from which death ensues. In other cases the lump or tumor undergoes suppuration and forms an abscess, which is finally discharged from an opening formed through the integument. Sometimes the same opening penetrates the intestine and thus admits of the escape of feces into the cavity of the abdomen. If the pain assumes a throbbing, pulsating character, it is a sure indication of the formation of an ab- scess. These symptoms may be present for a few days, or for many weeks, and during their continuance there is great pros- tration. When the inflammation involves the appendix, in addi- tion to the symptoms just described, the pain extends through the groin and along the anterior surface of the thigh. The slightest touch is followed by excruciating pain, the thigh is fully bent upon the abdomen, and all attempts to straighten it increase the suffering. The inflammation in the loose tissues around the cecum, is not accompanied by so severe a pain as those conditions just described. There is no disturbance of the natural action of the bowels. The swelling is located higher up near the crest of the ileum, and it develops slowly, but attains a con- siderable size. Treatment.-Hot fomentations of hops should be applied over the seat of the inflammation as early as possible. The action of the skin must be maintained, and the severity of the pain controlled. For these purposes ten grains of Dover's Powder may be given every four hours till the inflammation subsides. To control the fever the following must be used: Fluid Extract of Aconite Root, io drops; Fluid Extract of Veratrum Viride, 20 drops; water, 4 ounces. Mix, and give a teaspoonful every hour. Cathartics must be avoided, but mild laxatives may be used with advantage. From one to two teaspoonfuls of Calcined Magnesia, stirred up in water, may be given two or three times a day till the bowels are INFLAMMATION OF THE RECTUM. 327 moved. This remedy liquifies the passages, and for this reason is specially applicable in this disease. When indications of the formation of an abscess' are present a competent surgeon should De sent for. INFLAMMATION OF THE RECTUM. Inflammation of the rectum is commonly produced by the accumulation of feces, which harden and give rise to severe irritation. Exposure to cold and damp, obstruction of the circulation of the liver, the continued use of Aloes as a purga- tive, and the frequent employment of stimulating enemas may also give rise to the disease. It is also called catarrh of the rectum, and is technically named proctitis. Symptoms.-There is a burning sensation in the rectum, a constant desire to go to stool, straining at stool, and at first the passages are only mucus. This continues for some time, and the constant straining and desire to evacuate the bowels is called tenesmus. The mucous discharges are soon mixed with blood, which with hard lumps of fecal matter is all that passes. The pain now extends from the rectum to the back, hips and neighboring parts. The colon is also distended with fecal matter, and in severe cases the inflammation involves both colon and rectum, and even extends to the peritoneum. In these cases considerable blood escapes, and headache, muscular soreness, and febrile symptoms develop. In some cases abscesses form in the tissues immediately surrounding the rectum, or in the cavity of the pelvis, and their formation can be determined by the deep-seated throbbing pain. After a time the bowels become relaxed, and the stools contain hard lumps coated with mucus and pus, and have a purulent odor. Ulcerations of the mucous membrane follow, and large patches sometimes slough off, and are seen in the pas- sages. As soon as the bowels begin to act the tenesmus is lessened, and the patient is much relieved, but the disease often grows worse. It may last in acute cases, from four to 328 DISEASES OF THE DIGESTIVE SYSTEM. ten, or twelve days, while chronic cases may continue for months, and develop serious complications in the surrounding tissues. Treatment.-The first thing to be done is to empty the bowel of the accumulated feces. As before stated the Cal- cined Magnesia is the best remedy to liquify the contents of the rectum. The dose is from half a dram to one dram, and it should be stirred in water before taking. If this does not act in two or three hours the dose should be repeated. If the feces still remain impacted, warm water should be slowly injected into the rectum in large quantities, and retained as long as possible. This should be repeated at short intervals till the bowel is cleared. After the bowels are moved, many cases will get well without further treatment. When the inflamma- tion is well established, however, other remedies must be employed. Morphine in one-eighth grain doses may be given to re- lieve the pain and tenderness, and should be repeated about every four or five hours as required. Hot fomentations of hops over the lower part of the abdomen and perineum, also afford much relief In chronic cases the bowels must be kept regular, and local remedies should be applied to the rectum by means of injections. The following will be found valuable in such cases: Fluid- Extract of Witch Hazel, 2 ounces; Glycerine, 1 ounce; water, 5 ounces. Mix, and inject about an ounce into the rec- tum, two or three times a day. For this purpose a long nozzled syringe should be employed, or a catheter should first be introduced well up the rectum, and the mixture injected through that. If digestion is impaired two drops of Fluid Extract of Nux Vomica should be given before each meal; and two drops of Fowler's Solution of Arsenic, three times a day, after meals, will be found serviceable. The most nutritious articles of food should be employed, and care should be taken to avoid such articles as contain in- digestible particles. Seeds and rinds of fruit should be par- ticularly avoided, and pickles and condiments should not be used. DYSENTERY. 329 DYSENTERY. Dysentery is the result of inflammation of the large intes- tine. It begins in the colon, and rapidly assumes the form of ulceration. The inflammation soon extends to the other parts of the large intestine, and they sympathize in the dis- turbance. In consequence of the nature of the passages from the bowels, it has been called " flux" and " bloody-flux." The disease is met with in isolated cases; as an endemic, where it attacks a number of persons in the same vicinity; and as an epidemic, where it spreads over a large section of country,. This last form is supposed to be due to some specific germ floating in the atmosphere. Sudden atmospheric changes, exposure to cold that may obstruct the free action of the skin, the accumulation of mor- bid matter in the bowel, and the germ of the epidemic type, are so many causes that tend to develop the disease. Symptoms.-As a rule the bowels have been inclined to constipation; but for a couple of days before the disease really develops there is tenderness over the lower part of the abdomen, general languor, chilliness and finally febrile symp- toms. Pain is felt along the left side of the abdomen which is increased on pressure. The pain in the rectum is of a burn- ing character, and there is a constant desire to go to stool, and strong efforts to expel something only causes the pas- sage of jelly-like mucus, that is sometimes tinged with blood. This condition soon develops tenesmus, and these unpleas- ant symptoms continue till the second or third day, when blood is discovered in the stools. The bloody stools continue till the fifth or sixth day, and these are often mixed with mu- cous membrane. The spasm of the muscles of the anus and rectum becomes very severe and distressing. In some cases nausea and vomiting supervene. In the epidemic form of the disease the attacks come on suddenly, and run their course rapidly. Great prostration occurs and in severe cases collapse may take place in a few DISEASES OF THE DIGESTIVE SYSTEM. 330 hours. The great tenderness, and the bloody character of the discharges, with an absence of all evidence of piles or other local disease, will usually enable any one to determine the nature of the disorder. The disease may continue from three days to as many weeks, or it may become chronic and continue for months. Treatment.-The proper regulation of the diet is the first thing to be considered in the treatment of dysentery. When the stomach is irritable milk with lime water should be the only diet, and an ounce of the lime water should be added to four ounces of milk. If the stomach is not affected, milk, eggs, oysters, animal broths, &c., may be used, but all solid foods should be withheld. When prostration of the vital powers takes place, alcoholic stimulants are needed, and may be given as egg-nog, milk punch, or brandy. Champagne is valuable in allaying nausea and vomiting, and may be used in this disease, in preference to other stimulants. The early administration of hot-drops does harm, and must be guarded against. At the onset of the disease the object should be to change the character of the evacuations. For this purpose the following should be given :. Podophyl- lin, 3 grains; Cream of Tartar, 2 drams. Mix well and divide into twelve powders, and give one powder night and morn- ing. In addition to this 15 drops of the Fluid Extract of Aconite Root should be mixed in a goblet with eight tablespoonfuls of water, and a dram of the Fluid Extract of Ipecac, with 12 tablespoonfuls of water, should be prepared in another goblet. A teaspoonful should be given from one goblet on the even hour, and the same dose from the other goblet on the half-hour, thus giving each medicine once an hour. Great benefit is also derived from injections of starch- water and Laudanum. After each action of the bowels about a tablespoonful of Laudanum to six ounces of starch-water should be slowly injected in the rectum and retained as long as possible. When the tenesmus is severe a hot fomentation of hops may be applied over the lower part of the abdomen, and carried between the legs so as to cover the whole CANCER OF THE INTESTINES. 331 perineum. If this does not afford relief, a one grain Opium pill may be given every four hours. This treatment will be found effective in all cases of dysentery that are not epidemic in character. When the disease is epidemic there is often considerable nausea. In these cases Fluid Extract of Ipecac, should be given in doses of io drops, every ten or fifteen minutes, till free vomiting is produced. After that the above treatment should be adopted, and continued throughout the disease. If the spasm of the rectum is very severe the Opium pills may be repeated at intervals of three hours.. When prostration occurs cognac brandy should be given in such quantities as may be needed to bring about a reac- tion. In all cases of dysentery the passages should be removed from the house at once and thoroughly disinfected with Car- bolic Acid. The sick chamber should also be disinfected daily, and attention should be paid to proper ventilation. CANCER OF THE INTESTINES. Cancer in any of its forms may attack the intestines in the same manner as it does the stomach. The disease may be located at any part of the large or small intestine, but is most common in the large intestine, and particularly in the rectum. It also occurs in the duodenum, either as a primary affection, or as a continuation of the disease from the stomach, pancreas or liver. It soon results in a complete obstruction of the bowels with the attendant symptoms. SYMPTOMS.-The pain is slight at first, but soon becomes acute and lancinating, and is constant in the place where it is first noticed. Sometimes it darts in every direction and then centres in the seat of the disease as a heavy tense ache. A sense of soreness, with tenderness on pressure, is also present from the beginning. The face becomes sallow and sunken, the skin is wrinkled and dry, the lips pale. The glands in the groin, neck and under the arms are enlarged. 332 DISEASES OF THE DIGESTIVE SYSTEM. the breath is offensive, and there is great loss of flesh, A distinct tumor is soon felt at the seat of pain, the bowels are constipated, and after a time nausea and vomiting occur. When obstruction of the bowel is complete fecal matter is vomited, and great prostration sets in which is soon followed by death. In the rectum the disease can be recognized by a direct examination through the anus. Like cancer in the stomach this disease in the intestines usually goes from bad to worse and terminates fatally in from six months to a year and a half from its first appearance. In some forms of cancer fatal hemorrhage may take place at any time. Treatment.-The treatment of this disease is entirely palliative, except in some cases of cancer of the rectum, where an operation may be performed during its early stage. The most nutritious diet that can be given in fluid form should be provided, and all solid food should be avoided. Two drops of Fowler's Solution of Arsenic given three times a day will aid in relieving the pain and will retard the devel- opment of the disease. In the advanced stages something must be given to relieve the intense pain, and for this purpose one-eighth of a grain of Morphine will answer as well or better than any- thing else. This may be repeated often enough to allay the suffering. NEURALGIA OF THE INTESTINES, OR COLIC. Neuralgia of the intestines, or as it is commonly called colic, is due to a condition of the nervous system, which pre- disposes a person to general attacks of neuralgia. It closely resembles neuralgia of the stomach in everything except the location of the pain. Acrid and undigested articles of food, accumulation of gases, spasmodic contraction of the intes- tines, and irritating secretions may act as exciting causes of the disease. Irritation of the nerves and diseases of the structure of the intestinal canal may also excite it. NEURALGIA OF THE INTESTINES, OR COLIC. 333 Three forms of the disease are commonly spoken of, viz.: wind colic, bilious colic and lead colic. Persons are liable to it at all periods of life, and it is invariably associated with deranged digestion. Infants when allowed to overload their stomachs by too frequent feeding, and children when they first begin to eat solid foods, are very liable to attacks of wind colic. SYMPTOMS.-Wind colic is usually excited by undigested food and acrid secretions. In this form of the disease a severe griping pain is first felt in the region of the navel, which gradually moves from side to side and from the upper to the lower part of the abdomen. The pain will be very severe for a time, and then ceases for a few minutes, only to recur again with greater severity. No tenderness is experi- enced on pressure, but on the contrary pain is often relieved by it. The bowels are usually constipated but there is no disturbance of the circulation. The symptoms rarely last more than a few hours, although in some persons attacks are liable to occur whenever digestion is in the least deranged. In some cases the tongue is coated, there is a bad taste in the mouth, the skin is dry, bowels constipated, and a general lassitude is felt, accompanied by imperfect digestion for several days before an attack of colic. When the pains come on they are very severe, the abdomen is distended and hard, and there is tenderness on pressure. Severe nausea and retching set in and finally vomiting occurs. The matter vomited consists of the contents of the stomach with which a considerable quantity of bile is mixed. In consequence of this vomiting of bile the condition is commonly called bilious colic. In these cases the patient is irritable, the pulse is increased, the extremities become cold, and the strength is diminished. The pain may continue for several hours, or even in some cases with slight intermissions for seven or eight days. Workers in lead, and painters who are constantly absorbing the fumes of lead, are often liable to frequent and severe attacks of colic. In addition to the above symp- toms there is a tendency to paralysis in these cases, which is 334 first manifested by a drooping of the wrists. A blue line is also recognized on the edges of the gums, and is a distinctive symptom of lead poisoning. The pain often extends to the back and extremities, and besides the constipation of the bowels there is frequently a retention of the urine. These attacks may last from two or three days to two weeks, as the paroxysms are not relieved until the lead is eliminated from the system. Treatment.-The first object in the treatment of colic is to remove the exciting cause. A full dose of Castor Oil will accomplish this in the majority of cases, and it should be given in doses ranging from one teaspoonful to two table- spoonfuls, according to the age of the patient. For imme- diate relief of wind colic in infants, Aniseed Tea will usually act promptly. If this fails, four or five drops of Chlor-Ano- dyne may be given in water, at intervals of twenty minutes or half an hour. As soon as the oil operates, a permanent relief is usually secured. For the wind colic in adults, half a teaspoonful of Chlor-Anodyne may be given every half hour until the pain is relieved. In bilious colic the same remedy may be used to give temporary relief, or the physician may give a hypodermic injection of one-eighth of a grain of Morphine. The Fluid Extract of Gelsemium in doses of five drops every half hour will also prove valuable in relieving the spasms. To move the bowels in these cases, instead of Castor Oil, the follow- ing should be used: Powdered Jalap, I dram; Powdered Senna, 2 drams. Mix, and divide into two powders. Put one of the powders into a bowl and pour upon it half a pint of boiling water. Allow this to stand until it settles, then pour off the clear tea into a goblet. Add a heaping tea- spoonful of Cream of Tartar and sweeten to suit the taste. This should be taken at a single draught. If the bowels are not moved within two or three hours, the second powder should be prepared and taken in the same way. Should the first be vomited the second should be taken a few minutes after- ward. This will produce a free action of the bowels and DISEASES OF THE DIGESTIVE SYSTEM. INTESTINAL PARASITES, OR WORMS. 335 give immediate relief. To prevent a recurrence of the disease a Compound Podophyllin pill*should be taken every night, till all tendency to constipation is overcome. Sometimes colic assumes an intermittent character that is dependent upon malarial conditions. In these cases from 3 to 5 grains of Quinine should be given three times a day. If the patient manifests any particular nervous disorder, that should be treated as recommended in the chapter on those diseases. In lead colic the Jalap and Senna Tea described above, will serve an excellent purpose to clear the bowels. To counteract the, effect of the lead poisoning and prevent the continuance of the colic, 30 grains.of Powdered Alum should be given in a teacupful of Peppermint Tea every three hours until the symptoms are relieved. This remedy has been demonstrated to be the best that can be given in these cases. INTESTINAL PARASITES, OR WORMS. Parasites of various kinds are found in the intestinal canal in the human family. They are severally named according to their shape and origin, and are now known to be introduced from without by swallowing the eggs or embryos with the food. Space will not admit of a minute description of the var- ious kinds of worms, so we will have to confine ourselves to a brief reference to those most commonly met with. They are popularly known as tape-worms', round-worms, or stomach- worms', and thread-worms, or pin-worms. Tape Worms.-There are three varieties of tape-worms commonly met with in man, and they are supposed to be in- troduced into the intestines by eating pork, beef and fish. These worms are flat, made up of little links or joints, and are usually of immense length. They are, most frequently, met with in adults, though they are sometimes found in children. Sometimes the first evidence of the existence of a tape- worm is the presence of segments of it in the stools, and with •See page 360. 336 DISEASES OF THE DIGESTIVE SYSTEM. nervous persons this knowledge causes great anxiety and worry. Generally, however, there is a feeling of lassitude, colicky pains in different parts of the abdomen, itching of the nose and anus, palpitation of the heart, and occasional faintness. The digestion is deranged, the appetite being generally inordinate without satisfying the hunger, while emaciation is usually present, the special senses are impaired, the breath has a peculiarly disagreeable odor, wakefulness is persistent, and there are occasional attacks of bleeding from the nose. In nervous persons paroxysms or spasms of various kinds occur. Cramps and pains in the extremities, St. Vitus' dance, hysteria, and even spasms resembling epilepsy, may be de- veloped. These conditions are often serious, and may remain some time after the worm has been expelled. While the presence of tape-worm may be suspected, the segments in the passages from the bowels give us the only positive evidence of its existence. Treatment.-The victim of tape-worm should fast for at least twelve hours, and if constipation exists, should take a brisk saline cathartic before taking the medicine to expel the worm. A bottle of Citrate of Magnesia acts quickly and serves a good purpose. The two remedies that are the most certain in their action are Pomegranate and Male Fern. The Pomegranate is best given in decoction, which is pre- pared as follows: Macerate three ounces of fresh Pomegranate Bark in a pint and a half of water for twelve hours. Then apply a gentle heat till the water is boiled down one half. After the proper fast this decoction should be taken in three equal doses, fifteen or twenty minutes apart. This will usually expel the worm within a few hours. The oil of Male Fern is an effective remedy, but is very dis- agreeable to take. This difficulty can now be overcome by the use of soft elastic capsules, containing Male Fern and Kameela, and after twelve hours fast, six of the capsules may be given at bed time and in the morning give an ounce of Castor Oil. If ROUND, OR STOMACH WORMS. 337 this fails to dislodge the intruder the dose should be increased the next night. In some cases 20 or 30 drops of Chloroform, stirred up quickly in water or milk, and swallowed, will prove a good remedy. Care should be taken to examine the worm after its expulsion, to see if the head has been discharged. With a little care this can be easily determined by the shape of the narrow pointed extremity of the worm. If the head is not expelled the worm will re-develop, so if it cannot be found it is always safer to repeat the medicine. Round or Stomach Worms.-These worms are usually introduced into the human subject by the eggs being swallowed with drinking-water. They are reddish-brown in color, rounded in shape, and taper at both extremities, though the head is a little larger than the tail. They may occur singly, or in twos and threes, or they may exist in enormous numbers Poor nutrition and a free use of raw vegetables are supposed to favor their development. They are most gen- erally met with in children from five to fifteen years of age, but are also found in adults. When only a few of these worms are present, the patient is usually in good health, and no special symptoms are mani- fest. When they are present in large numbers the patient presents a chain of nervous symptoms, and digestion and nutrition are impaired. Sometimes the appetite is ravenous, and at other times wanting; there is a distention of the abdomen; colicky pains are felt about the navel; nausea and vomiting are occasionally present; and sometimes a diarrhea sets in, with mucus and blood mingled with the stools. There is also an itching sensation felt in the nose and anus, the pupils are dilated, there are dark lines under the lower eye- lids, the pulse become irregular, emaciation occurs in spite of a good appetite, symptoms of hysteria or St. Vitus' dance show themselves, sleep is disturbed by unpleasant dreams and grinding of the teeth, and there is a peculiar earthy or cadaverous odor to the breath. All these symptoms may, however, be present, and yet we cannot say positively that 338 DISEASES OF THE DIGESTIVE SYSTEM. they are caused by worms, unless they are seen in the pas- sages. A person who is troubled with worms will sooner or later have one or more pass the bowels, and in rare cases they find their way into the oesophagus and are expelled by the mouth. Treatment.-The most efficient remedy for the removal of stomach worms is Santonin. Before it is given the patient should abstain from eating for about twelve hours. The medicine should be prepared as follows: Santonin, 5 grains; powdered sugar, 1 teaspoonful. Rub thoroughly together, and give at bed time, after fasting. For a child under six years of age half this dose will be sufficient. A full dose of Castor Oil should be given the following morning before breakfast. If the worms are not expelled after the first treat- ment, it may be repeated for several days in succession. The Santonin will turn the skin and urine yellow, and so affects the eyes as to give a yellowish appearance to all objects looked at. This condition, however, can do no harm, and will soon disappear. Other remedies are recommended by many authors, but this one is the surest in its action and the least objectionable to take. Thread, or Pin-Worms.-This variety of parasite is called thread-worm from its resemblance to a short piece of fine white thread, and pin-worms because of the pricking character of the sensation it leaves. They vary in length from a quarter to half an inch, are rounded in shape, and taper at both ends. They are more frequently found in children, and inhabit the rectum and the folds of the mucous membrane and skin at the verge of the anus. The symptoms caused by these worms are severe itching and pain, and persistent tenesmus, which are usually more severe at night, when in bed. The bowels are relaxed, and the stools are fetid, covered with mucus, and sometimes streaked with blood. An examination of the parts shows the integument to be rough and irritated, and the mucous surface raw and cracked; while one or more of the worms may be seen if the edges of the anus are well separated. CONGESTION OE THE LIVER. 339 In girls these worms may crawl into the vagina and develop there in large numbers, thus causing great irritation and even inflammation in that cavity. Sometimes they extend higher into the intestinal canal, and when they do the same general symptoms are developed as are met with when other forms of worms are present. Treatment.-The same treatment should be resorted to as recommended for round worms. In addition, however, an injection into the rectum of a solution of Carbolic Acid may be needed. For this purpose 15 drops of Carbolic Acid (95 per cent.) should be added to the gobletful of tepid water, and the whole should be injected into the rectum in the morning, after the medicines have acted. The folds of the anus should be stretched apart and the surface well washed with the same solution, so as to insure the destruction of all the worms. After the Carbolic Acid injection has been used, the rectum should be washed out with tepid water. This treatment repeated two or three times will effectu- ally destroy these annoying worms and prevent their re-pro- duction. CONGESTION OF THE LIVER. Congestion of the liver is a condition in which there is an increased amount of blood carried to the organ. It may be caused by deranged conditions of the heart and lungs, by im- paired digestion, and by the absorption of malarial poisons. Symptoms.-General languor, aching pains in the back and limbs, a yellowish coated tongue, loss of appetite, nau- sea, headache, and a dragging sensation when lying on the left side, mark the beginning of congestion of the liver. The hardness of the liver can be felt below the lower margin of the ribs, there is tenderness on pressure, and tight clothing cannot be borne. The right side will be seen to be enlarged from the distention of the liver, and a slight jaundiced condi- tion of the skin and eyes is noticed. In severe cases vomit- ing and purging of bilious matter takes place, and a decided yellow condition of the skin comes on. 340 DISEASES OF THE DIGESTIVE SYSTEM. Treatment.-When the disease is due to any organic dis- ease of the heart and lungs, these conditions must be treated as recommended in the pages devoted to those subjects. When the cause is local or malarial it is best to begin the treatment with a saline cathartic. A bottle of Citrate of Magnesia answers the purpose well; but in its place the Com- pound Jalap powder made into a tea with half a pint of boiling water, will often prove more prompt. After the tea is made it should be allowed to cool and settle. It is then decanted so as to leave the grounds, and to the clear tea a large tea- spoonful of Cream of Tartar is added. The half pint should be taken at a draught. This should be followed up with the following: Podophyllin, 2 grains; Sugar of Milk, 14 grains. Mix thoroughly, divide into sixteen powders, and give one powder night and morning. Hot fomentations or a mustard plaster, and in severe cases a blister over the region of the liver will materially relieve the distress. If there is any evidence of malarial conditions, Quinine in doses of 15 or 20 grains should be taken twice a day; if preferred 5 grains may be taken every three hours, instead of the larger doses. If the kidneys are inactive hot lemonade may be drank freely, or it may be necessary to give the following: Acetate of Potash, 4 drams; water, 6 ounces. Mix, and give one table- spoonful three times a day, after meals. When errors of diet or the excessive use of alcohol bring on this congestion, attention should be directed toward rec- tifying these abuses, at the same time that the other treat- ment is being employed.* INFLAMMATION OF THE LIVER. Inflammation of the liver is a rare disorder; and when it occurs it often terminates in suppuration, in a.chronic enlarge- ment of the organ, or in a condition of hardening that is commonly called cirrhosis. SYMPTOMS.-A decided chill, attended by nausea and the vomiting of bilious matter, usually marks the beginning of the *See page 359. INFLAMMATION OF THE LIVER. 341 disease. Febrile symptoms immediately follow the chill, the skin becomes hot and dry, the tongue is coated with a dirty yellowish fur, the bowels are constipated, the urine is scanty and colored with bile, the patient is dull and heavy, and com' plains of a severe aching pain in the temples. There is also present a full and oppressed feeling in the region of the liver and stomach. There is a slight remission of the fever in the morning, but as a rule the symptoms continue, and the fever assumes a typhoid character. The patient then grows very weak, and difficulty of breathing comes on which is associated with a hacking cough and expectoration. Sometimes dysentery sets in from the inflammation extending ^o the colon. After eight or ten days the inflammation usually termi- nates in the restoration of the liver to its normal condition. In some cases the products of the inflammation are deposited in the substance of the liver and cause an induration or hardening of the organ. When suppuration sets in increased prostration is mani- fested, and severe rigors occur, which are followed by high fever with flushed cheeks, and night sweats. At some point in the liver, a dull, deep-seated, throbbing pain is felt, and sometimes continues for several days before the pus works its way out of the liver. The matter may be discharged through an opening in the skin in the region of the liver, into the colon, or it may pass through the diaphragm into the lung substance and be discharged through the bronchial tubes. The disease usually terminates favorably, even in many cases where suppuration takes place. Treatment.-The first thing to be done in the treatment of this disease is to control the febrile symptoms. For this purpose the following may be given: Fluid Extract of Aconite Root, 15 drops; Fluid Extract of Veratrum Viride, 20 drops; water, 4 ounces. Mix, and give one teaspoonful every hour. If nausea is persistent, 15 drops of the Fluid Extract of Ipecac, should be given every twenty minutes till free vomiting is produced. After this a tea made of Peach DISEASES OF THE DIGESTIVE SYSTEM. 342 Tree Bark may be drank freely, and two drops of Carbolic Acid should be added three or four times a day. A good sized Spanish Fly blister should be applied over the region of the liver, and after it has done its work, hot linseed meal poultices should be kept over that portion of the abdomen. Small doses of Podophyllin (one-eighth grain) should be given as recommended in a previous article, with the view of relieving the congestion of the liver. After two or three days the fever will be much relieved, when Quinine in 15 grain doses may be given with advantage two or three times a day. The complications arising from suppuration must be met as they occur. GALL STONES. Gall-stones are hard concretions formed in the liver and gall-bladder. They are usually composed of an ingredient of the bile known as Cholesterin, but may sometimes be formed by accumulations of hardened bile. They are usually oval in shape and their size varies from that of a small pea to an English walnut. They are most frequently found in persons in the prime of life whose habits are sedentery, and are more common in women than men. SYMPTOMS.-An intermittent pain in the right side near the lower margin of the ribs, which often radiates to the navel, shoulde/ and small of the back, is usually indicative of the presence of gall-stones. In addition to this pain, nausea, sometimes vomiting, and even chills and fever are present. These symptoms are caused by the irritation of the ducts of the liver and gall-bladder by the presence of the gall-stones, when they are too small to obstruct these canals. These symptoms so closely resemble those of intermit- tent fever, even to the recurrence of the chill, fever and sweating in regular paroxysms, that the condition is often mistaken for "chills and fever." If the calculi are large enough to obstruct the duct of the liver, they cause severe cutting pains, enlargement of the GALL STONES. 343 liver, and a general condition of jaundice. When they fill up the duct leading from the gall-bladder the irritation they create causes a severe spasm, and an intense cutting pain sometimes spoken of as hepatic or liver colic. The severity of the pain is always associated with the passage of large sized gall-stones through the ducts of the \iver and gall-bladder, and through the common duct that conveys the bile into the duodenum. This pain usually com- mences two or three hours after a meal, or after some great mental excitement. It comes on suddenly, and is felt at the lower margin of the ribs, a little in front of the line of the haunch bone. It commences in one point and is boring and lancinating in character. It soon becomes so severe that it spreads over the entire abdomen, into the back and down the thighs, and the patient finds it difficult to locate it in any one point. The cutting pain first noticed gradually moves down- ward, and when the stone, or stones, have passed into the intestine the pain is instantly relieved. During the con- tinuance of the pain the surface is bathed in cold perspira- tion, distressing nausea is present, vomiting occurs but does not afford relief, and the heart's action is depressed. The pain may last from a few hours to several days. When it continues beyond a few hours, the general pain will occa- sionally cease for a short time and then begin again. After the pain has ceased a feeling of soreness often remains for several days. Sometimes these attacks occur but once, again they may come on at long intervals, while in some cases they recur after intervals of a few weeks; their frequency depending on the rapidity of their formation and the size of the calculi. When these attacks are persistent careful exam- inations will detect the gall-stones in the feces, sometimes only one or ttvo being found, while in other cases they may be present in large numbers. Occasionally a calculus may remain in the common duct for several weeks, and when it finally passes it is accompanied by bilious vomiting and diarrhea. As soon as the obstruction 344 DISEASES OF THE DIGESTIVE SYSTEM. is relieved the symptoms rapidly disappear and the patient soon regains his health. Treatment.-Various methods have been recommended for the relief of biliary calculi, but Opium and its prepara- tions have been almost universally employed for the relief of the severe pains. Experience has demonstrated, however, that this practice often does great harm, while under no cir- cumstances does it do more than deaden the pain for the time being. The most successful treatment is that in which remedies are used to produce a relaxation of all the tissues of the body. For this purpose large doses of Gelsemium may be given with advantage in the first stage of the disease. It may be prepared for use as follows: Fluid Extract of Gel- semium, 4 drams; water, enough to make 6 ounces. Mix, and give two teaspoonfuls every half hour until the pain is re- lieved, or till drooping of the eyelids or double vision takes place. If either of these symptoms appear the medicine should be discontinued, but by this time the pain will cer- tainly be relieved. Should this fail, Chloroform may be administered either internally or by inhalation, or both ways. From io to 15 drops of Chloroform stirred with water may be given every fifteen or twenty minutes until relief is obtained; or in severer cases the Chloroform should be taken by inhalations. In addition to these remedies tablespoonful doses of sweet Olive Oil should be given every half hour until 6 or 8 ounces have been taken, if necessary. This treatment will invariably relieve the pain, and produce sufficient relaxation of the ducts to admit of the ready passage of the gall-stones into the intestines. This may be aided by the external ap- plication of warm fomentations of hops, which should be renewed every twenty minutes or half hour, until the pain is relieved. With a view of preventing the formation of gall-stones the continued use of sweet Olive Oil in tablespoonful doses, night and morning, has been found to serve a good JAUNDICE. 345 purpose, and in the majority of cases will be the only treat- ment required. It is well, however, to keep up an action of the liver by the use of the Compound Podophyllin Pills,*as may be indicated. In cases where there is a great tendency to the forma- tion of biliary calculi, another method of treatment has been highly recommended. It consists in giving Chloroform in- ternally, in doses from io to 15 drops every six hours, and con- tinuing this for fifteen or twenty days. If the patient cannot tolerate these doses four or five drops may be given, but in this case it must be continued for a longer period of time. In addition to this, a preparation known as the Succinate of Peroxide of Iron is given in teaspoonful doses three times a day, half an hour after eating, and continued for several months after all evidence of the presence of calculi has dis- appeared. It is claimed that this treatment not only des- troys what calculi may be in the liver and gall-bladder, but also prevents the formation of other stones. With one or the other of these methods of treatment there is no question but that all cases of biliary calculi can be speedily relieved, and the tendency to their re-formation greatly diminished. JAUNDICE. Jaundice is a condition in which the coloring matter of the bile is absorbed and carried into the general circula- tion, so as to be deposited into the various structures of the body. It is, properly speaking, only a symptom of the various diseases of the liver, but in consequence of its fre- quent occurrence and the extensive yellowish discoloration of the skin and structures of the eye, it is popularly spoken of as being itself a disease. Jaundice may be produced from an over-secretion of the bile, from congestion of the liver, from obstruction of the biliary ducts by gall-stones, and from diseases of the duodenum in which the common duct of the liver and gall-bladder become obstructed. Symptoms.-The symptoms that precede and accom- pany jaundice vary greatly, as they necessarily depend upon * See page 360. 346 DISEASES OF THE DIGESTIVE SYSTEM. the disease that produces them. The most common symp- toms are colicky pains, constipation, pale, clay-colored feces; when the bowels are moved, coated tongue, bad taste in the mouth, sometimes nausea, and pain in the head. A yellow tinge first shows itself in the eyes, and then spreads to all parts of the body. The urine is high-colored, and so yellow as to leave a stain on articles of clothing with which it comes in contact. These symptoms are so constant and so apparent to the casual observer that no one can fail to recognize the presence of jaundice, but the causes that produce it are not so easily determined. Symptoms.-The treatment of this disorder must depend entirely upon the nature of the disease that has tended to pro- duce it. If the symptoms point to congestion or inflamma- tion of the liver, or to the presence of biliary calculi, or to any disease of the alimentary canal, these disorders must be treated as recommended under their respective headings. If the ex- act cause cannot be ascertained at once, mustard plasters may be applied over the region of the liver, if severe pain is present, and if there is fever, the Aconite and Veratrum mixture given on page 341 for inflammation of the liver will be desirable. In cases where no acute symptoms are present a Compound Podophyllin Pill*given every night at bedtime, and continued till the bowels begin to move more than once a day, will more frequently relieve the difficulty than anything else we can use. If the urine is scanty and highly colored with bile, the following should be given until it becomes normal: Acetate of Potash, 4 drams; water, 6 ounces. Mix, and give a tablespoonful after each meal. The Fluid Extract of Nux Vomica, in drop doses after each meal, may also prove serviceable. Special attention should be paid to the hygienic condition of the patient. Easily digest d food must always be selected and articles containing sugars, starches and fats must be avoided. It is best to keep the patient on the smallest quan- tity of food that he can be persuaded to take, and the tepid sponge bath every morning, with brisk friction over the entire body, should also be urged as an essential part of the treat- * See page 360. CONSTIPA TION. 347 ment. When the condition is prolonged in spite of all treat- ment, and when the cause has not been definitely ascertained, no time should be lost in consulting a competent physician, with the object of determining the character of the organic lesions of the liver or bowels, if any exist. CONSTIPATION. While constipation is often a condition or symptom of disease affecting various parts of the digestive apparatus, it is often habitually present in persons who consider themselves healthy. A normal condition of health requires a free evacu- ation of the bowels, once in twenty-four hours, and if such action is not had regularly, the person will soon feel depressed and languid, will suffer from headache, will feel a distress in the stomach, a fullness of the lower bowel, and a chain of other symptoms that render him unfit for the enjoyment of life. When the functions of digestion are being properly per- formed, there is a continual contraction from above downward of the muscular structure of the alimentary canal, which has been named the peristaltic action of the stomach and bowels. This is kept up by the stimulus of the food, and the several secretions; while the bile plays an important part in keeping up this action of the intestines. When a certain amount of effete material accumulates in the lower bowel this peristaltic action from above presses the mass so as to occasion increased action of the rectum, and thus its contents is expelled. Now, if from any cause this peristaltic action is diminished or arrested the "force from behind" is removed, and the feces will accu- mulate in the lower bowel, thus giving rise to the condition commonlv called constipation, Some persons will go two or three days without any action of the bowels, while others may go for a week or ten days. When the bowels do move in these cases, the action is caused by the mechanical irritation, in- duced by the accumulated feces in the rectum; the passage is hard and fails to relieve the sense of fullness that is usually present. 348 DISEASES OF THE DIGESTIVE SYSTEM. Habitual constipation maybe due to a cancer or stricture of the stomach or bowels, to the mechanical pressure of a tu- mor oh any part of the intestines, or to diseases of the liver in which there is a deficiency in the secretion of bile, or some obstruction to its passage into the intestine. It also occurs in all conditions where there is nervous debility or prostration of the general vitality. In the first class of cases the stimu- lus is not supplied to the mucous surface of the intestines and consequently no muscular action-is excited; while in nervous debility, though the stimulus is supplied the nerves are too weak, either to transmit the sensation or impart the motion. We have still another cause for constipation which is very common, and for which the individual sufferer is responsi- ble. It is a failure to obey the demands of nature to evacuate the bowels. In these cases the stimulus is applied, and the reflex action causes the muscular contractions necessary for evacuating the bowels. But instead of yielding to this nat' ural and involuntary desire, many persons prefer to wait for a more convenient time, and to prevent the motion of the bowels they set in action muscles that are partly under the control of the will. This action opposes the peristaltic motion of the intestines, and the desire to go to stool passes off. This is repeated day after day, and finally the stimulus fails to excite a reflex action. Then the lower bowel becomes a passive tube in which the feces accumulates. Symptoms.-The chief and only important symptom is the absence of daily evacutions from the bowels. Then there is a general feeling of languor; a fullness of the abdomen, and particularly of the rectum; headache over the eyes, which sometimes affects the entire ball of one eye; a feeling of heavi- ness and sleepiness, with a disposition to sleep at anytime; a tired feeling in the morning; sometimes a coated tongue, and a bad taste in the mouth. Treatment.-The constant use of purgative medicines and enemas, instead of relieving constipation, always aggra- vate it, and should, therefore never be employed in these cases excepting on rare occasions, when it is necessary to clear the bowels. CON STI PA TION. 349 When the tongue is coated with a brownish fur, and when the patient feels drowsy during the day, the continued use of the Compound Podophyllin Pills* will stimulate the action of the liver, and gradually overcome the constipation. One pill should be given every night till the bowels move more than once a day, and after that a pill may be given every second or third night as required. If these pills act too much like a purgative the Eclectic Compound Podophyllin pills should be used in their stead. If the bowels remain inactive after two or three days, it may be better to resort to the use of an enema to clear out the lower bowel. For this purpose a thick soap- suds should be made in a pint of tepid water, and to this an ounce of Castor Oil should be added. As much of this should be thrown into the bowel as it will hold, and it should be re- tained as long as possible before it is allowed to escape. If the feces are firmly impacted in the rectum, from one to two drams of Calcined Magnesia may be given with a view of liquefying the passages. As soon as the bowel is cleared the pills should be given as recommended above. When the tongue is cleared, or but slightly coated, when the lower bowel feels distended, and a general fullness of the abdomen is present, the muscular coats of the intestines need toning so as to increase the peristaltic action. For this pur- pose the New California remedy, Cascara Sagrada, is the most valuable remedy known to the profession. When given in large doses it acts as a cathartic, but in small continued doses, it is a mild laxative. It may be given in io drop doses of the Fluid Extract, but in this form it is disagreeable to the taste. The introducers of this remedy prepare it in a palatable form under the name of Cascara Cordial. Of this preparation a teaspoonful should be given four times a day for a week. If the constipation is not relieved the dose should be gradually increased till the desired effect is produced. Then the dose should be gradually decreased in amount and frequency, till the constipation is permanently relieved. In some cases one drop of fluid Extract of Nux Vomica before each meal will aid in giving tone to the bowels. • *See page 360. 350 DISEASES OF THE DIGESTIVE SYSTEM. In addition to the use of medicines the subject of consti- pation should establish a custom of going to stool at a fixed time every day. About half an hour after breakfast is a good time, as the food taken into the stomach stimulates the peristaltic action of the entire canal. Even when no desire is felt a slight effort at stool should be made daily, and when the bowels begin to move this regularity should be kept up, when it will in time become a habit. INFLAMMATION OF THE SPLEEN. Although little is known about the functions of the spleen, yet it is often the seat of inflammation which is tech- nically spoken of as splenitis. This disease may arise from obstruction of the circulation of the spleen by a clot of blood in its blood-vessels, or it may result from an inflamma- tion of the adjoining tissues extending to the spleen. Direct blows on the left side of the abdomen may also give rise to an inflammation of that organ. Symptoms.-A deep-seated, aching pain is felt under the lower ribs, on the left side, which may be increased by pres- sure upward under the ribs when the patient takes a full breath. This pain continues about a week, when a rigor or chill occurs which is followed by fever and sweating. The face is pale, the lips are white and thin, and the patient becomes extremely weak. The appetite is impaired, and sometimes vomiting takes place, and diarrhea comes on toward the termination of the disease. In some cases a dry hacking cough and hiccough come on and occasion much annoyance. Toward the last the spleen becomes considerably enlarged as can be easily recog- nized by distention of the left side. In severe cases the in- flammation may often extend to suppuration, and the abscess opens so as to communicate with the stomach, colon, or lung. The development of the abscess can be recognized by the deep-seated throbbing pain, which is relieved as soon as the pus is formed. ENLARGEMENT OE THE SPLEEN. 351 Treatment.-When we have the above symptoms, with the history of injury of the left side, or anything that points to the spleen as the seat of the trouble, full doses of Quinine given from the beginning of the symptoms will often tend to cut short the disease. Ten or fifteen grains of Quinine should be given for this purpose three times a day. Sometimes a brisk cathartic will relieve the congestion of the spleen by de- termining the blood to the lower bowel. For this purpose the Compound Jalap powder should be used. A tea is made with half a pint of boiling water to the dram of the powder, and after it has cooled a teaspoonful of cream of tartar is added. The whole is taken at one draught. Favorable results follow the action of this remedy. Warm fomentations of hops or linseed meal, applied over the region of the spleen, will also prove serviceable. When an abscess is formed the pus may be drawn off with an instrument called the aspirator by a compe- tent surgeon. During the continuance of the disease the strength must be kept up by good nutritious diet and stimu- lants. ENLARGEMENT OF THE SPLEEN. Enlargement of the spleen occurs in most cases of dis- eases of the heart, lungs and liver, in which there are obstruc- tions of the circulation. Nearly all contagious and infectious diseases also give rise to it, but it is more marked in those who have suffered from so-called malarial fevers. The condi- tion is due to engorgement of the veins of the spleen result- ing from some obstruction of the circulation; but in some, where no fever is present, the tissues of the organ become hypertrophied, and assume a dense, firm texture. The chronic enlargement of the spleen resulting from malarial diseases, is commonly spoken of as ague cake. It is manifested by the presence of a hardened mass, which extends a considerable distance below the margin of the ribs on the left side, and often reaches even beyond the navel toward the right side. The abdomen is greatly distended, and a heavy, dragging sensation is felt under the ribs, and over the entire 352 DISEASES OF THE DIGESTIVE SYSTEM. left side of the abdomen. In some cases there is difficulty of breathing, palpitation of the heart, and disturbed digestion from the mechanical pressure of the enlarged spleen upon the several organs. Treatment.-Attention must first be given to the disease upon which the enlargement of the spleen depends. It is next important to overcome the constipation, that is usually pres- ent, by the use of the remedies recommended for the relief of that condition. In the way of special treatment the general application of the Faradic current of electricity over the ab- domen will be found of great value. As an internal remedy the Fluid Extract of Ergot will serve a good purpose. It should be given in doses of from io to 30 drops, in water, three times a day, after meals. In some cases the enlargement will disappear with the disease that developed it, while in other cases it will resist all known treatment and form a per- manent splenic tumor. PERITONITIS. The peritoneum forms the inner lining of the walls of the abdomen, and supports the various abdominal organs in posi- tion by throwing folds of its layers around them from the back part of the cavity. Inflammation of this membrane is called peritonitis. It may involve the entire membrane, when it is said to be gen- eral, or it may be limited to a particular part, thus constitut- ing local peritonitis. It may arise as a primary affection, or the inflammation may extend from some other part or organ so as to affect the peritoneum secondarily. Blows on the abdomen; exposure to cold and damp; se- vere inflammations of the abdominal organs; ulcerative per- foration of the stomach, intestines or bladder; inflammation of the pelvic organs, particularly of the womb after abortion, are among the more common causes that produce peritonitis. It also frequently develops as an attendent upon blood-pois- oning, Bright's disease of the kidneys, and the eruptive fevers. PEPJTON/TIS. 353 After acute peritonitis has continued for some time, the symptoms may subside in a measure, and develop a chronic form of the disease. More or less effusion of fluid takes place in the acute disease, which often deteriorates into pus in the chronic form, or results in the formation of adhesions of contiguous surfaces. Symptoms.-When peritonitis results from a blow on the abdomen or exposure to cold, it is ushered in by a sudden and severe chill, followed by fever, with pain and tenderness over the abdomen. When the disease is developed by the exten- tion of inflammation from other organs, the fe/er is increased, pain and tenderness of the abdomen is felt, and vomiting takes place. If perforation of any of the viscera occurs a severe pain is felt at that point, which soon extends over the entire ab- domen. When the disease once sets in, the pain in the abdomen becomes very severe, and is of a cutting, boring character; the slightest touch occasions great suffering, hence the pa- tient draws up his legs, and breathes short to prevent muscu- lar movement; by the second or third day the bowels become greatly distended by the accumulation of gas; a hollow sound is heard by gently tapping the abdomen with the fingers; the appetite is impaired, the tongue coated, and vomiting is usually present; constipation is the usual condition, though in some cases diarrhea may set in; hiccough comes on as the disease progresses, and is usually very distressing; the pulse is small, quick and frequent; the breathing is short and la- bored; and when the collapse of fatal cases comes on, the skin is bathed with cold perspiration that emits a cadaverous odor; the voice is husky, but the mind is usually clear. The febrile symptoms run high during the continuance of the disease, with only a slight intermission in the morning; but in some cases it assumes an intermittent character. Treatment.-Hot fomentations of hops should be applied to the abdomen from the onset of the disease. They should be covered with oiled silk to retain the heat, and changed every hour or two. The Spirit of Turpentine applied over the 354 DISEASES OF THE DIGESTIVE SYSTEM. abdomen once or twice a day will often be found a valuable addition to the fomentations. To reduce the fever, and control the action of the heart, the following will be found reliable: Fluid Extract of Aconite, 20 drops; Fluid Extract of Veratrum Viride, 30 drops; water, 4 ounces. Mix, and give one teaspoonful every hour. As soon as the fever has somewhat abated, 10 grains of Dover's powder may be given to relieve the pain and promote perspira- tion. This may be repeated every four or six hours, as re- quired. After the first two or three days the Dover's powder should be discontinued, and the fever mixture only given once in two or three hours. To keep up the action of the skin, and to relieve the accumulation of gas the following will be found a good combination: Fluid Extract of Pleurisy root, I ounce; Fluid Extract of Prickly Ash berries, I ounce; Glycerine, 2 ounces. Mix, and give a teaspoonful every three hours. To overcome the constipation after the first few days, one Com- pound Podophyllin pilFshould be given every night, or every alternate night, till the desired effect is produced. In some cases where the fever is severe from the start, 20 grains of Quinine may be given twice a day for a couple of days, and then the dose should be reduced to 5 grains. This with the fever medicine and the fomentations will give relief. When the kidneys are inactive 20 grains of the Acetate of Potash, dissolved in a wineglassful of water, may be given three times a day. Food should be given sparingly at first, and such articles must be selected as will not aggravate the inflammation by irritating the intestinal tract. Absolute quiet in the recumbent position should be en- joined for some time after the symptoms have subsided, and one or two layers of flannel should be worn over the abdomen for months, with the view of protecting against the possi- bility of a relapse from exposure to cold. DROPSY OF THE ABDOMEN. Dropsy of the abdomen or ascites, is a condition in which a large accumulation of fluid is found in the cavity of the *See page 360. DROPSY OF THE ABDOMEN. 355 abdomen inclosed in the sac of the peritoneum. The effusion of serum that follows as a sequence of peritonitis, however, is not classed as dropsy as in the majority of cases it is removed by aborption as soon as the inflammation subsides. Dropsy is not a disease. It is only a symptom attendant upon diseased conditions of other organs. As nearly all the blood from the abdominal and pelvic organs returns to the heart through the liver, it .can be readily seen that any disease of that organ, by obstructing its circulation, would necessarily cause a general venous congestion of the contents of the ab- domen. This congestion causes a great pressure of blood in the capillaries and forces the serous portions of the blood through the vein walls, and thus is developed the effusions into the cavity of the peritoneum, known as abdominal dropsy. Diseases of the heart and lungs in which the circulation of the blood is obstructed, also results in obstruction of the cir- culation in the liver, and the development of dropsy. The same condition results as part of the general dropsy that fol- lows chronic inflammation of the kidneys. The amount of fluid found in dropsy of the abdomen, varies from a few ounces to several gallons, and the abdomen may be so distended by it as to interfere with the normal func- tions of all the thoracic and abdominal organs. Symptoms.-The several symptoms that mark the dif- ferent diseases of the liver may be present before any evidence of dropsy appears. An increased fullness of the abdomen is the first symptom noticed. At first the lower portions of the abdomen will be distended while the patient is sitting or stand- ing; but the fluid will gravitate to the side when the patient lies down. Thus the distention will be seen at the most de- pendent part of the abdomen, and is immediately changed by change of position. The circumference of the abdomen in- creases with the increase of the effusion, and it often enlarges to two or three times its natural dimensions. With a hand placed on either side of the abdomen and pressure made alter- nately first on one side and then on the other, the motion of the fluid can be distinctly felt. As the distention of the abdo- men increases the diaphragm is pushed upward and thus 356 DISEASES OF THE DIGESTIVE SYSTEM. diminishes the capacity of the thoracic cavity. This produces difficulty of breathing and irregular action of the heart, which are increased by the recumbent position; and after a time the patient is obliged to sleep in the sitting posture in order to breathe at all. The urine becomes very scanty, constipation sets in, the integument over the abdomen becomes shiny and puffy, and as the trouble increases the lower extremities be- come swollen with the skin thickened and hardened. The enlargement of the abdomen is uniform, it yields to pressure, but fills out as soon as the pressure is removed, in the same manner as an India rubber ball, and there is usually no pain or tenderness. Treatment.-It is important to ascertain the nature of the disease that gives rise to the dropsy. This done, treatment should be directed to that part with the view of freeing the obstruction to the circulation of the blood in the liver. For the removal of the accumulated water in the abdo- minal cavity several remedies are recommended. The Com- pound Powder of Jalap and Senna, with Cream of Tartar, pre- pared in a tea as described on page 334, will be found the most valuable agent we can use for this purpose. A dose should be taken early in the morning and repeated every two hours till free watery evacuations from the bowels are pro- duced. It should be repeated in the same way daily, till the abdominal distention has disappeared. In some cases Indian Hemp will prove more efficacious, as it not only produces watery evacuations from the bowels, but also acts freely on the kidneys. It is best used in the form of a decoction, made by boiling one ounce of the root in a pint of water. Of this a tablespoonful should be given every three hours till a free action is produced. It may then be con- tinued about three times a day. In some cases it causes severe nausea, which should suggest the reduction of the dose to half a tablespoonful. If the nausea still keeps up the remedy should be discontinued. Elaterium is also a remedy of great value in this condi- tion. It should be prepared as follows: Powdered Elaterium, 3 grains; Powdered Capsicum, 24 grains; Cream of Tartar, 2 DROPSY OF THE ABDOMEN. 357 drams. Mix, divide into 12 powders, and give one powder every hour or two till it operates. This will produce free watery evacuations from the bowels and also an action on the kidneys. If any nausea is produced it is best to give half a powder every hour, and to continue their use for a longer time. If these measures fail to give relief the fluid must be re- moved by tapping. This should only be resorted to when the difficulty of breathing becomes intolerable. The canula and trocar, or the aspirator may be used, but no one but an ex- periencd physician should attempt it. The relief obtained is very decided, and the patient may be comparatively comforta- ble for some time afterward. If the bowels are kept active by the use of the Compound Podophyllin Pills,*and the kidneys by 20 grains of Acetate of Potash given in a little water three times a day, a considerable time may elapse before the abdo- men will again fill up. * See page 360. Dr. M. D. DENNIS' SYSTEM RENOVATOR AND BLOOD PURIFYING SYRUP. The System Renovator and Blood Purifying Syrup is compounded of some of the most valuable medicinal plants known to the profession. Poke Root, Black Cohash, Yellow Dock, Blood Root, Dandelion and Sarsaparilla, are among the most active ingredients, and with such a combination the remedy is a valuable tonic, anti-periodic, blood purifier and anti-rheumatic. The drugs are selected with the greatest care, and the active principles are extracted by exact chemical processes, so that all the crude portions of the plants are rejected, while the me- dicinal properties are retained in such a condensed form that the dose is reduced to the minimum. The compound has been thoroughly tested and can be relied on for use in the several diseases for which it is recommended. DYSPEPSIA. Dyspepsia has become so common in this country that it may well be called our national disease, and whenever it is present it is always associated with disorders of the liver. Now, with an inactive liver and bad digestion, the food taken into the stomach cannot be properly prepared to supply SYSTEM RENOVATOR AND 359 the waste of the several tissues of the body, and as a result unnatural chemical changes take place in the undigested food in the stomach and intestines, and thus we have produced a chain of blood disorders from the impurities thus collected in the system. The Dennis System Renovator can be relied upon as an effective and speedy cure for dyspepsia. For further instruc- tion concerning dyspepsia, see page 304. RHEUMATISM. Rheumatism. The littric acid in the system, which is the predisposing cause of Rheumatism, is also due to imperfect di- gestion, and it may be laid down as a fact that where the functions of the stomach and liver are normal there can be no rheumatism. As a preventive and a cure the System Renovator is a remarkably efficacious agent in overcoming this painful dis- order. On page 268 may be found a more extended article on this subject. FEVER AND AGUE. Malarial Disorders, commonly called Fever and Ague, or Chills and Fever, arise from miasmatic poisons that prevail in certain districts and at certain seasons of the year, though introduced into the system through the lungs, they are more likely to seriously affect persons who have disorders of the liver and stomach. Blood poisons, such as Syphilis, Erysipelas and the like also take firmer hold of persons who have been previously weakened by deranged digestion. It can thus be seen that Dyspepsia, Disorders of the Liver, Fever and Ague, Rheumatism and Impurities of the Blood, are always intimately associated or dependent on each other, and that a proper combination of remedies will give much 360 BLOOD PURIFYING SYRUP. better general results than when each special condition is treated with a single remedy. While the prescriptions given in the treatment of the various diseases, described in this work, are the most approved known to the medical profession of to-day, still the difficulty of having them filled with pure drugs, especially in country drug stores, is such as to frequently disappoint the expectations of the patient. Therefore, in the diseases for which the System Renovator is recommended, it can be substituted for the other treatment with a certainty of obtaining pure and reliable ingredients that will meet the indications above referred to, and speedily relieve the sufferer. This remedy should be given in doses of from one half to one teaspoonful three times a day for an adult. When given to children, the dose can be determined by reference to Part III, Chapter I, The Action and Doses of Me- dicine. Persons who are easily affected by medicines, and whose stomachs are sensitive, should always begin with the small dose and gradually increase to the teaspoonful, and when necessary it may be diluted with water. When the System Renovator does not move the bowels sufficiently, from one to three of Dr. Dennis' Anti-Bilious Pills should be given at bed time. DR. M. D. DENNIS' ANTI-BILIOUS PILLS. This improved Anti-Bilious Pill contains the same ingre- dients as the Compound Podophyllin Pill, with the addition of gentian and peppermint, which adds to its value as a stomach tonic and a preventive of fermentation. When the Compound Podophyllin Pill is recommended in the foregoing pages, this one can always be substituted with advantage. As a remedy for habitual constipation it has no superior, and has the advantage of overcoming the constipation perma- SYSTEM RENOVA TOR, 361 nently, instead of leaving the bowels more constipated than before. In health the bowels should move freely every morning, and persons of a constipated habit will find that this action can be secured without pain or irritation by taking one of these Pills every night for a few days in succession. When a free cathartic or purgative action is desired the above should be increased to two or three Pills at bed time ; and after a thorough action has been secured, one pill should be taken every second or third night till any coating of the tongue is entirely removed. Dr. Dennis' remedies are sold by his agents at the following prices. The System Renovator and Blood Purifying Syrup, full size bottle, $1.00; half size, 50 cents. Catarrh Remedy 25 cents per bottle. Anti-Bilious Pills 25 cents per box. It is his desire to have an agent at every point where there is a demand for the medicine. If however, the remedies cannot be obtained from an agent, he will send them to any address in the United States upon the following terms. The Anti-Bilious Pills will be sent by mail upon receipt of price, postage free. The System Renovator and Blood Purifying Syrup and Catarrh Remedy cannot be delivered through the mail, but will be for- forded to any address by Express upon receipt of price, and a sufficient quantity of the S. R. and B. P. S. or Catarrh Remedy, as desired, will be sent free to pay the Express charges. Dr. Dennis makes the above favorable terms solely for the purpose of accommodating those who are unable to purchase the remedies from an agent. All orders should be addressed to Dr. M. D. Dennis, P. O. Box 1680, New York. CHAPTER VII. DISEASES OF THE HEART. In order to study the various diseases to which the heart is liable, it is necessary to understand its structure. It is a muscular organ and is divided into four sections, which are specially arranged to constitute it the central organ of the circulatory apparatus. The cavities are lined with a delicate membrane called the endocardium and the several orifices are protected by valves, which are essential for the proper circu- lation of the blood, as described on page 69. An investing membrane is spread over the exterior of the heart, and is reflected around it so as to form a shut sac, in which the heart is inclosed. This membrane is called the pericardium. The muscular structure is liable to inflammation, hyper- trophy, atrophy, fatty degeneration, rheumatism and spas- modic action; the endocardium is liable to inflammation, to morbid growths and changes of structure; the valves undergo changes of structure and are liable to fibroid growths; while the pericardium may be the seat of inflammation, watery effusions within its cavity, of adhesions of its surfaces and of morbid growths. The nervous connection between the heart and the other organs of the body is so intimate, both through the great INFLAMMATION OF THE PERICARDIUM. 363 sympathetic and spinal nerves, that diseases of other organs almost invariably react upon the heart and produce a disturb- ance in its action. These disturbances are so severe as to demand special attention, and for that reason are generally described as functional diseases of the heart; while those previously referred to, which involve the structure of the organ, are spoken of as structural or organic diseases of the heart. The most of these diseases are obscure, and may escape recognition, even by experienced physicians. It is, there- fore, not to be expected that a non-professional reader can make himself so familiar with them as to be able to distin- guish one from the other. For this reason we shall only speak of the principal forms of heart disease, and urge the importance of consulting a competent physician whenever any condition develops that points to derangement of the heart's action. INFLAMMATION OF THE PERICARDIUM. Inflammation of the pericardium, or pericarditis, may occur as the result of an injury or from exposure to cold. It may also be due to the extension of an inflammation from neighboring parts, or to rheumatic conditions of the system. The inflammation may be confined to that part of the peri- cardium that surrounds the heart, or to the portion that lines the walls of the sac, and it may manifest itself in either an acute or chronic form. It sometimes occurs during the continuance of the erup- tive fevers, and in. Bright's disease of the kidneys; but it is more frequently developed as a complication of acute rheu- matism. SYMPTOMS.-When pericarditis occurs as a primary dis- ease, a general feeling of languor, chills, and fever are first noticed. Loss of appetite, nausea and vomiting with more rapid respiration soon follow; then comes a dull, heavy pain in the region of the heart, and when the adjacent portion of 364 DISEASES OF THE HEART. the pleura is affected the pain becomes acute in character. The pulse is full, strong and frequent, the urine is scanty, and the bowels constipated. In a few days, the feeling of depres- sion becomes very great and is attended by deep anxiety; the pulse becomes small and rapid, and frequently intermits; the heat of the skin is greatly increased over the trunk, while the extremities become cold, and are often covered with clammy perspiration. When effusion takes place into the cavity of the peri- cardium, the pulse becomes very feeble and faintness is occasioned by the slightest motion. Tapping over the region of the heart with the ends of the fingers or knuckles gives a dull, heavy sound as if striking a solid body, which extends beyond the boundaries of the heart. Treatment.-At the very beginning of the disease, twenty grains of Quinine should be given at one dose, and ten grains should be repeated every three or four hours, for twenty-four hours. After this time, the Quinine should be omitted. With a view of controlling the febrile action, the following- should be administered: Fluid Extract of Veratrum Viride, 30 drops; water, 4 ounces. Mix, and give one teaspoonful every half hour. This should be continued until the skin becomes moist, or the action of the heart is greatly dimin- ished. At the very onset of the disease, ice-bags may be placed over the region of the heart, but they should not be continued more than five or six hours. If the symptoms are not relieved when the ice-bags are removed, great relief is often obtained by the application of a Spanish Fly blister. When the acute symptoms of the inflammation subside, the absorption of the effusion around the heart may be hastened by the use of the following: Fluid Extract of Jaborandi, 1 ounce; Simple Syrup, 2 ounces. Mix, and give one teaspoonful every half hour until free perspiration is pro- duced. In some cases an increased flow of saliva will take place before the patient perspires. Stimulants should be freely used in conjunction with 5 grain doses of Quinine, as soon as the fever subsides. In some cases it may be neces- sary to resort to mechanical means for removing the fluid ENDOCARDITIS. 365 from the pericardial sac. This is best done by means of the aspirator, which can only be used by a competent surgeon. INFLAMMATION OF THE HEART. When the muscular structure of the heart becomes the seat of inflammation it is spoken of as carditis. Little has yet been learned of the causes that produce this disease, although it is known to result from sudden chilling of the body when a person is overheated, or from extension of sur- rounding inflammation to the heart's structure. Symptoms.-A violent pain in the region of the heart, and great distress immediately following a severe chill, are the first symptoms noticed. Increased heat in the region of the heart follows, the extremities become cold, and the body is covered with perspiration. The pain is of a cutting or bor- ing character, and is frequently so severe as to cause convul- sions and fainting. Every pulsation of the heart is violent, and the patient presses his hands to his side to obtain relief. Treatment.-As soon as these symptoms are felt, a phy- sician should be sent for without delay; and until he arrives, relief is best obtained from a quarter of a grain of Morphine. ENDOCARDITIS. Endocarditis is an inflammation of the membrane that lines the cavities of the heart. It may occur as a primary disease or as a secondary inflammation, following pleurisy, pneumonia, pericarditis or carditis. It is also a secondary condition resulting from acute rheumatism. Symptoms.-Uncomplicated endocarditis is not accom- panied by acute pain. There is, however, a feeling of oppres- sion in the region of the heart that is accompanied by faint- ness. These conditions are preceded by a slight chill, which is followed by a febrile re-action. The action of the heart is 366 DISEASES OF THE HEART. so violent that a strong impulse is imparted to the sides of the chest, which is readily felt by passing the hand over that region. The physician in making his examination detects marked changes in the sounds of the heart, caused by the changes in the endocardium and valves. The face is bloated and livid, breathing is difficult, the patient cannot lie down, and great restlessness is present. Treatment.-The same general treatment should be employed that has been recommended in pericarditis, but the disease is so grave in its character, and so fatal in its results, that a physician should be sent for as soon as the first symp- toms are manifest. RHEUMATISM OF THE HEART. Acute rheumatism that changes from one part of the body to another, is liable to attack the several structures of the heart. When this occurs, the symptoms either cease or become greatly modified in the localities that were first affected. Symptoms.-In mild cases, a dull gnawing sensation is constantly felt in the region of the heart, with an occasional sharp, darting pain that lasts but a moment. As in all car- diac diseases, there is a feeling of great depression and anxiety that cannot be accounted for. The action of the heart is sometimes strong and imparts a marked impulse to the walls of the thorax, but it is more frequently feeble, with a dullness of the normal sounds. The breathing is difficult and accompanied by sighing; the pulse is quick and irregular; the extremities are cold; and the action of the skin, bowels and kidneys obstructed. In severe cases, a violent, boring pain is felt in the heart, a marked chill occurs, and great anxiety is experienced. In a short time the body becomes hot, but the face and extremi- ties are cold and covered with perspiration. Every pulsation of the heart is attended with severe pain and the hands are DISEASES OF THE VALVES. 367 pressed to the sides to obtain relief. The head is thrown back and the chest is elevated so as to prevent the motions of the ribs, and respiration is performed with difficulty. In severe cases fainting frequently takes place, continued delirium sets in, and soon after death occurs. Treatment.-With the view of relieving the heart, hot fomentations of hops should be applied over the left side of the chest, and the feet should be placed in a mustard foot- bath, as hot as can be borne. To control the heart's action the following should be given: Fluid Extract of Veratrum Viride, 30 drops; Tinc- ture of Night Blooming Cereus, 3 drams; water, enough to make 4 ounces. Mix, and give a teaspoonful every half hour. As soon as some relief is obtained, this mixture should be given at intervals of three or four hours, or discontinued entirely. If the pain in the heart is not promptly relieved by these means, a Spanish Fly blister placed on the side over the heart, and mustard plasters over the entire length of the spine will be of great service. In addition to the above treatment, that recommended for rheumatism, on pages 269 and 270, must be employed till all the symptoms have disappeared. DISEASES OF THE VALVES. Diseases of the valves of the heart include all those con- ditions in which there are changes in the structure of the valves or of the orifices. The valves may be so changed as to be incapable of closing the orifice, and thus some of the blood flows back behind the valves, giving rise to a condition commonly called regurgitation or insufficiency. In other cases the orifices may be contracted or the valves may be thickened so as to obstruct the flow of blood, a condition that is called stenosis. These changes may take place at the opening between the left auricle and left ventri- cle, guarded by the mitral valve; at the opening into the aorta, guarded by the aortic semi-lunar valve; at the open- ing between the right auricle and right ventricle, guarded by 368 DISEASES OF THE HEART. the tricuspid valve; and at the opening into the pulmonary artery, guarded by the right semi-lunar valve. Symptoms.-When the mitral valve and orifice are affected by stenosis the pulse is small and sometimes irregu- lar; there is difficulty of breathing, cough, mucus secretions from the bronchial tubes, and sometimes bloody sputa or hemorrhage from the air passages; the right cavities of the heart are dilated; the veins of the body are congested by sluggish circulation, thus giving the mucous membranes and skin a bluish tinge; the liver is enlarged; abdominal dropsy sets in; the feet become swollen and puffy, indicating gen- eral dropsy which soon becomes severe; and the urine is scanty and filled with albumen. In regurgitation, or insufficiency at the mitral orifice, an uneasiness is felt in the region of the heart; palpitation is constant; cough and difficulty of breathing occur; the pulse is small, irregular, and intermittent; the feet and legs become dropsical; the cavity of the abdomen fills with fluid; the urine is scanty and loaded with albumen; and when death occurs the patient is literally drowned by the accumulations of fluid in the cavities of the body. In stenosis of the aortic valves the pulse is hard, small and slow; there is headache, vertigo, and fainting; some- times a sudden relaxation or prostration; difficulty of breath- ing comes on at intervals; bleeding from the lungs some- times occurs; and attacks of neuralgia of the heart are de- veloped. In aortic regurgitation the beats of the pulse are sudden and rapid; headache is present a good deal of the time, the pain being of a throbbing character, and associated with diz- ziness and ringing in the ears; and after a time these symp- toms may be modified, and no more serious ones may develop for years. Diseases of the right auriculo-ventricular opening are rare, and when they do occur they are associated with other conditions, and present the same general symptoms. The opening into the pulmonary artery may be deranged at birth, or may occur as a result of inflammation of the lining DISEASES OE THE VALVES. 369 membrane of the cavities of the heart. Either stenosis or regurgitation at this point produces the same general re- sults. As a general rule in all cases of stenosis, when the ear is placed over the region of the heart, a sound resembling that made by a rip-saw is heard; while in regurgitation the sound resembles that made by a hand bellows. While the first symptoms of the various forms of valvu- lar diseases of the heart are characteristic and decided, yet as the diseases progress, the heart accommodates itself to the new condition, and dilatation and hypertrophy of its several parts take place. This is called compensatory change, and after it occurs the patient may be comparatively well for a long period of time When this compensatory action is over- come by over-work, worry or any other cause, the symptoms of both stenosis and regurgitation are developed; and in the severer cases, the general symptoms of dropsy, albumen in the urine, difficulty of breathing, &c., come on, no matter what may have been the form of the original disease. Treatment.-When the first symptoms of any valvular disease of the heart show themselves, complete rest from both physical and mental labor is essential. If this precaution is taken, little or no medicine need be used. But as this is very rarely practiced, we must do what we can with remedies. With the view of controlling the frequency of the heart's action and relieving the sense of oppression the following should be used: Fluid Extract of Veratrum Viride, 30 drops; Fluid Extract of Pulsatilla, 1 dram; water, 3 ounces. Mix, and give one teaspoonful every hour. In addition to this, Tincture of Cactus Bonplandii, in 3 drop doses, may also be given every hour, in such a way that it may be alternated on the half hour with the previous mixture. If the nervous sys- tem is prostrated one Phosphorus and Strychnia pill should be used after each meal. When the symptoms are somewhat relieved the Cactus should be given in doses of 10 drops three or four times a day, and continued for months. During the period of compensation all excitement should be avoided, a good, nutritious diet should be supplied. 370 DISEASES OF THE HEART. tobacco in all forms should be discarded; and the excessive use of alcoholic liquors should be guarded against. The moderate use of wine at dinner, and some pure stimulant when the heart's action lags a little, will be found highly ser- viceable. When the dropsical conditions develop and the breathing becomes difficult, efforts should be made to remove the water. For this purpose the Compound Jalap Powder, prepared and used as described on page 334 will often prove valuable. It causes a free watery evacuation of the bowels and thus drains off the effused fluids. This may be repeated,once a day for a few days, if necessary. The alcohol sweat will also relieve the effusion promptly at times. Other remedies previously recommended for dropsy, may also be used with advantage. With this general treatment for cases of emergency, the patient should send for a competent physician as soon as he is satisfied that he has a disease of the heart. He must also remember that his recovery or relief will depend to a great extent, upon himself. As much absolute quiet as can be obtained should be had, and mental anxiety or trouble should always be guarded against. When the kidneys are inactive they should be relieved by the following: Acetate of Potash, 4 drams; water, 6 ounces. Mix, and give one tablespoonful after each meal and at bed time. HYPERTROPHY OF THE HEART. By hypertrophy of the heart is meant an increase in the size of that organ resulting from growth of its tissues. The walls of one of the cavities may be thus increased in size, or the entire organ may be enlarged. In some cases the cavities remain normal, or nearly so, while in others they are dilated. Hypertrophy may be caused by the extra labor the heart is called upon to perform in forcing the blood through some obstructed opening, or by an increased amount of nutrition being carried to the organ. In the majority of cases it is associated with obstructive diseases/of the orifices of the heart. HYPERTROPHY OF THE HEART. 371 SYMPTOMS.-The heart contracts with increased force, the pulse is full and bounding, the face is red, the nose bleeds frequently, there is a full feeling in the head, ringing in the ears, and dizziness. Frequent attacks of palpitation come on, a sense of oppression and a dull ache in the region of the heart are usually felt, and sometimes sharp pain, beginning at the heart, extends to the shoulder and arm and down the side. Difficult breathing is also experienced in severe cases. A close examination will show a prominence of the chest which is the most marked at the junction of the fourth and fifth ribs with the sternum. Treatment.-The patient should avoid all physical exer- tron and mental anxiety as far as possible. Stimulants should not be used, and light diet should be enforced for a time. When the compensatory dilatation takes place the patient may be comparatively free from the symptoms for many years. Should the symptoms be severe the violence of the heart's action may be controlled by the following: Fluid Extract of Aconite Root, 20 drops; water, 4 ounces. Mix, and give a teaspoonful every two hours. In addition to this, the bowels and kidneys should be kept active. The frequent use of the Compound Podophyllin pills*will serve to keep the bowels in a good condition, while 20 grains of the Acetate of Potash, given in water three times a day, for a couple of days each week,will act well on the kidneys. DILATATION OF THE HEART. By dilatation of the heart is meant an increase in the size of the cavities of the organ. This may occur with a thinning of the walls, or with hypertrophy, while in some cases the muscular structure may retain its normal condition. Dilata- tion occurs most frequently in young persons who are sub- jected to excessive physical effort, and in persons of delicate constitution. Symptoms.-The pulse is frequent and irregular; palpi- tation of the heart is common; dizziness, ringing in the ears, * See page 360. 372 DISEASES OF THE HEART. and faintness come on; and later, a short, hacking cough and difficulty of breathing. A lowered vitality and genaral wast- ing of the tissues of the body gradually result, a bluish appearance of the skin is present, and a dropsical con- dition of the extremities and abdomen sets in, and the urine becomes scanty and loaded with albumen. These symptoms may exist for a time and then subside in a measure after the compensatory changes in the heart take place. They may, however, be reproduced at any time that the action of the heart is disturbed. Treatment.-Attention must be given to the proper nutrition of the patient. The diet must be the most gener- ous that can be procured, stimulants in moderate quantities are desirable, and the patient must walk out daily, so as to secure all the fresh air possible. When there is general debility, Quinine in doses of 5 grains three times a day will serve an excellent purpose, while 15 drops of Dialyzed Iron, in water, three times a day, is also serviceable. As a special heart tonic the best remedy that can be used is Cactus Bonplandii. This should be given in doses of 10 drops of the Tincture, after each meal and at bed time; and it may be gradually increased to 20 drops at a dose. When the dropsical effusions become excessive they may be relieved by the remedies recommended on pages 356 and 357, for the treatment of abdominal dropsy. FATTY DEGENERATION OF THE HEART. By fatty degeneration of the heart is meant a changing of the muscular tissue of the organ into fat. It is caused by anything that diminishes the supply of blood to the substance of the heart. Fevers and infectious diseases, and the exces- sive use of alcohol, also tend to bring about fatty degenera- tion of the heart. SYMPTOMS.-The pulse is small, weak, irregular and intermittent; the respiration is slow; faintness on the slightest exertion, and sometimes actual fainting occurs; dis- tress and difficulty of breathing on going up stairs, are felt PALPITATION OF THE HEART. 373 long before any suspicion of heart trouble is entertained; and the veins of the neck are habitually distended, while the face assumes a bluish tinge. Towards the last the legs become dropsical, the liver enlarges, abdominal dropsy comes on, and the urine is scanty and albuminous. Treatment.-Nutritious diet and tonics are of the first importance in this disease. As a tonic the Elixir of Calisaya, Iron and Strychnia, answers a good purpose, and should be given in doses of a teaspoonful three or four times a day. The Tincture of Cactus Bonplandii in doses of io drops four times a day is the best special heart tonic that can be given. When the symptoms common to the advanced stages of organic diseases of the heart appear, they should be treated as previously described in this chapter. PALPITATION OF THE HEART. Palpitation of the heart is a term applied to irregular and rapid actions of the heart, that occur without any disease of the structure of that organ. This condition may come on during the continuance of any nervous disease as a result of a lack of nerve power in the heart itself, or it may come on through sympathy in diseases of the lungs or digestive organs. In diseases of the stomach, palpitation is frequently developed through sympathy, and it is more likely to occa- sion alarm to the patient than organic diseases. Symptoms.-Following many chronic diseases a sense of uneasiness, or dull pain, is felt in the region of the heart, for some time before any other symptom is noticed. When the palpitation takes place it consists of a rapid, tremulous beat- ing of the heart, accompanied by anxiety, a sense of choking, and difficult breathing. Sometimes the patient feels as though the heart was turning over, or was powerfully grasped and pulled, or was rising into the throat; and these sensa- tions are aggravated by lying down, particularly on the left side. Dizziness, faintness, coldness of the surface, cold per- spiration, and a weak pulse are also among the common symp- toms. 374 DISEASES OF THE HEART. These attacks come on while walking, eating or smok ing, or on the slightest excitement. Sometimes the shutting of a door or any loud noise, is sufficient to produce them. An attack may last only a few minutes, or may continue for sev- eral hours. After the attack the patient usually passes a large quantity of clear urine, and experiences a feeling of great exhaustion, with a desire to sleep. As soon as rest has been obtained there is no evidence of any disturbance of the heart's action till another attack comes on. Treatment.-The diseases that may give rise to palpitation must be attended to, and the hygienic condition of the suf- ferer considered. As a general rule nervous prostration and derangement of digestion are responsible for palpitation, and the treatment directed to the relief of these conditions will be the most likely to relieve this affection. If the attacks are persistent the best remedy that can be given for immedi- ate relief is Fluid Extract of Gelsemium. This should be given in doses of 5 drops, every half hour, till relieved, or till six or eight doses are taken. If constipation is present it should be relieved by the Compound Podophyllin pills*taken at bed time. Ice bags placed over the region of the heart will also serve a good purpose in some cases. ANGINA PECTORIS. Angina pectoris is a disease that is characterized by intense pain beginning in the heart and spreading over the entire thorax. It is sometimes called neuralgia of the heart, although some writers claim that it is different from simple neuralgia of that organ. It is in some instances associated with organic disease of the heart or arteries, and in other cases no such diseases exist. Symptoms.-Angina pectoris usually comes on without warning, while the patient is at work, while walking, or during any mental excitement. In many confirmed cases it occurs while the patient is asleep. A severe pain begins in the heart with a sense of constriction affecting the entire left 'Seepage 360. ANGINA PECTORIS. 375 side of the chest. The pain extends to the left arm and along the neck to the head, causing great agony. Palpitation and great difficulty of breathing, with a sense of suffocation, come on immediately after the pain, and the sufferer feels as if death was approaching. He attempts to seize upon some object for support, and is afraid to move while the attack lasts. The agony may only last for a few minutes, or may continue for two or three hours. At first there are long intervals between the attacks, but after a time they come on more frequently, and finally the patient is not sure of being free from them at any time. Treatment.-Various remedies have been recommended in the treatment of this disease, but till recently none have been found to give relief. The latest remedy suggested is Nitro-Glycerine, and from the testimony thus far given in its favor, it promises to take the place of all others in the treat- ment of this disease. It is a powerful medicine and is pre- pared in pill form, each pill containing a one-hundredth of a grain of Nitro-Glycerine. One of these pills should be given three times a day. It may occasion a severe headache, but this soon passes off and leaves the patient much improved. The remedy must be continued for several weeks to accom- plish a cure. CHAPTER VIII. DISEASES OF THE RESPIRATORY APPARATUS. The respiratory apparatus comprises all those parts and structures necessary for the introduction of air into the body, and for the separation of the oxygen from it for the purifica- tion of the blood. Its component parts are the nose, larynx, trachea, bronchial tubes and lungs. Covering the lungs and lining the cavity of the chest we have the pleura, which is also considered as belonging to these organs. All these parts are liable to inflammation and sequences developed by it, and some of them undergo organic changes that seriously interfere with the performance of their func- tions. The several parts affected by the diseases to be consid- ered in this chapter are represented in Fig. 25, page 65, Figs. 26 and 27, page 67, and in Fig. 42. The outline of the lungs and the ramifications of the bronchial tubes, are represented in Fig. 25, while the general conformation and texture of the lungs are shown in Figs. 26 and 27. In Fig. 42 a vertical section of the head and neck in the median line is represented. The front part of the nasal HEAD AND NECK. 377 Fig. 42. 378 DISEASES OF THE RESPIRATORY APPARATUS. cavity is represented at 20, the middle at 18, and the pos- terior nose or cavity at 19. Following this comes the pharynx, the upper part of which is seen at 21, while the lower boundary is at the very base of the tongue. The soft palate and uvula are seen at 22, the cavity of the mouth at 23, the tongue at 24, and the front teeth at 25. The plate of the upper jaw bone that separates the cavity of the nose from the mouth is seen at 26, while 29 marks the entrance to the larynx, 32 shows the interior of the larynx, and 31 the interior of the trachea. The trachea branches off to form the two large bronchial tubes, and these continue to sub- divide till the minute air-cells are reached. It will thus be seen that the air passages begin at the nostrils and terminate in the ultimate air-cells in the lungs. The mucous membrane is also continuous, and it thus happens that an inflammation beginning at any one point may spread to the adjacent parts. Although the nasal cavities are the natural passages through which the air should enter the lungs, many people acquire the habit of breathing through the mouth. The structure of the nose is such that the air passing through it is in a measure filtered so that particles of dust are prevented from entering the lungs. The extensive mucous surface over which the air must pass through the nose is also intended to regulate the temperature of the air before it enters the larynx. Now it can readily be seen that in mouth breathing the cold air, loaded with particles of dust, must necessarily tend to develop irritation in the pharynx, trachea and lungs. When inflammation of any of these parts is present it is important to bear these facts in mind, as breathing through the nose, particularly during cold weather, will materially aid in over- coming the inflammatory condition. CORYZA, OR NASAL CATARRH. An inflammation confined to the mucous membrane of the nose is usually spoken of as coryza, or nasal catarrh; and it may be either acute or chronic. It is acute when it comes CORYZA, OR NASAL CATARRH. 379 on suddenly, runs it course rapidly, and then disappears; and chronic when the symptoms are less aggravated and continue a longer period of time. The chronic form of the disease usually develops after repeated attacks of acute coryza. Ex- posure to severe cold, damp feet, suddenly going from a warm into a cold atmosphere, or the reverse, and the inhalation of irritating vapors and gases, are among the exciting causes of the disease. Simple acute coryza is popularly spoken of as cold in the head, and when it continues for some time it is usually denominated nasal catarrh. Symptoms.-General muscular soreness, languor, head- ache and chilliness are the usual forerunners of this disease. Soon after these symptoms are felt the nose becomes dry, a frequent inclination to sneeze is manifest, and a stuffed up feeling in the head is developed, with an inability to breathe through the nose with the mouth closed. In a short time a profuse watery discharge takes place from the nostrils which speedily becomes thick and purulent. The voice takes on a nasal twang and the patient is forced to breathe through the mouth, while in many cases the sense of smell is blunted or entirely destroyed for the time being. The thickening of the membrane subsides and the secretion diminishes after a few days, and in a week or two the parts are restored to their normal condition. Repeated attacks of the acute disease with the manifes- tation of these symptoms may take place, and after a time the mucous membrane becomes permanently thickened and continues to discharge a greenish, offensive matter, which often forms in crusts resembling in shape the depressions in the cavities of the nose. This condition indicates the devel- opment of the chronic form of coryza, and may often extend to ulceration which may even involve the bones of the nose. Treatment.-When the symptoms of acute catarrh are first noticed, and the patient feels as if he had taken a severe cold, the disease may be cut short by proper treatment. For this purpose the feet should be placed in a hot mustard bath or what is better still, an alcohol sweat should be adminis- tered before going to bed. The body should then be 380 DISEASES OF THE RESPIRATORY APPARATUS. thoroughly rubbed and the patient placed in the bed with plenty of clothing over him. A hot sling, made with an ounce of good whiskey or brandy, should then be adminis- tered. This will usually cause a free perspiration and' a determination of blood from the head, which promptly relieves the catarrhal symptoms, and the patient will often awaken in the morning entirely free from cold in the head. The Turkish bath before retiring will also be found a valuable means of breaking up an acute catarrh. Should the skin remain hot and feverish after the patient has been put to bed, Aconite should be given as follows: Fluid Extract of Aconite, 30 drops; water, 4 ounces. Mix, and give a teaspoonful every half hour, until the skin becomes moist or the febrile symptoms are relieved. For children this dose should be reduced according to the age. If the symptoms of catarrh remain in the morning, the ad- ministration of 15 or 20 grains of Quinine at one dose may be found serviceable. When a bath cannot be had, 10 grains of Dover's Pow- der, given at bed time, will often cause a free perspiration, give the patient a good night's rest, and prevent any further development of the disease. If the inflammation continues for a few days, the Aconite solution should be given every hour or two, while the Quinine should be continued in 5 grain doses three times a day. The local inflammation is often relieved by the following: Carbolic Acid, (95 per cent.) 2 drams; Aqua Ammonia, 2 drams. Mix in a wide-mouthed bottle, and pack into the bottle enough cotton batten to absorb the fluid. Thus prepared, the bottle may be held under the nostrils, and 'with one nostril closed, the fumes should be drawn into the other, till they can be felt in the upper portion of the nasal cavities. This may be repeated in each nostril several times, and it will often afford prompt relief of the unpleasant symptoms in the head. Good results follow the use of a Carbolic Acid solution, snuffed into the nostrils. For this purpose 10 drops of Carbolic Acid should be added to six tablespoonfuls of tepid water, and a teaspoon- ful should be snuffed up each nostril, three or four times a day. EPISTAXIS, OR BLEEDING OF THE NOSE. 381 To accomplish this the head should be thrown well back, so that the mixture, after passing into the anterior nose, will pass into the mouth. As the chronic form of coryza is seldom confined to the mucous membrane of the nose, but extends downward so as to involve the pharynx, we will consider its treatment under the head of Chronic Catarrh. EPISTAXIS, OR BLEEDING OF THE NOSE. Epistaxis, or bleeding of the nose, is a condition in which a free escape of blood takes place from the nasal cavities. It may be produced by ulceration of the mucous membrane, by chronic catarrh, by the presence of swollen bunches of blood vessels, by direct local injuries, by a weakened condition of the system, and as a consequence of valvular disease of the heart, in which there is a marked congestion of the veins of the head. Symptoms.-Preceding the flow of blood the patient feels a sense of fullness in the head, noises in the ears, deaf- ness and headache, all of which are greatly relieved by the bleeding. In some cases no symptoms may be noticed until the blood shows itself. Sometimes the bleeding may take place in the posterior cavities, when the blood flows down into the mouth, and may be mistaken for bleeding from the lungs. This mistake can be readily detected by opening the patient's mouth and examining the throat, when the blood will be seen to drop down behind the soft palate. Treatment.-A piece of ice should be placed over the bridge of the nose and small pellets may be introduced into the nostrils; or cold water may be snuffed up the nose and allowed to pass into the throat. Ice applied to the back of the neck will also be found efficacious. A firm wad of soft paper may be rolled up and placed under the centre of the upper lip, so as to press upon the small artery that supplies the anterior part of the nose with blood. When this wad is 382 DISEASES OF THE RESPIRATORY APPARATUS. in place the lip may be firmly pressed against it, and thus .the bleeding will be controlled. If these means fail a strong solution of Alum should be injected into the nose with a syringe, and the nostrils should be plugged with cotton dipped in the same solution. Should the bleeding still con- tinue, a solution of Per-Sulphate of Iron should be used in the same manner as the Alum; and this failing, a physician should be called upon to place a plug of cotton into the pos- terior nose, which must be introduced through the mouth with an instrument specially designed for the purpose. OZENA. Ozena is a term applied to that form of chronic inflamma- tion of the mucous membrane of the nose that has extended to ulceration, involving the nasal bones. The disease is gen- erally developed by chronic catarrh, but it sometimes occurs as one of the forms of secondary syphilis. SYMPTOMS.-The usual symptoms of chronic catarrh are always present in this disease. To these are added a dis- charge that is much more offensive than that usually met with in catarrh, which surgeons recognize as being associated with the destruction of the bony tissue. After the disease has existed for some time, pieces of the bones of the nose are frequently thrown off with the discharges, and in some cases, the bony partition between the cavities of the nose and mouth is eaten through, and the voice is destroyed, or so altered that the person can hardly be understood. Treatment.-For the general treatment of ozena, the reader is referred to the treatment of chronic catarrh. The special treatment consists in supporting the system by nutri- tious food and tonics. If any syphilitic taint is present, the treatment recommended for constitutional syphilis should be employed. The Syrup of Lacto-Phosphate of Iron, given in teaspoonful doses, three times a day, will be found a valuable remedy. The ulcerated surfaces should be freely touched with pure Carbolic Acid, and the particles of diseased bone PHARYNGITIS. 383 should be detached and removed as soon as possible. The closest daily attention of a surgeon is necessary in severe cases to prevent the great destruction of bony structure that sometimes takes place. PHARYNGITIS. The pharynx is the large cavity forming the back part of the throat. It is continuous with the mouth and oesophagus on the one hand, and with the posterior nasal cavities and larynx on the other. It's mucous membrane is often the seat of inflammation, that is technically called pharyngitis, which may be either acute or chronic. The acute inflammation may be caused by taking cold, by extending from the posterior part of the nose, by irritating vapors or gases, by too hot food, or by injuries inflicted by foreign bodies. The chronic form of the disease results from repeated acute attacks, and from the gradual extension of chronic inflammation from the nose or larynx. SYMPTOMS.-In acute pharyngitis there is a feeling of dryness and obstruction in the upper and back part of the throat, a swelling of the mucous membrane, and an increased redness of the surface, which can be seen when the mouth is open and the tongue depressed. The hot, dry condition remains for a few days when it is followed by an increased secretion of mucus. When the inflammation involves the upper part of the pharynx headache is sometimes present, the voice is thick and husky, and nasal breathing is obstructed. The secretion is a clear mucus at first, but it soon becomes yellowish. These symptoms subside in a few days, the huskiness leaves the voice, and breathing through the nose becomes normal. In chronic laryngitis the mucous membrane is of a red- dish-brown color, the blood-vessels are enlarged and twisted, and little elevated points of a reddish-gray color, can be seen all over the surface. There is a constant feeling of fulness 384 DISEASES OF THE RESPIRATORY APPARATUS. and irritation, with a continual hawking effort to remove what feels like some foreign body, from the throat. Treatment.-In acute pharyngitis, involving the upper part of the pharynx, the treatment recommended for acute catarrh should be used. If the lower part is involved, some soothing gargle may be employed. The following answers a good purpose: Fluid Extract of Eucalyptus Glob- ulus, i ounce; Glycerine, I ounce; water, 6 ounces. Mix, and use as a gargle three or four times a day. If this does not give prompt relief the following should be substituted: Hy- drastin, 20 grains; Powdered Borax, io grains; Glycerine, 2 ounces. Mix, and apply to the throat with a camel's hair brush two or three times a day. The mixture must be thor- oughly shaken each time before it is used. When chronic pharyngitis follows, it constitutes a part of the general condition described below as chronic catarrh, and the same treatment must be employed. CHRONIC CATARRH. Although the term catarrh is applied to an inflammation of any mucous surface that is accompanied by an increased secretion of fluid, common usage has restricted its application. We speak of catarrh of the stomach, catarrh of the rectum, &c., but when we use the term catarrh, without qualification, it is generally understood as referring to an inflammation of the mucous membrane of the nose and pharynx. Acute inflammation of these localities have already been described, and it now remains to consider the chronic inflam- mation that is commonly called catarrh, or more properly chronic catarrh. The acute inflammation of the nose or throat that arises from cold may pass off in a few days, or it may be aggravated by repeated colds till a chronic condition is developed. The constant application of some irritant may also result in chronic inflammation of these parts. Whatever the cause, or causes of chronic catarrh may be, certain it is that serious CHRONIC CATARRH. 385 conditions are developed, which often tax the patience of the sufferer as well as the physician. Symptoms.-The symptoms of acute nasal catarrh are all present in a modified form, when the catarrh begins in the nose. As far as can be seen the mucous membrane of the nose presents a livid color with a distended condition of the veins, and a marked thickening of the entire tissue. In some long-standing cases, however, the membrane is thin, pale and atrophied. The discharges are of a greenish color, and often very offensive. They sometimes collect in the recesses of the nose and form hard scales, which are blown out with difficulty. As these accumulate they decompose and make the breath extremely offensive. When the inflammation involves the back part of the nose and upper part of the pharynx there is a constant sensa- tion as of something dropping into the throat, and an exam- ination will often show the back part of the throat covered with a tenacious mucus. An effort to clear the throat, by hawking and spitting, or swallowing, is constantly being made, but it is much worse in the morning. The discharges having accumulated during the night, leaves considerable to be removed from the throat in the morning. After a time, large, hardened lumps of a greenish secretion, accumulate and are hawked up at intervals; breathing through the nose becomes more obstructed, and the irritation extends along the whole length of the pharynx, and in some cases affects the larynx, trachea, and bronchial tubes, from continuity of tissue. The repeated effort to clear the throat causes an irritation of the soft palate, that may so elongate the uvula as to lead to a continued irritation from that cause. In some cases the hearing is impaired, and after a time almost destroyed, by the inflammation extending into the Eustachian tube, and so closing it as to prevent the introduc- tion of air into the middle ear. As the minute filaments of the olfactory nerve-the special nerve of smell-are spread over the mucous surface of the nose, the continued inflammation of that membrane 386 DISEASES OF THE RESPIRATORY APPARATUS. must necessarily affect the sense of smell. In many cases this sense is entirely destroyed, and when such is the case, the person's breath is so offensive that others can hardly re- main in the same room. These symptoms are all more severe in winter than in summer, and after exposure to cold or damp, those of acute catarrh often set in and last for a few days. Treatment.-So many failures have been made in the treatment of catarrh, that many people believe that it is in- curable. The reason for this is that when but little inconven- ience is felt from the disease, as is the case during the sum- mer months, persons suffering from it give little or no atten- tion to treatment. On the other hand, when it is aggravated by the cold, raw weather of winter, they consult a physician and begin treatment. Under such circumstances fresh colds are constantly being added, and the benefit derived is only temporary. This suggests the importance of treating catarrh during warm weather, when no set-backs are liable to be met with. We firmly believe that the worst cases of catarrh can be radically cured if properly treated during the summer months, and this belief is based on the successful treatment of a large number of cases in this way that had been pronounced incur- able. In mild cases of catarrh, Carbolic Acid is one of the best remedies that can be used. To a half gobletful of tepid water io drops of Carbolic Acid (95 per cent.) should be added, and this may be snuffed up the nostrils twice a day. A teaspoonful of this solution may be held to one nostril, and while the other is closed with the finger, the head is thrown back while the fluid is snuffed up. This may be repeated twice in each nostril during the one treatment, and the balance of the solution may be used as a gargle. The solution is made with the tepid water each time it is to be used. A tablespoonful of glycerine or honey, added to the solution, will often render it more soothing, When the hard scales or lumps of offensive secretion accumulate in the nose and throat, the same Carbolic Acid CHRONIC CATARRH. 387 solution is best used by means of the catarrhal syringe. This syringe has a long, curved nozzle, which is perforated at the end with a number of small openings. It is filled with the solution and carried into the mouth so that the end is passed up behind the uvula, (22, Fig. 42.) into the posterior nose. When in this position the fluid is forced out of the syringe and thrown in every direction through the small holes in the nozzle. As this is done the patient leans his head forward and the fluid comes out of the nostrils. By repeating this two or three times at each treatment, the cavities of the throat and nose are thoroughly cleansed, while the Carbolic Acid stimulates the surfaces to healthy action. This syringe cannot be used by the patient, and should only be attempted by the physician; One of the most complete instruments for the treatment of catarrh, is Reynder's Improved Atomizer, with tongue depressor, represented in Fig. 43. The flihd to be inhaled is placed in the bottle, and the rubber bulb held in the hand pumps the air into the second ball. This ball contracts and keeps up a con- stant stream of air, which passes over the orifice of a tube that goes into the bottle. This draws the fluid up and drives it off in a fine spray as seen to the left of I, in the cut. When ready for use the tongue is held down by the tongue-depressor, and the medicated spray is carried into the throat. Three spray- ing tips are provided as shown by I, 2 and 3 in cut. That attached to the instrument carries the spray to the back part of the throat, while 2 can be directed upward so as to carry Fig- 43- 388 DISEASES OF THE RESPIRATOTY APPARATUS. it behind the soft palate into the posterior nose, and 3 directs the spray downward, and is used when it is desirable to carry the spray into the larynx and trachea. By placing 2 in the nostril the anterior nasal cavity can also be thoroughly treated. In using this instrument for the treatment of catarrh an ounce of tepid water should be placed in the bottle with the medicine. The spray is then carried in every direction where any inflammation is present, and thus every particle of the diseased mucous membrane can be reached. In beginning the treatment, 3 drops of Carbolic Acid should be put into the bottle with the water, and this should be used twice a day till all disagreeable odor is removed. The solution should be made fresh each time it is to be used. With the view of reducing the thickness-of the membrane and diminishing the discharge any astringent can be used. In some cases 8 grains of Alum to the ounce of tepid water will serve a good purpose; or 3 grains of Tannic acid, may be used in place of the Alum. The Chloride of Zinc or Sulphate of Iron may also be used of the strength of 2 grains of either to the ounce of tepid water. When the surfaces are irritated and tender, 20 grains of Bromide of Potassium to the ounce of tepid water, inhaled two or three times a day will give decided relief. For bleeding from the nose 10 grains of Tannic Acid or 5 grains of Per- Sulphate of Iron to the ounce of water may be used with the atomizer to con- trol the bleed- ing. In cases where it is desirable to have the spray penetrate the trachea or bron- chial tubes, more Fig- 44- TONSILITIS. 389 force is required than can be obtained by the hand atomizer. The instrument represented in Fig. 44, in which the spray is produced by compressed air should be used under the super- vision of the physician in such cases. As the force with which the spray is carried into the air passages can be regulated as desired, the results obtained by the use of the instrument have been very satisfactory. When the catarrh affects the lower part of the pharynx or the larynx, the steam atomizer, represented in Fig 45, may be used in place of the instru- ment just described. As soon as the water in the boiler begins to boil the steam is thrown out and sucks up the medicated fluid, which mixes with the steam, and is carried through a glass funnel. The spray is inhaled from the small end of the funnel, and can be felt to extend well into the air passages. The same remedies as recommended above may be used, but as the strength is reduced by the steam, the solutions should be made double the strength that is re- quired for the hand atomizer. When ulcerated conditions of the mucous membrane are met with they must be touched with pure Carbolic Acid every second or third day, so as to destroy the tendency to ulcera- tion and stimulate to a healthy action, No irritating or stimulating inhalation or other applica- tion should be made to the throat or nose on a wet or very cold day, if the patient is obliged to be out. If treatment is required in the winter the applications should be made in the evening, and the patient should remain in doors afterward, if he is obliged to be out during the day. Attention must also be paid to the general health. Good nutritious food must be supplied, and if any debility is present teaspoonful doses of the Elixir of the Phosphates of Quinine, Fig- 45- 390 DISEASES OF THE RESPIRATORY APPARATUS. Iron and Strychnia, will be found as good a remedy as can be employed. TONSILITIS. On either side of the throat, situated between two folds of the soft palate, are to be seen two glandular bodies called the tonsils. These are often the seat of an inflammation which is called tonsilitis. It may be slight or severe, and is usuallyproduced by cold, though some persons are more prone to the disease than others. In some cases suppuration takes place and the gland has to be opened with a knife, or breaks and discharges itself. This condition is commonly called quinsy. Symptoms.-Tonsilitis first develops a soreness and stiffness of the throat, which is sometimes preceded by a chill, and febrile symptoms. The throat is dry, hot and swol- len, and in a few hours the pain becomes severe. The patient swallows with difficulty and every attempt to do so is attended with excruciating pain. Respiration becomes difficult, the voice becomes harsh and hoarse and is sometimes lost. On examining the throat it is found completely filled by the en- larged tonsils, which usually look red and shmy. These symptoms may continue from four or five to twenty days and then subside. In some cases the tonsils continue to enlarge, a deep-seated throbbing pain is constant for a few days and then subsides. This indicates the formation of matter, and we have not now long to wait before the tonsil breaks and a free discharge of pus takes place. In some cases the surface of one or both tonsils is covered with little ulcerated patches that secrete a whitish substance. This condition is often mistaken for diphtheria, and treated as such. Usually one tonsil is involved, and after the inflammation has subsided in that it attacks the other. Treatment.-As soon as we are satisfied that the case is one of tonsilitis, hot fomentations of hops, or flaxseed meal SORE THROAT. 391 poultices should be applied to the neck and close under the lowerjaw. To control the fever the following may be given: Fluid Extract of Aconite, 20 drops; water, 4 ounces. Mix, and give a teaspoonful every hour. Fluid Extract of Poke Root should be given in 10 drop doses every three hours, with the view of preventing the formation of the abscess. The most relief, however, is obtained by freely lancing the inflamed gland, before the matter begins to form. This causes local bleeding, relieves the tension and fullness, and thus quiets the pain, and cuts short the disease before any tissue is destroyed. It must, however be done by a careful surgeon, who knows where to cut. Hot poultices should be applied after the gland is lanced, and a quarter grain of Morphine may be given to produce sleep. The symptoms will now rapidly disappear and the parts are soon restored to their natural condition. When the little ulcers appear on the tonsils, thus giving rise to what is called follicular tonsilitis, they should be touched with pure Carbolic Acid, and then the throat may be gargled with the following: Tannic Acid, 30 grains, water, 6 ounces. Mix, and use as a gargle three or four times a day. Sometimes the tonsils become permanently enlarged from frequent attacks of tonsilitis. When in this condition they keep up a constant irritation of the throat which is accom- panied by a hacking cough. In these cases the only sure method of relieving the diffi- culty is by cutting out the enlarged glands. It is a simple operation and is attended with very little pain. SORE THROAT. Sometimes after exposure to cold or damp a general in- flammation of the mucous membrane of the throat occurs, which involves the pharynx, tonsils, and soft palate, and ex- tends to the roof of the mouth. A condition commonly called sore throat is thus developed. It maybe mild or severe, may last only a few hours, or may continue for several days. DISEASES OF THE RESPIRATORY APPARATUS. 392 The mouth and throat are dry and hot, and there is a sore raw feeling while swallowing. Sometimes all the symptoms of pharyngitis and tonsilitis are present. Treatment.-Mustard plasters to the throat and the in- halation of the vapor from an infusion of hops and vinegar, will materially relieve the symptoms. To control the local inflammation, the following should be used: Chlorate of Potash, I dram; Tannic Acid, 20 grains; wa- ter, 6 ounces. Mix, and use as a gargle, three or four times a day. In addition to this a small piece of saltpetre may be held in the mouth till it dissolves. This will allay the feeling of heat and dryness, and hasten the cure. ACUTE LARYNGITIS. Acute laryngitis is an inflammation of the mucous mem- brane lining the larynx. It maybe confined to the larynx it- self, or may be a continuation from the pharynx above or from the bronchial tubes or trachea below. It is usually pro- duced by cold and sudden changes of temperature. The in- halation if irritating gases and vapors may also give rise to it. SYMPTOMS.-In the milder forms of acute laryngitis there is little or no constitutional disturbance. A feeling of raw- ness, heat, and a tickling of the upper part of the wind-pipe are the usual symptoms manifested. Pressure on the throat over the region of the larynx is followed by pain and irrita- tion; there is a marked sensation of dryness, and a constant desire to clear the throat of what appears to be a foreign body;and swallowing usually occasions sharp pain. The se- verer form of the disease is ushered in by a slight chill which is accompanied by a feeling of languor, soreness, and stiffness of the throat, and difficulty in swallowing. A harsh, dry cough sets in at once, and every paroxysm of coughing causes ascratching sensation of the surfaces. In a short timea secre- tion is thrown out, which at first consists of frothy mucus, ACUTE LARYNGITIS. 393 and as soon as this appears the cough becomes less. The expectoration is sometimes streaked with blood, but it usually assumes the character of a mixture of mucus and pus. As the disease progresses the hoarseness increases, till at length there may be a complete loss of voice. In children the cough becomes croupy in character, and difficulty of breathing comes on which sometimes results in spasms of the glottis. Some- times the vocal cords are swollen to such a degree that great oppression is felt for want of air which the swelling prevents from entering the lungs. When complete loss of voice is not produced the tone of the voice is materially altered, a condi- tion that depends upon the thickening of the vocal cords. The disease may run its course in a week, or in severe cases may continue for three or four weeks. Sometimes the symptoms may disappear entirely, and from slight exposure to cold a re- lapse may take place, in which the symptoms are all re-pro- duced. These relapses may occur frequently, and may thus develop the chronic inflammation. The loss of voice and spasms of the glottis are the two important sequences of acute laryngitis, and are so characteristic in themselves that a spec- ial description of them is desirable. Sometimes the inflam- mation may extend to the other tissues of the larynx and thus serious complications may arise. Treatment.-In mild cases the patient may be confined to a room with an even temperature of from 70 to 73 degrees and the air should be kept moist by the steam from boiling water. In the severer forms of the disease the patient should be confined to bed. A mustard plaster should be placed over the throat, and allowed to remain as long as the patient can bear it. When this is removed a long narrow bag of hops should be placed around the neck, as hot as can be borne, and it may be changed as often as is desirable to keep up the heat. The feet should be placed in a hot mustard bath, and as soon as possible the patient should be placed in bed and well covered up. The milder cases may often be benefited by a hot whis- key sling, or by 10 grains of Dover powder taken at one dose after getting into bed with a view of relieving the local inflam- mation. Aconite should be given as follows: Fluid Extract 394 DISEASES OF THE RESPIRATORY APPARATUS. of Aconite Root, 20 drops; water, 4 ounces. Mix, and give a teaspoonful every hour. A child should receive one-half or one-quarter of this dose according to the age. Mustard plas- ters may also be applied to the whole length of the spine and even to the ankles and wrists. The inhalation of the fumes of hop tea, moistened poppy heads, or any anodyne herb may be found of great advantage in relieving the local irritation. When a person has had one attack of this disease he is liable to have it again, and for this reason the feet should be properly protected against damp; good heavy flan- nels should be worn next to the skin, and the general health should be maintained by good food and proper exercise. Sometimes at the very beginning of the disease 15 or 20 grains of Quinine taken at one dose may cut it short, and after it has once developed, and there is a possibility of its recurrence Quinine should be given in 5 grain doses every day for a week or two. CHRONIC LARYNGITIS. Chronic Laryngitis is a chronic inflammation of the mu- cous membrane of the larynx, and is sometimes a part of a general catarrhal condition of the air passages. This form of the disease is frequently the result of acute inflammation though it may sometimes develop without any well-defined inflammatory action being manifest. In such cases, to- bacco smoke, excessive use of all alcoholic liquors, and the improper use of the voice in speaking and singing are among the exciting causes that keep up the irritation from which the inflammation develops. This condition is sometimes denom- inated ministers' sore throat, from the fact that ministers and others, who speak a great deal in public, are often attacked with it. In these cases the improper use of the voice always develops the disease, and it is not relieved until the constant speaking is discontinued. SYMPTOMS.-Chronic laryngitis develops gradually, and many a time the patient is hardly aware of the fact. The soreness of the throat when speaking, an alteration of the CHRONIC LARYNGITIS. 395 voice which is toned to a higher key, and a frequent irrita- ting cough, with a constant hawking to clear the throat, are the most common symptoms. These often subside after a short time, only to develop again and to last longer than before. The expectoration, which is at first scanty and of a mucus character, becomes mixed with pus and assumes a sanious character as the disease advances. After a time evi- dences of the inflammation are seen in the throat, and the inflammatory condition extends downward into the trachea and bronchial tubes. Every change of the weather or expos- ure to damp aggravates the symptoms. The most severe paroxysms of coughing occur in the morning; as considerable hawking and straining are necessary to remove the accumula- tions of mucus that have gathered during the night. This condition, though sometimes existing as an independent dis- ease, is most frequently met with in cases of chronic catarrh, and many of the symptoms described under that title may be found to exist hdre. In the severer cases there is a disability of the digestive organs to perform their functions, the secretions are deficient, and the patient somewhat debilitated. After a time the symptoms become more marked, there is a loss of weight and strength, and in some instances, consumption may be devel- oped as a direct result of this disease. Treatment.-Before beginning the treatment of all marked cases of chronic laryngitis it is important to know the extent of the surface involved in the inflammatory action. To ascertain this the competent physician uses an instru- ment known as the laryngoscope. This instrument consists of a reflecting mirror for reflecting the light from a lamp into the throat. There is a small hole in the centre of this mirror through which the physician looks without obstructing the light. With the throat thus illuminated, small throat-mirrors are introduced into the throat and the reflection of the dis- eased vocal cords and cavity of the larynx is seen in the mirror. A good illustration of the method of using this 396 DISEASES OF THE RESPIRATORY APPARATUS. instrument is seen in Fig. 46. Such an examination in many cases, is necessary before any attempt at treatment is made. Fig. 4b. The constant irritation and hoarseness known as minis- ters' sore throat can be very easily and successfully treated. Public speaking must be entirely avoided for a time, and as much rest as possible given to the vocal cords. If the patient is debilitated good results are obtained from the use of Fluid Extract of Nux Vomica, in doses of 2 drops before each meal, while Dyalized Iron should be given in doses of 15 drops, in water, after meals. With special reference to the condition of the larynx, the following may be given: Fluid Extract of Collinsonia, 1 ounce; Simple Syrup, 2 ounces. Mix, and give a teaspoonful every two or three hours. The throat should be done up in a cold pack every night, and the cold sponge bath should be used every morning, followed by a thorough friction of the skin. In the severer cases of chronic laryngitis the Nux Vomica and Iron, as recommended above, should be given to tone the general system, and the patient should be enjoined to use the voice as little as possible, and under no circumstances to speak (EDEMA OF THE GLOTTIS. 397 above a whisper. Pure Cod Liver Oil will, in many cases, answer a good purpose in strengthening the patient. If there is great debility, the Elixir of the Phosphates of Iron, Quinine and Strychnia should be given in teaspoonful doses three times a day. If the tongue is coated and the bowels constipated, the Compound Podophyllin pill*should be used at bed time, and if this should act too freely, the Eclectic Compound Podophyllin pill should be substituted. The remedies that are recommended for inhalation in the treat- ment of chronic catarrh are serviceable in this disease, and should be persistently employed, as local applications are the most effective means of controlling the inflammation. When evidence of ulceration or granulated conditions of the mucous membrane are present, the direct application of strong, stimulating substances must be made by the physi- cian, who first located the difficulty with his laryngoscope. (EDEMA OF THE GLOTTIS. By oedema of the glottis is meant a dropsical condition of the mucous membrane at the orifice of the larynx, which is properly a symptom of laryngitis. It may, however, occur during the development of Bright's disease of the kidneys, or from dropsical conditions following obstructive diseases of the heart. Symptoms.-During the progress of inflammation of the upper part of the larynx the breathing becomes hard and a feeling of obstruction is felt in the throat, the voice becomes very hoarse, is soon sunk to a whisper, and is finally lost. A cough comes on, which is associated with fits of suffocation and great agony. Expiration is performed without difficulty, while inspiration is almost impossible. The difficulty of breathing increases, as do also the fits of agony and suffo- cation. Symptoms of suffocation often come on, the breathing is arrested, the face becomes blue, and the patient gasps for breath. After one of these paroxysms a relaxation may take place, air will again enter the lungs, and for a moment the * See page 360. 398 DISEASES OE THE RESPIRATORY APPARATUS. symptoms will be relieved. If these symptoms are not promptly arrested death may occur at any moment. Treatment.-In the milder forms of oedema of the glottis, the same treatment as that adopted for acute laryngitis should be employed. When the special symptoms begin to manifest themselves, a competent physician should be sent for at once. Before suffocation comes on the Fluid Extract of Jaborandi, given in half teaspoonful doses, every half hour till perspiration or salivation occurs, will often serve a good purpose, by relieving the dropsical condition surrounding the glottis. The hypodermic injection of Pilocarpin when the patient cannot swallow will answer the same purpose. The Fluid Extract of Lobelia, given in half-teaspoonful doses every twenty minutes until vomiting is produced, will also prove a valuable remedy. In some cases the surgeon is obliged to make an opening into the trachea to admit air into the lungs and prevent suffocation. When this is done, a tube is placed in the open- ing, and kept there, until the disease has subsided. APHONIA. By aphonia is meant loss of voice. It is properly a symptom of other diseases and may occur temporarily in con- nection with acute laryngitis or croup. It is also associated with what appears to be an ordinary cold, without any other symptom of involvment of the larynx. It may be more per- manent when there are structural changes affecting the vocal cords, or when the inflammation extends to ulceration of the surfaces. It may also be caused by paralysis of the muscles of the larynx. Symptoms.-When resulting from a cold, without evi- dence of inflammation of the larynx, there is a slight huski- ness of the voice for a few days, when it suddenly sinks to a whisper. In other cases there are the usual symptoms of the inflammation of the larynx, with hoarseness of the voice, which gradually loses its tone till the patient cannot speak above a whisper, and in some instances may not be able to CROUP. 399 utter any sound. In cases of paralysis the voice may be lost suddenly or gradually. Treatment.-All attempts at speaking should be avoided, even in cases of partial aphonia. When symptoms of in- flammation are present, the treatment recommended for acute laryngitis should be adopted, or continued, if already em- ployed. In all cases of aphonia arising from paralysis, 3 drops of the Oil of Erigeron on a lump of sugar may be placed on the tongue and allowed to dissolve gradually. If this is repeated two or three times, good results are often obtained from it. Benefit is also derived by inhaling the fumes of Vinegar and Capsicum. A gobletful of Vinegar and a tablespoonful of the Tincture of Capsicum may be placed in a tin teapot and boiled. When the steam begins to escape from the spout, the mouth may be opened and held over the steam, which is thus inhaled. If this is repeated two or three times a day it will usually restore the voice. In aphonia from paralysis, stimulating applications may be made to the throat and the Faradic current of electricity should be applied once or twice a day by a physician who thoroughly understands it. The following should also be given internally: Sulphate of Strychnia, 1 grain; Dilute Muriatic Acid, 3 or 4 drops; water, 4 ounces. Mix, and give a teaspoonful three or four times a day. CROUP. Croup is a term that is commonly applied to the various inflammatory conditions that affect the mucous membrane of the larynx in children. There are three forms of the disease viz.: mucous, membranous and spasmodic croup. Mucous Croup.-^his is the most common form of croup. It is a mild inflammation of the mucous membrane, caused by exposure to cold. The attacks come on suddenly during the night, the child being usually awakened from a sound sleep, with difficult breathing and a croupy cough. The symptoms of cold, with a slight cough, may have been present for a day or two, but the child is not considered sick. 400 DISEASES OF THE RESPIRATORY APPARATUS. The difficult breathing comes on in paroxysms at first, but it soon becomes continuous. During both inspiration and expiration a rough whistling sound is produced, the voice and cry are hoarse, and the cough becomes rougher and has a metallic sound. The voice becomes weaker as the disease continues, and it finally sinks to a whisper. If the child is inclined to sleep, the accumula- tion of mucus in the throat and larynx renders the breathing more difficult, and symptoms of strangulation occur. The skin is at first dry and hot, and the pulse is hard and full; but after a time the pulse becomes feeble and frequent, the extremities are cold, and the skin is bathed in a cold, clammy perspiration. The peculiar hoarse, spasmodic cough cannot be mis- taken after it is once heard, and the increased accumulation of mucus in the throat is sufficient to distinguish between this and the other forms of croup. Treatment.-Small doses of Aconite are valuable in con- trolling the fever and preventing the exudation of mucus, while Lobelia relaxes the parts and thus renders the respira- tion easy. These remedies are best given alternately, in small doses, frequently repeated. The Aconite should be prepared as follows: Fluid Extract of Aconite Root, 3 drops; water, 4 ounces. Mix, and give from one to three teaspoon- fuls every fifteen or twenty minutes. The Syrup of Lobelia should also be given in doses of from 20 to 30 drops every fifteen or twenty minutes, and in such a way that from seven to ten minutes may intervene between the doses of the two medicines. Fomentations of Hops should be applied to the throat as hot as can be borne, and changed every twenty minutes till the symptoms are relieved. If this cannot be done, some stimulating liniment may be used. The Compound Liniment of Stillingia, applied to the front and sides of the throat every half hour, will be found of great service. It may be applied freely with the finger, and well rubbed into the skin. Inhalations of the steam of an infusion of Vinegar and Hops, will also be of service in relieving the paroxysm. MEMBRANOUS CROUP. 401 Membranous Croup.-This form of croup is fortunately rare. It begins with a cold and progresses gradually. In- stead of a mucus exudation being thrown out, a tough, gluey material, called plastic lymph, is deposited in considerable quantities on the mucous membrane of the larynx. This exudation adheres to the surface and encroaches on the tube of the larynx, till it is finally completely closed. The symptoms of membranous croup begin with a cold, hoarseness and cough, which are usually present for several days, or a week before the attack. During this time the breathing is attended by a dry, whistling noise, that may often be heard across the room. Finally the hoarseness increases and the cough takes on the metallic sound charac- teristic of croun. This may be noticed in the evening, with- out any special difficulty of breathing. After the child has gone to bed and has slept for a time, the whistling respiration becomes more marked, restlessness, with difficulty of breath- ing come on, attacks of coughing occur during sleep and finally he is awakened by a severe fit of coughing. Now the skin is dry, the pulse is hard and frequent, the voice is rough and harsh, or sunk to a whisper, the whistling noise during respiration is increased, and accompanies inspiration and expiration, and the cough is rougher and more hollow and metallic than before. These symptoms increase as the dis- ease advances. The difficult breathing is constant while the cough is spasmodic. If these symptoms are not relieved the lips soon become blue, the veins are distended, the skin assumes a leaden color the extremities grow cold, general languor comes on, and finally the patient sinks into a coma that terminates in death. From six to forty-eight hours is the usual duration of the paroxysm of membranous croup. Treatment.-The objects to be attained in the treatment of membranous croup are the relaxation of the larynx to render the breathing easy, and to promote the detachment of the false membrane by controlling the inflammatory action. To accomplish the first object, hot fomentations of hops 402 DISEASES OF THE RESPIRATORY APPARATUS. should be applied to the throat. It is best to saturate the hops in hot vinegar, and when they are applied to the neck the heat should be retained by covering the bag with a piece of oiled-silk. By renewing this application every half hour the relaxation obtained by the heat is kept up, and at the same time benefit is derived from the inhalation of the fumes of the hops and vinegar. Lime-water has been demonstrated to be a valuable sol- vent of the false membrane of croup. It should be used by inhalation, and kept up till the severity of the symptoms subside. For this purpose the steam atomizer, represented by Fig. 45, page 389, is the best. The spray should be directed to the mouth and nose of the sufferer continuously, and at short intervals the end of the funnel should be placed in the mouth, and forcible inhalations insisted on. To control the febrile action, the following is the best remedy: Fluid Extract of Veratrum Viride, 10 drops; water, 4 ounces. Mix, and give one teaspoonful every fifteen or twenty minutes. This should be continued till the pulse is reduced to sixty or sixty-five beats to the minute, and if the above dose will not do this it may be gradually increased. If the pulse is kept down to this point no false membrane can follow. When the patient is irritable and restless, with flushed face and contracted pupils, 20 drops of Fluid Extract of Gelsemium should be added to the Veratrum mixture. When the breathing is greatly obstructed by the false membrane, it may often be necessary to use an emetic to remove it. For this purpose, 20 drops of the Compound Tincture of Lobelia and Capsicum, may be given every fifteen minutes till vomiting is produced. In cases where the patient seems in danger of strangula- tion, the finger may be carried as far back in the throat as possible, so as to. irritate the glottis and thus cause expulsive efforts of the larynx, which will frequently dislodge the membrane, and afford immediate relief. In some families the children are liable to attacks of croup on the slightest exposure to cold. When such is the case the parents should keep some remedy on hand for use ACUTE BRONCHITIS. 403 when the first symptoms are apparent. For this purpose the following is a valuable mixture: Compound Fluid Ex- tract of Lobelia, 4 drams; Fluid Extract of Ipecac., I dram; Simple Syrup, enough to make 3 ounces. Mix, and give from half to two teaspoonfuls every half hour, till decided nausea is produced. Spasmodic Croup.-This form of croup is due to the same causes that give rise to the forms just described. It is not as severe, however, as those just mentioned, and the patient speedily recovers from it. There is a slight cough and hoarseness in the evening, but the child goes to bed, comparatively well. After two or three hours he becomes restless, and is finally awakened from sleep by a difficulty in breathing. A paroxysm of coughing now comes on, and the cough is hoarse and metallic; the voice, which is at first hoarse, soon sinks to a whisper; and the child cries in a shrill, high key. There is no nervous excitement, the skin is moist and natural, and the pulse regular. In a few minutes the paroxysm ceases, the breath- ing becomes easy, and the child usually falls asleep again. After a short interval, another paroxysm comes on, and the same symptoms are reproduced. These paroxysms may con- tinue to recur in this way for a few minutes, or for several hours, but they grow lighter after a time, and finally disap- pear, leaving no after symptoms, but a slight cough. Treatment.-The treatment recommended for mucous eroup, is applicable in this form of the disease. It is best, however, to substitute Gelsemium for the Aconite, in the fol- lowing form: Fluid Extract of Gelsemium, 1 dram; water, 3 ounces. Mix, and give a teaspoonful every fifteen or twenty minutes till the spasm is relieved. ACUTE BRONCHITIS. By bronchitis is meant an inflammation of the mucous membrane lining the bronchial tubes. When the terminal branches of these tubes, ramifying the lung tissue, are in- volved in the inflammation, it is called capillary bronchitis. 404 DISEASES OF THE RESPIRATORY APPARATUS. If the trachea and bronchial tubes are simultaneously af- fected, the disease is called tracheo-bronchitis. The disease may involve the mucous lining of both bronchi, or it may be confined to a part of one of the tubes. It may be mild or severe, acute or chronic. Bronchitis is usually produced by exposure to cold, and particularly to sudden changes in temperature. The seasons of the year in which cold rains, high winds and alternating frosts and thawing prevail, develop many cases of the dis- ease. Exposure to these influences, when the system is debilitated from any cause, is more likely to give rise to it than when the vitality is up to its normal standard. The old and young are more liable to bronchitis than those in the prime of life. ; The inhalation of irritating gases and vapors, and of minute organisms floating in the atmosphere, may also give rise to acute bronchitis. In the latter cases, this disease often assumes an epidemic or endemic character. The con- gestion of the bronchial tubes, arising from valvular diseases of the heart, also induces an inflammation of the mucous membrane of the bronchi. The milder forms of this disease are commonly spoken of as "cold in the chest," and are fre- quently met with in our northern latitudes, in the damp changeable weather of the spring and fall. SYMPTOMS.-Acute bronchitis may follow an inflamma- tion of the upper air passages, and is accompanied by a sense of rawness and soreness under the breast-bone. A dry, harsh cough is present from the commencement of the dis- ease. The cough is at first most troublesome in the evening, and during the night the patient feels a sense of fatigue and languor, sometimes followed by chills and flashes of heat; there is a sense of constriction in the throat; pain is felt when a long breath is drawn; the voice is usually hoarse for two or three days; the cough brings up a thin, glairy mucus as an expectoration; and a day or two later this secretion is in- creased in quantity, is raised easily, and is of a yellowish color, and purulent in character. As soon as the free expec- toration takes place, the pain and soreness diminish, the * ACUTE BRONCHITIS. 405 febrile symptoms disappear, and though the cough may last for several days longer, it is easy and less frequent. These are the usual symptoms of a simple acute bronchitis, or cold in the chest, which runs its course and terminates in recovery in from ten to twenty days. In the severer forms of this disease, a general feeling of languor, extensive muscular soreness, and headache, are first manifest, and these symptoms are usually followed by chilli- ness and fever. The chilly sensation may be felt several times during the course of the day, but the fever continues and reaches its height in the evening, but is somewhat abated in the morning. These general symptoms are felt for a few days before any local manifestations are developed. Sometimes a sensa- tion of heat, and fullness under the breast-bone is felt, and a dry, harsh coughing, attended by pain in the chest, is present. The severity and frequency of the cough causes a soreness of the muscles of the chest and diaphragm, and in some cases, there is nausea and vomiting during a fit of coughing. These symptoms continue from three to five days, at the end of which time a frothy mucus is brought up with each paroxysm of coughing. This expectoration becomes thicker every day, and finally assumes a thick, yellowish, opaque appearance, and becomes purulent in character. The febrile symptoms now subside, but in some cases, particularly in children, we have evidence of aii inflammation of the stomach and intes- tines developing, as is manifest by the presence of nausea, vomiting and diarrhea. With the free expectoration, the fever subsides, the tongue, which has been coated, clears off, the appetite improves, and the cough decreases in force and frequency. By the fifteenth or twentieth day after the com- mencement of the disease, the inflammation has terminated in recovery. When the inflammation extends to the smaller bronchial tubes, it is called capillary bronchitis. This condition is fre- quently met with in whooping cough and in the eruptive fevers, particularly in measles. In persons who have been debilitated by previous illness, by old age, or by intemper- 406 DISEASES OF THE RESPIRATORY APPARATUS. ance, this condition is certain to follow an ordinary acute bronchitis, and in such cases it is apt to prove serious. This form of the disease is manifest by increased fever and difficulty of breathing. The respirations are short and rapid, the patient cannot lie down, the difficult breathing is incessant, andthe suffering is great. If these symptoms continue long, the blood is not supplied with the proper amount of oxygen, and stupor takes the place of restlessness and anxiety that have previously existed, and in this condition the patient dies. In favorable cases the difficulty of breathing gradually diminishes, the pulse is less frequent and fuller, the fever sub- sides and the expectoration becomes free and easy. The worst of the disease is over in ten or twelve days, but many of the symptoms of simple bronchitis may remain for several weeks. Treatment.-At the very onset of acute bronchitis it is important to secure an action of the skin, bowels and kidneys. An alcohol sweat given on going to bed is the quickest and surest means of inducing copious perspiration. This may be aided after the patient is in bed by administering 20 drops of the Fluid Extract of Pleurisy Root in a cupful of boil- ing water, and repeating the same every half hour until the patient is in a free perspiration. The bowels should be kept free by a Compound Podophyllin Pill* taken every night at bed-time, and the action of the heart is controlled by the fol- lowing: Fluid Extract of Aconite Root, 10 drops; Fluid Ex- tract of Veratrum Viride, 30 drops; water, 4 ounces. Mix, and give a teaspoonful every half hour until four or five doses are taken, and after that it should be given every hour. In mild cases this treatment resorted to early, will abort the disease in a day or two; but if the cough continues, some rem- edy must be employed with a view of promoting expectora- tion. For this purpose the following may be used: Syrup of Squills, 2 ounces; Fluid Extract of Pleurisy Root, 3 ounces; Simple syrup, I ounce. Mix, and give a teaspoonful every two or three hours. In place of this mixture the following may be used: Fluid Extract of Blood Root, I dram; Fluid Extract of * See page 360. ACUTE BRONCHITIS. 407 Lobelia, 3 drams; Simple Syrup, enough to make 4 ounces. Mix, and give a teaspoonful every two or three hours. In using these remedies, it is best to keep up a slight nausea, but not enough to distress the patient. In the severe forms of bronchitis, when the febrile symp- toms are marked, the following should be given: Fluid Ex- tract of Veratrum Viride, 30 drops; Fluid Extract of Gelse- mium,3drams; water enough to make 4ounces. Mix, and give a teaspoonful every half hour, for 3 or 4 doses, and afterward every hour until the fever subsides. A hot foot bath should be given before the patient is put to bed, and hot fomentations of hops should afterward be applied to the chest and renewed every couple of hours. In these cases it is always advisable-to give 10 grains of Quinine, twice a day, for two or three days. When the fever has subsided the expectoration should be promoted by the prescriptions recommended in the milder forms of the disease. When the breathing is obstructed, and the expectoration is scanty, with a continuous dry cough, a free emetic will frequently do more good than any other rem- edy. For this purpose one half-teaspoonful of the Fluid Ex- tract of Lobelia may be given every twenty minutes or half hour until free vomiting is produced. After this the reme- dies above described may be employed with advantage. In cases of capillary bronchitis, the Aconite and Vera- trum mixture recommended for mild bronchitis should be given on the start, and when breathing becomes difficult the Lobelia mixture should be used. In children the dose should vary from 5 to 20 drops every half hour until the effect is produced. As an expectorant for this form of the disease the following will be found one of the best mixtures that can be used: Carbonate of Ammonia, 30 grains; Fluid Extract of Squills, 4 drams; Tincture of Tolu, 2 drams; water, 1 ounce; Simple Syrup, enough to make 4 ounces. Mix, and give a teaspoonful every two or three hours. For children under a year old, who may suffer from this form of disease the following is preferable: Carbonate of Ammonia 30 grains; Syrup of Tolu, 1 ounce; water, 3 ounces. Mix, and give one teaspoonful every two or three 408 DISEASES OF THE RESPIRATORY APPARATUS. hours. In cases where there is a failing of the strength of the patient, alcoholic stimulants should be used about every two or three hours, the quantity depending upon the condition and age of the patient. Most of the old expectorants, or cough mixtures, as they are called, contain more or less Opium in some form, but the majority of cases of bronchitis are best treated without them. When the patient is irritable and is so constantly harassed by the cough as to be unable to sleep, the following mixture may be substituted for the others mentioned: Sulphate of Morphine, 3 grains; Dilute Hydrocyanic Acid, 30 drops; Syrup of Seneka, 1 ounce; Syrup of Tolu, 1 ounce; water, enough to make 3 ounces. Mix, and give one teaspoonful every three hours. In all cases of acute bronchitis, attention should be paid to the diet of the patient, especially when the symptoms of inflammation of the stomach and bowels supervene. The food should be nutritious and easily digested, and should consist, principally, of fluids during the height of the dis- ease. CHRONIC BRONCHITIS. Chronic inflammation of the mucous membrane of the bronchial tubes is a disease that frequently occurs. It is usually a sequence of acute bronchitis, although it may be developed by an inflammation of the lungs themselves. It rarely occurs from a single attack of the acute disease, but is due more to a succession of colds. The person is usually attacked by acute bronchitis, and when the acute symptoms subside, the cough remains for a considerable time; it may disappear with the warm weather, and recur on the first exposure to a lower temperature. A cough may be present during the winter months, for two or three years, and finally it is noticed that it becomes permanent. The inflammation is fora time confined to the mucous surface, but it soon extends to the substance of the tubes. This dis- ease is also present in cases of valvular diseases of the heart CHRONIC BRONCHITIS. 409 and Bright's disease of the kidneys. It may also be devel- oped during the progress of the various infectious diseases. Symptoms.-Chronic bronchitis comes on gradually and is not attended by fever. Persons who suffer from the dis- ease have been subjected to an annoying cough during the winter season for a number of years. The cough is usually dry, and it is with great difficulty that a little expectoration is thrown off. When warm weather comes on, the cough gradually diminishes, until finally it disappears entirely. In the early falfi it re-appears, with the usual symptoms of cold, on the slightest changes of temperature, and continues throughout the winter. With every sudden change the cough is more distressing, and after a time, difficulty of breathing is more pronounced, and is always aggravated by undue exertion. When the inflammation is extended to the other struct- ures of the bronchial tubes, the cough and difficulty of breathing continue throughout the year. At this stage of the disease, inhalation of dust, exposure to cold, or breathing the air of a crowded room, will usually develop the symptoms of acute bronchitis, which may continue for a while and then pass off, leaving the chronic cough the same as before. Sometimes extensive ulceration of the bronchial tubes takes place, when a muco-purulent expectoration is thrown off in large quantities. The breathing at this time assumes a wheezing character, and the patient complains of his ina- bility to fill his lungs with air; sometimes streaks of blood, or even profuse hemorrhage, may take place from the bronchial tubes. This blood is dark colored, and does not form clots, and is mixed with the purulent expectoration. In the advanced stages of the disease it may extend to the sub- stance of the lungs and tubercular deposits may occur in the lung tissue, which may ultimately result in the death of the patient. These conditions will be discussed under their proper headings. Chronic bronchitis may continue for a year, or even for a life time, the patient dying at an advanced age from some other disease. When not controlled it usually develops 410 DISEASES OF THE RESPIRATORY APPARATUS. hypertrophy and dilatation of the right side of the heart and a general dropsical condition of the body,so that in some cases, congestion of the liver or kidneys may result, either of which may be sufficient to cause death. When properly treated in the early stages of the disease the majority of cases may be radically cured. Treatment.-The general condition of the patient should be first considered in chronic bronchitis. When the appetite is impaired and the digestion imperfect, the following may be given: Fluid Extract of Nux Vomica, 2 drams; Fluid Extract of Prickly Ash Berries, 4 drams; water, 4 ounces. Mix, and give a teaspoonful before each meal. If the bowels are constipated, as they usually are, the Compound Podo- phyllin pill*should be given at bed time, and repeated as often as may be necessary. The action of the kidneys should .be maintained by the following: Fluid PLxtract of Gelsemium, 1 dram; Acetate of Potash, 4 drams; water, 6 ounces. Mix, and give a teaspoonful three times a day. When the cough is severe and irritating, the breathing difficult, and the expectoration slight, the following prepara- tion will be found to give marked relief: Iodide of Ammon- ium, 1 ounce; Fowler's Solution of Arsenic, 3 drams; water, enough to make 6 ounces. Mix, and give a teaspoonful three times a day, after meals. In addition to this, the following may be given to pro- mote expectoration: Balsam of Fir, Balsam of Tolu, and Balsam of Peru, of each 4 drams; Oil of Anise, 15 drops; Laudanum, 4 drams; Simple Syrup, 2 ounces; Jamaica Rum, enough to make 8 ounces. Mix, and give one teaspoonful every two or three hours. The bottle should, however, be well shaken before administering each dose. In addition to these internal remedies, a Capsicum plas- ter may be worn over the chest, or what is better still, Liquid Tar may be poured over surgeon's lint, and applied to the chest. Then a piece of muslin cloth may be wound tightly around the body to hold it in place. Stimulating inhalations should also be used. For this purpose equal parts of Carbolic Acid and Aqua Ammonia * See page 360. ASTHMA. 411 may be placed in a bottle, and the fumes inhaled several times a day. Carbolic Acid may also be used in the Inhaler repre- sented in Fig. 43, page 387, with good results. Five drops of Carbolic Acid should be added to an ounce of tepid water in the Inhaler, and this should be used two or three times a day. In the severer cases it is important that sufficient force should be used in the spraying apparatus to carry the inhala- tion well into the lungs; and for this purpose it is best that the patient should consult a physician, and use the inhalation from the instrument represented in Fig. 44, page 388. ASTHMA. The term asthma has been applied to any condition in which spasmodic difficulty of breathing is a characteristic symptpm. It is, however, properly restricted to paroxysms of difficult breathing, that last for several hours, and terminate in the health of the patient, without any morbid changes in the structure of the breathing apparatus. Various theories as to the nature and cause of asthma have been advanced, but it is now generally believed to be of nervous origin. Some peculiar condition exists in which there is an irritation at the origin of the pneumogastric nerve, or of the terminal branches distributed to the mucous sur- faces of the breathing apparatus. This irritation causes spasm of the bronchial muscles, and thus gives rise to the symptoms of the disease. The exciting causes of asthma are numerous. Some- times a damp atmosphere will excite the disease in one person and have no effect on another. The inhalation of dust, or floating particles from certain plants and flowers, will also excite a paroxysm in some persons. The atmospheric or hygienic conditions of particular localities will induce an attack of the disease in one person, while the same surround- ings may cure it in another. 412 DISEASES OF THE RESPIRATORY APPARATUS. Pressure of the pneumogastric nerve by enlarged glands in the neck, distention of the stomach from indigestion or the accumulation of gases, and the presence of various nervous affections will also induce attacks of asthma. The disease occurs at all ages, but is more common in childhood and up to middle life. Symptoms.-The first attack of asthma comes on sud- denly, but the succeeding ones are usually preceded by acute catarrh, slight bronchial irritation, general languor and head- ache. In other cases the symptoms of indigestion may pre- cede the attack. The first attack usually comes on during the night, when the patient is aroused from a sound sleep by a feeling of suffocation, which compels him to lean forward and make great muscular effort to fill his lungs. He will per- haps run to a window and open it with a view of obtaining more air. A loud wheezing noise accompanies the breathing, the face is flushed and often appears bluish, and after a time the patient can only gasp for breath, and he feels as if he must certainly die. These symptoms may last only a few minutes or may continue for several hours. They will finally subside, however, and breathing becomes easier, the air enters the lungs more freely, the blue condition of the face disappears and finally the paroxysm ceases. Sometimes free eructations of gas from the stomach will relieve the difficult breathing and the same result follows an expectoration of a mucus secretion from the bronchial tubes. After the paroxysms subside the patient is completely exhausted and usually sinks into a sound sleep. After awakening from sleep the respira- tion often appears perfectly normal, and may remain so for a long period of time. The paroxysms may occur at short intervals, the patient often suffering from the disease almost continuously for the greater part of the year, and in other cases, months may intervene between the attacks. As a rule, however, the disease, when once developed becomes constitutional, and the paroxysms may recur on any sudden change in the weather; as the result of indiscretion in eating, which gives rise to indigestion; upon the inhalation ASTHMA. 413 of noxious gases or particles of dust; or upon a residence in a locality that tends to excite the disease. Treatment.-The first thing to be considered in the treat- ment of asthma, is the prompt relief of the paroxysm. For this purpose Chlor-Anodyne, given in half-teaspoonful doses, every half hour, will act more promptly than any remedy we know. It should be mixed with a little water, and continued till the symptoms are relieved, or till five or six doses are taken. In severe cases, Nitrite of Amyl may be used by break- ing a 3 drop Capsule in a handkerchief, and inhaling the fumes. If one Capsule fails to give relief it should not be repeated. Recurring attacks of the disease may be modified by the use of Chlor-Anodyne, as above recommended; and relief is also frequently obtained by inhaling the fumes of Belladonna leaves, Stramonium leaves, Nitre, &c. Equal parts of Stram- onium and Belladonna leaves may be soaked in a saturated solution of Saltpetre, and then thoroughly dried. A bundle of these leaves,, when dried, may be set on fire and the fumes inhaled. A coarse paper may be prepared with the Saltpetre solution in the same way, and the fumes inhaled while the paper is burning. The new California remedy, Grindelia Robusta, has been proved to be the most valuable remedy for the relief of asthma that has yet been introduced to the profession. With the view of controlling the recurring paroxysms of asthma, it should be given as follows: Fluid Extract of Grindelia Robusta, 2 ounces; Glycerine, I ounce; water, 2 ounces. Mix, and give one teaspoonful every hour till the paroxysm is relieved. With the view of preventing a return of the disease the following should be given after a paroxysm, and continued for several months: Iodide of Potassium, 4 drams; Fluid Extract of Grindelia Robusta, 3 ounces; Glycerine, 3 ounces. Mix, and give one teaspoonful after each meal and at bed- time. In debilitated patients, 8 grains of Quinine may be 414 DISEASES OF THE RESPIRATORY APPARATUS. given before each meal, and 15 drops of Dialyzed Iron after each meal and at bed time. The remedies suggested above will usually afford relief in most cases, while in some they will appear to act as specifics. Sometimes, however, nothing but change of residence will give relief, and this will often do so in a few hours. The confirmed asthmatic should study the effect of differ- ent localities, and take advantage of those that afford him the greatest freedom from suffering. The condition of the digestive organs should never be overlooked in this disease. The bowels should be kept regu- lar by the Compound Podophyllin pills* Milk, pastry, and articles containing much sugar and starches should be excluded from the diet. P"luids should also be avoided as much as possible. Meats, broiled or roasted, and ripe fruits, should constitute the diet. PNEUMONIA, OR INFLAMMATION OF THE LUNGS. Pneumonia is an inflammation of the substance of the lung proper. It is a disease of frequent occurrence and pro- duces serious effects upon the general system. Sometimes only a part of a lung is involved in the inflammation, and this is called circumscribed, or lobular pneumonia; at other times one entire lung is attacked, and this is termed single pneu- monia; and again, the disease affects both lungs, and is then called double pneumonia. The disease is popularly known as " lung fever " and " winter fever." Pneumonia is produced by cold in the majority of cases, and is more liable to attack those who have been debilitated from previous diseases, intemperance, or impaired nutrition. It is a noticeable fact that in all cases where the action of the skin is arrested from cold, pneumonia is liable to set in, unless the arrested secretion is soon freely established. Symptoms.-A general feeling of dullness and languor, quick short breathing, a short hacking cough, a feeling of oppression in the chest, with a chilly sensation and coldness * See page 360. PNEUMONIA, OR INFLAMMATION OF THE LUNGS. 415 in the extremities are the premonitory symptoms of pneu- monia. These may be present for a day or two, when well- marked chills, or rigors occur, which continue from one to two hours. These chills closely resemble those of malarial fever. The feeling of depression and the cough are now increased, and as soon as the chill has disappeared, febrile symptoms set in. The pulse becomes frequent, the skin is hot and dry, the face is flushed, the eyes are injected, there is severe pain in the head and back, the appetite is lost, the tongue is covered with a white coat, the bowels are consti- pated, and the urine is scanty. The respiration has now become shorter and the breathing is difficult, the shoulders and chest being elevated with every effort at inspiration. In some cases the languor may be accompanied by inflam- mation of the bronchial tubes, with pain in the left side, and an occasional sensation of chilliness, for a day or two after the fever sets in. When children are attacked with the disease, one or more convulsions may mark its beginning, instead of the chill. About the third or fourth day the breathing is carried on by the diaphragm and abdominal muscles, it is impossible to take a full inspiration, and the feeling in the chest is one. of uneasiness rather than pain, which is accompanied by a sen- sation of constriction and fullness. The breathing is now very rapid and difficult, and pain is felt when an attempt is made to take a long breath. The cough, at first, brings up a little frothy mucus which soon becomes opaque, and about the fifth or sixth day it assumes a rusty tinge, which is the characteristic expectora- tion of pneumonia. As soon as this expectoration begins to be thrown off, the cough becomes loose, the difficulty of breathing and pain are relieved, the febrile symptoms sub- side, and about the seventh or ninth day, the patient is convalescent. In the severer cases, all the symptoms previously de- scribed become more aggravated, the cough is persistent and annoying, fetid accumulations appear around the teeth, periods of delirium set in which finally become continuous, 416 DISEASES OF THE RESPIRATORY APPARATUS. or may terminate in profound stupor. With these symptoms the disease may terminate fatally in twelve or fourteen days or it may continue for three or four weeks. Persons of a strong vitality may recover even after this stage of the dis- ease is reached. In this advanced stage the expectoration is free and purplish red, or light yellow in color, of the con- sistency of cream, and purulent in character. In cases where the symptoms of delirium are developed, and where great prostration of the vital powers are manifest, it has been common to denominate the condition "typhoid pneumonia," but it is now generally conceded that typhoid fever is not developed in these cases, but that the symptoms are due to the great prostration that takes place during the progress of pneumonia. Pleuro-pnettmonia is a condition where the inflammation extends from the lungs to the pleura. In these cases the usual symptoms of pneumonia are complicated by the development of severe pain and increased difficulty of breathing. Treatment.-At the commencement of the disease the treatment should be active, and employed with the view of cutting it short. Quinine is a valuable remedy for this pur- pose, and should be given in doses of 20 grains every four hours, till the heat of the skin is reduced. At the same time the feet should be placed in a hot mustard foot bath, and hot fomentations of hops should be applied to the chest, and changed every hour or two. To control the action of the heart and reduce the fever, the following should be given: Fluid Extract of Veratrum Viride, I dram; water, 4 ounces. Mix, and give a teaspoonful every half hour till the skin becomes moist, or nausea is produced. If the patient is very nervous, I dram of Gelsemium may be added to the Vera- trum mixture. Whenever the skin becomes moist and the patient feels more comfortable, the Quinine may be discontinued, and the interval between the doses of the Veratrum mixture may be extended to one hour. CHRONIC PNEUMONIA. 417 The Spirit of Mindererus, given in doses of two table- spoonfuls, in the same quantity of Carbonic Acid water, and repeated every three or four hours, will prove grateful to the patient, and will hasten the removal of the mucus accumula- tions in the air-cells. After the fourth or fifth day the previous treatment should be discontinued, with the exception of the hot fomentations and the Spirit of Mindererus. These should be used until the febrile symptoms have entirely subsided. In addition, the following mixture should be employed: Fluid Extract of Aconite Root, io drops; Fluid Extract of Veratrum Viride, 20 drops; Fluid Extract of Pleurisy Root, I ounce; water, enough to make 4 ounces. Mix, and give a teaspoonful every hour or two. As soon as the fever subsides the bowels should be regu- lated by the Compound Podophyllin pills* and if the urine is scanty, 20 grains of Acetate of Potash may be given, in water, three or four times a day. From the beginning of the disease strict attention must be given to the diet. Solid foods should be avoided, but beef essence, animal broths, milk punch and wine whey, should be given freely. The patient should have some nourishment every two hours, and when stimulants are given the quantity should be from half an ounce to an ounce of good whiskey or brandy. When the symptoms of pleuro-pneumonia are present, the treatment recommended for pleurisy should be employed for the first couple of days, and afterward that given above should be followed. When typhoid symptoms are developed, the treatment recommended for typhoid fever will be required, in addition io the hop fomentations and the Spirit of Mendererus. CHRONIC PNEUMONIA. Sometimes an acute inflammation of the lungs may be slow to subside, and the condition will gradually assume a chronic form. * See page 360. 418 DISEASES OF THE RESPIRATORY APPARATUS. Symptoms.-Continued difficulty of breathing, quickness of respiration, a continued harassing cough, with a rusty or grayish expectoration, and a general feeling of languor and prostration, remaining after acute pneumonia, are the most prominent symptoms of chronic pneumonia. Symptoms of intermittent fever, followed by flushed cheeks, night sweats, and great reduction of flesh, are next developed, and finally, if not relieved, the patient becomes so prostrated that death ensues. Treatment.-When these symptoms are manifest after an acute attack of pneumonia, absorption may be promoted by the application of Spanish Fly blisters over the affected side. The following will also be found a valuable preparation: Iodide of Ammonium, I dram; Syrup of Iodide of Iron, 3 ounces. Mix, and give half a teaspoonful, in a wine-glassful of water, every three hours. It should be taken through a glass tube to avoid injuring the teeth. The Fluid Extract of Pleurisy Root should also be given in doses of 30 drops, in water, three or four times a day. In some cases Quinine may be used to advantage for its tonic effect, in 3 grain doses, three or four times a day. PHTHISIS PULMONALIS, OR CONSUMPTION. Phthisis pulmonalis, or as it is commonly called, con- sumption, is a disease that is characterized by a deposit of what is called tubercular matter in the substance of the lung, and finally a breaking down of the structure of the lung, itself. It is said to be hereditary, but we believe that nothing but a debilitated or weak condition of system can be trans- mitted, and that the application of an exciting cause is nec- essary for its development. At least, it is a well established fact that children of consumptive parents, who change their residence early in life, and are thus freed from the conditions under which the parents lived, will usually escape the dis- ease. On the other hand, persons who are strong and robust, PHTHISIS PULMONALIS, OR CONSUMPTION. 419 and in whose families no trace of disease has ever been known, often acquire consumption from exposure to cold, damp, the sudden changes of temperature and various excesses that usually give rise to inflammatory diseases of the respiratory organs. It is also a proven fact that the number of con- sumptives has largely increased with the extension of vaccina- tion. We believe that vaccination has done more to spread consumption, by inoculating tubercular matter into healthy persons, than all other causes combined. Symptoms.-The symptoms of consumption are so well known that a lengthy description of them here is unneces- sary. When the disease begins to develop, the person gener- ally fails in health and strength, without there being any evidence of any special disease. A slight cough soon comes on, which is usually more noticeable in the morning and evening, and there is some pain felt in the upper part of the chest. The loss of strength continues till the patient can no longer attend to his business, and even then he is not inclined to think that his lungs are affected. As the disease advances, the bowels become constipated, the urine is scanty, the circulation feeble, the skin dry, and digestion and assimilation fail. The cough now becomes more distressing, the pains in the lungs are more continuous and severe, bleeding frequently occurs, and difficulty of breathing is developed. Up to this time the expectoration has been a whitish or yellowish mucus, it now becomes thick and cheesy, and sinks in water. The cheeks are now flushed and feverish in the afternoon, and sweats take place every night, and even during the day, if the patient takes a nap. Some- times the expectoration is profuse for a time, and then becomes scanty. This results from a breaking down of the tubercular deposit and part of the lung tissue. This material is raised and thrown off by the paroxysm of coughing, and when a quantity has been thus removed, the cough is less fre- quent, and for a short time, the patient seems better. When the material again accumulates the severe symptoms are renewed, and thus the disease progresses till the sufferer is completely worn out. 420 DISEASES OF THE RESPIRATORY APPARATUS. In some cases, however, it would seem that one entire lung is destroyed, or both may be extensively involved, and yet the vitality of the patient is sustained to a remarkable degree. The average duration of consumption is from one to four or five years, and unless arrested during the early stage, it terminates in the death of the patient. In some cases, however, the deposit in the lungs takes place rapidly, and is attended by marked febrile symptoms. These run their course rapidly and terminate fatally in two or three months. Treatment.-For the treatment of consumption the thoughtful care of the experienced physician is an absolute necessity, as many conditions arise during the development of the disease that must be treated according to the special requirements of each individual case. As soon as the first symptoms of the disease begin to manifest themselves, means should be adopted to prevent its development. The food should be light and nutritious, the bowels should be kept soluble by the Compound Podophyllin Pills* and the function of the skin should be promoted by fre- quent bathing. The cold, or tepid sponge bath, followed by brisk friction of the skin with a coarse towel, will answer a good purpose in guarding against catching cold; while an occasional Turkish bath will also be valuable. If the digestion is impaired it should be managed as rec- ommended on page 305 for the treatment of dyspepsia. When the debility is marked and the loss of flesh is rapid, Cod-Liver Oil should be resorted to without delay, and 30 drop doses of the Syrup of Iodide of Iron may be added to the oil, three times a day. If symptoms of catarrh, or bron- chitis, are present, these should be treated as recommended on pages 386 and 406. The most important consideration is the change of climate. A dry, rare atmosphere, rich in oxygen, will arrest the majority of cases of incipient consumption. The climates of Colorado, Nebraska, and California, are particularly * See page 360. HEMOPTYSIS, OR BLEEDING FROM THE LUNGS. 421 favorable for consumptives, but a physician should be con- sulted before any change is made. Breathing compressed air is as yet little practiced in the treatment of this disease, but we believe that if a consump- tive could remain in a chamber of compressed air, for one hour a day, the tubercular deposits of the early stages would be entirely removed. Morphine and alcoholic stimulants do harm in the first stages of consumption and should never be used. At the very last, both may be used to make the patient more com- fortable, but only under the directions of the physician. HEMOPTYSIS, OR BLEEDING FROM THE LUNGS. Bleeding from the lungs is rarely met with excepting in persons who are suffering from some disease of the lungs or bronchial tubes. The bleeding is slight when it comes from the bronchial tubes but may be profuse from the tissues of the lung. After a person begins to manifest the early symptoms of consumption, a free bleeding from the lungs will often be fol- lowed by a marked improvement in the condition of the patient. In such cases nature has succeeded in throwing off what was the beginning of a tuberculous deposit on the lung, and a long time may elapse before other deposits accumulate. In the last stages of consumption the bleeding indicates extensive breaking down of lung tissue, and points to a speedily fatal termination of the disease. SYMPTOMS.-Marked evidences of impaired health are always present before hemoptysis takes place. Aside from the general debility the bleeding may be the first indication of the presence of any disease of the lungs. There is usually a feeling of oppression and heat in the chest, or there may be palpitation of the heart, headache and dizziness. A sudden cough and a warm feeling under the breast-bone precede the filling of the mouth with blood. The cough is now repeated frequently, and with each cough a quantity of blood is raised. 422 DISEASES OF THE RESPIRATORY APPARATUS. hen the blood is dark, mixed with mucus, and small in quantity, it is likely to come from the bronchial tubes. When it is frothy, bright red, and free, it comes from the lung tissues. Sometimes it may be so profuse that it gushes sud- denly from the mouth and nose. Following the bleeding, even when slight, the patient becomes pale, the heart's action is feeble, and a sensation of fainting comes on. After the bleeding is arrested the patient continues to expectorate streaks of clotted blood mixed with viscid mucus, for several days. The bleeding may only last a few minutes, or it may continue for several hours. In some cases from a teaspoonful to a tablespoonful of blood may be spit up several times a day, for several days, and then gradually subside. Treatment.-The patient should be placed in the recum- bent position, with the head and shoulders elevated; the feet should be put in a hot mustard foot bath; and common salt should be freely given every half hour. In addition to these means, io drops of the Oil of Erigeron in a tablespoonful of Syrup, repeated every fifteen or twenty minutes, till four or five doses are taken, will prove very valuable. The Fluid Extract of Veratrum Viride will also prove valuable in con- trolling the action of the heart. It should be given in doses of 2 or 3 drops every half honr, till the bleeding is controlled or till the violent heart action is subdued. After a person has had one attack of bleeding from the lungs these remedies should be kept on hand ready for an emergency, and the Veratrum and Oil of Erigeron should be taken from the beginning of the attack. The patient must keep absolutely quiet for several days after the bleeding, to prevent the possibility of a recurrence. After that good food, fresh air, change of scene, and the gen- eral treatment recommended for consumption should be employed. PLEURISY. Pleurisy is an inflammation of the membrane called the pleura, that covers the lungs and lines the inner surface of the PLEURISY. 423 walls of the thorax. This inflammation may be either acute or chronic; may occur as a primary affection or as a secondary condition, following other diseases; and it may be confined to the membrane surrounding one lung, or may extend to both. As a primary affection it is usually caused by exposure to cold or to drafts, when the body is in a state of perspiration,, or may result from some wound penetrating the walls of the thorax. As a secondary disease, it may be associated with inflam- mation of the lungs, bronchitis, pericarditis and diseases of the liver and stomach. Symptoms.-In its mildest form pleurisy sets in with chilliness, fever, pain in the side, and difficulty of breathing; but in some cases pain in the side is the only symptom present. The efforts at inspiration cause a severe pain which arrests the breath before the lung is inflated, and the patient usually bends the body toward the affected side. If the ear is placed over the seat of the pain, a rubbing sound is dis- tinctly heard, which is caused by the surfaces of the pleura rubbing against each other. These symptoms seldom continue longer than forty-eight hours, and are often so slight as not to require confinement to bed. After they subside there may be a dull, gnawing pain felt for a long time, which results from the surfaces of the pleura being glued together by adhesive bands produced by the inflammation. In the severer cases there is a decided chill, general lan- guor, high fever, and severe cutting pains in the side, which usually come on suddenly, though in some cases, the patient may feel dull and languid, and complain of slight headache, loss of appetite, constipated bowels, and a scanty flow of urine for two or three days before the chill occurs. The pain is sharp and cutting, and is increased with every effort to fill the lungs with air. This fact causes the patient to take short breaths, and to fix the ribs so that the breathing is carried on through the diaphragm and abdominal muscles. There is a short, dry, hacking cough that greatly annoys the patient on account of its increasing the pain. The fever is continuous 424 DISEASES OF THE RESPIRATORY APPARATUS. and is the highest toward the evening, with a slight remission in the morning; the pulse is small, hard and frequent; the bowels are constipated; the skin is hot and dry, the urine is scanty; and the breathing is difficult. After three or four days the pain is lessened in conse- quence of the inflamed surfaces being relieved by the effusion or throwing out of the watery portions of the blood into the cavity of the pleura. The fever also decreases at this time, but the difficulty of breathing is increased by the pressure of the accumulated fluid, and is often so severe that the patient cannot lie down. The cough may continue throughout the disease, but there is only a little frothy mucus expectorated. There is great emaciation, loss of strength and depression of the nervous system, with marked pallor and an anxious expression of the face. Sometimes the effusion is so great that the skin between the ribs protrudes, and by placing one hand in front and the other on the side of the chest and giving a sudden movement the fluid can be distinctly felt to fluctuate. The disease may terminate fatally during the first few days, particularly if both sides are involved in the inflamma- tion; or the patient may die of exhaustion before the effused fluid is absorbed. Treatment.-As soon as the first symptoms are felt, the feet should be placed in a hot mustard foot bath for fifteen or twenty minutes. The patient is then placed in bed and a large mustard plaster should be applied over the seat of the pain, and kept there as long as can be borne. This is fol- lowed by the application of a large hot fomentation of hops, which should be well covered with oiled-silk, and renewed every hour. In the way of medicines the following is the most certain and speedy treatment we have been able to find: Fluid Extract of Veratrum Viride, I dram; water, 4 ounces. Mix, and give a teaspoonful every fifteen or twenty minutes, till the skin becomes moist, or till 10 drops are taken. After that a teaspoonful should be given every hour, alternated on the half hour with 20 drops of the Fluid Extract of Pleurisy PLEURISY. 425 Root, in water, so that the patient gets each remedy once an hour. If the pain is not relieved by these remedies, a Spanish Fly blister may be applied, and a quarter of a grain of Mor- phine may be given every three hours, in addition to the Veratrum mixture. After the effusion has taken place, and the fever subsided, Quinine should be given in 5 grain doses, every four hours, and the Fluid Extract of Pleurisy Root should be continued in half-teaspoonful doses three or four times a day. To help in removing the effusion the following should also be em- ployed: Acetate of Potash, 4 drams; water, 6 ounces. Mix, and give a tablespoonful three or four times a day. The bowels should now be kept active by the Compound Jalap powder till the effusion has disappeared. If the patient is slow in recovering, and there is reason to believe that the effusion has not been removed, the follow- ing may be given: Carbonate of Ammonia, 4 drams; water, 6 ounces. Mix, and give a teaspoonful every three or four hours. In addition to this the following should be given as a nerve tonic: Sulphate of Strychnia, I grain; Dilute Muriatic Acid, 3 drops; water, 4 ounces. Mix, and give a teaspoonful three times a day. Good nutritious food and stimulants should be given from the commencement of the disease. Milk, soft-boiled eggs, beef essence, milk punch, &c., should be given in small quan- tities, frequently repeated, so as to sustain the system against the great prostration that attends the latter stage of the disease. While we give the treatment thus fully, we would always urge the importance of consulting a physician when severe symptoms develop. CHAPTER IX. DISEASES OF THE URINARY ORGANS. The urinary apparatus is designed for the removal from the body of a considerable amount of waste materials that are no longer necessary for the support of animal life. These ma- terials if allowed to accumulate in the system poison the blood and thus produce deleterious effects. It will thus be seen that any derangement of these organs that interferes with their normal functions must prove disastrous to life. These ingredients are removed from the blood through the agency of the kidneys, and when passed from the body are held in solution in the urine which is a clear amber-colored fluid, with a decided acid reaction. The amount of urine secreted by a healthy adult will average about 35 ounces daily, with a specific gravity of 1,024. This quantity may, however, vary materially from day to day. Some days it may be considera- bly below this amount, while on others, it may exceed it. By the specific gravity of urine is meant the weight as compared with water. If a quantity of water weighing 1000 grains be taken as a standard, a similar quantity of urine will weigh 1,024 grains, which would indicate that there are 24 grains of solid matter held in solution in that quantity of urine. When CONGESTION OF THE KIDNEYS. 427 the quantity of urine is scanty the specific gravity is increased, and when there is an excess of urine the specific gravity is di- minished. This is due to the fact that the amount of solid matter is about the same without regard to the quantity of fluid, as analyses have proved that about 600 grains of solid matter are thus eliminated from the body every twenty-four hours. Diseases that affect the urinary apparatus in any way must interfere with this elimination, thus occasioning serious trouble. Among the diseases belonging to this class are con- gestion of the kidneys, acute and chronic inflammation of the kidneys, renal calculi, diabetes, inflammation of the bladder, etc. CONGESTION OF THE KIDNEYS. By congestion of the kidneys is meant an increased flow of blood to those organs. It maybe caused by the continued use of remedies that act too freely on the kidneys and thus ex- cite irritation, by exposure to cold, or as the result of venous obstruction in diseases of the valves of the heart and associated with lung disorders. When the congestion occurs as the re- sult of cold or the too free use of medicines that act on the kidneys it is called active congestion, and when from ob- structions in the circulation it is known as passive conges- tion. Symptoms.-In passive congestion pain is felt in the re- gion of the kidneys, which extends downward toward the groin through the bladder and hips; the bladder becomes very much irritated, and there is a frequent desire to pass water, though the quantity voided each time is small and high-colored, and sometimes there may be small quantities of blood mixed with the urine. In ordinary cases these symp- toms following cold will pass off in two or three days, but may continue for some time, and even extend to inflammation, es- pecially if produced by the excessive use of powerful drugs that act on the kidneys. In passive congestion that attends diseases of the heart and lungs, the kidney symptoms are 428 DISEASES OF THE UE IN ARY ORGANS. rarely noticed until a dropsical condition of the abdomen and legs occur. In these cases the urine is scanty and high-col- ored. On standing, a white deposit settles to the bottom of the vessel. When heated the urine will at first clear up, and then as it begins to boil a thick milky deposit will settle to the bottom, which is coagulated albumen. Treatment.-If the symptoms first mentioned as belong- ing to active congestion are due to the use of medicines, these should be discontinued, and lemonade, Vichy water, or other- saline water may be drank freely for a day or two. If the bladder is much irritated, and the frequent desire to urinate continues, marked relief will be obtained from the use of 5 drops of the Fluid Extract of Gelsemium, taken every half- hour until five or six doses are taken. In some cases a hot fomentation of hops placed over the bladder and between the legs will also be found to give relief. When the symptoms result from cold the same treatment should be employed, and the trouble will be entirely relieved in a few days. In passive congestion of the kidneys the same treatment must be employed as is recommended on page 370 for dropsi- cal conditions growing out of valvular diseases of the heart. ACUTE INFLAMMATION OF THE KIDNEYS. Acute inflammation of the kidneys is not a common dis- ease. When it does occur it may result from severe injuries, exposure to cold, any local irritation, long retention of urine and the extension of inflammation from other parts. The disease is also developed during the course of scarlet fever, diphtheria and other febrile diseases. SYMPTOMS.-Sometimes the disease comes on suddenly with severe pains in the back, over the regions of the kidneys, and deep-seated, well-marked chill and high fever. At other times its development is slow and obscure. The first symp- toms are those which usually follow exposure to cold, while the patient is over-heated and perspiring. After a day or ACUTE INFLAMMATION OF THE KIDNEYS. 429 two the pains in the back become very severe, and extend downward toward the groin and even to the testes. Strain- ing at stool, and while urinating increases the pain and the urine, which now becomes of a reddish brown color, is passed with difficulty, and but a small quantity is voided at a time. In many cases the urine may be tinged with blood, and in the latter stages of the disease more or less mucus, or mucus mixed with pus will be present; while the bowels are consti- pated; the skin is dry and hot; nausea and vomiting are sometimes present, and the patient is restless and sleepless. When the urine becomes very scanty as the disease pro- gresses, delirium sets in, which is soon followed by a stupor that indicates the poisoning of the blood by the retention of effete matter that should be thrown off with the urine. In some cases the symptoms assume a decidedly typhoid char- acter, with a heavy coating on the tongue, fetid accumula- tions around the teeth, and general prostration of the sys- tem. In addition to these symptoms there will be a puffy con- dition of the feet and legs, and sometimes of the abdomen in severe cases. This is particularly true when the disease fol- lows the eruptive fevers. Treatment.-The main object in the treatment of this disease is to relieve the kidneys as much as possible by ex- citing the activity of the skin and bowels. Cathartics that pro- duce free watery evacuations should be given, and for this pur- pose the Compound Jalap Powder with Cream of Tartar, as recommended on page 334, will be found the most servicea- ble. This should be given in the morning and repeated in three hours if necessary to produce a free watery evacuation of the bowels. To secure an action of the skin the alcohol sweat may be used with advantage, and the action may be kept up by the following mixture: Fluid Extract of Jaborandi, 4 drams; Simple Syrup, 4 drams; water I ounce. Mix, and give a tablespoonful every half hour until a free action of the skin, or a free flow of saliva is produced. When the fever is high the Fluid Extract of Gelsemium should be given in 10 drop doses every half hour, until the eyelids feel heavy or 430 DISEASES OF THE URINARY ORGANS. double vision is produced. Hot fomentations over the kid- neys should be applied frequently until the acute symptoms have subsided. Warm drinks such as Slippery Elm tea, Flax- seed tea, and hot lemonade should be used so as to relieve the congestion of the kidneys. If the kidneys are inactive after the acute symptoms have subsided the following mixture maybe given with advantage: Fluid Extract of Hydrangea, 2 ounces; Fluid Extract of Col- linsonia, 4 drams; Simple Syrup, enough to make six ounces. Mix, and give a teaspoonful three or four times a day. Quinine may also be given in 5 grain doses, three times a day, for some time after the acute symptoms have subsided. CHRONIC INFLAMMATION OF THE KIDNEYS. Chronic inflammation of the kidneys may sometimes succeed the acute form, though it is more commonly developed insidiously when there is any depression of the vital forces. Chronic alcoholism, syphilis, long-continued malarial poison- ing and the effects of various mineral poisons tend to develop the disease. Symptoms.-A general weakness of mind and body, poor appetite, loss of flesh, and a muddy brownish complexion are the usual symptoms that mark the approach of this disease. After these have been present for a time the eyelids, ankles, and feet become bloated, and in a short time the legs and ab- domen become greatly distended by dropsical effusions. An examination of the urine shows it to contain large quantities of albumen, it is greatly diminished in quantity, and the speci- fic gravity is considerably increased. Sometimes after the dropsy has developed, it may disappear in a measure, but it will certainly return again after a time. Treatment.-As soon as the presence of the disease is re- cognized the skin and bowels should be acted upon to relieve the dropsical condition. If the patient is much prostrated, he should be put to bed in a warm room, and the following should be given: Fluid Extract of Jaborandi, 2 ounces; CHRONIC INFLAMMATION OF THE KIDNEYS. 431 Simple Syrup, 2 ounces. Mix, and give one teaspoonful every half hour till free perspiration is produced. After the action of the skin becomes free the Compound Jalap Powder with Cream of Tartar should be given to cause watery evacuations from the bowels. When the dropsy is reduced remedies should be given to act on the kidneys. Warm emollient drinks will always prove valuable, so Flaxseed tea, hot lemon- ade, &c., may be drank freely,-and 20 grains of Acetate of Potash may be taken in these drinks, three or four times a day. If the abdomen is greatly distended the fluid should be drawn off with an aspirator, and when the loose skin is badly puffed up it may be punctured at a number of points with a needle. After the dropsical condition has been reduced the nervous system should be sustained by the following: Sul- phate of Strychnia, 1 grain; Dilute Muriatic Acid, 3 drops; water, 4 ounces. Mix, and give one teaspoonful three times a day, before meals. To prevent the waste in the kidneys, the following will be found of great advantage: Fluid Extract of Eucalyptus Globulus, 2 ounces; Glycerine, 1 ounce; water, 3 ounces. Mix, and give one teaspoonful, three or four times a day. This remedy should be continued for several months. This treatment will, in many cases, entirely relieve the dropsy, and if serious changes have not already taken place in the kidneys, the symptoms may not recur for a long period of time. ALBUMINURIA, OR BRIGHT'S DISEASE. Under the general term of albuminuria, or Bright's dis- ease of the kidneys, some writers include acute and chronic inflammation of the kidneys, and in fact all conditions in which albumen is found in the urine. Properly speaking, however, Bright's disease is only applicable where there is a permanent change in the structure of the kidneys. It is true that the diseases just described may lead to Bright's disease, but they often stop short of it, and end in the recovery of the patient. This disease may occur at any period of life, but it is more common in middle life. It usually develops from acute 432 DISEASES OF THE URINARY ORGANS. or chronic inflammation of the kidneys, or from the congestion that frequently follows eruptive fevers. Sometimes, how- ever, it takes a different course, and the disease is not suspected till serious or fatal symptoms manifest themselves. The con- ditions developed in the kidneys are known to the profession as granular, waxy, and fatty degeneration, and evidences of their existence can be recognized by microscopic examinations of the urine. Aside from the general symptoms described as belonging to acute and chronic inflammation of the kidneys, when changes in the structure of these organs take place, no two cases present the same symptoms. Whenever dropsical con- ditions are developed the urine should be examined by a com- petent physician, with a view of ascertaining the exact nature and extent of the disease. Such examinations should also be made at short intervals so long as any albumen is present in the urine, for only in this way can the presence of Bright's disease be ascertained. Treatment.-True Bright's disease is an incurable disorder, and the sufferer should always secure the advice of a physician to guide him in his mode of life, and in such treatment as will make him comfortable. DIABETES. Diabetes is properly a disease resulting from impaired nutrition, but as its most prominent peculiarities are the presence of sugar in the urine, and a greatly increased urinary secretion, it is usually described with diseases of the urinary organs. The disease is marked by a continual wasting of the body, which indicates defective nutrition, Thin, nervous per- sons are liable to the disease, as are also persons who are in- clined to be fleshy, and of a dull, heavy disposition. It has been ascertained that blows in the region of the liver or kidneys, concussions of the brain and spine, mental shocks and anxiety act as exciting causes of the disease, but the nature of its predisposing cause or causes is not known. DIABETES. 433 Sometimes there is an excessive flow of urine without the presence of sugar, and the condition is known as diabetes in- sipidus. When sugar is present in the urine the disease is called diabetes mellitus. Symptoms.-In diabetes insipidus the first symptom no- ticed is the frequent desire to urinate, and the large quantity of clear urine voided each time. This may have come on gradually or may have become suddenly apparent. There is also pain in the back, a feeling of general languor, great thirst, ienpaired digestion, and a soft doughy condition of the skin. The body wastes and the system becomes feeble, but these changes may be slow. Diabetes mellitus usually develops in six or eight weeks, though in some cases several months may pass before the symptoms attract any special attention. The patient loses flesh and strength rapidly, and soon gets so he cannot attend to his usual business, though his appetite remains good. The desire to pass urine is frequent, and the quantity voided large, and he may be obliged to get up to urinate sev- eral times during the night. Thirst is excessive, and large quantities of fluids are drank to satisfy it. The weakness con- tinues till the patient can no longer walk around, and yet he feels no pain. Thirty pints and upwards of urine are often passed in twenty-four hours, and each pint may contain two ounces or more of saccharine matter. As the disease advances fever comes on in the afternoon, with flushed cheeks, and night sweats become frequent. The appetite now becomes impaired, but the thirst continues, and the patient may die of prostration or consumption or some other kidney complication may set in and prove fatal. Treatment.-In diabetes insipidus, fluids should be avoided as much as possible, and the nervous vitality should be main- tained by the following: Sulphate of Strychnia, I grain; Dilute Muriatic Acid, 3 drops; water, 4 ounces. Mix, and give a teaspoonful three times a day, before meals. Fluid Extract of Ergot, given in doses of 20 drops, three times a 434 DISEASES OF THE URINARY ORGANS. day, after meals, has proved valuable in diminishing the quan- tity of urine. The galvanic current of electricity, properly applied, will also serve a good purpose. Diabetes mellitus has not been successfully treated by the profession. Diet is of the first importance in the treat- ment, and all articles that contain sugar, or starch, which is changed to sugar during digestion, should be avoided. Meats of all kinds, fish, oysters, eggs, milk, and especially butter- milk, and such vegetables as spinach, lettuce, cabbage, toma- toes and cauliflower, may be used as diet. The exclusive use of a diet of skimmed milk is recommended by some mis valu- able in the disease. Moderate exercise not only increases the strength but also prevents the formation of sugar, and should therefore be insisted on. The Compound Podophyllin pills*should be given as often as may be necessary to keep the bowels regular, and full doses of Fluid Extract of Ergot can also be used with great advantage. It should be given in doses of 30 drops three times a day. Opium has long been recommended in this dis- ease, but we believe Ergot is a much more valuable remedy. RENAL CALCULI, OR GRAVEL. By renal calculi is meant the formation of hard concre- tions-commonly called "gravel"-of certain substances in the urine. These form in the kidneys, and pass from them through the ureters to the bladder, where they are usually carried off with the flow of urine. When they collect in the bladder they develop a condition known as stone in the bladder. SYMPTOMS.-One, or more calculi may remain in a kidney for a long time without producing any disturbance. When one of these concretions passes from the kidney to the ureter a severe, deep-seated pain is felt in the region of the kidney. The pain is sharp and cutting in character, and gradually moves down along the groin toward the bladder, and often extends to the glans penis and testes. The pain is so intense ♦See page 360. RENAL CALCULI, OR GRAVEL. 435 that the patient cannot control himself, the face becomes pale and pinched from suffering, and the whole body is bathed in perspiration. There is a frequent desire to urinate, which is attended by a burning pain, but only a few drops of urine passes, and that is dark and often bloody. Sometimes no urine can pass till the stone escapes into the bladder. The stone moves slowly toward the bladder, and finally passes into it, when the symptoms are all instantly relieved. The passage of the stone may take place in an hour or two, or it may take several days to work its way through. After it leaves the ureter, urine is voided, which is usually mixed with con- siderable blood. By watching the urine voided the gravel can often be detected as it passes from the bladder. A person who has had one attack of this kind is almost certain to have another, if not properly treated with the view of preventing it. Treatment.-The immediate treatment should be some- thing to relax the ureter so as to admit of the ready passage of the gravel. Fluid Extract of Gelsemium, in doses of io drops every twenty minutes, till drooping of the eyelids, or double vision is produced, will often promptly relax the ureter and allow the gravel to pass in a short time. If this fails the careful inhalation of Chloroform or Ether may be necessary to relieve the intense agony of the patient, but these should ■only be administered by a physician. Hot fomentations of hops over the abdomen will also be serviceable. Chloroform may be given internally, in doses of 20 drops stirred up in water. It may be repeated two or three times at intervals of half an hour. These remedies are preferable to Morphine, which is so often given, for though it eases the pain it often retards the passage of the calculus. After the gravel has passed, half a teaspoonful of Fluid Extract of Hydrangea should be given in a gobletful of Flax- seed tea, three times a day, for a few days. With the view of preventing a recurrence of the trouble, the urine should be examined by a physician to ascertain the 436 DISEASES OF THE URINARY ORGANS. nature of the calculi. This done, he can recommend the treatment necessary to prevent their formation, or dissolve those still remaining in the kidneys. BLEEDING FROM THE KIDNEYS. Bleeding from the kidneys may result from inflammation of the organs, from the presence of calculi, from falls, or blows across the small of the back. Symptoms.-There is a sense of fullness, and a dull, heavy pain in the region of the kidneys; a frequent desire to urinate, with severe pain attending the act after an injury; if the bleeding is severe, very great prostration comes on, and the urine is mixed with blood. Treatment.-The patient should be placed in bed and kept as quiet as possible. The feet may be placed in a hot foot bath, or bottles of hot water may be applied to them. Ice bags over the region of the kidneys will also prove ser- viceable. If the patient is excited, io drops of Fluid Extract of Gelsemium should be given every half hour till six or eight doses are taken. Oil of Erigeron in doses of 5 drops, in syrup, repeated every hour, will often promptly relieve the bleeding. RETENTION OF THE URINE. When the urine is excreted by the kidneys and carried to the bladder, and retained in that organ, the condition is spoken of as retention of urine. This may occur on account of paralysis of the bladder, or from some obstruction of its outlet. When the urine is voluntarily retained, long after there has been a natural desire to urinate, retention may also take place. Symptoms.-An unusual time has passed without voiding urine; there is a feeling of fullness, frequently associated with pain, in the lower part of the abdomen; and sometimes the ACUTE INFLAMMATION OF THE BLADDER. 437 distended bladder can be felt extending above the pelvic bone in front. Treatment.-A hot sitz bath or hot cloths applied over the bladder, and changed every few minutes, will often start the flow of urine when no permanent obstruction exists. If this fails to give relief, the physician should be sent for to draw off the urine with a catheter. If paralysis or stricture should cause the retention, the catheter may have to be used several times a day till the cause of the trouble is removed. ACUTE INFLAMMATION OF THE BLADDER. Acute inflammation of the bladder is usually confined to the mucous membrane lining that organ, but it may some- times extend so as to involve the muscular structure, and even the peritoneum. It may be produced by exposure to cold, by external injuries, by the continued use of remedies given to increase the flow of urine, by strong injections pass- ing back to the bladder from the urethra, and in women, by the continued pressure of a displaced womb, or by extension of the inflammation from the womb. SYMPTOMS.-The first symptom noticed is a dull pain in the lower part of the abdomen, just behind the anterior arch of the pelvic bones, which is increased by pressure above the bone. There is a frequent desire to urinate, and every effort to evacuate the bladder increases the pain. The urine becomes scanty and high colored, and causes a scalding sensation along the entire course of the urethra, when voided. In severe cases the desire to urinate becomes almost con- stant, and intense spasms of the neck of the bladder come on whenever any urine is voided, which does not subside before the desire recurs. Sometimes a chill, followed by fever, comes on with the pain, and the fever may continue throughout the disease. 438 DISEASES OF THE URINARY ORGANS. The disease may continue for a week or two and then gradually subside, or it may run into a chronic form. Treatment.-At the onset of the disease the patient should be placed in a hip bath as hot as can be borne, and should remain in it for an hour at least. Hot water should be added from time to time to keep up the temperature. After this, hot fomentations of hops should be applied over the lower part of the abdomen and carried between the legs to the back, and these should be renewed every half hour. The following should be given internally: Fluid Extract of Aconite Root, 15 drops; Fluid Extract of Gelsemium, 3 drams; water, 4 ounces. Mix, and give a teaspoonful every hour till the symp- toms are relieved. A hot infusion of Marsh Mallow should be given freely to act on the kidneys. A teacupful should be drank every two or three hours, and its action may be improved by adding to grains of Acetate of Potash to each cupful of tea. After the acute symptoms have subsided the following may be used till the flow of urine becomes normal: Fluid Extract of Bear Berry, 2 ounces; Fluid Extract of Black Cohosh, 4 drams; Glycerine, enough to make 6 ounces. Mix, and give a teaspoonful after each meal and at bed time. CHRONIC INFLAMMATION OF THE BLADDER. Chronic inflammation of the bladder is produced by the same causes that develop the acute form of the disease. In fact the acute disease precedes the chronic, though sometimes the symptoms are very mild. The presence of stone in the bladder, the irritation caused by diseases of the kidneys, and the extension of venereal diseases, act as exciting causes that favor its development. Symptoms.-The symptoms of acute inflammation of the bladder are present in this form of the disease in a modified degree. There is also a pain in the neck of the bladder which extends the whole length of the penis, and a sensation of scalding is also felt in the bladder. The desire to urinate is STONE IN THE BLADDER. 439 frequent and urgent, and the spasm at the neck of the bladder is severe, and continues for some minutes. Some- times the quantity of urine is quite normal, and again it is scanty. A heavy, white sediment is always present in the urine, and it is sometimes so thick and slimy that it adheres to the bottom of the vessel. In these cases the urine is strongly alkaline and has a putrid smell, even when first voided. After a time the bowels become constipated, the appetite is impaired, the skin is dry and sallow, and the patient fails in strength and flesh. Treatment.-In addition to the treatment recommended for acute inflammation of the bladder it is important that the bladder should be washed out once or twice a day. This is done by introducing a soft rubber catheter and injecting the water through it. The injection must be warm and not more than two ounces should be held in the bladder at one time. An infusion of Golden Seal, with 2 or 3 drops of Carbolic Acid to the ounce is about the best injection that can be used. In some cases it is best to wear a soft catheter in the bladder, continuously, with the end fixed in a rubber urinal, so that the bladder can be kept drained, and thus the irrita- tion that keeps up the disease is relieved. Dilute Acetic Acid, in teaspoonful doses, three or four times a day, will often render the urine acid, and improve the symptoms materially. Dilute Nitric Acid, in doses of 10 drops, largely diluted with water, may also be given with advantage for the same purpose. In severe cases the only way to insure a radical cure is for the patient to go to bed, and have this treatment persist- ently followed up for two or three months, if necessary. Without local treatment to the surface of the bladder and absolute rest, no permanent results can be obtained. STONE IN THE BLADDER. By stone in the bladder is meant the accumulation in the bladder of the hard concretions that pass from the kidneys in 440 DISEASES OF THE URINARY ORGANS. the form of calculi, or gravel. When these do not pass out of the bladder with the urine they gather into one solid mass or stone. When such a mass forms it often continues to increase till it has attained a large size. Symptoms.-There is a sense of irritation and burning when the bladder is empty, which is sometimes associated with intense pain, As soon as the bladder is sufficiently full to separate the surfaces this feeling is relieved, and till the urine is again passed, the patient is comfortable. Often while voiding the urine the stream is suddenly stopped, and after a moment or two, begins again. This may occur once or twice during each act of urinating. When these symptoms are present the patient should lose no time in being examined by a surgeon, who introduces a sound into the bladder and recognizes the presence of the stone. Treatment.-The stone must be removed by crushing, and then washing out the fragments through the urethra, or by cutting into the bladder and removing it entire. None but an experienced surgeon should be intrusted with either of these operations. INCONTINENCE OF URINE. Incontinence of urine is an involuntary escape of urine from the bladder. It occurs in paralysis, and as a symptom of some of the exhaustive diseases. It is commonly met with in children, and sometimes it occurs only at night. SYMPTOMS.-The control over the bladder may be par- tially or totally destroyed. Sometimes the desire to urinate comes on suddenly, and the urine passes before the patient is prepared for it. In other cases there is a constant dribbling away of the urine, and as a result the skin is excoriated in the adjacent parts, and the person is extremely filthy. Treatment.-In some cases there is a tendency to con- traction of the muscular fibres of the bladder as soon as a slight distention is caused by the accumulated urine. In such ca^es INCONTINENCE OF URINE. 441 the following will be found almost a specific: Fluid Extract of Belladonna, 20 drops; water, 4 ounces. Mix, and give a teaspoonful every three hours. When there is a relaxed condition of the muscles at the neck of the bladder, the following should be given: Fluid Extract of Nux Vomica, I dram; Fluid Extract of Golden Seal, 3 drams; Simple Syrup, enough to make 4 ounces. Mix, and give a teaspoonful three or four times a day. When associated with irritation of the mucous surface of the bladder, the following should be used: Bromide of Soda, 2 drams; Fluid Extract of Hydrangea, 2 ounces; water, 2 ounces. Mix, and give a teaspoonful three times a day, after eating. If any doubt exists as to the real cause of the trouble, these remedies should be tried successively for a week at a time. CHAPTER X. DISEASES OF THE NERVOUS SYSTEM. The several sections of the nervous system are liable to be affected by congestion, inflammation, and textural changes in the same manner as the other tissues of the body. In ad- dition to these disorders, however, we have a number of dis- eases that effect the nervous system as a whole or in part, without developing any well-defined condition to which their origin can be traced. These are supposed to be due to some particular condition of the nervous system which is present in some individuals and not in others. As these diseases are complicated and many of them ob- scure, we shall only describe those that are most common; and even in the majority of these the physician's experience is necessary in watching their progress and directing their treatment. CONGESTION OF THE BRAIN. A congestion of the brain is a condition in which there is an increased amount of blood in the brain. When the arteries of the brain are distended the condition is spoken of as active CONGESTION OF THE BRAIN. 443 congestion, and when the same condition is present in the veins it is called passive congestion. The excessive use of narcotics as Belladonna and Opium, the too free use of alcohol, protracted mental labor, business worry, &c., have a ten- dency to produce this condition. Symptoms.-In the most common form of slight conges- tion of the brain, there is a dull heavy headache which is in- creased by motion, sharp aching pains are occasionally felt running through the head, there is ringing in the ears, with dizziness, the eyes are bloodshot and intolerant of light, numbness develops in the extremities, and a feeling of great nervous exhaustion comes on whenever any mental effort is attempted. In the severer cases all these symptoms are present, but are more intense. The headache is much more severe, the numbness in the extremities is marked, and the dizziness is so great that the patient can hardly stand upright. The eyes are suffused with tears and the lids become swollen, the stomach is irritable, and every attempt at mental effort is accompanied with nausea and vomiting. If these symptoms continue acute inflammation may result, but they usually subside in a day or two, and health is restored in three or four days. In still severer cases the patient may lose con- sciousness, and have all the usual symptoms of apoplexy. When the congestion is caused by obstruction in the venous circulation, the headache is dull and heavy in character, the eyelids are swollen, but the eyes are not bloodshot, the veins are full, hearing is impaired, and there is a constant ringing in the ears, vision is dull, and a tendency to drowsiness, which is always present and will often extend to stupor. In this form of the congestion the scalp is always cool, while in active con- gestion it is hot. Treatment.-In active congestion the feet should be placed in a hot mustard foot bath. Mustard plasters may be applied along the spine and ice-bags should be placed to the head. In some cases benefit may be derived from tying a broad ligature around the thighs to prevent a part of the blood from returning to the head. Fluid Extract of Gelsemium 444 DISEASES OF THE NERVOUS SYSTEM. in five drop doses every twenty minutes or half hour until drooping of the lids is produced, will be found a valuable remedy. Stimulants of all kinds should be avoided, and the food should consist largely of fruit and vegetables. In severe cases a brisk cathartic will give prompt relief, and for this purpose an ounce of Rochelle salts is as good a remedy as can be used. The causes that tend to produce the disease should always be avoided as it is likely to occur on the application of the slightest exciting cause. INFLAMMATION OF THE BRAIN. Inflammation sometimes attacks the membranes that surround the brain, and also the structure of the brain itself. When one of these parts are inflamed the disease is liable to extend to the others, and as the symptoms of each form of inflammation cannot always be easily recognized we shall consider them under one general head. Inflammation within the cavity of the skull may be pro- duced by injuries impinged upon the head, exposure to severe cold, and causes that tend to produce great mental activity or irritation of the brain. SYMPTOMS.-The premonitory symptoms are a sense of fullness and pain in the head, redness and heat in the integu- ment of the head and neck, confused ideas, marked irritability and disturbed sleep. These symptoms are followed by a decided chill which may last from one to four or five hours. High fever then sets in, the skin is hot and dry, pulse rapid, tongue covered with a white coating, bowels are constipated, and the urine is scanty and high-colored. The entire head is very hot, the eyes are watery, pupils contracted and a deep- seated pulsating headache is present. As the disease advances these symptoms continue to increase in severity, the eyes be- come intolerant to light, ringing in the ears takes place, sleep- lessness is constant, and finally delirium sets in. After three or four days there is a general appearance of stupor, the de- lirium takes a low muttering form, or gives place to coma. INFLAMMATION OF THE BRAIN. 445 The fever now subsides, the pupils are dilated, the extremities are cold, and respiration is difficult and labored. If the dis- ease can be arrested in the first stages, a favorable result may be anticipated; but when delirium and stupor set in, serious changes take place in the structures involved and a fatal result may be looked for. Treatment.-When the first symptoms begin to develop an active cathartic should be promptly administered. The Compound Jalap powder with Cream of Tartar, maybe given at once, and repeated in two or three hours if it fails to act. An ounce of Rochelle Salts will also answer a good purpose. The hot foot bath should be used, and while the feet are in the tub an alcohol sweat should be given. To prevent determination of the blood to the head the Fluid Extract of Gelsemium should be given in io drop doses every half hour, until five or six doses are taken. When delirium and stupor begin to develop, this remedy must be discontinued. Mustard plasters to the back of the neck will be found serviceable in mild cases, but in the severer forms of the dis- ease a good sized Spanish Fly blister will answer a much better purpose. During the first stage of the disease, ice bags may be applied to the head with advantage. When delirium sets in, the Compound Podophyllin pills* should be employed to keep the bowels active, and the strength of the patient must be sustained as much as possible. Stimulating applications must now be applied to the extremi- ties in the form of Spirit of Turpentine, on hot cloths, or cloths wrung out of Mustard water, may be laid over the whole length of the spine, and hot water to the head. Car- bonate of Ammonia should now be given in 5 grain doses, in half an ounce of brandy, and this should be repeated every two or three hours. It is also important to keep up a free action of the kidneys. For this purpose the following mixture will be found valuable: Nitrate of Potash, 4 drams; Sweet Spirit of Nitre, 1 ounce; water, 5 ounces. Mix, and give a tablespoon- ful three times a dav. ' See page 360. 446 DISEASES OF THE NERVOUS SYSTEM. As soon as the patient recovers from the stupor and delirium, 5 grains of Quinine should be given three times a day, with a view of arresting the remaining fever; and as a tonic and stimulant, good results will be obtained from the following: Fluid Extract of Nux Vomica, I dram; .Fluid Extract of Prickly Ash Berries, 4 drams; water, enough to make 4 ounces. Mix, and give a teaspoonful three or four times a day. Every precaution must now be taken to avdid mental activity, and the patient must be guarded against all excite- ment. The diet must be nutritious and easily digested, and care should be taken that the stomach is not overtaxed. It is best to administer small quantities every two hours, rather than run any risk of overloading the stomach. WATER ON THE BRAIN. There is a condition met with in which there is a large effusion of water between the membranes and within the cavities of the brain, which is commonly called hydrocepha- lus. It may occur at any age, although it is rarely seen after the fifth year of life. It is usually met with where the nervous system predominates over the other bodily structures, and is frequently caused by the irritation of the digestive apparatus, teething, and as an attendant upon eruptive fevers. The acute and chronic forms of the disease are recognized. Symptoms.-Acute hydrocephalus sometimes comes on suddenly, and a large quantity of water is thrown out between the membranes of the brain, in a very short period of time. Unconsciousness, relaxation of the muscles, fixed pupils, and involuntary evacuations from the bowels and bladder are the attendant symptoms. In these cases the patient dies in a few hours, or may live several days. In other cases there is a low remittent fever, headache, nausea, and vomiting, for a few days, which are followed by pain or convulsions. The patient then becomes almost uncon- scious, is very uneasy, turns his head from side to side, and WATER ON THE BRAIN. 447 gives sharp cries indicative of pain. The tongue is now dry and red at the edges, the countenance is pale, the eyes are sunken in the head, the pupils are dilated, and the forehead is covered with a clammy perspiration. As these symptoms continue, spasmodic contractions of the muscles take place and epileptiform convulsions come on, which may soon be followed by death, or the convulsions may subside and pro- found stupor set in, which ends in death. These symptoms frequently develop during the progress of summer complaint. In chronic hydrocephalus the child complains of pain in the head with every slight movement, the face is pale, the extremities are cold, the appetite is impaired, and the bowels are constipated. As the disease advances he becomes stupid, the eyes turn inward, or roll in their sockets, the pupils are dilated and fixed, there is extreme irritation and restlessness, and finally a deep stupor comes on. The child sleeps with its eyes half open and the pupils are constantly moving. The stupor will sometimes pass off to an extent, when the child will be found extremely irritable, and is con- stantly picking his nose, lips, ears, and culling his hair. This irritability may be present for a time, when stupor will again occur. The disease may continue with these symptoms for several months during which time there is great emaciation of the system, from which the patient may finally die. When hydrocephalus exists in very young children the distension of the membranes becomes so great that the bones of the skull are forced apart, so that the child's head is seen to be very materially enlarged. Treatment.-When the disease is associated with summer complaint, which is the most common form in which it is seen, the use of Aconite and Ipecac, will be found serviceable. Ten drops of the Fluid Extract of Aconite Root, and 20 drops of the Fluid Extract of Ipecac, should be put in sepa- rate glasses, each containing 4 ounces of water. One tea- spoonful from each glass should be given once an hour, in such a way that the remedies may be given half an hour apart. DISEASES OF THE NERVOUS SYSTEM. 448 When the patient is irritable, I drop of the Fluid Extract of Gelsemium should be given every hour, but when stupor appears this remedy should be discontinued, and Belladonna given in its place in the same dose. Acidulated drinks will be found valuable, and when the edges of the tongue are red one or two drops of Sulphuric Acid, largely diluted in water, two or three times a day, will be found beneficial. The child may be placed in a hot mustard bath and kept there for twenty minutes or half an hour, and when it is removed the mustard plaster should be placed over the whole length of the spine. An infusion of Marsh Mallow may be given freely to act on the kidneys, and if this does not answer the purpose, two or three grains of Acetate of Potash may be added to each drink. Many physicians report good results in the treatment of this disease by the use of the following: Fluid Extract of Indian Hemp, io drops; water, 4 ounces. Mix, and give a teaspoonful every two or three hours. In chronic hydrocephalus the tendency to constipation may be overcome by the use of the following: Podophyllin, 1 grain; Sugar, 15 grains. Mix, divide into 16 powders, and give one powder night and morning. The strength should be maintained by the use of stimulants, in small quantities, Cod Liver Oil, sweet cream, &c. APOPLEXY. The term apoplexy is applied to a condition in which there is sudden diminution or loss of the mental powers, and of motion, with a partial or complete loss of consciousness, due to the pressure on the brain. In mild cases, the pressure is due to distention of the blood-vessels of the brain; while in severe ones the vessels rupture, and the condition known as cerebral hemorrhage takes place, and the accumulated blood presses on the brain, and produces the disease known as apoplexy. APOPLEXY. 449 Symptoms.-Usually the patient falls down suddenly in a more or less unconscious condition, and motion and sensa- tion are partially or entirely suspended. The face is livid, the muscles are relaxed or in a half rigid condition, breathing is labored, the pulse is slow and full, and the mind has no control over the body. In some cases the patient may complain of ringing in the ears, involuntary twitching of the muscles, and a feeling of tightness and weight in the head, for several hours or even a day or two before the attack. The apoplectic condition may only last for a few moments, the patient soon recovering consciousness and control over all his powers. It may last for hours, when profound stupor and paralysis may result; and in such cases the patient recovers slowly, and it is a long time before the effects of the attack entirely disappear. Sometimes the attack is so severe that the stupor rapidly deepens, and the patient dies in a few days after he is stricken down. After having one attack, others may occur after any great mental excitement, or imprudence in eating after long continued brain work. Treatment.-Whenever there is a tendency to a deter- mination of blood to the head, attacks of apoplexy may be prevented by the occasional administration of the Compound Jalap Powder with Cream of Tartar. The watery action of the bowels thus produced, causes a revulsion of blood from the head. The Fluid Extract of Gelsemium, given in doses of 5 drops every two or three hours, will also be valuable when fullness of the head and ringing of the ears are present. When an attack occurs the patient should be placed on a bed or lounge, and kept on his side or face so as to prevent the tongue from falling back, as it will obstruct the breathing. Stimulating applications, such as Tincture of Capsicum, or Mustard, should be applied to the extremities and spine, and ice to the head is desirable if there is much heat. In severe cases, where the head and neck are livid, cups should be applied to the spine, and wet cupping is preferable. 450 DISEASES OF THE NERVOUS SYSTEM. As soon as the patient can swallow, the Compound Jalap Powder should be given, and diffusive stimulants should be repeated at short intervals. , Aromatic Spirit of Ammonia given in doses of from one- half to i teaspoonful, largely diluted with water, every half hour, will serve a good purpose. Chloroform in 4 or 5 drop doses, mixed with water, will also prove valuable in rallying the patient. When the patient does not rally within twenty-four hours, it is certain that considerable bleeding within the skull has taken place; and all the cases where the recovery is slow, more or less effusion has occurred. When recovery is slow the bowels should be kept open, as above recommended, and the following should also be given to act on the skin and stimulate the system: Carbon- ate of Ammonia, 2 drams; Fluid Extract of Pleurisy Root, 2 ounces; water, I ounce. Mix, and give a teaspoonful in water three or four times a day. If the kidneys are inactive 20 grains of Acetate of Potash, may be given in half a pint of Slippery Elm Tea, three or four times a day. As the condition of the brain is improved, Quinine should be given in 5 grain doses. With the view of preventing a recurrence of the trouble 10 drops of Fluid Extract of Ergot, three times a day, will often prove highly valuable, particularly if cerebral hemor- rhage had occurred before. SUN-STROKE. By sun-stroke is meant a sudden prostration of the ner- vous system, as a result of extreme heat. SYMPTOMS.-The symptoms that indicate an approach- ing sun-stroke are a heavy feeling in the head, dizziness, derangement of vision, ringing in the ears, faintness, and diffi- cult breathing. Sometimes these symptoms are absent, and the patient falls unconscious without warning. After the attack the pulse is frequent and irregular, breathing is diffi- cult, the face is of a dusky, red color, the head is hot, nausea HEADACHE. 451 and vomiting are generally present, and sometimes the bowels and bladder move involuntarily. In severe cases these symptoms may continue to increase and the disease terminates fatally in a few hours, while in others they gradually subside, and the patient slowly regains consciousness. The sufferer is greatly prostrated for some time after a sun-stroke. Dizziness and faintness come on after the slightest mental effort; and a full, distressed feel- ing in the head continues to affect him for months after- wards. Treatment.-After a sun-stroke the patient must be removed to as cool a place as possible, in the shade, and placed in the recumbent position. Cold water, or ice bags, should be applied to the head; Turpentine, Camphor, Capsi- cum, or other stimulants, should be freely applied to the extremities; Mustard plasters should be used on the abdomen and chest; and Ammonia should be held under the nostrils. As soon as he can swallow, an ounce of brandy with a few drops of Essence of Ginger, should be given and repeated at short intervals. When improvement begins he should be kept as quiet as possible. Brandy may be continued in small quan- tities for two or three days, and care must be taken to withhold all indigestible articles of food. The bowels should be kept regular with the Compound Podophyllin Pills,*and the nervous system strengthened by the use of the following: Sulphate of Strychnia, I grain; Dilute Muriatic Acid, 3 drops; water, 4 ounces. Mix, and give a teaspoonful three times a day. HEADACHE. Headache, though considered by many as a slight affec- tion, undoubtedly occasions more suffering than any other disorder. Thousands of persons who have never known what it was to have a day's sickness in any other form, are subject to frequent attacks of headache that almost drive them mad. * See page 360. 452 DISEASES OF THE NERVOUS SYSTEM. Although it is a symptom of many other diseases, we shall only consider it here as it occurs, as the chief or only cause of suffering. There are many varieties of headache, which are due to as many different causes. We can only briefly mention a few of the most common forms of the disorder, as a full discussion of the subject would fill more pages than we have at our dis- posal in the remainder of this volume. Plethoric Headache.-This form of headache occurs in persons of stout frame and build, and who are what is commonly called full-blooded. It may come on frequently, and last only a few hours, or it may continue for several days, or even for weeks. When these cases are severe, they are accompanied by a sense of fullness and throbbing over the brows and temples, and with dizziness, that are increased by motion or stoop- ing. The sleep is sound but not refreshing, the pulsa- tions of the heart are heard by the patient, the appetite good but the bowels are constipated. Sometimes diarrhea sets in, but more frequently there is bleeding from the nose. Either of these conditions give relief. The temples ache constantly, and there is a feeling of heaviness in the back and loins, and wandering pains which are increased by motion. These attacks last for several days. The milder cases occur in persons who are obliged to stoop considerably. The pain is throbbing, and located in the temples, the bowels are constipated, the tongue is white and rough at the back part. It comes on during the night or in the morning, and usually wears off during the day. CONGESTIVE Headache.-Congestive headache is due to an engorgement of the blood-vessels of the brain. The pain is felt in one part of the head, and accompanies a sense of heaviness and fullness; noises in the ears are continuous, and dizziness is present. The patient is usually nervous and feeble, the skin is sallow, the lips are bluish, the extremities are cold, and the bowels torpid. HEADACHE. 453 Headache of Indigestion.-There are symptoms of some derangement of digestion, with a feeling of dull weight in the head. The tongue is white through the centre and red at the tip and edges. The hands are cold, slight nausea is present, the sight is dim and the eyes ache when em- ployed on close work. This dull weight follows each meal, and sometimes lasts for sevei'al hours. A brisk walk will often relieve it till after the next meal. Sick Headache.-The patient has a dull oppressed feeling in the head on awakening, or it may come on in a short time after getting up. This soon becomes a heavy, severe pain in the temples, which is often worse on the left side. The eye on the worst side is also tender and full, there is a bad taste in the mouth, the tongue is coated with a yel- lowish-white fur, the extremities are cold and moist, and a chilly sensation is often felt. There is a constant nausea, and sometimes vomiting, from the onset of the pain; the appetite is lost; and great flatulence is present. When the patient attempts to get up the nausea is greatly increased. After the nausea has continued for some time vomiting sets in and the pain is relieved. These attacks recur with great regularity after a few days, or a couple of weeks. Bilious Headache.-This condition is more common in young persons, and in those of dark complexion. When the bile accumulates in the system, the skin is sallow and often covered with pimples, there is a feeling of depression, the bowels are constipated, and flatulence is excessive. The headache is confined to the forehead and eye-brows, the white of the eyes are very yellow, the tongue is coated with a brown fur which is cracked in the centre, the appetite is poor, there is a bitter taste in the mouth, and nausea is con- stant. When there is an excessive flow of bile, in addition to the symptoms just mentioned, there is a throbbing pain, hot skin, and a sorenesss in the legs. Vomiting is rare in these cases, but when it does occur large quantities of what appears to be pure bile is ejected, and then relief is obtained. 454 DISEASES OF THE NERVOUS SYSTEM. Nervous Headache. - Nervous headache usually attacks persons of a nervous, excitable temperament, and is more common in women than men. Sedentary habits, excessive mental labor, or business worry, predispose to it; and noises, bad air, poor diet, sudden changes in tempera- ture, loss of sleep, going too long without eating, sexual excess, and womb diseases operate as the exciting causes. The character of the pain varies, but is usually so severe as to cause intense agony. It comes on suddenly at times, and it may cease in the same way. Dizziness, nausea, dis- turbed vision and cold extremities are usually present, but vomiting\rarely occurs. The pain is sharp, and assumes a darting, shooting character, and the patient feels as if the temples were being pressed together. The pulsations of the arteries can be plainly felt, and each one is attended by a thrust of pain. Sometimes the pain changes from one place to another, or it may be confined entirely to one side of the head. In some cases there is great despondency, restlessness, and an inability to attend to any kind of employment, which may last for several days. A sense of sinking, or fainting, is present when the patient attempts to walk, and violent pal- pitation of the heart comes on upon the slightest exertion. Sometimes the pain will only last an hour or two, and then again, it may continue all day and only be relieved after natural sleep. In some cases it may last for several days, and is at- tended by a feeling as if a lump were in the throat, and other hysterical symptoms. Rheumatic Headache.-Persons who have been sub- ject to rheumatism often suffer from headache under the eye-brows, in the back of the head or in the temples. A sense of coldness is felt over the head and face before the attack. The pain is dull and aching, there is no throbbing in the temples, there is tenderness on pressure over the affected part, and the skin over the part is cool and moist. It is worse toward evening, but seldom affects the mental powers. Sometimes it is confined to the brow or back of the HEADACHE. 455 head, while again it may shift from one of these points to the other. It may also extend to the temples, face, and even to the nerves of the teeth. Renal Headache.-When there is an aching pain and a feeling of soreness at the base of the brain, with the pain shooting from side to side, and from before backwards, it will be found that the flow of urine is scanty. This char- acter of headache is always met with when there is any trouble with the kidneys. Organic Headache.-The term organic headache is applied to the severe pains in the head that accompany diseases of the brain and its membranes. These have been described under the headings of congestion and inflammation of the brain, and are always associated with other symptoms of brain disorders. Treatment.-In all cases of headache, attention must be paid to the diet, and the condition of the bowels. Constipa- tion should be overcome by the use of the Compound Podo- phyllin Pills,*persistently used till free action is established. If the bowels are constipated during an attack, an ounce of Rochelle Salts, or the Compound Jalap powder sho,uld be given to cause a quick action, and thus relieve the head. In the plethoric headache of stout, full-blooded persons, the salts or Jalap powder should be given at once, and this may be followed by Fluid Extract of Veratrum Viride in drop doses every half hour till the symptoms are relieved. The diet should be spare, and meat should not be used more than once a day. Active exercise in the open air, frequent bath- ing, abstinence from the use of stimulants and condiments, and a free action of the bowels are indispensible to guard against frequent attacks. In congestive headache a brisk cathartic is also desira- ble. Mustard to the neck and spine, cold to the head, and hot mustard water to the extremities will serve a good pur- pose. The Fluid Extract of Veratrum Viride should be given in drop doses every half hour or hour, and 20 grains of Brom- ide of Ammonium .should be given in water, three or four * See page 360. 456 DISEASES OF THE NERVOUS SYSTEM. times a day. When the symptoms have somewhat subsided Fluid Extract of Ergot in io drop doses, should be given three times a day, to contract the blood-vessels, and this remedy may be continued for some time after the attack. If there is any evidence of malaria, 3 drops of Fowler's Solu- tion of Arsenic, three or four times a day will prove val- uable. Regular habits, freedom from mental excitement, out door exercise, and regular bowels are indispensible in pre- venting recurrences of the trouble. In the headache of indigestion the undigested food that gives rise to the headache must be got rid of by an emetic. For this purpose the following may be given: Fluid Extract of Ipecac. 1 dram; Carbonate of Ammonia, 15 grains; water, 2 ounces. Mix, and give a tablespoonful every twenty minutes till vomiting is produced. After the stomach is emptied, half a teaspoonful of Aromatic Spirit of Ammonia should be given in water, every half hour till the pain is re- lieved. To prevent the attacks attention should be paid to the diet. Food should not be taken immediately after severe mental effort or excitement, nor should the mind be actively employed for an hour after a meal. The bowels must be kept regular with the Compound Podophyllin Pills,*and the indi- gestion treated as recommended on page 305- In sick headache the emetic above-mentioned should be given as soon as the attack begins. After it has acted the following should be given: Fluid Extract of Nux Vomica, 10 drops; Fluid Extract of Veratrum Viride, 15 drops; water, 6 ounces. Mix, and give a teaspoonful every fifteen or twenty minutes. Elixir Guarana is an excellent remedy in this form of the disease, and it should be given in teaspoonful doses every half hour till the pain is relieved. This will some- times relieve the nausea and pain without the emetic, but in severe cases the emetic will more promptly relieve the severity of the pain. Here, too, the use of the Compound Podophyllin Pills*to keep the bowels moving freely every day, will aid in preventing a recurrence of the conditions that cause the disease. * See page 360. HEADACHE. 457 In bilious headache the torpid condition of the liver is the principal trouble to overcome. The Eclectic Compound Pod- ophyllin Pills will serve the best purpose here, as the dose of the Podophyllin must be small, and continued every night till the tongue is cleared, and the bowels move regularly. If the symptoms of excessive secretion of bile are present these pills should be continued, and three drop doses of Fluid Extract of Nux Vomica should be given three or four times a day, for a week or two at a time. In nervous headache the best remedy that can be given during the attack is Fluid Extract of Gelsemium. It should be given in io drop doses, twice, and then 5 drops every half hour, till relieved, or till the eyelids droop or double vision is produced. It is sometimes best to combine it with a stimu- lant, and for this purpose 5 drops of the Fluid Extract of Prickly Ash Berries may be added to each dose. To guard against the attacks the nervous system must be built up. For this purpose the Compound Phosphorus pill will be found valuable. Where there is marked nervous irritability and wakefulness, the Gelsemium should be given in 10 drop doses, at bed time, and repeated in half an hour if the patient remains awake. If feelings of dizziness are felt between the attacks, 10 drops of Fluid Extract of Ergot, three or four times a day will relieve that symptom. When the rheumatic headache is present, the treatment heretofore recommended for rheumatism, should be given; and when we have the headache associated with the kidney obstruction, 20 grains of Acetate of Potash in a half pint of the infusion of Marsh Mallow, three times a day will serve a good purpose. In all varieties of headache it is important to ascertain the exact exciting cause, if possible. Then by removing or preventing this we may hope for permanent results from our treatment. It is essential in all cases that the digestive func- tion should be kept normal, and that the bowels should move freely once a day. Good air, moderate exercise, healthful employment, abstinence from undue excitement and excesses of all kinds, and regular habits, are indispensable 458 DISEASES OF THE NERVOUS SYSTEM. at all times, to persons who are liable to any form of head- ache. VERTIGO. Vertigo is a condition in which the individual feels as if everything around him was moving in a circle, or to and fro; and the condition is commonly known as dizziness. It is not itself a disease', but a symptom produced by various other disorders. It is frequently met with as a symptom of dis' eases of the ear, as well as of the heart and stomach. A persistent dizziness, with flashes of heat in the head and face, is also frequently met with in suppressed menstrua- tion, and at the "change of life" in women. Treatment.-For the treatment of vertigo it is necessary to determine the nature of the condition that gives rise to it. If it is associated with any disease of the ear that affection must be relieved before the vertigo ceases. When we are certain that it does arise from this cause, from 2 to 15 grains of Quinine should be given three times a day. If the stomach is at fault, attention should be given to that trouble before the vertigo will disappear. If suppres- sion of the menses exists, the proper treatment for the re-es- tablishment of that function should be adopted. With a view of relieving the vertigo itself, without reference to the' exciting cause, the Fluid Extract of Ergot should be given in 10 drop doses three or four times a day, for the purpose of contracting the small blood-vessels of the head. If this does not answer the purpose, the dose should be increased to 20 or even 30 drops. In addition to this, the Rochelle Salts or Compound Jalap powder should be given to produce free watery evacuations, and thus overcome the tendency of blood to the head. APHASIA. By aphasia is meant an inability to give utterance to thoughts in words that express ideas. Sometimes the. INSANITY. 459 difficulty consists in a loss of memory of words, while in other cases there may be an inability to use the words in their proper places. Sometimes the difficulty extends to written language, so that the person cannot write at all, or uses meaningless char- acters to express ideas. Again he may be able to write cor- rectly without being able to speak. Aphasia may be caused by hemorrhage of the brain, abscess of the brain, inflammation of the brain and its mem- branes, and by occlusion of the blood-vessels of the brain by the formation of clots. Whatever its cause the condition frequently remains long after all other symptoms of brain trouble have disappeared. Treatment.-An experienced physician should be called upon to treat the brain lesion that may have given rise to the aphasia. The friends of the patient, however, may do much to remedy this disorder by careful management. He may be directed to repeat, after another person, all the words over which he seems to stumble. Some common expression should be articulated slowly and the patient required to repeat each word as spoken. This should be gone over and over until he can repeat the sentence himself. Other sen- tences should be taken in the same way, and thus by a complete system of word exercise, the aphasia may be over- come, in cases where there is no permanent brain trouble to keep it up. INSANITY. By the term insanity is meant a departure from that normal intelligence which we expect to find in persons whom the law describes as "of sound mind, memory and under- standing". When a person forgets what has happened, is inca- pable of forming a judgment on any subject, when he acts contrary to all reason and can't tell why he does so, when he is lead off by delusions that have no foundation in fact, or when he acts entirely unconscious of what he is doing, he is said to be of unsound mind. 460 DISEASES OF THE NERVOUS SYSTEM. Unsoundness of mind may depend upon some nervous disorder, which affects not only the brain but also the bodily functions, as does epilepsy, apoplexy, &c.; or it may exist with- out the external evidence of any other disease. It matters not, however, what the manifestations of mental derangement may be, it is certain that all such conditions must result directly from changes that take place in the nerve centres, which are thus rendered incapable of properly performing their normal functions. There are a few general symptoms that are usually present in all cases of incipient insanity. These are de- fective sleep, pain in the head, with flushed face, throbbing of the arteries of the neck and watery eyes; an alteration of the general emotional conditions, the individual sometimes manifesting great depression and dullness of spirits, and at other times restlessness, irritability, or excitability ; and finally delusions or hallucinations appear in some form. In some cases the person may entertain some strange delusion or hallucination for a long time, without developing any other symptom, excepting a general weakening of the mental faculties. In other cases, the patient is melancholy, takes no interest in what is passing around him, looks upon the dark side of everything, and has forebodings of impending evil, and may finally refuse to take food and drink, thus assuming a condition that is commonly known as melancholia. From this state he may pass to complete mental stupor, and finally becomes incapable of even attending to his own wants, a condition which is termed dementia. When great mental excitement is present, and the patient becomes wild, boisterous and uncontrollable, the con- dition is known as mania. These various mental conditions demand special atten- tion from the experienced physician, as well as from the friends of the sufferer; and as soon as any impairment of the mental faculties is recognized, a doctor should be con- sulted with a view of ascertaining the nature of the exciting SPINAL MENINGITIS. 461 cause and suggesting the remedy best adapted for relief or cure. At the present time the management of our insane asylums is such as is calculated to increase rather than diminish insanity. In order to treat the insane successfully they must be cared for outside of large institutions, with the patient surrounded with everything that is calculated to make him feel as if he were at home. No person should be placed in an insane asylum whose friends can by any possi- bility care for him in their own homes, and no one should be committed to an asylum as insane, without a thorough and careful examination by a jury of physicians; and every per- son committed as insane should be so examined at least every three months, that their real mental condition may be positively ascertained. It is impossible to properly consider this subject here, nor can we attempt to give any line of treatment, as the cases are so varied that no two persons can be treated aliker None but a physician who watches his patient daily, and has given the subject of insanity special study, can expect to properly treat the insane, and no other should be employed for the purpose. SPINAL MENINGITIS. Spinal meningitis is an inflammation of the membranes covering the spinal cord. It may be caused by injuries of the spine, by exposure to cold while the body is overheated, and from diseases of the bones of the spinal column. It is also met with as an epidemic miasmatic disease which has been already described. SYMPTOMS.-The disease is ushered in by a severe chill which usually lasts for several hours. A high fever then sets in, with a hot, dry skin, the tongue is coated white, the 462 DISEASES OF THE NERVOUS SYSTEM. bowels are constipated and the urine is scanty and high colored. The pain in the back is very severe and is increased by motion. By the third day the fever reaches its height and great irritability and restlessness are developed. Tenderness is felt on pressure along the spine, and at some points the slightest touch causes severe pain. As the disease advances, nervous irritation is increased, and the fever assumes a typhoid type. In severe cases delirium sets in which may soon extend to profound stupor. Muscular twitching affects the legs, and partial paralysis develops. Sometimes the urine and feces are passed involuntarily, and again the urine is retained. The disease may last twelve or fourteen days or it may continue for eight or ten weeks. Treatment.-A Spanish Fly blister should be applied to the spine as soon as the disease is recognized, and after this a Flaxseed meal poultice, as hot as can be borne, should be applied to the raw surface, and it should be changed every couple of hours. The Fluid Extract of Gelsemium should be given in 5 drop doses, every half hour, till eight or ten doses are taken, or till drooping of the eye-lids or double vision is produced. After that it should be continued in the same dose every three hours. After the third or fourth day, 20 grains of Acetate of Potash should be given, in water, two or three times a day, till the urine flows freely. The following may now be substituted for the Gelsemium alone: Fluid Extract of Gelsemium, 2 drams; Fluid Extract of Golden Seal, I ounce; Fluid Extract of Pleurisy Root, 3 ounces; water, enough to make 6 ounces. Mix, and give a teaspoonful every three hours. Quinine will be required in 5 grain doses every four hours, and good brandy or whiskey should be used frequently to keep up the strength. Small doses of Podophyllin will also be found important in removing the effusion of water that takes place. It is best prepared as follows: Podophyllin, 2 grains; Sugar, 20 grains. Triturate thoroughly, and give one powder night and morning. SPINAL IRRITATION. 463 SPINAL IRRITATION. Spinal irritation is a condition that is often present as a symptom of diseases of the various internal organs. It may frequently exist as the only symptom of some obscure disease. Symptoms-There is an uneasy ache felt along the spine, with marked tenderness at some points. The functions of the abdominal and pelvic organs are impaired from lack of ner- vous tone, and there is a general lassitude present which the patient cannot shake off. Treatment.-The presence of any pain or irritation along the course of the spine should not be neglected. It indicates some abnormal condition, which the patient cannot definitely recognize, and for this reason a physican should be consulted. A careful examination of the spine, and of the organs of the chest, abdomen, and pelvis, is necessary to determine the cause of the trouble. Rest in the recumbent position, mustard to the spine, and the proper treatment of the associate disease will soon re- lieve the symptoms of spinal irritation. LOCOMOTOR ATAXIA. Locomotor ataxia is a disease involving tne posterior part of the spinal cord. It is most commonly met with between the ages of thirty and sixty, and is more frequent in men than women. Continued exposure to cold, dampness, or great fatigue tend to develop it. It is believed that con- tinual jarring of the body also predisposes to its develop- ment. SYMPTOMS.-At first there is a muscular soreness and pains of a rheumatic character in the body, hips, thighs and legs. Double vision and nocturnal emissions of semen soon 464 DISEASES OF THE NERVOUS SYSTEM. come on, and a loss of sensation with numbness is experi- enced in the soles of the feet. After a time all control of the motion of the legs is lost. The leg will fly off in a direction different from that the patient tries to place it, and thus walking is greatly interfered with. When the eyes are closed it will be almost impossible to retain the erect posi- tion. Treatment.-Absolute rest in the recumbent position should be enforced as soon as the disease is recognized, the diet should be light, and stimulants of all kinds, including tea, coffee and tobacco, should be given up. Compresses of cold water to the spine, and frequent rubbing will also prove valuable. Aside from these means galvanism is also of ad- vantage when applied to the spine. The proper medicines must be prescribed by the physician for each individual case, and no two can be treated alike. INFANTILE PARALYSIS. Infantile paralysis is a disease of early life, which comes on suddenly, and is usually met with before the fourth year. Symptoms.-The disease begins with a fever which lasts for a day or two. Headache, pain in the back and legs, diz- ziness and sometimes delirium may be present. When the fever passes off the child is found to be paralyzed. A correct diagnosis can only be made by a physician, and electricity is necessary to do this. Rest in bed must be insisted upon, and as soon as the paralysis is recognized, hot water should be applied to the spine. After this, strong Acetic Acid may be applied to the whole length of the spine twice a day till the skin begins to crack. If this application is too severe, hot water may be used afterward. The galvanic current of electricity must also be used by an experienced physician. The medi- cines should also be prescribed by the physician in every case. CONVULSIONS. 465 CONVULSIONS. Convulsions are frequently met with as a symptom of diseases of the brain and spinal cord. They are also produced by irritation of the extremities of the . nerves which is com- municated to the nerve centres, and thus excites reflex action. They are more commonly met with in children, and are due to the irritation of teething, to the presence of worms in the intestines, and to undigested food in the stomach. Inflam- mation of the stomach or bowels or other internal organs also give rise to them. SYMPTOMS.-The sudden and involuntary jerking of the extremities, muscular twitchings about the face, rolling up of the eyes, and partial or complete loss of consciousness, that attend convulsions are too well known to require special de- scription. Treatment.-If the child can swallow, the Compound Tincture of Lobelia and Capsicum should be given in 15 or 20 drop doses, every five or ten minutes, till the convulsion passes off. An adult may take a teaspoonful as often. When symptoms of the approach of convulsions are noticed, the Fluid Extract of Gelsemium in 3 drop doses, every half hour, to a child, will usually prevent it, while an adult should have from 10 to 20 drops. During the convulsions, this remedy may also be used, every half hour; 30 drops for an adult, and from 5 to 6 drops for a child under four years of age, being the proper doses. .These large doses must be discontinued as soon as the fit passes off. The feet should be put in hot water, mustard may be applied to the stomach and ankles, or the patient may be placed in a warm bath, to equalize the circulation. If the face is red, and the head hot, cold appli- cat'ons to the head will be required. As soon as the first convulsion has passed off, the cause of the irritation should be ascertained and removed if possible. If the stomach is irritated by undigested food, Ipecac, should be given to produce vomiting, if the bowels are constipated 466 DISEASES OF THE NERVOUS SYSTEM. they should be moved by Castor Oil, and if there is any evi- dence of worms these should be treated as previously de- scribed. If any disease of the brain is present the physician should direct the treatment of the case. EPILEPSY. Epilepsy is a disease of the nervous system characterized by a sudden loss of consciousness and convulsions. It usually begins early in life, and unless arrested by proper treatment it gradually becomes worse till finally the mental powers are destroyed. Some peculiar condition of the nervous system must exist in those who suffer from it, and the attacks are excited by teething, injuries to the cranium, irritation of the terminal branches of nerves, and by mental excitement or emotion. The disease is commonly known as the "the fall- ing sickness." SYMPTOMS.-Sometimes headache, dizziness, and mental confusion are present for some days before an attack of epilepsy. At other times the patient is despondent and gloomy, and is easily irritated for some time. Usually, however, some peculiar sensation, known as the epileptic mira, is felt, beginning at the feet and gradually extending upwards till it reaches the head, when the person falls in a fit. Sometimes the feeling is as if a current of cold air was blowing on the body, at other times the sensation is as if warm or cold water was being showered on the skin, while again a tingling or numbness is felt. In either of these con- ditions the sensation begins in the feet or hands, and can be felt to creep up slowly toward the head, which it reaches in a few seconds, or in a minute or two at the furthest. The patient now falls suddenly, loses consciousness, becomes suddenly pale in the face, and is finally attacked by convul- sions. Now the head is drawn back, or to one side, the jaws are tightly closed, all the muscles become rigid, the lips are EPILEPSY. 467 contracted, the lids are open and the eyes fixed, the respira- tion is temporarily suspended, and the palor of the face gives place to a livid hue. This condition lasts for about a minute or two when the muscles of the face begin to twitch, and finally a general convulsion may set in at once, without the rigor, and in some cases the twitching is confined to the mus- cles of the head and face. A slight convulsion may last from one to five minutes or even longer, and then an intermission of a few minutes may intervene before another occurs. Several convulsions may thus succeed each other, and finally they subside for the time. The patient is rarely conscious between the paroxysms, and some- times several days will elapse after an attack before conscious- ness returns. When recovery takes place, everything con- nected with the attack, and possibly all that transpired for several days before is a blank. After one attack months may pass before another is developed; or they may recur in a few days or a few weeks. As the disease advances they become more frequent and more violent, and finally lead to insanity, if not properly treated. Treatment.-During the convulsions care must be taken to prevent injury to the patient. The clothing around the waist and neck should be loosened, a cork should be placed between the teeth to prevent injury to the tongue by biting, and some one should guard the patient from falling out of bed or injuring his head or arms on the floor or wall. As soon as the convulsion has subsided, an attempt should be made to make him swallow something to break up the spasms. F'or this purpose a teaspoonful of Fluid Extract of Gelsemium should be given at one dose. This is a large dose, but none too much for a person over ten years of age who is suffering from the ''fits" of epilepsy. This may even be repeated in half an hour, if the spasms continue. After the paroxysm is over the patient is greatly prostrated for several days. Good nutritious food must now 468 DISEASES OF THE NERVOUS SYSTEM. be administered, and quiet and freedom from excitement enforced. With the view of preventing a recurrence of the attack the following should be given: Bromide of Potassium, I ounce; Bromide of Ammonium, 4 drams; water, 8 ounces. Mix, and give one teaspoonful in a wine-glassful of water, three or four times a day, after meals. This should be con- tinued without intermission for a year or even two years. If eruptions on the skin are produced, they may be relieved by the frequent use of the Compound Podophyllin pills *and by an occasional use of the following, for a week or two: Acetate of Potash, 4 drams; Fowler's Solution of Arsenic, 30 drops; water, 6 ounces. Mix, and give a table- spoonful three times a day. It will also be advantageous to tone up the nervous system, and for that purpose the follow- ing should be given in conjunction with the Bromide mix- ture: Sulphate of Strychnia, 1 grain; Dilute Muriatic Acid, 3 drops; water, 4 ounces. Mix, and give a teaspoonful three times a day, before meals. Tea, coffee, tobacco, and all alcoholic stimulants must be avoided, and the patient must have fresh air, moderate exer- cise, and freedom from business anxieties, and excitement of all kinds. HYSTERIA. Hysteria, or hysterics, is a nervous disease in which there is disturbed action of the nerves of motion and sensation, as well as derangements of the mental activities. It is most commonly met with in women, though men also suffer from it. In some cases it is marked by extreme irritability, and excitability of the nervous system. SYMPTOMS.-The subject of hysteria usually complains of a feeling of oppression, anxiety and uneasiness. At one time she seems exceedingly joyous and laughs inordinately, and at another she will cry without the slightest occasion and will seem weighed down with sadness. A feeling, as of a ♦See page 360, HYSTERIA. 469 ball or lump, in the throat is frequently present, which the patient says she can neither get up nor down; the limbs are stiff and painful; there are noises in the ears; confusion of mind and dizziness come on; and finally a temporary loss of consciousness takes place, during which short intervals of quiet are followed by violent muscular rigidity, throwing around of the arms and legs, biting the tongue, pulling the hair, and grinding the teeth. During these attacks the patient will struggle with her friends or attendants, will use abusive language, and will scream, laugh and cry in rapid succession. During such an attack the heart palpitates violently, the face becomes flushed and swollen, and the breathing is difficult. These attacks may pass off in a few minutes, or may con- tinue for several hours or even days. The excitement passes over and the patient falls asleep, and when she awakens con- sciousness is restored. In some cases she gradually comes to herself without sleep. After a severe attack she feels weak and sore for sev- eral days. In milder cases, periods of excitement followed suddenly by mental depression, may occur without the convulsion. The lump is felt in the throat, and the patient imagines she is suffering from a great variety of diseases. She cannot sew, write, read or walk, without great fatigue, and she soon loses her appetite and becomes pale and thin. Treatment.-Hygienic conditions are of the first import- ance in this disease. Good and easily digested food must always be had, tight lacing and wearing heavy skirts sus- pended from the hips should be avoided, the person should not be left alone, and should be kindly encouraged to exer- cise self-control. If the person is weak and debilitated, the Elixir of Cali- saya, Iron and Strychnia, should be given in teaspoonful doses three times a day, after meals; and the Fluid Extract of Gelsemium may be given at bed time, in 5 drop doses to control the nervousness. This may be repeated two or three times, at intervals of half an hour, if required to induce sleep. 470 DISEASES OF THE NERVOUS SYSTEM. When the patient is full-blooded, the following should be given: Bromide of Potassium, 4 drams; Fluid Extract of Gelsemium, 2 drams; Fluid Elxtract of Black Cohosh, 4 drams; water, enough to make 4 ounces. Mix, and give a teaspoonful after each meal and at bed time. During the convulsions, dashing cold water in the face will often serve a good purpose. If this fails, Chloroform or Ether may be inhaled till the excitement is controlled, when the patient will often fall into a natural sleep, before the effect of the anesthetic passes off. When complications arise, they must be recognized and treated by the physician. CHOREA, OR ST. VITUS' DANCE. Chorea, or St. Vitus' dance, is a disease characterized by a loss of control of the movements of the voluntary muscles, and by irregular spasmodic movements of some of these muscles. It is essentially a disease of childhood, and is usually met with about the age of puberty, though it may occur as early as the sixth or eighth year. Derangements of digestion, heart troubles following rheumatism, intestinal worms, and debility from previous disease are among the most common causes of chorea. SYMPTOMS.-Restlessless and unconscious movements of the hands and muscles of the face, are the first symp- toms that indicate the approach of chorea. Jerking in- voluntary motions of the hands, and other portions of the body are next noticed, and this grows worse till all control over the movements of the hands, arms, legs, and muscles of the face is lost. The action of the heart is irregu- lar and tremulous, the breathing is spasmodic, the face is swollen, there is marked tenderness over the upper part of the spine, and the patient has unpleasant dreams, or walks in her sleep. In severe and long-continued cases loss of mem- ory, mental dullness, and irritability are usually noticed. CATALEPSY. 471 Treatment.-Rest in bed, and freedom from all excite- ment is the first thing to be looked to in the treatment of chorea. It is even best to darken the room in order to protect the eyes from the light. A diet of milk, beef-essence, soft boiled eggs, clam broth, raw oysters, &c., should be provided. With this attention to the hygienic condition of the patient, a cure may often be effected in three or four weeks without medi- cine. It is always well, however, to keep the bowels regular, by thd use of the Eclectic Compound Podophyllin pills. If indigestion or worms can be recognized, these should be treated as recommended elsewhere. If the patient is pale and weak, the Elixir of Calisaya, Iron and Strychnia, should be given in doses of one-half to one teaspoonful, three times a day, after meals. The spasms are best controlled by the following: Fluid Extract of Gelsemium, 2 drams; Fluid Extract of Black Cohosh, 3 drams; Fowler's Solution of Arsenic, 30 drops; water, enough to make 4 ounces. Mix, and give a teaspoon- ful every three or four hours. When the muscular twitchings begin to diminish, the Gelsemium should be left out of this mixture, and the prescription then continued. In some cases of chorea, in boys, the irritation caused by a long foreskin may keep up the disease. If such a condition is present, and the treatment given above fails to relieve the disease, the operation for circumcision should be performed. CATALEPSY. Catalepsy is a condition in which there is loss of con- sciousness, a suspension of the functions of the brain, and a rigidity of the voluntary muscles. It might be properly called a state of suspended animation or trance. It may occur as an independent affection, or it may follow attacks of hysteria. Sleep-walkers sometimes go into this condition, and it may also be produced by persons who possess the power of mesmerizing, or hypnotizing subjects. 472 DISEASES OF THE NERVOUS SYSTEM. Treatment - There are but few cases that require treat- ment during the trance. When the condition is prolonged, we believe that magnetism would prove more valuable than any other method of treatment. Stimulating applications to the skin, Ammonia to the nose, &c., may be tried to arouse the patient. To prevent a return of the condition, good food, fresh air, light occupation, and change of scene are desirable. If the disease is persistent, a physician must be consulted. TETANUS, OR LOCK JAW. Tetanus is a disease of the nervous system in which there are paroxysmal contractions of the voluntary muscles. The cause may be some obscure disease of the nervous system, or the action of poisons such as Strychnia. It is, however, usually caused by an injury to the nerve fila- ments. The prick of a pin or needle, a splinter of wood under the nail, a rusty nail or tack run into the sole of the foot, and similar injuries, are frequently followed by tetanus. In consequence of the muscles of the lower jaw being among the first to contract, so that the mouth cannot be opened, the disease is commonly called lock-jaw. Symptoms.-When due to some internal cause, a sense of chilliness comes on, which is followed by fever and stiff- ness of the neck. When an injury is the exciting cause, the wound becomes red, swollen and irritated, and a sharp shoot- ing pain starts from the wound and follows the course of the nerves toward the body. Swallowing now becomes difficult and painful, and the muscles of the jaw become fixed so that the lower jaw is immovable. Then the muscles in the back of the neck are attacked, and the head is drawn back. The muscles of the back, abdomen, or one side, may then become involved, and the body is bent in the direction of the con- tracted muscles; the backward bend being the most common. SHAKING PALSY. 473 At first the rigidity is not constant and goes from one set of muscles to another. The relaxation is then complete during the remission, but as the disease progresses the slight- est motion or irritation of any kind brings on a paroxysm, and one is hardly over before another occurs. With each paroxysm the pain in the muscles is intense, and the heat of the body becomes great. Treatment.-As soon as symptoms of tetanus begin to appear, no time should be lost in sending for a surgeon, as there is little that can be done by those who are not familiar with the conditions that present themselves. SHAKING PALST. Shaking palsy is a disease of advanced life, and is char- acterized by muscular tremor and loss of power. Strong mental emotions, long continued exposure to cold and damp- ness, and injuries to the small branches of nerves, are among the exciting causes, but these could not produce the disease without the existence of some peculiar condition of the ner- vous system to favor its development. Symptoms.-This disease usually comes on slowly. A jerking of the thumb, hand or foot is generally the first symp- tom noticed, and this can be controlled by the will. These involuntary movements persist till finally one arm or leg, or even the entire side of the body is affected. The motion is now a succession of jerks of the affected parts caused by rapid con- traction and relaxation of the muscles. All mental excite- ment aggravates the trouble, but it is usually suspended during sleep. The disease may last for many years and toward the last the afflicted one is entirely disabled. Treatment.-The Fluid Extract of Gelsemium, in doses of io drops, three or four times a day, is the best treatment that can be adopted in these cases. Massage or magnetism offer the best prospects of permanent improvement, and these should be faithfully tried. 474 DISEASES OF THE NERVOUS SYSTEM. HICCOUGH. The term hiccough is applied to a peculiar noise pro- duced by simultaneous contractions of the diaphragm and larynx. It is usually a symptom of indigestion, but it may come on during the progress of diseases of the liver and inflammation of the peritoneum. It is also met with in other diseases and is frequently a symptom of approaching- death. SYMPTOMS.-There is a full expiration of air from the lungs, and a sudden jerking or short inspiration. The glottis closes and occasions the peculiar sound which is known to every one. In severe cases the hiccough may occur seventy-five or more times a minute, and the paroxysm may last for several days. Sometimes hiccough is developed as a result of some temporary indigestion, and passes off in a very short time. Treatment.-A sudden fright or other strong mental impression will often arrest a paroxysm of hiccough. Some- times a dash of cold water on the face, head or neck will serve the purpose. In some cases a block of sugar saturated in cider vinegar, and held in the mouth till it dissolves, and then swallowed will give relief. The Fluid Extract of Gel- semium, in doses of io drops, every half hour, will often relieve even severe cases after all other means have failed. The faradic current of electricity applied over the diaphragm will also give prompt relief. In some cases the condition is so distressing that it may be necessary to resort to the inhalation of Chloroform. SEA-SICKNESS. The faintness, nausea, and vomiting that occur during the first few days at sea and occasion so much distress, has led physicians to give considerable study to the subject of DELIRIUM TREMENS. 475 sea-sickness, with the hope that some remedy might be found that would control or prevent it^. At the present day the general opinion prevails that sea-sickness results from a series of shocks to the minute cells of which the brain and spinal cord are made up. These shocks are of course caused by the motions of the vessel. Treatment.-We have recommended to a number of our patients a treatment suggested by Dr. Soule, of the Steamship City of Sidney, and the reports of the results are highly satisfactory. The following is the mixture referred to: Bromide of Sodium, 4 drams; Bromide of Ammonium, 2 drams; Peppermint water, 3 ounces. Mix, and give a tea- spoonful before meals and at bed time. This remedy should be given three or four days before sailing. When the disease has developed before the treatment is begun, a teaspoonful of the above mixture may be placed in half a goblet of water, with 5 drops of the Fluid Extract of Ipecac , and a teaspoon- ful should be given from the goblet every 5 minutes. It is important that a person who has never been on the water before should look into the distance so as to avoid seeing the motions of the ship. It is also best not to look at others who are suffering from sea-sickness. DELIRIUM TREMENS. Delirium tremens is an acute delirium occasioned by the abuse of alcoholic liquors. None but confirmed drinkers are liable to it, and it usually comes on after a spree. In some cases the disease will develop when a person who has been long accustomed to the use of alcohol is suddenly deprived of it. SYMPTOMS.-A recent debauch may be followed at once by the symptoms of delirium, or the stomach may be irritable, the appetite lost, and even liquor may be re- fused, for some days before the disease sets in. A tremb- ling of the body comes on, mental excitement begins 476 DISEASES OF THE NERVOUS SYSTEM. to show itself, and persistent insomnia is experienced. Hal- lucinations of various kind§ now take possession ofthepatient and the acute delirium becomes so great that he can hardly be controlled. He sees all kinds of horrible objects, as demons, snakes, monsters, &c., and believes that his life is endangered. During the delirium the skin is hot and dry, the tongue is coated, the appetite is lost, the pulse is small and frequent, the bowels constipated, and the urine scanty. After a time the patient becomes completely exhausted, and finally sinks into a sound sleep, from which he awakes in a few hours, free from the delirium. In other cases the delirium increases till at last the vitality of the nerve centres becomes exhausted and the patient dies. The usual duration of the disease is a week or ten days. Treatment.-As a person who is attacked by delirium tremens is liable to have abstained from food for some time, it is important that attention should be given to the proper nutrition of the patient. Milk and lime-water should be given every two hours, if there is any irritation of the stomach; and beef essence, soft-boiled eggs, broths, raw oysters, and some stimulant in the form of egg-nog, will constitute the diet, and some one of these should be given every two hours. It has been demonstrated that the best results are obtained by administering a little stimulant till the disease has subsided. Capsicum is a valuable remedy in this disease and often acts like a specific in cutting short the delirium. It should be administered in capsules and 30 grains should be given every three or four hours. In the early stages, before the delirium sets in, 20 grains of Bromide of Potassium should be given in water every two hours till sleep is produced. To control the excitement, 10 drops of Fluid Extract of Gelsemium should be given every half hour for four or five doses, and after that it may be continued at intervals of two hours. Opium in all its forms and Chloral should be avoided, for they will always do harm. PAR AL YSIS. 477 PARALYSIS. Paralysis is a term applied to a condition in which there is a partial or complete loss of motion or sensation, or both, in some part of the body. It is not a disease but a symptom of several diseases that affect the brain and spinal cord. Paralysis may follow apoplexy, inflammation of the brain, softening of the brain mass, the formation of tumors inside of the skull, and injuries of the head that cause bleeding within the skull. When the paralysis is caused by any of these con- ditions it usually affects one entire side of the body, and is then called hemiplegia. When the spine is involved, all that part of the body below the seat of the disease or injury is paralyzed, and the condition is called paraplegia. If there is any injury of, or pressure on a large nerve sup- plying a limb or single muscle, the part so supplied will be paralyzed. In some cases the paralysis comes on suddenly, while in others its development is gradual. Sometimes motion is lost while sensation remains normal, again the motion may be present while there is no feeling in the part; but usually both motion and sensation are destroyed. In some cases the skin of the back and affected side is over sensitive, to such a degree that the slightest touch will occasion great suffering. Symptoms.-Inability to speak, and loss of motion or sensation, or both, on one side, with the face drawn to the opposite side, indicate paralysis from causes originating in the brain. Loss of motion and sensation below a fixed point in the back, and entire freedom from head symptoms indicate that the seat of the trouble is located in the spine. When only one limb, or one muscle or set of muscles, is paralyzed it indicates that a large nerve is involved. 478 DISEASES OF THE NERVOUS SYSTEM. Whatever the cause of paralysis, when it once occurs a long time is necessary to restore the normal functions of the affected parts, and in many cases, a recovery from one attack is no protection against another. Treatment.-The physician should determine the nature of the exciting cause of paralysis, and do what he can to relieve that. The most successful treatment consists in the proper use of electricity. The alternate use of the faradic and galvanic currents will usually prove the most serviceable. Strychnia and Phosphorus should be given as follows: Sul- phate of Strychnia, 2 grains; Dilute Muriatic Acid, 4 or 5 drops; Dilute Phosphoric Acid, 1 ounce; Glycerine, I ounce; water, enough to make 8 ounces. Mix, and give a teaspoon- ful before each meal. Due attention must be given to the diet, which should be nutritious and principally fluid. The bowels should be kept regular by the Compound Podophyllin pills,*and whenever the urine is scanty, 20 grains of Acetate of Potash should be given two or three times a day. Attention should also be given to the condition of the skin. A tepid sponge bath should be used every morning, and the entire body rubbed thoroughly with a coarse towel. This treatment, however, should be followed out under the doctor's directions, as it may be found necessary to vary it from time to time. NEURALGIA. Neuralgia is a disease characterized by a greatly increased sensibility of the nerves, that usually extends to intense pain. Sometimes there is a congested condition of the affected nerve, but usually no change can be recognized. The disease may attack any part of the body, but the face and thigh seem to be more susceptible to it than other localities. Any condition that tends to lower the vitality of the body may predispose to the disease, but the common exciting *See page 360. FACIAL NEURALGIA, OR TIC-DOULOUREUX, 479 causes are exposure to cold and damp, malarial influences, and injuries to branches of sensitive nerves. SYMPTOMS.-The pain of neuralgia comes on gradually. It is at first dull and aching and associated with a feeling of numbness; but after a time it becomes sharp, darting and cutting. In some cases it is confined to one point, but it usually runs along the course of the nerves both toward the trunk and the extremities. In severe cases the pain is so intense that the patient can hardly endure it, and then marked febrile symptoms are produced. In the average case the skin may be dry and slightly hot, the bowels constipated, the tongue coated, and the appetite poor. When the paroxysms of pain recur every alternate day, it indicates a malarial condition. Treatment.-Gelsemium is the best remedy that can be used for neuralgia. It maybe given in the following mixture: Fluid Extract of Gelsemium, 4 drams; Fluid Extract of Prickly Ash Berries, 2 drams; Simple Syrup, 1 ounce; water, enough to make 4 ounces. Mix, and give two teaspoonfuls for the first dose, and one teaspoonful every half hour after- ward, till sleep is produced, or till five or six doses are taken. It is best for the patient to be in the recumbent position and then the remedy can be pushed to double vision and complete muscular relaxation if required to relieve the pain. Peppermint oil applied over the affected part will also aid in relieving the pain. When the pain is more severe, every alternate day, 20 grains of Quinine should be given twice a day for several days. The Compound Podophyllin pills* should also be used every night if necessary, to keep the bowels regular. FACIAL NEURALGIA, OR TIC-DOULOUREUX Tic-douloureux is a term applied to neuralgia affecting the fifth cranial nerve. * See page 360. 480 DISEASES OF THE NERVOUS SYSTEM. SYMPTOMS.-The symptoms of this disorder are the same as those just described. The pain is here confined to one side of the face and it extends to the teeth. For months before the severe pain develops, a dull ache may be felt in the cheek and teeth, but finally the characteristic pain shows itself, and the patient suffers the most intense agony. At times the pain lets up somewhat, but comes on again more severe than before. After one attack, a person is liable to have another, and at last they may recur quite frequently. Treatment.-The same treatment as described under the heading of neuralgia (page 479) will be found highly valua- ble. In fact, this treatment for facial neuralgia more nearly approaches a specific than any we know for the treatment of any disease. TOOTHACHE. Toothache is properly a neuralgia affecting the small branches of nerves that supply the teeth. In severe facial neuralgia the pain extends to all the teeth, but usually the trouble is confined to one or two. A decay of the substance of the tooth is commonly the cause of the toothache, and the pain generally resembles that of neuralgia. Sometimes the pain is of a throbbing, jumping character, and very intense. Treatment.-The Gelsemium mixture recommended for neuralgia on page 479 will usually give temporary relief, so that sleep may be obtained. If there is a cavity in the tooth, a small piece of cotton may be saturated in the Fluid Extract of Aconite, and intro- duced into the cavity. This will deaden the pain and some- times relieve it entirely; but care must be taken to press out the surplus Aconite so as not to burn the mouth. The pain will certainly recur and sometimes leads to extended facial neuralgia unless the decayed tooth is either treated and filled, or extracted. SC I A TIC A. 481 SCIATICA. Sciatica is a term applied to neuralgia affecting the sciatic nerve. SYMPTOMS.-The pain usually begins in the small of the back and gradually extends down through the hip and thigh, following the course of the sciatic nerve to the knee. The pains are of the same general character as those of neuralgia in other localities, but are more intense. The disease when once established may continue for weeks, or even months. Treatment.-The general treatment recommended for neuralgia should be employed. In addition to this the gal- vanic current of electricity properly applied will be followed by the best results. When the pain is very severe it may be relieved by Fly Blisters applied along the course of the nerve. Opiates should be avoided if possible, and when used should always be prescribed by the physician. CHAPTER XI. DISEASES OF THE SKIN. The skin is the investing membrane that incloses and protects the more delicate structures of the body. It is the seat of the sense of touch, and performs an important part in throwing off effete material from the system. It consists of two layers, the epidermis or cuticle, commonly called the scarf- skin, and the derma, or true skin. The scarf-skin has no nerves or blood-vessels, but is a scaly structure that is closely moulded over the true-skin. It forms a protection against irritation of the true-skin, and aids in preventing too free evaporation of watery vapor from its surface. This layer is very thick in the palms of the hands, the soles of the feet, and all parts exposed to con- tinued irritation. In its deeper parts where it joins the true- skin, its structure differs from the surface, and it is here that the coloring matter, which gives the color to the different races, is located. ' The true-skin is composed of little bundles of fine fibrous threads interlacing each other in every direction, and bound ACNE 483 together by areolar or connective tissue while its meshes are filled with minute nerves, blood-vessels and glands. It is tough, flexible, and very elastic, and is covered over its en- tire surface by little elevations called papillae. These eleva- tions contain the terminal filaments of the nerves and vessels. The entire surface is also closely marked by minute depres- sions or holes, commonly called the "pores of the skin" These are the orifices of the hair follicles and sweat glands. The nails, hair, sweat-glands, sebaceous or oil-glands and the hair follicles are called the appendages of the skin. The nails and hair are developed from the same material that forms the scarf-skin, and the glands are located in the struc- ture of the true-skin. The hair follicles, which are scattered over almost the entire surface of the skin, contain the roots of the hair, and the sebaceous glands secrete an oily substance that lubricates and keeps the skin soft and elastic. The ori- fices of most of the sebaceous follicles open into the hair folli- cles and thus supply a natural oil for the hair, but some of them open on the surface of the true-skin. The sweat glands throw off the principal part of the watery and gaseous ma- terials that are excreted by the skin, and they are found in every part of its surface. It is from these that the perspira- tion proceeds, and they are constantly throwing off a vapor loaded with impurities, even when there is no visible perspira- tion. From various causes the action of these glands may be interfered with or the tissues of the skin may be injured. In many forms of blood-poisoning, or when the blood is im- poverished, the skin becomes affected in consequence of its office in eliminating the poisons from the body. Of the great variety of skin diseases we can only describe a few of those most commonly met with, leaving the more obscure ones to the care of the family physician. ACNE. Common acne is an inflammatory affection of the seba- ceous glands. It is most frequently located on the face, neck, breast and back, and is common to youth and early adult 484 DISEASES OF THE SKIN. life. Sometimes it may continue to show itself from time to time till the fortieth year. It is clue to excessive secretion of the glands, or to obstruction of their orifices, and is usually associated with disordered digestion. In either case the sebaceous matter accumulates and distends the gland. Some- times a hard lump is formed, which will feel tender for a few days, and then gradually disappear. More frequently, how- ever, a little red pimple with a hard base develops, and in a few days it becomes a pustule with an accumulation of a drop or two of pus at its summit. After the pus is discharged the pimple gradually disappears. There may be only one or two present at one time, or there may be a large number. They usually come on in successive crops, thus frequently causing a constant disfigurement. Acne Punctata.-Acne punctata is the term applied to that condition in which the face, or other parts of the skin is studded with little black points. It originates in a sluggish action of the sebaceous glands, in which the sebaceous mat- ter fills up the pores of the skin. The black specks are caused by fine particles of dust being imbedded in the oily sebaceous matter at the opening of the pores. Inflammation often sets in around these points, and thus the condition of com- mon acne is produced. By many, this condition is called " flesh worms," and ignorant charlatans often illustrate their advertisements with cuts representing the worm of acne punctata. Such claims have no foundation in fact, and those making them are impostors. Acne Rosacea.-Acne rosacea begins with the appear- ance of small red spots, or a red patch on the nose or cheek. This redness gradually spreads till it covers the entire nose, and sometimes the whole face. It may persist a long time as a simple redness of the skin, or the skin may become very much thickened and marked by little blood-vessels that can be distinctly seen. In some cases little pustules arise and the pus in them is very apparent on account of the redness of the part. Acne Miliaris.-Little white elevations, not much larger than grains of sand are sometimes seen in the super- ACNE MALI A RIS. 485 ficial layers of the true-skin. They are usually seen in the eye-lids, face and scrotum, and consist of sebaceous matter filling up the follicles. They are not painful, and seldom give rise to inflammation, but if they are numerous they disfigure the skin. The name acne miliaris has been applied to this condition. Treatment.-The treatment of acne in all its forms must be largely hygienic. The diet should be nutritious and easily digested, the bowels must be moved every day, and fresh air, and moderate exercise must be insisted upon. Above all, frequent bathing is absolutely necessary. The sponge bath should be used every morning, and a hot bath once or twice a week. The affected parts should be bathed every night with water as hot as can be borne, and at the same time well rubbed with a coarse wash cloth. The Turkish bath will also be found of great advantage in these conditions. When the pimples appear each one should be opened with the point of a needle, or a little instrument for the purpose, but it is best not to squeeze them when inflammation is present. When the black specks of acne punctata are present, the bathing is also essential, and especially the nightly bathing of the affected parts with hot water. The accumulated sebaceous matter should be gently squeezed out of the pores, but too much force should not be used. A large-sized watch key maybe used for this purpose, by placing it perpendicularly on the skin with the hole over the obstructed pore, and press- ing the key gently against it. When the key is removed a long spiral mass of sebaceous matter will be found in it. This can be repeated over every black point that appears, and thus the pores are kept free and inflammation is pre- vented. Ointments arc frequently used in these two forms of acne, but they rarely do good. As a local application the follow- ing will be found about the best that can be used: Boracic Acid, 15 grains; Nitrate of Potash, 2 drams; water, 8 ounces. Mix, and apply to the affected part night and morning. This should be applied after bathing, and should not be washed off. 486 DISEASES OF THE SKIN. As an internal medicine, the following may be used with good results: Fowler's Solution of Arsenic, 2 drams; Fluid Extract of Blue Cohosh, 4 drams; water, enough to make 6 ounces. Mix, and give one teaspoonful three times a day, after meals. In acne rosacea, where the extended redness is present, the wash recommended above may prove beneficial in the early stages. As the disease advances the best application is Bonjean's Ergotin. The pure Ergotin should be applied at bed time, and during the day also if the patient need not be seen. This seems to contract the small blood-vessels, and thus relieves the reddened condition. The internal treatment recommended in the other forms of acne may also be employed here; but IO drops of Fluid Extract of Ergot, three times a day may sometimes be added with advantage. The proper use of galvanism will be found of great value, if other means fail to give the desired relief. In acne miliaris, the little white elevations may be punc- tured with the point of a needle or lancet, and the accumu- lated sebaceous matter squeezed out. Nothing further will be required in these cases. ALOPECIA, OR FALLING OUT OF THE HAIR. Falling out of the hair usually takes place with advancing age, but it is often met with in comparatively young persons. After continued and eruptive fevers it generally falls out, but is soon reproduced. Syphilis, or the continued use of large doses of Iodide of Potassium, will also occasion it; and many cases are due to some form of disease of the scalp, or the pre- ence of parasites. Long-continued mental labor, which causes undue heat of the scalp may also give rise to baldness. The wearing of fur caps, or any covering for the head that keeps the scalp too hot will have the same effect. Treatment.-As soon as rapid falling of the hair is noticed, it should be cut as short as possible, and this should be done every two or three weeks. When the hairs are few and fine, it is better to shave the scalp once or twice a week. This BCD NS AND SCALDS. 487 always strengthens the roots of the hair, and will frequently cause it to grow thick and long. Kerosene oil applied every night is said to be a valuable stimulant for the scalp, and several of our friends have tried it with highly satisfactory results. It must, however, be persis- tently employed for several months, if it is expected to do good. The following may also be used as a hair tonic: Tannic Acid, 20 grains; Sulphate of Quinine, 20 grains; Dilute Sulphuric Acid, 20 drops; Glycerine, I ounce; water, enough to make 6 ounces. Mix, and use as a hair dressing every morn- ing In all cases the scalp should be well-rubbed. If any local or constitutional disease exists, that must be treated as required, before any good results can follow the treatment of the scalp. BURNS AND SC ALDS. Burns and scalds differ from each other only in the char- acter of the heat producing them, the former resulting from dry while the latter is produced by moist heat. When a burn or scald is extensive the shock to the system is usually severe. Treatment.-In all cases of burns or scalds where the surface of the skin is only reddened, or where the cuticle alone is destroyed, the most prompt relief is obtained from washing the part with a solution of Bicarbonate of Soda, made by adding i ounce of the Soda to the pint of water. This can be applied freely with pieces of soft muslin saturated in it, till the burning pain is relieved. After that the follow- ing may be used: Carbolic Acid, 30 drops; water, 6 ounces. Mix, and apply to the part with pieces of old muslin or linen, and wet the cloths several times a day without removing them. When the injury involves the true-skin and is extensive, the part should be dressed at once with Carbolic Oil prepared as follows: Carbolic Acid, 1 dram; Sweet Olive Oil, 8 ounces. Mix, and apply freely over the entire surface. The part should be cleansed once a day with a Carbolic Acid wash, of the strength of 5 grains to the ounce of water. 488 DISEASES OF THE SKIN. This should be squeezed on the raw surface from a sponge, or a syringe may be used, so that no irritation may be oc- casioned. When a burn is in the vicinity of a joint, or about the neck, care must be taken to prevent a deformity from the contraction of the scar. To do this the limb must be kept straight and the head must be inclined to the side opposite the burn for a long time after the scar has formed. Some- times a surgeon must be called in to perform an operation called " skin-grafting," to prevent these deformities. BEDSORES. Bedsores are raw surfaces resulting from inflammation and mortification of the skin and underlying tissues, caused by continued pressure on prominent points of the body during long confinement in bed. Treatment.-All pressure must be removed from these sores either by change of position or by the use of rubber air cushions. The sores should then be syringed with the Car- bolic Acid solution, (5 grains to the ounce of water), and the part dressed with the antiseptic dressings.* When the sore is sluggish it may be necessary to sprinkle its surface with burnt Alum to remove any proud flesh that may have formed. BARBER'S ITCH. Barber's itch is an inflammation of the roots of the hair of the beard. It forms hard round lumps, which gather and discharge a pus that forms brown crusts around the hairs. It is most frequently found on the chin and upper lip, but it may occur wherever hair grows on the face. It is believed to be communicated by barbers, and, when once developed it may last for months. Treatment.-The beard should be cut as close as possible, and the following mixture used: Carbolic Acid, 30 drops; Glycerine, 3 ounces. Mix, and apply to the part two or three *For Antiseptic dressings see page 590. CARBUNCLES. 489 times a day. In some cases it may be necessary to pull out the roots of the hairs of the affected part before the disease will yield to treatment. BOILS. A boil is a circumscribed inflammation of the skin and underlying tissue that extends to the formation of pus. A single boil may appear, or several may develop at one time; while in some cases a succession of crops may be seen, a number of new ones forming as soon as the old ones begin to decline. They usually depend on some disorder of digestion or some defect in the action of the excreting organs. Treatment.-Much suffering is saved by making a free incision through the boil as soon as it begins to be painful. It may then be poulticed for a day, with hot Flaxseed poultices, and afterward washed with the Carbolic Acid solution. If it is not lanced a poultice should be applied early to bring it to a head, and when it begins to look yellow it should be opened with a needle and the pus and core should be squeezed out, if possible. The cavity may then be washed out with the Carbolic Acid solution. Frequent resort to the Turkish bath will prevent the recurrence of boils. CARBUNCLES. A carbuncle is simply a very large boil. They are most commonly met with on the back, and particularly on the back of the neck. Sometimes the inflammation restilting from them is so great that serious constitutional disturbance sets in, and may even terminate in death. Treatment.-As the general health of persons suffering from carbuncles is usually impaired, that should be looked to at once. Dialyzed Iron may be given, in doses of 15 drops, in water, three or four times a day, and should be continued for two or three weeks. The bowels should be kept regular and attention must also be given to the action of the kidneys and skin. 490 DISEASES OF THE SKIN. The local treatment is important and must not be trifled with. An early and free crucial incision should be made through the carbuncle, and hot poultices should then be applied freely to separate the core from the surrounding tissues. The Carbolic Acid solution should be freely used, and the antiseptic dressings applied after the core is removed. CORNS. Corns consist in a thickened and hardened condition of the cuticle, and are divided into hard and soft corns. Hard corns are situated on the outer surface of the toes, and on the sides and soles of the feet, while soft corns are situated between the toes. They are developed by the irritation caused by the pressure of tight shoes or by the friction of loose ones. Treatment.-After the corn has been softened by soak- ing the foot in hot water it can be removed by a dull knife. The edge of the knife should be carried to the outer edge of the hardened cuticle, and then by pressing it against the natural skin the thickened cuticle can be raised. This should be done all around the corn and then by scraping toward the centre the entire corn can be raised from the underlying integument, and thus removed. If any of the hard cuticle is left, the same plan should be adopted till it is entirely removed. In soft corns it may be best to apply some pure Carbolic Acid on a pine stick, in such a way that the acid penetrates between the hard centre of the corn and the surrounding tissue. A few such applications will remove the corn entire. CHILBLAINS, By chilblains is meant a condition of undue redness, ulceration, or mortification, affecting the integument of the toes, heel, instep, fingers, ears and nose, as a result of expos- ure to cold. By many the condition is believed to be con- fined to the feet, but this is a mistake. A burning, tingling sensation, is first felt in the part and this is followed by a DANDRUFF. 491 number of minute blisters. There is incessant, itching present which may sometimes last through the cold weather, while the skin continues to look red and congested. Sudden changes in the weather aggravate the difficulty, when the part is swollen and painful. In extreme cases ulceration or mortification of the skin may take place, but such results are rare. Treatment.-Bathing the part in cold water or snow, always gives relief. In addition to this the following may be applied with advantage: Iodine, 8 grains; Brandy, 6 ounces. Mix, and apply to the part two or three times a day. When blisters form they should be opened and the surface touched with pure Carbolic Acid, on the end of a match. When ulceration or mortification sets in, the treatment recommended elsewhere for such conditions must be employed. DANDRUFF. The term dandruff is applied to a disease of the scalp, characterized by a slight redness and the formation of minute scales. These scales may be thick and heavy, and formed in part by an excessive secretion from the sebaceous glands; or they may be white, dry and powdery. The condition may last for a long time, and the scales fall out on the clothing in great quantities, and are also removed whenever the hair is combed. The scalp is often itchy and is temporarily relieved by scratching. Treatment.-The scalp should be thoroughly washed once a week, with half an ounce of powdered Borax in a pint of tepid water; and afterward rinsed with clear water. A stimulating hair dressing will always be serviceable. The following is as good as can be used: Sulphate of Quinine, 12 grains; Dilute Sulphuric Acid, 12 drops; Tincture of Can- tharides, 1 dram; Glycerine, 1 ounce; Alcohol, enough to make 6 ounces. Mix, and apply to the hair and scalp every morning. DISEASES OF THE SKIN 492 ECZEMA. Eczema is a non-contagious disease characterized by an eruption of little blisters grouped together in patches, which secrete a tenacious fluid that often hardens on the skin, and forms a thin scab. It may sometimes develop in large, hard pimples in which pus forms, and again in small pimples. The skin is usually hot and itchy, and the eruption may last for six or eight.days, and then disappear. It is liable to recur and is more commonly met with in cold weather than in warm. It often assumes a chronic form and may then last for months or even years. It takes on a great variety of forms, many of which can only be recognized by the physician. Treatment.-As the condition is supposed to be due to a thin or watery condition of the blood, it is sometimes desira- ble to bring about a free action of the bowels and kidneys. For the kidneys, 20 grains of Acetate of Potash should be given in water two or three times a day. The Compound Jalap powder with Cream of Tartar may be given once to cause a free action of the bowels, and this should be followed by the Eclectic Compound Podophyllin pill every night at bedtime. The parts affected, in mild cases, should be bathed with a strong solution of Bicarbonate of Soda, (1 ounce to 16 ounces of water) two or three times a day. In severe cases the following should be used: Carbolic Acid, 30 drops; Sulphate of Morphine, 3 grains; Glycerine, 2 ounces; water, enough to make 6 ounces. Mix, and apply to the part three or four times a day. Sometimes Dialyzed Iron may be required internally, and should be given in doses of 15 drops after each meal. The following will also be serviceable: Iodide of Potassium, 4 drams; Fowler's Solution of Arsenic, 2 drams; water, 6 ounces. Mix, and give one teaspoonful three times a day, after each meal. It may often be well to take this mixture for one week, and then the Dialized Iron for two weeks. FROST-BITES. 493 FRECKLES. Freckles are small brown spots that appear on the face, neck and hands of some persons, who are exposed to the rays of the sun during warm weather. Treatment.-An application to the face that will destroy the discolored cuticle will remove the freckles, but they will usually return on exposure to the direct rays of the sun. A convenient wash is the following: Corrosive Sublimate, 8 grains; Alcohol, 4 ounces. Mix, and apply to the face with a towel, night and morning. When little scales begin to detach themselves from the skin, the wash should only be used once a day. In cases where the freckles are so numerous as to cause a deformity, a part of the surface may be blistered, when the freckles will be found to have disappeared after the blister heals. The application of galvanism, however, is without doubt the most effective means of removing freckles. FROST-BITES. The term frost-bite is applied to those conditions in which the ears, nose, fingers, toes, or other portions of the body are so affected by cold that the circulation is for the time being obstructed. After exposure to cold for a short time, a sense of numbness and tingling is usually felt, and there is a determination of blood to the exposed parts. If this con- tinues the sensibility is entirely destroyed, the minute blood- vessels are contracted, and the blood is driven from the part, leaving it perfectly white and stiff. If this condition remains long the tissues soon become discolored and mortification takes place. Treatment.-The proper treatment of frost-bites consists in gradually elevating the temperature and restoring the cir- culation. The part should be bathed in iced-water or rubbed thoroughly with snow, with a view of establishing the circu- lation. " Warm applications of all kinds must be avoided, the 494 DISEASES OF THE SKIN. sufferer must be kept away from fire, and must not even remain in a hot room. As soon as the stiffness of the part is relieved and the color begins to return, stimulating applica- tions may be used. The Tincture of Arnica freely applied to the part serves a good purpose, while equal parts of Alcohol and the Tincture of Iodine may be painted thickly over the affected surface. When any part of the body has been frozen, the effect upon the general system is usually severe. In order to estab- lish a re-action it may be necessary to apply friction to the extremities of the body, and rubbing should be kept up until some warmth is produced. Then brandy or Spirit of Cam- phor may be applied to the extremities and the patient warmly covered in bed. Brandy may be given internally, an ounce at a time, and Mustard should be applied over the heart, stomach and spine. As soon as the patient begins to get warm, these measures may be discontinued, and broths, beef essence, milk-punch, &c., may be given to nourish the system. ITCH. Scabies, or itch, is a disease characterized by vesicular eruptions which are produced by an animal parasite. In con- sequence of the great vitality of the parasite, the disease may be transmitted from one person to another, and is hence recognized as contagious. The eruption usually makes its ap- pearance between the fingers and on the wrists, in the form of small, elevated blisters which contain a clear fluid. From these radiate little grooves in which the parasite is located. Intense itching is usually present, and the patient scratches the part and thus increases the local disturbance. In severe cases large festering sores are developed which are covered with thick scabs, and the hands are stiff and pain- ful. Though usually confined to the hands it may sometimes be communicated* to other portions of the body by the fingers, while scratching. The disease may last for years and very seldom terminates without treatment. LICE. 495 Treatment.-The treatment of this disease must be directed to the destruction of the parasite. This is best accomplished by the application of pufe Carbolic Acid. A small pine stick should be saturated with the Acid, and then applied to every point where a vesicle is seen. The crack in the skin leading from the vesicle should also be touched with the Acid in the same way. This at once destroys the germ and any simple dressing will heal the part. The following will be found serviceable after the applica- tion of Carbolic Acid: Salicylic Acid, io grains; Vaseline, 4 drams. Mix, and apply to the part two or three times a day. This treatment will usually cure the disease in six or eight days. LUPUS. Lupus is a non-contagious disease in which there is extensive destruction of the skin. It is usually located in the nose, cheeks, and around the eyes and ears. It is similar in its action to a malignant ulcer and often destroys a large portion of the skin in a very short time. In some cases all the bones of the face may be exposed during the progress of the disease. Treatment.-The treatment of lupus is entirely surgical, and requires close attention. The thorough antiseptic dress- ings give the best results, but they should be applied under the direction of the surgeon. Internal remedies, as a rule, are of little or no service. LICE. The skin of the human body is frequently invaded by parasites that are commonly called lice, of which there are three kinds. One variety is found principally in the head, and is called the head louse, another locates on any portion of the body, and is called the body louse; while the third is generally found in the hair over the pubis and upon the geni- tals, and is commonly called crabs. The presence of any of these creates an irritation of the skin, which causes great itching and a continuous desire to scratch. 496 DISEASES OF THE SHIN. Treatment.-Whatever variety of lice may be present they can be easily removed; but cleanliness is of the first importance in the treatment. When they are found on the head, the hair should be thoroughly combed with a fine comb to remove as many as possible. After this is done the head should be bathed with an infusion of Larkspur Seeds. For this purpose, a pint of boiling water should be poured on an ounce of the powdered seeds, and this should be covered and allowed to stand until it becomes tepid. This infusion is then poured on the head and thoroughly rubbed into the scalp. Care should also be taken that the hair is thoroughly washed with this preparation, as a single treatment properly applied is usually sufficient to destroy the parasites. In some cases, however, it may be necessary to wash the head in the same way two or three times. When body lice are present the only sure method is to destroy all the clothing that has been worn. If this cannot be done, the clothes may be thoroughly disinfected by pro- longed boiling, or fuming them with burning Sulphur. The irritation of the skin that is caused by the lice will be promptly relieved by bathing the body with an infusion of Larkspur, just described. When crabs are present, the hair of the part should be shaved off and the skin thoroughly washed with the Larkspur solution. This parasite sometimes attacks the beard and hair of the head, and it is difficult to get rid of them in these loca- tions, without shaving off the hair. MOLES Moles are small projecting points, of a brownish color, and covered with short hairs, that are present at birth on dif- ferent portions of the skin. There are usually not more than one or two found on the same person, and these are small; but sometimes we meet with those who have them scattered in great numbers over different portions of the body. They vary in size from a mere point to that of a dinner plate. MOTHERS' MARKS. 497 Treatment.-When moles are so situated so as to cause deformity they may be easily removed by the surgeon's knife, if small. When they attain a large size this is not always practicable, and in such cases Chromic Acid or Chloride of Zinc may be applied to a limited surface. When the part thus touched with the caustic is thrown off, and a scab forms, the application may be made to the adjacent parts. This treatment may be continued until the whole mole is des- troyed. The proper application of the galvanic current of electricity will also be followed by good results in the treat- ment. MOTHERS' MARKS- Mothers' marks is a term applied to a class of deformities that are present at the birth of a child, and are supposed to be due to mental impressions made upon the mother during preg- nancy. They usually consist of an enlarged condition of the minute blood-vessels. Sometimes the enlargement is so great as to produce an elevation, and the appearance of a well-defined tumor; at other times the elevation maybe slight and extend over a large surface; while again the deformity may be con- fined to a bright scarlet patch on the skin. They may be present in different regions of the body, but are more com- mon about the head and face. Treatment.-The treatment of these deformities has undergone important changes of late years. Surgical meth- ods are now employed, which, in the majority of cases, will effectually remove these marks, with little or no deformity, if treated during early life. Even in cases of long standing, marked improvement will result from proper treatment, though we cannot promise as good results as in those cases which are treated soon after birth. NETTLE RASH, OR HIVES. Nettle rash, or hives, is essentially a disease of childhood though it is sometimes met with in adults. It comes on sud- denly by the appearance of a number of rounded or oblong 498 DISEASES OF THE SKIN. elevations resembling those caused by the blow of a whip or switch. They are attended by marked heat and itching, which sometimes precede the eruption. They may be white or red in color, or a red patch of skin maybe present with a white elevation rising in its centre. The elevations maybe few and scattered, or they may be numerous. Sometimes a crop may come out and disappear in a short time without any recur- rence, or they may be renewed on several days in succession. In some cases they may continue to appear, for weeks or even months. The disease is usually due to some disorder of di- gestion, and the bowels are apt to be constipated. Treatment.-When the disease is first manifest, Fluid Ex- tract of Ipecac, should be given in io or 15 drop doses, every twenty minutes till vomiting is produced. An Alcohol sweat should be given as soon as the effects of the emetic have passed off, and the body should then be rubbed thoroughly with a Turkish towel. Should the heat and itching still continue, a solution of one ounce of Bicarbonate of Soda (common Baking Soda) to a pint of water, may be applied to the affected parts, as awash. Compound Podophyllin pills* should be used every night, to regulate the bowels, and proper attention should be given to the diet. OFFENSIVE PERSPIRATION. Many persons are annoyed by profuse and offensive per- spiration, which is usually confined to particular localities. The places most commonly affected in this way are the arm- pits, the groins, between the legs, and the feet. Treatment.-To overcome this condition a Turkish bath should be taken two or three times a week, and the bowels and kidneys should be kept active. The affected parts may also be bathed with alcohol every night at bed time. When the feet are offensive, much benefit is obtained by satura- ting the stockings in a solution of 2 drams of Boracic Acid to a pint of water. The stockings are then hung up to dry, without wringing, and they are ready to put on in the morning. The stockings are thus impregnated with the Bor- acic Acid, which acts as a disinfectant, and also as a stimulant * See page 360. RINGWORM. 499 to the skin. Pieces of flannel may be similarly treated and fastened under the shirt, so as to come in contact with other parts from which offensive perspiration is thrown off. PRICKLY HEAT. Prickly heat is an eruption on the skin resulting from continued over heating of the body during extremely warm weather. Persons of fair complexion and soft skin are liable to it, and they usually suffer severely from it. The eruption consists of a large number of minute pimples, about the size of a pin's head. They are of a bright red color, and often two or three run together. The disease is attended by intolerable itching, which often prevents sleep, and when the parts are scratched, the irritation is increased and the pimples fre- quently bleed. Treatment.-A Turkish bath or an Alcohol sweat will always give prompt relief from the itching, and in some cases cut short the eruption. If these cannot be had, a hot water bath, as hot as can be borne, should be used every night. Solutions of Baking Soda or Borax, in the proportion of 2 ■drams to the pint of tepid water, should be used as a sponge bath night and morning. P'requent draughts of lemonade will have a good effect on the eruption, and sometimes lemon juice may be applied locally to the skin, with good results. RINGWORM. Ringworm is a contagious affection of the skin caused by the presence of parasites. It develops in circular patches, which usually begin small and' spread outward. They retain the circular form, with the edges of the circle elevated and reddened, while the skin within the circle retains almost its natural condition. When a ringworm attacks the scalp the hair is soon destroyed. Sometimes only a single patch may be present, while at other times there may be two or more. Again, one may develop and begin to disappear, and then another will show itself. Treatment.-A few applications of Tincture of Iodine will often destroy the parasite in a few days, when the patch will 500 DISEASES OF THE SKIN. rapidly disappear. Instead of this, pure Carbolic Acid may be applied to the surface with a thin pine stick till the ringworm and the adjoining margin of integument turns white. One application of this kind is usually enough. When parts cov- ered with hair are involved, the hair should be shaved from the part before the applications are made. SCALD HEAD. Scald head is a disease of the scalp caused by the pres- ence of parasites. It is undoubtedly contagious, and is fre- quently communicated from one to another, till a number of persons have become affected. It is characterized by the presence of pale, yellow crusts that are closely attached to the scalp. Sometimes the entire scalp is covered with one mass of these crusts. Parts of the crust drop off from time to time, and carry with them more or less hair. Children more commonly suffer from the disease than adults, and it is often due to the improper washing of infants. Treatment-.-The hair should first be cut as close as possi- ble, and then a large Flaxseed meal poultice should be ap- plied over the entire scalp. This should be renewed every hour or two till the crusts are loosened, when they should all be removed. As soon as there is any evidence of their being reproduced, the poultice should be again applied. Now, the following may be used: Salicylic Acid, 20 grains; Vaseline, 1 ounce. Mix, and apply to the scalp two or three times a day. If this ointment should cause too much irritation it may be weakened to suit, by adding a little more Vaseline. The scalp should be syringed every morning with the Carbolic Acid Solution of the strength of 5 grains to the ounce of water. Dialyzed Iron in doses of 15 drops, in water, four times a day, will be found valuable in increasing the general tone of the patient. SHINGLES. Shingles is a disease in which large, irregular, red-col- ored patches make their appearance on the sides of the body. New patches come out till the eruption extends half way TETTER AND SALT RHEUM. 501 around the body, or in some cases all around. The patches are soon covered with little blisters, and then the eruption begins to disappear. They are usually gone in five or six days, though in some cases a brown crust is left, which drops off a day or two later. Sometimes a marked febrile condition attends the appearance of the eruption. Treatment.-Cleanliness and fresh air are more important than medicines in this disease. The irritation of an attack may be relieved by the application of equal parts of Glycerine and Rose water. Recurrences may be prevented by keeping the bowels open, and the kidneys active, and by the free use of Turkish baths or Alcohol sweats. Due attention should also be given to the general condition of the stomach. TETTER AND SALT RHEUM. Tetter is ushered in by general languor, loss of appetite, and constipation, attended by a smarting, burning sensation of some parts of the skin. Soon a number of red spots will show themselves, and little blisters will form on them. The blisters at first contain a clear fluid, but this soon becomes milky. There is a painful sensation of itching at these points during the continuance of the disease. By the fourth or fifth day the eruption begins to dry up, and forms scales or crusts which fall off by the tenth day, only leaving the underlying skin slightly red. When this disease assumes a chronic form patches of the eruption may remain for a long time, and may often result in deep cracking of the skin, particularly during cold weather. This condition is commonly called salt rheum. In some forms of the disease the eruption develops around the mouth and closely resembles fever sores. Treatment.-As tetter belongs to the same class of dis- eases as shingles, the same general treatment will apply to both. In the chronic form it is usually necessary to adopt more vigorous treatment. The following ointment should be used: Salicylic Acid, 20 grains; Vaseline, 1 ounce. Mix well, and apply to the part two or three times a day. The follow- ing should be given internally: Iodide of Potassium, 4 drams; 502 DISEASES OF THE SKIN. Fluid Extract of Poke Root, I ounce; Simple Syrup, 5 ounces.. Mix, and give a teaspoonful after each meal. WARTS. Warts are hard, conical shaped excrescences, which con- sist of an enlargement of the papillary structure of the skin. They are commonly met with in young persons, and often dis- appear spontaneously. They sometimes grow rapidly and attain a large size. When cut they are painful and sometimes bleed freely. They are not contagious as is popularly believed. Treatment.-Equal parts of Chromic Acid and water can be applied to each wart with a glass rod. This turns the wart black, and in a few days the whole or part of it drops off. If part of it remains another application can be made. When a large number of warts are present several of them may be treated at a time by galvanism. A needle is carried into the wart,-and then the galvanic current is passed through the needle, thus destroying the growth in a short time. CHAPTER XII. THE FUNCTIONS AND DISEASES OF WOMAN. Both sexes are alike liable to the majority of the diseases heretofore described. The important structural and physio- logical differences of the sexes, however, give rise to diseases of the generative organs,'that necessarily differ in each sex. It is with the functions and diseases of those organs in woman that we have to deal in this chapter. The subjects here considered are all important, and should be fully understood, as a knowledge of them will certainly prove one of the greatest benefits to the women of every house- hold. We shall consider each subject as briefly as possible, and make our language as plain and comprehensible as lies in our powei. In the health of women lies our future happiness, and the subject is necessarily one of great interest and cannot be too carefully considered. That we may understand the special functions of woman it is necessary to know how she differs, anatomically, from man. This necessitates a brief reference to the structure of 504 THE FUNCTIONS AND DISEASES OF WOMAN. the female generative organs. Next in order we shall con- sider the normal functions of those organs, and such derange- ments of function as are most likely to occur. Finally, we shall endeavor to point out the symptoms and treatment of all diseases due to structural changes, as well as the various displacements of the womb. ANATOMY OF THE PELVIC ORGANS OF WOMAN. The female organs of generation are divided into the external and internal. The external organs have been named the mountain of Venus, the greater lips, the lesser lips, the clitoris, and the orifice of the vagina. The mons Veneris, or mountain of Venus, is the prominent eminence over the pelvic bone which is covered by hair; the double folds on either side constitute the greater and lesser lips; the clitoris is a prominent erectile body situated between the folds of the lesser lips at the upper part of the opening, where the lips come together; the orifice of the passage from the bladder is located about an inch below this; and the orifice of the vagina is the opening into the long mucous canal that leads to the womb, and is partly closed at its lower part by a membrane called the hymen. In speaking of all these parts together, the term -vulva is used. The hymen is ruptured after marriage and it soon disappears, leaving the orifice of the vagina much larger in married women than in young girls. The presence of this membrane is a sign of virginity, but its absence is no evidence of the contrary, as it is liable to be ruptured by accidents and various other causes. The several parts of the vulva are supplied with little glands which secrete a fluid that keeps the parts lubricated and in a normal condition. The internal organs are the vagina, uterus, Fallopian tubes, and ovaries. These are located in the interior of the bony ring called the pelvis, and may be seen in their normal positions in Fig. 47, which represents a section of the pelvis. ANATOMY OF THE PELVIC ORGANS OF WOMAN. 505 Fig. 47.-Side View of the Contents of the Female Pelvis. i, the pubic bone; 2, the front wall of the abdo- men; 3, section of the mons Veneris; 4, the bladder; 5, the entrance to the bladder of the canal leading from the kidney; 6, the urethra, or passage from the blad- der; 7, the orifice of the urethra; 8, the clitoris; 9, the lesser lip; 10, the greater lip, 11, the orifice of the vagina; 12 and 22, the vagina; 13, wall be- tween the bladder and vagina; 14, wall between vagina and rectum; 15, the perineum; 16, the mouth of the womb; 17, the neck of the womb; 18, the upper part of the body of the womb, the cavity being marked by the dark line; 19, the rectum; 20, the anus; 21, upper part of rectum; 23, fold of peritoneum; 24, peritoneum extending to wall of abdomen; 25, last lumbar vertebra; 26, sacrum; 27, the coccyx. Fig. 47- The vagina is composed of a muscular layer of circular fibres, a layer of erectile tissue, and a lining or mucous coat. It is about six inches long, and at its upper extremity receives and supports the neck of the womb. It is capable of great distention and plays an important part in child birth. The womb rests in the upper part of the vagina, with the neck extending into it, in a manner resembling the stopper in the neck of a bottle. It is situated between the bladder and rectum, and is supported in position largely by the vagina, though it is claimed that the broad bands of peritoneum that connect with it, also aid in supporting it in place. Passing from each side are two broad folds of peritoneum, between the layers of which the ovaries are located, while the Fallo- pian tubes run along their upper borders. The relative posi- tions of these parts are represented in Fig. 48. 506 THE FUNCTIONS AND DISEASES OF WOMAN. Fig. 48.-Uterus, Ovaries and Fallopian Tubes. 1, fundus, or base of womb; 2, 3, 4, wall of womb; 5, 8, wall of neck of womb; 7, cavity of womb; 6, mouth of womb; 9, 9, walls of vagina; 10, interior of vagina, 11, 11, openings from Fallopian tubes; 12, Fallopian tube; 13, split extremity of tube; 14, processes that grasp the ovary; 15, 18, band of peritoneum that holds the ovary in position; 16, 17, ovary with peritoneum removed; 19, attachment of Fal- lopian tube to womb; 20, outer extremity of tube intact; 21, ovary covered by peritoneum; 22, folds of peritoneum called the broad ligament. Fig. 48. The wall of the womb is made chiefly of muscular fibre and is lined with mucous membrane, which is continuous above with the Fallopian tubes, and below with the vagina. The ovaries are glandular bodies in which the egg is developed, while the Fallopian tube conveys it to the womb. An ovum, or egg, develops in the ovary about every twenty-eight days, and at a certain time it escapes and is grasped by the expanded extremity of the Fallopian tube, (20, Fig. 48.) which sucks it into the tube, through which it passes to the uterus. This process is called ovulation, and is attended by a flow of blood from the womb, which is called menstruation. MENSTRUATION, OR MONTHLY PERIOD. At the age of puberty, which is about the thirteenth or fourteenth year of life, a flow of blood escapes from the vagina in healthy girls, and recurs every twenty-eighth day there- after, till the age of forty or forty-five, excepting during the periods of pregnancy. AMENORRHEA, OR ABSENCE OF THE MENSES. 507 This nionthly show of blood is supposed to result from a congestion of the womb which always attends the escape of the egg from the ovary. The blood passes through the lining membrane of the womb into its' cavity, and from there it passes out of the womb into the vagina, from whence it is discharged. When the flow is normal the blood is of a dark color and free from shreds and clots. Girls should be informed of this change before it takes place, and cautioned against such imprudence as might sud- denly arrest the flow when it first appears. Many serious troubles arise from neglect of this important duty on the part of mothers. The usual duration of healthy menstruation is from four to five days, and it should not be attended by pain or sick- ness. It is a natural function, and if properly performed it can in no way impair either the mental or physical vigor. When suddenly arrested or when it fails to make its ap- pearance at the regular time, except during pregnancy, it becomes a derangement of function, and is called amenor- rhea, or suppression of the menses; when the show is pre- ceded or attended by great pain it is called dysmenorrhea, or painful menstruation; and when it is very profuse it is denomi- nated menorrhagia, or excessive menstruation. AMENORRHEA, OR ABSENCE OF THE SENSES. By amenorrhea is meant the non-appearance of the men- strual flow at the age of puberty, or its suppression after it has once occurred. If a girl is weak and debilitated, or seems undeveloped, no special symptoms are present to indicate any menstrual disturbance. If she is full-blooded and well developed at the age when the menses should come on, and it does not make its appearance, she will suffer from head- ache and a sense of great fullness in the head, and have more or less pain in the region of the womb and in the back. Sometimes there will even be a bearing down sensation resembling the first pains of labor. Suppression of the menses may take place suddenly dur- ing the period, as a result of exposure to cold or wet weather; 508 THE EUNCTIONS AND DISEASES OF WOMAN. or it may come on gradually, as a sequence of debility of the general system. Sudden suppression is attended by the same symptoms as mark the non-appearance of the flow in the full- blooded girl, but they may be often so severe as to occasion general febrile disturbance. Treatment.-When the monthly flow is absent in the weak and debilitated girl or woman, no attempt should be made to force it. Ory the contrary the treatment must be directed towards the toning up of the system and increasing the quantity and quality of the blood. For this purpose Iron and Strychnia are the best remedies. The first should be given in the form of Dialyzed Iron, in doses of 15 drops, in water, after each meal and at bed time. The Strychnia should be given as follows: Sulphate of Strychnia, 1 grain; Dilute Muriatic Acid, 3 or 4 drops; water, 4 ounces. Mix, and give a teaspoonful three times a day before meals. In addition to these remedies, good food, fresh air, and moderate but daily exercise are essential. In the full-blooded, who suffer from the symptoms pre- viously mentioned something must be done to bring on the flow. Hot sitz baths should be taken every night, and some- times injections of hot water in the vagina will be ser- viceable. The Aloes and Iron pill should be taken, in doses of 4 or 5, till the bowels move freely. Hot drinkswill also answer a good purpose. Sometimes 2 or 3 drops of the Fluid Extract of Pulsatilla, taken in some hot drink every three hours, will have a decided action in establishing the flow. If these means fail the following mixture should be con- tinued for a month or two: Fluid Extract of Pulsatilla, 2 drams; Fluid Extract of Black Cohosh, 1 ounce; Glycerine, 1 ounce; water, enough to make 6 ounces. Mix, and give one teaspoonful after each meal and at bed time. The hip-baths should be taken whenever the fullness of the head and bear- ing down pains are felt. If this treatment does not give the desired relief, the physician must make a vaginal examina- tion to ascertain the cause of the continued suppression. PAINFUL MENSTRUATION. 509 PAINFUL MENSTRUATION. When severe pain precedes or attends the menstrual flow, the condition is called dysmenorrhea, or painfnl menstruation. The pain is caused by the retention of the blood in the womb and the efforts of nature to expel it. It may be due to a congestion of the neck of the womb, which temporarily obstructs the cervical canal; or there maybe a permanent constriction of the mouth of the womb which prevents the ready passage of the flow. Treatment.-As the majority of cases of painful menstrua- tion are due to congestion, it may be well to adopt such treatment as will relieve this condition before resorting to other means. For the relief of the pain during the period, the following may be given: Fluid Extract of Gelsemium, 2 drams; Fluid Extract of Prickly Ash Berries, I dram; water, enough to make 3 ounces. Mix, and give two teaspoonfuls for the first dose, and one teaspoonful every half hour after- wards until the pain is relieved, or until six or eight doses are taken. During the administration of the medicine the patient should remain in the recumbent position. With a view of permanently relieving the congestion, the following will be found valuable: Fluid Extract of Black Cohosh, 1 ounce; Fluid Extract of Gelsemium, 2 drams; Glycerine, 1 ounce; water, enough to make 6 ounces. Mix, and give a teaspoonful three times a day, after meals. This should be continued for three or four months. If a discharge, commonly called the "whites," is present, it may be necessary to use the following injection: Sulphate of Zinc, 2 drams; Acetate of Lead, 2 drams; Tincture of Cate- chu, 1 ounce; water, 5 ounces. Mix, and prepare an injection by putting a tablespoonful of the medicine in a gobletful of tepid water, care being taken to shake the bottle thoroughly before using. The mixture thus prepared in the goblet should be injected into the vagina twice a day. If this treat- ment fails to give relief, an examination should be made by a physician to ascertain the condition of the womb. If ulcera- tion is present, that should be treated; and if there is 510 THE FUNCTIONS AND DISEASES OF WOMAN. evidence of a narrowness of the cervical canal, means should be taken to relieve it. These and other local causes can only be ascertained on examination, by a competent phy- sician. PROFUSE MENSTRUATION. When the menstrual flow is excessive in quantity or when it recurs at shorter intervals than four weeks, it indicates a departure from health, and the condition is spoken of as menorrhagia, or profuse menstruation. This may result from a debilitated condition of the system, or from causes that tend to produce a relaxation or enlargement of the womb. Treatment.-With a view of controlling profuse men- struation, Fluid Extract of Ergot should be given in half- teaspoonful doses three or four times a day, and the patient should be enjoined to keep as quiet as possible. In severe cases, cold water injected into the rectum will frequently be followed by good results. For the purpose of overcoming the condition that causes the excessive flow, the following should be given during the month: Fluid Extract of Mango Bark, I ounce; Glycerine, I ounce; water, 2 ounces. Mix, and give one teaspoonful three times a day, half an hour before eating. If the patient is debilitated from any cause, Pyalized Iron should be given in doses of 15 drops after each meal. As soon as the menses recurs, these remedies may be discontinued and the Ergot again administered. If this treat- ment fails to give relief, an examination of the womb should be made. In some cases, among women who have borne children, the womb will be found large and soft, when the administra- tion of the Ergot should be continued during the month. If any evidence of internal uterine tumors is discovered, these must be treated before the profuse flow will cease. CHLOROSIS. Chlorosis, or green-sickness, is a condition of general debility that is frequently met with in young girls about the ANAL MIA. 511 period of puberty. It is characterized by a yellowish green color of the skin, general lassitude, headache, pain in the back, loss of appetite, coated tongue, and constipated bowels. The condition is due to a deficiency of the red globules in the blood, and this is sufficient to account for the color of the skin which has given the name to the disease. Treatment.-Rare beef and mutton should constitute a large part of the diet, and starches, sugars and fats should be avoided. The bowels should be regulated by the Compound Podophyllin pills,*one of which should be taken every night, or every alternate night. The Elixir of Calisaya, Iron and Strychnia should be given in teaspoonful doses, three or four times a day, and moderate daily exercise in the open air should be insisted on. If the menses has not appeared, nothing should be done to force the flow, till the health of the patient is restored. ANEMIA. Anaemia is a term applied to a condition of debility- caused by a deficiency of blood in the system. It is fre- quently met with in women and is one of the most common causes of amenorrhea, menorrhagia and the several dis- eases of the womb. Deficiency of food, bad air, and pre- vious diseases are the causes that develop the condition of anaemia. Treatment.-An abundance of nutritious food is of the first importance in the treatment of this disease. In addition to this fresh air and moderate exercise are also desirable. Egg- nog, or pure Port wine, will prove valuable and should be taken two or three times a day. In the way of medicines, 15 drop doses of Dialyzed Iron should be given after each meal. The following should also be given: Sulphate of Strychnia, 1 grain; Dilute Muriatic Acid, 3 or 4 drops; water, 4 ounces. Mix, and give a tea- spoonful before each meal. The bowels should be regulated by the Compound Podophyllin pills. In some cases, Cod- Liver Oil will answer an admirable purpose, or when it can be had, fresh cream may be used instead. * See page 360. 512 THE FUNCTIONS AND DISEASES »F WOMAN. PREGNANCY. The function of reproduction should not entail suffering and sickness. Pregnancy and childbirth, among the savage tribes, are free from the disorders and agonizing pains to which the women of civilized nations are liable. False methods of educating girls and absurd modes of dress have prevented the normal development of the generative organs, and hence the functions have been so perverted that they cannot be performed without pain and sickness. When a perfectly healthy woman becomes pregnant, the only signs are the cessation of the menses, the darkening of the circles around the nipples, and the gradual enlargement of the breasts and abdomen at the proper time. With most women, however, a persistent nausea occurs in the morning, and in some cases continues during the day. At the end of four and a half months "quickening," or the life of the child is felt. This is the first positive sign of pregnancy, and conditions may occur when the expectant mother may be deceived, even now. The detection of the beating of the heart of the child, and the position and condi- tion of the neck of the womb, however, give the physician positive evidence of the pregnant state. Management of Pregnancy.-The pregnant woman should take regular exercise daily, and should have her mind suffi- ciently occupied to keep her from thinking of herself. The bowels should be made to move daily, and regularity in sleeping and eating should be enforced. When morning sickness is present, a light breakfast should be taken an hour before rising. If the sickness still continues, the following should be used: Ingluvin, 2 drams; Sugar, 2 drams. Mix, divide into 24 powders, and give one powder after each meal and at bedtime. This will act more promptly in controlling the nausea than any other remedy that we have used. If spasmodic twitchings of the muscles take place, they can be controlled by 5 drop doses of Fluid Extract of Gelsem- ium, every half hour till relieved, or till five or six doses are taken. MISCARRIAGE. 513 Should the woman suffer from fits of despondency, or brood over some possible trouble that is likely to come upon her, she should be carefully watched by a physician. If such cases develop any evidence of convulsions toward the latter part of the pregnancy, the physician should be sent for immediately, and in case the convulsions set in before his arrival, from 5 to 10 drops of the Fluid Extract of Veratrum Viride should be given, and it may be repeated in half an hour if the convulsions continue. MISCARRIAGE. The term abortion, or miscarriage, is applied to the expulsion of the foetus from the womb before the seventh month of pregnancy. The causes that lead to miscarriage may be the death of the foetus, a debilitated condition of the mother, or some severe shock or injury to the pregnant woman. When a miscarriage has once occurred it is likely to take place about the same time at each succeeding pregnancy. It may come on at any time prior to the seventh month, but it occurs most frequently between the eighth and twelfth weeks of gestation. The usual symptoms are intermittent pains resembling those of labor, and sudden and free hemor- rhage from the womb. Treatment.-When the first symptoms of miscarriage appear the patient should at once assume the recumbent posi- tion, and then send for her physician. If the pains are severe a light opiate should be taken at once to relieve them. For this purpose, an eighth of a grain of Morphine is about the best that can be used. As soon as the pains subside, the fol- lowing mixture should be given: Fluid Extract of Black Haw, 2 ounces; Glycerine, 2 ounces. Mix, and give one tea- spoonful three or four times a day. This may be considered almost a specific for miscarriage, if the foetus is not dead or the membranes ruptured. In habitual miscarriage this pre- paration should be taken several days before the time that the miscarriages usually take place; and it may be relied upon as a certain remedy in such cases. 514 THE FUNCTIONS AND DISEASES OF WOMAN. MANAGEMENT OF LABOR. In the absence of a physician, labor may be facilitated by using an injection of tepid water in the rectum to remove any impacted feces, as soon as the first pains are felt. The com- mon custom of pulling on a sheet, fastened to the foot of the bed, should be avoided during the first stage of labor, as it exhausts the strength and does no good. It may aid after the mouth of the womb is fully dilated, and the child's head begins to descend. In a large majority of cases the attendant has nothing to do but to wait for the natural expulsion of the child. When the head is born, a few minutes usually elapse before the body is expelled. During this time the attendant should pass her fingers around the neck of the child to ascertain the position of the cord. If this is found around the neck it should be slipped over the head, so as to prevent strangula- tion. It is best not to cut the cord till there is a certainty that the child is breathing. If it does not do so at once, the cord should be grasped between the finger and thumb, and gently pressed while the hand is moved back and forth. If the breathing is still absent, the cord should be tied and cut, and special efforts made to resuscitate the child. After the child is born, forcible traction should not be made on the cord to remove the after-birth. There should be a delay of at least half an hour, before an attempt is made in this direction. If pains are absent at this time they may be excited by placing the hand over the abdomen and gently grasping the womb. The old custom of wearing the bandage is based on a false notion, and has done more to occasion displacements of the womb than all other causes combined. No woman should wear a bandage after confinement, as it crowds the enlarged womb down into the pelvis, and thus prevents it from being restored to its normal condition, while it gives no support, as is erroneously supposed. If flowing is profuse after labor, the head should be low- ered, the hips raised, and cold water dashed over the abdomen. CARE OF THE INFANT. 515 Cold compresses may also be placed over the vulva, and tea- spoonful doses of Fluid Extract of Ergot may be given every half hour, till three or four doses are taken. CARE OF THE INFANT. It is useless to speak of the care of a new-born infant to women who have had experience in such cases, but young women often find themselves in a position where they are obliged to wash and dress a child, and for their benefit we add a few words on this subject. The child should be wrapped in a woolen blanket, as soon as born, and placed in a warm room till it can be washed and dressed. It should be thoroughly oiled with Sweet Oil or Vaseline, before it is washed. The room must be warm and the water with which the child is washed must feel quite warm to the hand of the nurse. The greatest care must be taken to get the skin thoroughly clean, especially about the head, groin, arm-pits, vulva, and between the buttocks. A fine toilet soap and a soft linen cloth should be used in wash- ing. The eyes and mouth must be thoroughly cleaned with clear water, and care must be taken that no soap enters the eyes. After the skin is dried it should be well powdered with rice powder. The dressing of the navel must be next attended to. A piece of fine linen, about three inches square, is then taken, and a hole is cut in it large enough to give passage to the cord. The linen is then smeared with Vaseline and placed on the abdomen, with the cord passing through the hole. The stump of the cord is then laid to one side and another piece of linen, greased with the Vaseline, is laid over it. The flannel bandage is then firmly applied around the body, but care must be taken not to have it too tight. The child must then be dressed warmly, and safety-pins should be used to fasten the clothing. After the child is dressed, a teaspoonful of cold water may be given it, but nothing else. It will obtain the mother's milk as soon as it is required, and herb teas, molasses, sugar. 516 THE FUNCTIONS AND DISEASES OF WOMAN. &c., are sure to derange the stomach and cause serious trouble. The child must be washed daily, and this must be done with the greatest care to prevent chafing. It is also important to bear in mind that the dressing of the navel should not be disturbed till the stump of the cord separates, which will occur in from four to six days. A little oil may be poured on the dressing, however, if it appears dry and hard. No food of any kind, except the mother's milk, should be given, and the living-room must be warm and well ventilated, though drafts must be avoided. In case the mother cannot nurse her child the food should be prepared as recommended on page 107. CARE OF THE MOTHER. After the labor is over the mother should be made com- fortable, and left alone so that she can sleep. After a few hours rest the child should be put to the breast so that it may become accustomed to sucking. Though there is no milk, a watery secretion is drawn out which is good for the child. If any evidence of fever is present during the succeeding five or six days, the following should be given: Fluid Extract of Veratrum Viride, 30 drops; water, 4 ounces. Mix, and give one teaspoonful every hour till the skin becomes moist. If the breasts become hard and painful, they should be rubbed well till they become soft, and the milk should be squeezed from the nipples with the fingers, or removed with a breast pump. The child should be applied to each breast alternately, with the view of drawing out the milk. These precautions will always prevent "gathered breasts." It is a mistake to keep a woman on low diet at this time. Broths, soft-boiled eggs, and moderate quantities of meats should be added to the toast and tea that is usually given. The vagina should be syringed daily with a solution of Carbolic Acid. To a pint of tepid water, a teaspoonful of the acid should be added, and afterit is well mixed this should be used as an injection. Such a treatment will keep the parts clean and prevent all tendency to fever from blood-poisoning. It is not necessary to keep an ordinarily healthy woman in bed for nine days after child-birth, as is the usual custom. RUPTURE OF THE PERINEUM. 517 After two or three days she may sit in an easy chair or recline on a lounge, but it is best that she should not attempt to be much on her feet for a couple of weeks. RUPTURE OF THE PERINEUM. The space between the vagina and rectum, which is called the perineum, is frequently torn during the birth of the child. If the tear is slight the legs may be fastened together with a towel, the woman directed to lie on her side, and the parts kept clean by the injection of the Carbolic Acid solution. This will usually result in a union of the parts in a few days. In severer cases the surgeon must be called in at once, so that he can bring the parts together, and secure a union while the edges of the tear are yet raw. If this is not done an operation will have to be performed later, which will necessitate con- finement in bed for some weeks. CHILD-BED FEVER. Child-bed fever sometimes comes on a few days after con- finement. It is usually due to the absorption of poisonous matter from the womb, and when it develops, it is a serious complication that requires the closest attention of the physi- cian. The first thing to be done in such cases is to cleanse the vagina with the Carbolic Acid solution, and to control the fever with the following: Fluid Extract of Veratrum Viride, I dram; water, 4 ounces. Mix, and give a teaspoonful every half hour till the skin becomes moist or nausea is pro- duced. Beyond this nothing should be done without the advice of the doctor. Convulsions may develop before the birth of the child, or some days afterward. They may be due to some peculiar condition of the nervous system, to derangement of the kid- neys, or to blood-poisoning from putrid matter accumulating in the womb after confinement. Whatever their cause or time of appearance they must be looked upon as serious. As soon as the first evidence of their approach is noticed the most experienced, physician that can be found should be con- sulted. Large doses of Fluid Extract of Veratrum Viride 518 DISEASES AND FUNCTIONS OF WOMAN. should be given to control the convulsions. The dose may range from 5 to 10 drops, but the physician may give 30 drops at a dose in severe cases. This dose should never be given by the family without instructions. GATHERED BREASTS. As a result of neglect in drawing the milk from the breasts when it first begins to secrete, or in consequence of exposure to cold, or some local injury, inflammation of the breasts may be developed. The breast first becomes dis- colored, and the pain assumes a throbbing character that indicates the formation of pus. When the hardness and pain are present, and the milk cannot be drawn off with a breast pump, or by rubbing, the following should be given: Fluid Extract of Poke Root, 2 drams; Water, 4 ounces. Mix, and give a teaspoonful every two or three hours. In addition to this the inflamed breast should be kept wet with cloths saturated in the following mixture: Muriate of Ammonia, I dram; Fluid Extract of Poke Root, 1 ounce; Alcohol, 2 ounces; water, 5 ounces. If the deep-seated throbbing pain is felt, much suffering and destruc- tion of tissue may be prevented by calling a surgeon who will make a free incision into the breast. A hot poultice of Flax- seed meal should then be applied, and in a few days the symp- toms will have subsided. If the knife is not used, the poultice must be resorted to as soon as the throbbing pain is felt, and it should be changed frequently so as to keep the breast as hot as possible to hasten the formation of the pus. If left till it opens itself, intense suffering must result, and a long time must elapse before the part is entirely well. In spite of the popular dread of the surgeon's knife, in such cases as these it is the sufferer's best friend. INFLAMMATION OF THE WOMB. Like other organs of the body, the several tissues of which the womb is composed are liable to inflammation, and sequences resulting therefrom. These diseases comprise DISPLACEMENTS OF THE WOMB. 519 congestion and inflammation of the neck of the womb, ulcer- ation of the neck of the womb, and chronic inflammation of the mucous membrane lining the neck and cavity of the womb. When any of these conditions are present the patient has more or less pain, with a dragging or bearing down sensation in the region of the womb; pain in the small of the back and the very end of the spine, which often extends down through the hips and thighs; severe headaches, especially on the top of the head are also common, and there may be more or less discharge from the vagina. When these symptoms are present they clearly point to the womb as the seat of the trouble, and no time should be lost in consulting a surgeon for proper examination and treatment. DISPLACEMENTS OF THE WOMB. In its normal position the womb is situated high up in the cavity of the pelvis, and five or six inches from the entrance to the vagina, as seen in Fig. 47, page 505. It is loosely sus- pended in this position, and various causes may tend to dis- place it. Inflammation of its tissues may cause an enlarge- ment of the organ, or it may never have returned to its natural size after child-birth, and this increased size and weight must necessarily result in some form of displacement. The use of a tight bandage after confinement is a frequent cause of these troubles A relaxed condition of the vagina from inflammation, frequent child-bearing, sexual excess, habitual constipation, and the use of injections of cold water to prevent conception also give rise to displacements. When the womb drops down into the vagina, and can be felt close to the vulva, the condition is called prolapsus, or falling of the womb; when it falls forward against the bladder it is called anteversion; and when it is tipped backward on the rectum it is spoken of as retroversion. Falling of the Womb.-Falling of the womb is the most common form of displacement. In this condition the womb sinks down into the vagina as represented in Fig. 49. The symptoms present in this condition, are a sensation of 520 THE FUNCTIONS AND DISEASES OF WOMAN. dragging and weight in the lower part of the abdomen, irrita- tion of the bladder and rectum, pain in the back and loins, unusual fatigue after walking even short distances, inability to do any lifting, and the presence of leucorrhea, or "whites." Fig- 49- By introducing the finger into the vagina the patient can feel the enlarged womb well down toward the entrance to the vagina. Treatment.-When these symptoms are present, the patient should at once consult a surgeon, and should place herself under treatment for the cure of such conditions as may cause the falling. It is often necessary to wear some mechanical support to hold the womb in place for a time. Many women dread to wear supporters, but when the right kind of instrument is properly adjusted they can do no harm, and can be worn without inconvenience and with great ad- vantage. The best kind of support is obtained from what is called a "stem pessary," one of which is represented in Fig. 50. ANTEVERSION OF THE WOMB. 521 This holds the womb in position without pressure on the walls of the vagina, as it is supported by rubber straps fastened to a belt around the abdomen. Fig. 51 represents the instru- ment in position with the "fallen" womb, represented in Fig. 49, re- stored to its proper place. Sometimes a soft rubber ring may be placed in the vagina to hold the womb in position, and when the prolapsus is slight it may often serve a better purpose than the stem pessary. Fig- 50. Fig. 51- Anteversion of the Womb.-When the womb is thrown forward on the bladder there is a frequent desire to urinate, and other symptoms of inflammation of the bladder are present. Painful menstruation, a dragging sensation in the region of the pelvis, and sterility are also common to this 522 THE FUNCTIONS AND DISEASES OF WOMAN. form of displacement. Sometimes the womb is bent forward upon itself at the junction of the neck and body of the organ. When such displacement occurs, the body of the womb presses upon the bladder while the neck may retain its normal position. This condition is spoken of as anteflexion, and the symptoms are similar to those of anteversion. ♦ Treatment.-The conditions giving rise to the displace- ment must first be treated. The womb must then be re- stored to its normal position by mechanical means in the hands of the surgeon, and retained there by pessaries con- structed for this special purpose. Retroversion of the Womb.-By retroversion is meant the falling backward of the womb so that the body presses against the rectum. Various diseases of the womb, the presence of tumors, the wearing of tight bands across the abdomen, and tight bandages after confinement with a com- press under the bandages are the common causes of this form of displacement. When the womb is in this position, the neck presses against the bladder while the body rests on the rectum and thus irritation of both bladder and rectum are produced. There is a dull, gnawing pain in the back which is increased by walking, the bowels are constipated, and more or less pain is felt in the womb upon the slightest motion of the body. If this displacement occurs suddenly the patient maybe unable to walk, severe pain is felt in the pelvic region, and the bowels and bladder fail to act. An examination by the surgeon is the only sure way of determining the nature of the trouble. When the body of the womb is bent backward from the neck, the condition is known as retroflexion. Treatment.-In these cases, the first thing is to restore the womb to its normal position, and then means must be employed for preventing a recurrence of the displacement. It is important that the patient should place herself under treatment without delay, as the restoration of the womb becomes more difficult the longer it remains in an abnormal position. FIBROID TUMORS OF THE WOMB. 523 FIBROID TUMORS OF THE WOMB. Fibroid tumors frequently develop in the womb. When the growth takes place in the structure of the organ, it is called an intra-mural fibroid tumor, which means that it develops in the wall of the womb. When it grows outside of the womb it is called extra-uterine, or outside the womb; and when it grows from the inner surface and fills up the cavity, it is known as an inter-uterine tumor. When the growth is on the outside of the womb no special disturbance may take place, except that produced by its pressure on surrounding parts. In the other varieties, however, the symptoms are usually well marked. Profuse menstruation attended with severe menstrual pains, frequent bleeding from the womb between the menstrual periods, con- tractions of the womb resembling the pains of labor, irrita- bility of the bladder and rectum, dragging pains in the pelvis, which extend through the hips, profuse "whites," and fre- quent watery discharges from the womb, are the most promi- nent symptoms of the presence of these tumors. After a time a hard lump may be felt above the pelvic bone. Treatment.-When these symptoms are present, the growth of the tumor may be arrested, and in some cases a cure effected by the continued use of Fluid Extract of Ergot in teaspoonful doses, three times a day, after meals. In place of this, the Ergotin pills may be given. Two of the three grain pills are equal to the teaspoonful of Ergot, and this dose should be given after each meal. Examination by the surgeon should always be had, as surgical methods can frequently be adopted for the cure of the trouble. If the tumor is developed in the structure of the womb, various injections can be made into it to hasten its absorption. When it fills up the cavity of the womb it may be removed by the proper operation. The mouth of the womb is dilated by the use of Molesworth's dilator, which is represented in Fig. 52. 524 THE FUNCTIONS AND DISEASES OF WOMAN. The small tubes are introduced into the neck of the womb, and water is forced into them with the syringe, thus increasing their circumference by dilatation, as they are made Fig. 52- of rubber. This gradually opens the mouth of the womb, and instruments can then be carried around the tumor for its removal. After the operation the Ergot is given to contract the womb to its natural size. UTERINE POLYPUS. The term polypus is applied to those tumors of the womb that develop in the cavity of the organ, and are attached to its inner surface by a narrow neck. There are several varie- ties of these tumors which present the same general symptoms. They begin to develop in the cavity of the womb and soon excite contractions, which in time result in the expulsion of the tumor, with the neck attached near the mouth of the womb. The symptoms are the same as those met with in fibroid tumors, and a proper examination is neces- sary to recognize the difference. Treatment.-Sometimes the tumor is found hanging from the mouth of the womb, when it can easily be grasped with a pair of forceps and twisted off. Again, the neck of the womb must be dilated before the attachment of the tumor can be reached. In some cases there may be a tendency to the for- mation of a number of small tumors of this kind in the womb. When this condition is recognized, the cavity needs to be scraped with appropriate instruments to secure the removal of all the growths. When properly treated, these INFLAMMATION OF THE OVARIES. 525 tumors can be removed and the conditions causing them radi- cally cured. CANCER OF THE WOMB. Cancer may develop in the womb in the same manner as it may attack any other tissue of the body. The symptoms of the early stages may be so slight as not to attract the attention of the patient, or there may be present only a slight show of " whites " with occasional bleeding. As a. rule, however, the symptoms develop early, and increase with the extension of the disease. The most common symptoms are darting pains through the cavity of the pelvis, tenderness on motion and during cobus, profuse menstruation at the regular periods, frequent hemorrhages during the month, watery discharges which sometimes assume a dark muddy character, offensive and scalding leucorrhea, or whites, gen- eral debility, and a sallow or sunken appearance of the face and skin generally. The darting, shooting pains, and the fetid and irritating discharge, are sufficient to distinguish cancer of the womb from the uterine tumors just described. Treatment.-In spite of the belief that cancer is incura- ble, recent advances in surgery have demonstrated that in the early stages of the disease it can be radically cured. As soon as any of the symptoms begin to show themselves, the patient should at once consult a surgeon, and submit to such treatment or operation as he may deem necessary. INFLAMMATION OF THE OVARIES. Inflammation of the ovaries may follow confinement or miscarriage, or it may be caused by inflammation of the peritoneum and disturbances of menstruation. The symptoms of this disease are severe pain in the lower part of the abdomen just above the groin on either side; in- creased heat with febrile disturbance, sometimes preceded by a chill, great tenderness on pressure over the seat of the pain; and inability to walk or stand without great suffering. Treatment.-The patient should be kept absolutely quiet, hot water injections should be thrown into the vagina, hot 526 THE FUNCTIONS AND DISEASES OF WOMAN. fomentations of hops should be applied over the abdomen, and 5 drop doses of Fluid Extract of Gelsemium should be given every half hour till six or eight doses are given. If the pain is not relieved by this time, this medicine should be dis- continued, and Morphine should be given in doses of a quarter of a grain, repeated every two hours, till three or four doses are taken. In severe cases, a Spanish Fly blister applied over the seat of the pain will often promptly relieve the pain. OVARIAN TUMORS, The ovaries are liable to be the seat of various kinds of tumors, that develop rapidly, and usually attain enormous .size. Little is known of the causes that produce them, and the symptoms attending their development vary in different cases. As a rule, painful menstruation, constipation, the presence of piles, irritability of the bladder and neuralgic pains in the pelvic cavity, mark the first stage of the develop- ment of an ovarian tumor. Soon the abdomen begins to en- large, particularly on one side, and the patient is able to recognize a lump in the abdomen. As the enlargement in- creases, digestion is deranged, respiration becomes difficult, emaciation is noticed, the heart's action is disturbed, swell- ing of the feet and legs takes place, and finally vomiting and diarrhea may set in. While these symptoms are being manifest, the abdominal enlargement continues to increase, till it finally attains enormous dimensions. These symptoms, in the absence of pregnancy, are sufficient to suggest the presence of ovarian tumor, but the diagnosis cannot be satis- factorily made without a thorough examination by an experi- enced surgeon. Treatment.-The only treatment that offers any satisfac- tory result is an operation for the removal of the tumor. As formidable as it may appear, this operation has been ren- dered both simple and safe by the improvements in modern surgery; and the woman who submits to the operation before her health is completely broken down, has ten chances in INFLAMMATION OF THE VAGINA. 527 favor of recovering to one against it. On the other hand, if no operation is performed, death will surely occur in from one to three years. STERILITY. The subject of sterility or "barrenness," is one of great importance to the profession, and to a rapidly increasing number of women. A healthy woman should be capable of bearing children from the time the menstrual flow first ap- pears till it ceases entirely, at the period commonly called the " change of life." Yet thousands of women go through life without ever being pregnant. The causes of sterility are numerous, and yet the majority of them may be overcome. Whenever a married woman fails to become pregnant within a year after marriage, if offspring is desired, a physician should be consulted to ascertain the cause of the barrenness. If the menstrual function is normal, and there is no displacement of the womb or appearance of leucorrheal discharge, it may be in- ferred that the fault is not with the woman. If any of the diseases of the womb, just described, are present, or if there is obstruction or inflammation of the vagina, impregnation cannot take place till these conditions are relieved; and the sooner they are attended to, the more speedily will the de- sired result be attained. It is a mistaken idea that sterility cannot be overcome, for a majority of the cases are due to removable causes. INFLAMMATION OF THE VAGINA. The mucous membrane of the vagina is liable to be attacked by inflammation in the same way as other mucous surfaces. It may result from exposure to cold, injury from the use of pessaries, the use of powerful injections, lack of cleanliness, child-birth, and sexual abuse. The usual symptoms are great heat and burning in the vagina, frequent desire to urinate with a scalding sensation when the urine is passed, a dragging ache between the vulva and anus, severe pain in the pelvic region, a profuse and 528 THE FUNCTIONS AND DISEASES OF WOMAN. offensive discharge, of a yellowish matter from the vagina, and a rawness of the external parts, from coming in contact with the discharge. Sometimes inflammation of the vagina is caused by a specific poison communicated by the male. This disease is called gonorrhea, or clap. The symptoms are the same as those of simple inflammation, and the history of the case can alone guide us in determining its character. Treatment.-The patient must be put to bed and kept absolutely quiet, and the marital relation must be pro- hibited. Hot fomentations of hops should be placed over the vulva, and made to extend over the lower part of the abdomen, and hot injections should be thrown into the vagina every three or four hours. At first the water should be used as hot as it can be borne, and a tablespoonful of Laudanum should be added to the pint of water. When using the injection a ped-pan should be placed under the buttocks, so that the patient may be treated in the recumbent position. As soon as the symptoms begin to subside, a tablespoonful of Fluid Extract of Golden Seal, and the same quantity of Laudanum may be added to a pint of hot water and used as an injection. When the acute symptoms have entirely dis- appeared and the discharge still continues the following will be found a valuable injection: Powdered Alum, 4 drams; Sulphate of Zine, 2 drams. Mix, divide into four powders, and use one powder in a pint of warm water for an injection. If the pain is very severe and the patient irritable, 5 drop doses of Fluid Extract of Gelsemium should be given every half hour, till relieved, or till six or eight doses are taken. If the bowels are constipated a Compound Podophyllin pill*may be given every night, till the condition is relieved. LEUCORRHEA. The term leucorrhea is derived from two Greek words which mean " a white flow," and it has been applied to all whitish or yellowish discharges escaping from the vagina. To the same condition the popular term "whites" has been applied. * See page 360. PAGINAL INJECTIONS. 529 Leucorrhea is not itself a disease, but is pr operly a symp- tom that attends inflammations affecting the structures of the womb and vagina. Sometimes a profuse discharge may be present without any other serious symptom, and when this is the case it denotes the presence of some chronic inflammation. It is well enough to resort to injections for the relief of leu- corrhea, but as a rule some other treatment is necessary to restore the parts to a healthy condition. Treatment.-In the absence of local treatment for the cure of the conditions that cause leucorrhea, the use of astringent vaginal injections and the internal administration of tonics will be of great service. The vagina should be cleansed twice a day, and free in- jections of hot water can be used with advantage, for this pur- pose. If there is much tenderness of the womb or vagina, 30 grains of Acetate of Lead and a tablespoonful of Laudanum may be added to a pint of tepid water for the injection. If there is little or no pain an infusion of Golden Seal, or oak bark may be used. The following will also give good satisfaction: Pow- dered Borax, 1 ounce; Fluid Extract of Golden Seal, 1 ounce; Glycerine, 2 ounces; water, enough to make 8 ounces. Mix, and use of the mixture a tablespoonful to the pint of tepid water, for an injection. The diet should be nutritious; frequent bathing should be resorted to, and in the season, sea-bathing will prove bene- ficial; long walks and hard work must be avoided; and when possible, change of scene, and especially country air, should be sought. In the way of medicines, the Elixir of Calisaya, Iron and Strychnia, given in teaspoonful doses after each meal, will give the best results. VAGINAL INJECTIONS. The methods of using injections in the treatment of dis- eases of the womb and vagina must not be lost sight of if we hope to obtain the best results from them. One of the best instruments for cleansing and medicating the vagina and neck of the womb is Dr. Molesworth's vaginal syringe represented in Fig. 53. It consists of a small glass tube attached to an 530 THE FUNCTIONS AND DISEASES OF WOMAN. India-rubber bag. The bag is filled with the fluid to be used and the tube is introduced into the vagina, and carried well up to the neck of the womb. The bag is then pressed gently, and the fluid is carried along the tube, and may be held Pig- 53- against the womb, or allowed to fill the upper part of the vagina. The pressure is slowly removed from the bag, and the fluid returns to it. This may be repeated as often as is necessary, and as the instrument is withdrawn the whole vagina is cleansed. In all cases where syringes are used, it is best to select instruments that will separate the walls of the vagina, so that the injection may come in contact with the entire mucous sur- face. When the ordinary bulb syringes are used, the vaginal tube should be provided with a wire-frame to dilate the vagina while the tube should be perforated on the sides as well as on the end. Walker's Vaginal dilator is specially designed for this purpose, and can be attached to any syringe. Chamberlin's utero-vaginal syringe answers the same purpose and is cheaper than any other of the kind. When medicated injections are used, it is desirable to retain the solution in contact with the parts for some time. This can be done with Molesworth' vaginal syringe as long as desired, when the patient is sitting on the edge of a chair or bed, but with other syringes it is necessary to assume the recumbent position. VAGINISMUS. The term vaginismus is applied to a condition of spasmodic contractions of the vagina, resulting from extreme sensibility INFLAMMATION OF THE VULVA. 531 of the mucous membrane lining the vulva. It is usually associated with a thickening of the membrane called the hymen. It is seldom recognized till after marriage, when it is found that sexual intercourse is attended with excessive pain, or is altogether impossible. Treatment.-The only treatment that offers any relief is an operation which was first performed by Dr. J. Marion Sims. We have operated on several cases in this way with perfect success. In one case the woman had been married for five years, during which time the marital act had not been accom- plished. As soon as the parts healed the result was in every way satisfactory, and within a year she gave birth to a healthy child. INFLAMMATION OF THE VULVA. The external female organs are usually spoken of collect- ively, and the term vulva is applied to them. Inflammation affects these parts, and occasions symptoms similar to those of inflammation of the vagina and the womb. In fact the disease often extends from the vagina to the vulva, and is often so severe that an abscess forms in one of the lips, which causes great swelling of the parts and throbbing pain. Treatment.-Hot applications should be made to the part, and the surfaces should be freely bathed with the solu- tions recommended on page 528, as injections in inflammation of the vagina. If abscesses form they should be opened and Flaxseed meal poultices afterwards applied. TUMORS OF THE URINARY PASSAGE. Sometimes the orifice of the vagina is very sensitive to the touch, and there is a frequent desire to urinate, with severe pain attending the passage of the urine. An examination occasions no pain till the orifice of the passage from the blad- der is touched, when the patient will experience acute pain. A careful examination will reveal the presence of one or more little growths commonly called caruncles. THE FUNCTIONS AND DISEASES OF WOMAN 532 Treatment.-When such a condition is found the little tumors must be removed either by twisting them off with the forceps, or cutting them off with a pair of scissors. After they are removed the surface must be touched with pure Carbolic Acid to prevent the recurrence of the caruncles. ITCHING OF THE VULVA. As a result of various diseases of the womb, vagina, bladder and rectum, and often during pregnancy, an intolera- ble itching is experienced around the external organs of gen- eration. This condition is increased by warmth, and by the use of stimulants. It is often worse at night than at any other time, and in some cases it is never felt except while in bed. Sometimes slightly elevated little pimples may be seen on the surface of the affected part, and again, there may be no evidence of any local trouble. Treatment.-The condition of the several neighboring organs must be ascertained, so that they may be relieved of any condition that might cause the itching. As a rule, the following will be found the most valuable remedy that can be used to relieve the itching for the time: Powdered Borax, 4 drams; Fluid Extract of Golden Seal, 2 ounces; water, 4 ounces. Mix, and use to bathe the parts freely, three or four times a day. SORE NIPPLES. Many nursing women suffer severely after every confine- ment from sore nipples. Sometimes the pain is so severe that the application of the child's mouth to the nipple cannot be tolerated, and if such cases are neglected, deep cracks and pain- ful ulcers develop, and sometimes the nipple is destroyed. To guard against this painful affection, the nipples should be bathed in a solution of 20 grains of tannic acid to an ounce of brandy, for several weeks before the birth of the child ; and if the nipples are small they should be drawn out daily by the aid of a breast pump. Immediately after the child has nursed, SOLE NIPPLE. 533 the nipple should be washed off with warm water and carefully- dried. This precaution will often prevent sore nipples even in those who have previously been subject to them. When the nipples are already inflamed or ulcerated, a hot poultice of flax-seed meal should be applied and changed every hour or two till the inflammation is relieved. The part should then be washed with a solution of 5 drops of pure carbolic acid to an ounce of water, and the nipple may be covered with a piece of lint saturated in the same solution. If this dressing is renewed every two or three hours, the inflammation will rapidly disappear and the skin will heal in a few days. As long as the soreness continues the nipple should be pro- tected by a nipple-shield whenever the child nurses, and in severe cases the child should be kept from the breast till the part is entirely healed. When once well the skin can be hardened and a recurrence of the trouble prevented by washing the nipple after each time the child nurses and then applying the tannic acid and brandy solution referred to above. 534 DENTITION, OR TEETHING. DENTITION, OR TEETHING. The period of dentition, or "teething" as it is commonly called, has always been considered a critical time for young children; and many of the disorders of infantile life are attri- buted directly to "cutting the teeth." At birth the teeth are imbeded in the jaw-bones, in a rudi- mentary form, and a gradual development goes on till about the seventh month, when the two central incisors, or cutting teeth, of the lower jaw make their appearance through the gum, and in a week or two the corresponding ones of the upper jaw show themselves. In a month or six weeks later an incisor appears on each side of those already through in the upper jaw, and these are speedily followed by the correspond- ing ones below, thus completing the eight incisor teeth. The front molars, or grinding teeth of the under jaw are cut about the twelfth or fourteenth month, and shortly afterward those of the upper jaw appear. The canine, or eye teeth come through between the sixteenth and twentieth month, and before the thirtieth month the second molars pass through the gum, thus completing the eruption of the twenty temporary or milk teeth. While the above is the usual order of the appearance of the teeth, it is not adhered to invariably. Some infants cut their first teeth at the age of four months while others may be over a year old before the first tooth shows itself. The order of the appearance of the incisorswill also vary considerably in different children. After the appearance of the last of the temporary teeth, the jaws gradually develop until between the sixth and seventh years, when the permanent teeth begin to appear. As the growth of the jaw permits the first four molar teeth appear at the back of the milk-teeth, and before the seventh year the second four molars are through. The incisors are developed at eight, the bicuspids at nine and ten, the eye-teeth from eleven to twelve, and the last molars, or wisdom teeth, from seventeen to twenty, though one or more of these may not appear till several years later. As the period of second dentition approaches the perma- nent teeth are developed in the jaw bone underneath the milk- teeth, and the two sets of teeth are separated by bony par- titions. These bony partitions, as well as the fangs of the milk-teeth, ate absorbed and the milk-teeth become loose while the permanent teeth gradually develop, crowd the temporary teeth out and take their places. When the permanent teeth are all through there are in each jaw four incisors, or cutting- teeth, two canine, or eye-teeth, four bicuspids, and six molars, or grinders, making in all thirty-two permanent teeth. Disorders of Teething.-Cutting the milk-teeth is always attended with some irritation, which is invariably increased when the teething is delayed. The symptoms present during the process are, excessive flow of salva from the mouth, swell- ing of the gum, which becomes tense, hot, and painful before the tooth is through ; general fever with flushing of the cheeks ; irritability of temper; thrusting its hand and any substance it can reach into its mouth, and restlessness when the child usually sleeps. As soon as the point of a tooth is through, these symp- toms subside till another tooth begins to press upon the gum. Among the more annoying complications met with are in- flammation and ulceration of the mouth, vomiting, diarrhoea, cough, eruptions of the skin, swelling of the glands, muscular contractions, which sometimes produce cross-eye, and convul- sions. These conditions are in a measure due to the fact that at this period important changes are taking place in the pro- cess of development of the digestive apparatus, which renders the nervous system of the child more liable to the influence of any irritation. Treatment.-The restlessness and irritability of the child as well as the fever is best allayed by the following: Fluid Ex- tract Gelsemium (green root), io drops; water, 4 ounces; mix and give a teaspoonful every half hour till relieved. Warm baths will favor the development of any skin eruptions and also allay the heat of the body, while cold applications to the head are gratifying, where there is much heat and a constant DENTITION, OR TEETHING. 535 536 DENTITION, OR TEETHING. motion of the head. If the gum is much swollen and tense, cutting down to the tooth will invariably give prompt relief, for it relieves the irritation caused by the tooth pressing against the unyielding gum and cuts short the inflammation of the gum and mouth. When white patches are seen in the mouth, it should be swabbed out several times a day, with equal parts of sage tea and honey, to a teacupful of which io grains of powdered borax should be added. When vomiting and diarrhoea are present the treatment given for Cholera Infantum should be followed; but in all cases where the symptoms are severe and especially where there is great heat in the head, muscular contractions or convul- sions, a competent physician should be sent for. In no case should soothing syrup or any other preparation of opium be given. CHAPTER XIII. DISEASES OF THE MALE GENERA- TIVE ORGANS. The male organs of generation are liable to special dis- eases which may result from ordinary causes, or from contact with specific poisons that are usually transmitted from one per- son to another by impure coitus. The specific diseases affect- ing these organs are generally spoken of as venereal, and are fully described in the author's treatise on that subject. Chancres and syphilis have been described in a previous chapter, so that we have only to consider here such diseases as are usually denominated local in character. GONORRHEA. The term gonorrhea, or clap, is applied to an inflamma- tion of the urethra caused by impure coitus. In some cases, however, such an inflammation may occur after intercourse with a woman suffering from the " whites," or immediately after her menses has ceased. In from two to five days after exposure, an uneasy, tick- ling sensation is felt in the head of the penis, just within the DISEASES OF THE MALE GENERATIVE ORGANS. 538 lips of the opening of the urethral canal. Soon after this, a clear, whitish discharge appears, which soon becomes thick and yellow, and there is a smarting, burning sensation while urinating. The head o-f the penis and foreskin often becomes, swollen and the parts present a reddened and angry appear- ance. When the severity of the first stage of the disease subsides, painful erections during the night frequently occur. In some cases the inflammation may be so severe as to cause general febrile symptoms that may last three or four days. Treatment.-During the height of the inflammation the patient should remain quiet, and hot fomentations should be applied over the genitals. The urethra should be syringed with warm water, with the view of removing the matter from the canal. After this is done, the following should be' used: Morphine, 3 grains; Glycerine, 1 ounce; water, 3 ounces. Mix, and use as an injection three or four times a day. It is im- portant that care should be used in injecting fluids into the urethra. A small, hard rubber piston syringe should be filled with the fluid to be used, and the nozzle introduced into the urethra. The penis should then be grasped with the finger and thumb of one hand, about an inch behind the head of the organ. A tight pressure is applied here while the injection is being slowly forced into the canal from the syringe. The injection thus reaches the inflamed part of the urethra, while it cannot pass to the neck of the bladder, where it might pro- duce an annoying irritation. When the injection is forcibly carried into the canal, it is also liable to extend the disease along the surface of the urethra. After the inflammation subsides somewhat, the following will be found a valuable injection: Chloride of Zinc, 10 grains; Wine of Opium, 1 ounce; Tincture of Catechu, 4 drams; water, enough to make 6 ounces. Mix, and use as an injection three or four times a day, always after urinating. The following will also be found good: Carbolic Acid, 15 drops; Glycerine, 2 ounces; Fluid Extract of Golden Seal, 1 ounce; water, enough to make 6 ounces. If the burning sensation while urinating is severe and persistent, the following should be used internally: Acetate BALANITIS. 539 of Potash, 4 drams; Fluid Extract of Hydrangea, 3 ounces; water, 3 ounces. Mix, and give two teaspoonfuls after each meal. The term chorclee is applied to the painful erections that attend the second stage of gonorrhea.. The condition maybe relieved by 20 grains of Bromide of Potassium, given in water about two hours before going to bed. If this fails to give relief, I grain of Opium may be given at bed time, and the dose may be repeated in three or four hours if the patient is disturbed. GLEET. Gleet is a chronic gonorrhea, and it never occurs except as a sequence of the acute disease. There is no pain, redness or swelling in this disease. In fact the only symptom present is a slight discharge of a clear, viscid fluid, which glues the lips of the urinary opening together. This condition is par- ticularly noticed in the morning. In some cases the stream of water may be smaller than usual. Treatment.-The chronically inflamed mucous membrane often needs to be stimulated by some strong injection, before this disease can be cured. For this purpose the following may be used: Permanganate of Potash, 20 grains; water, 3 ounces. Mix, and inject into the urethra two or three times a day, till a new irritation with increased discharge is pro- duced. After this is done the case may be treated in the same manner as a recent case of gonorrhea. In using this injection the root of the penis should be firmly pressed with the finger and thumb to prevent the injection extending to the bladder. If this treatment fails, a surgeon should be consulted, when it will usually be found that the discharge is kept up by the presence of a stricture. BALANITIS. By balanitis is meant an inflammation of the mucous membrane covering the head of the penis and lining the foreskin. It may be caused by the gonorrheal poison, want of cleanliness, or irritation from any cause. DISEASES OF THE MALE GENERATIVE ORGANS. 540 The parts become tender and swollen, and a free dis- charge is thrown off from the surface. Treatment.-The foreskin should be drawn back and the parts thoroughly cleansed with warm water. The following should then be used as a wash: Sulphate of Zinc, 8 grains; Rose water, 4 ounces. Mix, and apply to the part every two or three hours. If the foreskin cannot be kept back, the following should be applied after the part is bathed with the above wash: Boracic Acid, 10 grains; Vaseline, 4 drams. Mix, and apply freely over the head of the penis before drawing down the foreskin. This ointment should be carefully washed off at least night and morning, and the wash again applied. PHYMOSIS. The term phymosis is applied to a constriction of the orifice of the foreskin, that prevents it from being drawn back so as to expose the head of the penis. Many children are born with this condition present, and in these cases the fore- skin is usually very long. It may also result from inflamma- tion of the foreskin. Treatment.-In acquired phymosis from inflammation, the foreskin generally assumes its natural condition as soon as the inflammation subsides. * When the orifice has been permanently contracted by the formation of scars, and in cases of congenital phymosis the operation of circumcision must be performed. The operation is simple and the advantages derived from it are very decided. P1RAPHIM0SIS. Paraphimosis is the term applied to a condition in which the foreskin is contracted behind the head of the penis, so that it cannot be drawn forward. It results from inflamma- tion , and if it is not relieved in a short time, ulceration or mortification of the head of the penis may result. It is at- tended with marked swelling of the penis and foreskin, and severe pain. Treatment.-The foreskin should be forcibly drawn over the head of the penis, if possible. To accomplish this, the SWELLED TESTLCLE. 541 patient can grasp the penis on each side, between the index and second fingers, and then place both thumbs on the end. Now by pressing down with the thumbs, and pulling up with the fingers, the difficulty may be overcome. If this fails after one or two attempts, the surgeon will be obliged to relieve the constriction with a knife. When the paraphimosis is reduced hot applications should be made to reduce the in- flammation. STRICTURE. The term stricture is commonly applied to any narrow- ing of the urethral canal that prevents the free passage of water from the bladder. Such conditions generally result from gonorrhea, chancre in the canal, or injuries; and are either caused by deposits which permanently narrow the urethra, or by some irritation that produces spasmodic con- tractions of its muscular fibres. The symptoms of stricture are a gleety discharge from the urethra, a frequent desire to urinate, difficulty in starting the urine, a diminished size of the stream, and sometimes its division into two or more streams. These symptoms continue to become more marked, till finally the urine is passed with difficulty, and a dull pain is felt at the neck of the bladder, in the head of the penis, and between the anus and scrotum. Treatment.-These are tedious and annoying cases to treat, under the most favorable circumstances, and the suf- ferer should lose no time in consulting a surgeon. A con- siderable time is required to effect a radical cure of stricture, and the patient must not get discouraged in a few weeks. When properly treated, all cases can be radically cured, either by dilatation or by cutting. SWELLED TESTICLE. An inflammation of the testicle, followed by great swell- ing of the organ, is frequently met with. The left testicle is more frequently involved than the right, and the inflamma- tion occasionally extends up to the spermatic cord. Sometimes a slight fever followed by a chill, and a dull pain in the perineum and cord precede the trouble in the 542 DISEASES OF THE MALE GENERATIVE ORGANS. testicle; but more frequently it begins without premonitory symptoms. A pain is felt in the testicle and it soon becomes swollen and tender on pressure. The swelling increases rapidly, the pain grows very severe, and the scrotum becomes tense and assumes a purple hue. General febrile symptoms now appear and continue till the local inflammation begins to subside. Treatment.-The treatment of swelled testicle requires absolute rest in the recumbent position, with the testes well supported with a small pillow between the legs. The follow- ing should be used: Muriate of Ammonia, 2 drams; Fluid Extract of Poke Root, i ounce; Alcohol, I ounce; water, 6 ounces. Mix, and apply to the part by means of cloths sat- urated in the mixture. When the cloths are once applied they should be kept wet by pouring on the wash from the bottle. With the view of controlling the pain and relieving the fever 5 drops of Fluid Extract of Gelsemium should be given every half hour, till six or eight doses are taken. If the testicle remains hard and large after the inflamma- tion has disappeared, adhesive straps must be applied around it in such a way as to make a uniform pressure. PROSTATITIS. By prostatitis is meant an inflammation of the prostate gland. It is usually caused by the extension of the inflamma- tion of gonorrhea, and injuries from the use of bougies, cathe- ters, &c. It may also follow inflammation of the bladder or may result from exposure to cold. The symptoms are dull pain in the perineum, frequent desire to urinate, attended with scalding pain at the neck of the bladder, and a fullness and pressure in the rectum. Treatment.-Hot fomentations should be applied to the perineum, and hot hip baths may be used two or three times a day. When the pain is severe, Morphine may be given in doses of one-eighth of a grain every four hours. If the symptoms do not speedily subside, a physician should be consulted. VARICOCELE. 543 ENLARGED PROSTATE. Sometimes after an acute inflammation of the prostate gland, and more frequently in old men a marked.enlargement of that gland is found. This is manifested by a frequent de- sire to urinate; a scalding sensation during the passage of the urine; pain and uneasiness in the perineum, hips and thighs; difficulty in voiding the urine and increased time required to do so, and irritation of the rectum. In some cases there is a discharge from the urethra of a clear, transparent mucus, but this is not always present in old men. Treatment.-The bowels must be kept regular by the Compound Podophyllin pills,*and the general strength must be sustained. The Elixir of Calisaya, Iron and Strychnia, may be given in teaspoonful doses after each meal; and io drops of Fluid Extract of Gelsemium may be given at bed- time, every night, with advantage. Hydrocele is a dropsy of the scrotum, or bag. It may attain a large size, and give rise to inconvenience and de- formity. Treatment.-This condition can only be treated surgi- cally. The water may be drawn off with an aspirator, or with the canula and trochar, but the bag will soon fill up again, and even become larger than before. After the water is drawn off, Tincture of Iodine or some other irritant is often injected into the sack with the view of effecting a radical cure. This method is not always safe and seldom gives entire satisfaction. The sack can be cut open and its surfaces ex- posed, when the healing will take place so as to insure a good result, without danger. HYDROCELE. VARICOCELE. Varicocele is an enlarged condition of the veins that enter into the formation of the spermatic cord and testicles. When this condition once develops, it is likely to continue till the testicle is entirely destroyed. ' See page 360. 544 DISEASES OF THE MALE GENERATIVE ORGANS. A suspensory bandage should be worn till such time as a proper operation can be performed to effect a radical cure. SPERMATORRHEA. By spermatorrhea is meant an unnatural escape of semen. In a healthy unmarried man such an escape occurring once in two, three or four weeks, cannot be considered an unnat- ural condition, for the semen is being secreted continuously and must escape in some way. When this loss occurs very frequently, it constitutes a weakness. Masturbation, or self-abuse, and excessive sexual inter- course are the most common causes of the condition, and these must be discontinued before the trouble will cease. Reading the trash issued by advertising specialists con- cerning the horrors of masturbation, and seminal weakness, has much to do with developing a condition of the nervous system that results in spermatorrhea. While self-abuse is a deplorable and injurious practice that should be cried down in every way, it does less harm of itself than the falsehoods told concerning its effects on the system, by the unprincipled charlatan, and the deluded phil- anthropist. Treatment.-The first thing to do in the treatment of spermatorrhea is to convince the sufferer that he will not lose his memory or become an idiot. Assure him that he has sim- ply exhausted some of his nervous energy, and that he can be cured, that his vitality is not lost, and that there is no barrier to his marrying and becoming a father. Then medicines may be given with advantage. The following will prove valuable: Sulphate of Strychnia, I grain; Dilute Muriatic Acid, 3 or 4 drops; Dilute Phosphoric Acid, I ounce; water, 3 ounces. Mix, and give a teaspoonful, in water, before each meal. In place of this, one Compound Phosphorus pill may be given, half an hour after each meal. If emissions take place during the night with lascivious dreams and erections, 15 grains of the Bromide of Sodium may be given in water, at bed time. If the patient is pale and weak, 15 drops of Dialyzed Iron should be given immediately after each meal. SPERM A TORRHEA. Fresh air, exercise, wholesome food, cheerful company, and above all marriage should be insisted on. This last expedient will invariably cure the worst of these cases after the nervous system has been toned up by the remedies just recommended. Bathing the genitals every morning with cold water, and then applying brisk friction with a coarse towel, will also be beneficial. In severe cases of long standing the proper use of the Faradic current of electricity will serve a good purpose, and when this fails, the surgeon may deem it necessary to apply some direct treatment to the orifices of the ducts that con- vey the semen to the urethra. 545 CHAPTER XIV, THE EYE AND ITS DISEASES. The sense of sight stands first in importance among the special nervous endowments Through it we receive the most varied and valuable impressions, and are enabled to appreciate all the beauties of nature. Without it all that is grand and beautiful in life is denied us, and we are forced to live imperfect lives. To behold a blind person fills us with pity, while the thought of such a calamity falling upon our- selves cannot fail to sadden the stoutest heart. It must be remembered, however, that very few persons are born blind, and that the loss of sight is almost always due to the neglect or bad management of the various diseases and injuries to which the eye is subject. True, sight may be des- troyed instantaneously by an injury to the eye, or gradually, as a complication of some nervous affection; but these in- stances are few in comparison to the large number of cases that might be prevented by proper management. Even slight injuries and diseases of the eye materially impair vision and cause much suffering, and most persons are inclined to ANATOMY OF THE EYE. 547 object to being treated, either through fear or ignorance. In this way simple affections are allowed to go on from bad to worse, till serious, and sometimes incurable complications, are developed. With a proper knowledge of the structure of the eye and its appendages, the people would be prepared to understand the nature of the simpler affections to which these parts are subject, and thereby be enabled to prevent the more serious ones. With this object in view we purpose, in the following pages, to give a brief description of the anatomy of the eye, to lay down a few rules for the preservation of sight, and to point out the importance of the proper adaptation of specta- cles and the injuries resulting from their imperfect adjustment. We shall then describe the various diseases and deformities of the eye, so that the non-professional reader may understand their nature and their possibilities of treatment. ANATOMY OF THE EYE. The eyeball is spherical in form, and is contained in a bony cavity called the orbit, while it is capable of the most extensive range of sight. It is protected in front by the eye- lids, eyelashes, and eyebrows, is supplied by vessels and serves the same as other organs, and has attached to it nu- merous muscles, which give it the freedom of motion it possesses. Fig. 54.-The Right Eye, with Muscles Attached. i, fragment of sphenoid bone; 2, the optic nerve; 3, the globe of the eye; 4, the elevator muscle of upper lid; 5, the su- perior oblique muscle that rotates the eye inward; 6, the pulley of superior oblique; 7, the tendon of same; 8, the inferior oblique muscle; 9, the superior rectus muscle, that raises the eye in look- ing upward; io, the internal rectus, that turns the eye inward, toward the nose; 11 and 12, parts of the external rectus, (the rest is cut away), that turns the eye outward; 13, the inferior rectus, that turns the eye down, in looking downward; 14, the white of the eye. Fig- 54- 548 THE EYE AND ITS DISEASES. The muscles and general exterior arrangements of the eye are distinctly represented by Figs 54 and 55. The natural appearance of the eye and perfect vision are largely due to the harmonious action of the various muscles. When one muscle is unduly contracted the eye is drawn by it out of the parallel optic axis (A A, Fig. 55), and a deformity and impaired vision is the result. When a muscle is relaxed the same condition is developed by the action of the opposite muscle. These are conditions that will be described under the head of Strabismus or Cross-Eye. Pig- 55- Fig. 55.-Both Eyes with Muscles. A A, the parallel optic axis; C. C, the centres of motion of the globes; B B, the axis of rotation of the oblique muscles; D D, the axis of rotation of the superior and inferior straight muscles; S, the superior straight muscle; N N, the external straight muscle; O O, the superior oblique muscle; S, the superior straight muscle of the left eye; M M, the attachments of inferior oblique muscles. The eyeball is a little less than an inch in diameter, and though spherical in appearance, is a little elongated from LATERAL SECTION OF THE EYE. 549 before backward. It is composed of three distinct layers, or tunics, inclosing three refracting media or humors, and the parts are so arranged as to form an intricate optical instru- ment, with powers greatly superior to any that can be made by man. Pig- 5^- Fig. 56.-Lateral Section of the Eye. C, cornea; I, iris; A H, aqueous humor; L. lens; C S, circular sinus; H hyaloid mem- brane; C ML, ciliary muscle and ligament; C P, canal of Petit; V H, vitreous humor; R, retina; C C, choroid coat; S, sclerotic coat; N, optic nerve; M, muscles If a section of the eye is made, as in Fig. 57, the various layers and humors are shown. Tho external layer is made of a hard, white, fibrous structure, the sclerotic coat (S), which forms about five-sixths of the globe, and the cornea, (C), which is the transparent anterior sixth, through which the light passes to the interior of the eye. The part called the 550 THE EYE AND ITS DISEASES. sclerotic coat maintains the shape of the eyeball, affords attach- ment to the muscles that move the eye, and protects the more delicate structures within, while the cornea is the window of the eye, and is as essential to sight as the window of a house is for the admission of the light. The second layer is described as being composed of the choroid coat (C C), ciliary processes, and iris (I). The choroid coat is a thin membrane that contains a large number of minute blood-vessels, and is rendered opaque by an abundant layer of a blackish-brown matter, called pigment-cells. This membrane absorbs all extra light that passes into the eyeball, and prevents its being reflected in such a manner as to con- fuse or dazzle the sight. The ciliary processes are simply prolongations of the choroid, folded inward. The iris (I) is a thin, circular-shaped contractile curtain, situated between the cornea and the lens. ' It is perforated by a round hole, the pupil, for the transmission of light. This curtain is lined behind by a black pigment similar to that found in the choroid coat, and upon the thickness of this layer depends the color of the eye. No light can pass through the iris except through the pupil, which contracts to exclude the light when too much enters the eye, and dilates to admit more light when that which enters is not sufficient for distinct vision. The retina (R) is the delicate nervous membrane that forms the interior layer of the globe of the eye. It is formed by an expansion of the optic nerve (N) on the interior of the choroid coat, and a delicate tissue that connects the minute nerve filaments. It is this membrane that receives the images and transmits the impressions along the optic nerve to the brain, to produce the sense of sight. The aqueous humor is a clear, watery fluid situated im- mediately behind the cornea (A H), and fills all the space between the cornea and the lens. The iris is suspended in it, and the space in front of the iris is calle 1 the anterior, and that behind it the posterior chamber of the eye. This fluid keeps the cornea in a natural condition and retains its con- vexity. The crystalline lens (L) is a double convex transpar- ent body, located behind the iris and between the aqueous LATERAL SECTION OF THE EYE. 551 and vitreous humors. It is composed of several layers, is in- closed in a delicate membrane called its capsule, and has at- tached to it the suspensory ligament, which assists in retain- ing the lens in position. The office of the lens is to converge the rays of light to a focus on the retina, and thus produce a perfect image of the objects around us. By the action of the ciliary muscle and ligament (C M L) the lens is made to change its shape and position so as to rapidly adapt the eye to long and short ranges of vision. The vitreous humor (V H) is that transparent rounded mass, of gelatinous consis- tency, which fills the cavity of the eyeball behind the lens. It is enclosed in a delicate membrane, and acts in slightly diverging the rays of light after they pass through the lens. Now, in examining the ball of the eye, from before back- ward, we find a number of parts, the perfect condition of which are necessary for proper vision. The cornea must be rounded and perfectly transparent, the aqueous humor must be clear, and sufficiently abundant in quantity to fill the anterior and posterior chambers; the iris must hang perfectly free, with the pupil capable of contracting and dilating under the stimulus of light; the lens must be clear and transparent, and capable of adjusting itself to long or short ranges of vision, the vitreous humor must be transparent, the retina free from congestion and adhered to the choroid, and the choroid coat must have sufficient black pigment to absorb the light that passes through the retina. Then the optic nerve must be healthy in order to convey the impressions from the retina to the brain. Any departure from these normal conditions constitutes disease, and necessarily impairs vision. The appendages of the eye are equally as important as the globe itself, and demand our careful attention. Among these are enumerated the eyebrow, eyelids, conjunctiva, tear duct, and nasal duct. These protect the eye in front from injuries, exclude dust and cinders from the eye, and secrete tears in sufficient quantity to lubricate the eye and then admit of their passage into the nose. 552 The eyebrow surmounts the upper circumference of the orbit, and is covered with short, thick hairs. It consists of thickened skin, and a set of muscles which act in quickly clos- ing the eye. When exposed suddenly to a very bright light these muscles draw down the brows, and thus aid in excluding the light from the eyes. The eyelids are thin, movable folds, placed in front of the eye, protecting it from injury by their closure. The upper lid is larger and more movable than the under one, and is supplied with a separate elevator muscle. The integu- ment of the eyelids is extremely thin, as is also the mus- cle and connective tissue of which they are made up. The margins of the lids are much firmer and contribute largely to their shape and support. In consequence of their firm- ness of structure they are called the tarsal-cartilages. To the free margins of these cartilages are attached the eyelashes, which are so arranged as to interlace when the lids are closed thus protecting the eye against the introduction of dust or other foreign bodies. Upon the inner surface of the lids a number of small glands are situated, the ducts or canals of which open on the free margins of the lids. They are called Meibomian glands, from the anatomist who first described them, and their office is to throw out a secretion to lubricate the eyelashes and prevent the lids from adhering together. The conjunctiva is a thin mucous membrane that lines the under surface of the lids and the outer surface of the cornea and front part of the seierotic. The part of this membrane that lines the lids is thick, opaque, and contains numerous blood-vessels. It is very liable to inflammation, and is the part principally affected in the disease called grandular lids. The lachrymal gland is situated in a depression in the orbit, immediately under the bony eminence that forms the outer angle of the eye. It secretes the tears, and these are conveyed to the eye by a number of small tubes or ducts After the tears have lubricated the eyeball they pass toward the inner angle of the eye, and enter the lachrymal or tear canals through two little openings on the margins of the lids, called the lachrymal punctae, or tear openings. These tear THE EYE AND ITS DISEASES. THE HYGIENE OF THE EYE. 553 canals run along the margin of the lids to the point where the upper and lower lids join. Here they unite and expand into a kind of sac called the lachrymal, or tear sac; and this continues downward through an opening in the bones of the face till it opens into the cavity of the nose. This cajial is called the nasal duct, and is the terminus of the lachrymal apparatus. It is along this passage, from the eye to the nose, that the tears pass after they have performed their office of lubricating the eye. Now, if this passage is stopped up in any way the tears must flow over the cheek, thus giving rise to what is known as weeping, or watery eyes. When an exces- sive amount of tears is secreted, the excess must flow over the lower lid, as all cannot pass through the canal leading to the nose. THE HYGIENE OF THE EYE. When we look around and see how little attention is given to the proper care of the eye, and how much the sense of sight is overtaxed we cannot wonder that diseases of this organ are so numerous. Severe, and often fatal inflammations occur in the eyes of infants, a few days after birth, in conse- quence of neglecting to wash the eyes thoroughly. Poisons of various kinds are conveyed to the eyes by the fingers, through carelessness and uncleanliness; the eyes are strained and weakened by reading in railway cars, when the jarring is so great that it is impossible to hold a book or paper so as to retain a proper visual focus. The majority of persons, while using their eyes in reading, or for any kind of fine work, think it necessary to face the strongest light in order to see clearly, and when a particle of dust gets into the eye a furious rubbing is at once commenced, and continued until the eye is so irritated and inflamed that the sight is, for the time, destroyed. These things are so important that we shall venture to lay down a few rules as guides for the care of the eye, even though many may consider them too common-place to require mention: 554 THE EYE AND ITS DISEASES. First: It is the duty of a nurse to observe the utmost care in cleansing the eyes of a new-born infant. This should be attended to without a moment's delay, and close attention should be given to the care of the eyes, for several weeks at least. Second: The hands should be carefully washed after hand- ling anything poisonous or irritating, and particularly after dressing any old sore, or any diseased part from which a dis- charge of matter escapes. If this is not done the poison is apt to be conveyed to the eyes by the fingers, thus giving rise to serious inflammations. Third: While reading, the book or paper should be held firmly at the proper focal distance from the eyes. If this is not done the eyes are weakened and soon permanently injured by the rapid changes the muscles are required to make to retain the focus of the print. Hence, reading on cars is highly injurious and should be entirely avoided. Fourth: Whenever it is admissible the back or side should be turned to the light, so that the eye may be protected from an excess of light, while the book or work is fully illuminated. When we face a strong light the pupils contract to shut out a portion of it from the eyes, and consequently the rays from the object viewed are also shut out to some extent, and the vision is less distinct, while the eyes are irritated and weakened by the strong light. Fifth: When cinders or particles of dust get into the eyes, rubbing should be carefully avoided. They can generally be removed without much irritation by closing the lids for a few moments, so that the increased flow of tears they occasion may wash them toward the inner angle of the eye, when a soft handkerchief should be pressed into the angle between the lids and carried toward the nose. If this does not remove them the lower lid maybe pushed up with the fingers of one hand, while the upper eyelashes are seized with the other hand and the lid drawn outward and downward so as to overlap the lower lid. In this way the lower eyelashes sweep the eyeball and the under surface of the upper eyelid, and readily remove any particles that may be adhering to the surfaces. DEFECTS OF VISION REQUIRING SPECTACLES. 555 Sixth: If a piece of steel, iron, or glass is imbedded in the cornea or sclerotic, the eye should be closed and prevented from moving by a slight compress and bandage till a compe- tent surgeon can be consulted. Seventh: If lime or any other caustic gets into the eye, the lids should be opened immediately and Sweet Olive Oil freely applied to the parts till a skillful physician can be consulted. Eighth: Whenever the eye sustains an injury of any kind, surgical aid should be sought without delay; but till such can be secured the eye should be loosely bandaged so as to exclude light and prevent motion. DEFECTS OF VISION REQUIRING SPECTACLES The defects of vision requiring the use of spectacles are of great importance, for ignorance of the nature of such defects often results in abuses that materially affect the sight. In the normal eye the various parts are so arranged that objects can be seen distinctly at different distances, and this power is called the power of accommodation or adaptation. We often see persons, however, who cannot see distant ob- jects distinctly, while there are others who can see all objects at a distance, but cannot see near objects. And as age advances most persons lose the power of seeing near objects, while distant ones are clearly seen. These defects are due to differ- ences in the shape of the eyeballs and refracting media, and changes that take place in the media and the power of accom- modation, and are respectively described as myopia, or short sight; hypermetropia, or oversight; presbyopia, or old sight. Myopia.;-In myopia, or short sight, all objects must be brought very close to the eye to be distinctly seen, while dis- tant ones cannot be recognized. This condition may result from a too great convexity of the cornea and crystalline lens (C and L, Fig. 3), or from an elongation of the eyeball from before back, thus making the distance between the retina (R. Fig. 3) and the lens too great. In either of these condi- tions the rays of light come to a focus in front of the retina, and, consequently, no distant image is produced on the retina. 556 THE EYE AND ITS DISEASES. To remedy this difficulty a properly-selected pair of con- cave glasses should be worn, for by their aid the rays are made to diverge, and are thus brought to a focus at a greater distance from the lens. When the glasses are properly selected the rays can be made to meet accurately on the retina, and thus the defect of vision is corrected. HYPERMETROPIA;-In hypermetropia, or over sight, the cornea and crystalline lens are too flat, or the antero-pos- terior diameter of the eyeball too short, and, consequently, the rays of light do not come to a focus upon the retina, but would do so behind it, if extended. The adjusting power of the eye, in these cases, is severely taxed, even in looking at distant objects, while near objects cannot be seen at all dis- tinctly. The eyes tire very soon, a feeling of great lassitude extends to the brow, vision becomes hazy, and the use of the eyes must be discontinued. Convex glasses, of suitable focal length, make both dis- tant and near objects distinct, by causing the rays to converge to a focus on the surface of the retina. PRESBYOPIA.-By presbyopia is meant the change that takes place in the sight as age advances, and it is sometimes spoken of as old-sight. Its approach is manifested by the necessity most persons feel, as they advance in life, of holding small objects farther and farther from the eyes in order to see them distinctly. While near objects become more and more indistinct, distant sight is as acute as ever. This condition results from impaired power of accom- modation, due to the greater firmness of the lens, and the weakening of the force that regulates its convexity in the nor- mal eye. These changes are due to advancing age, and can only be remedied by the use of convex glasses, of such a curve as will bring back the needed " near point" to its normal position. ASTIGMATISM.- Astigmatism is a term applied to an un- symmetrical condition of the cornea, or other portions of the eye, which causes the rays of light to be differently refracted, and thus prevents them from forming a focus on the SPECTACLES. 557 retina. This difficulty often es- capes detection, and the sufferer, consequently, fails to procure the proper spectacles to correct the defect of vision. In looking at the lines of Fig. 57 if they seem to slant, or parts of them are seen more distinctly than others, the presence of astigmatism will be demonstrated. A competent oculist should then be consulted, and the defect of vision can be remedied by properly adjusted cylindrical lenses. Fig. 57. The great importance of spectacles, as a means of correct- ing defects of vision, cannot be over-estimated. Much annoy- ance and suffering can be avoided by exercising proper care in selecting spectacles with special reference to the condition of the eyes. Thousands of persons destroy their sight every year by putting off the use of spectacles till they can no longer use their eyes on any kind of fine work, and by pur- chasing them from jewelers and street venders, without refer- ence to anything but their magnifying power. The natural decay of vision usually commences between the ages of thirty-five and fifty, varying according to the habits and employment of the individual. This decay is first noticed while attempting to read small print by a dim or artificial light, and if the use of spectacles is put off for any length of time the eye changes rapidly, and will soon require very powerful lenses. Persons who have had good sight, both for distant and near objects, should not fail to observe the following rules as soon as vision begins to be impaired: First: Have spectacles properly adjusted as soon as it is found necessary to carry ordinary print farther from the eye than formerly, while reading by artificial light. Second: Do not use the spectacles during daylight till the "near point" begins to recede. It is often unnecessary to use SPECTACLES. THE EYE AND ITS DISEASES. 558 glasses during the day for a period varying from six months to two years after they are necessary for night reading. Third: In first selecting spectacles they should not mag- nify, but simply rest the eye while viewing small objects. For this purpose a very low power should be selected. Fourth: Avoid purchasing cheap spectacles from peddlers, as they are invariably defective, and cannot fail to injure the eye. Fifth: Always consult a competent oculist or optician before procuring glasses of any kind. Sixth: Spectacle frames are always desirable, as a more perfect adjustment of the lenses to the eyes can be secured by their use. Seventh: In old-sight, the spectacles used for near objects should never be used for viewing distant objects. Eighth: Single eye-glasses should never be used, as they give rise to a difference in the focal distances of the eyes. Ninth: A careful examination of short-sighted or over- sighted eyes should be made by an oculist before any glasses are worn, as a perfect adjustment of lenses cannot be made in any other way. Testing the Sight for Spectacles.-As many per- sons cannot avail themselves of the opinion of competent oculists or opticians without leaving home, we give below a few directions that will enable them to closely approximate the proper focus of the glasses required. By reference to the TEST TYPE commencing on page 573 the reader will see that there are twenty different sizes, num- bered from 1 to 20. By the use of these types oculists may be able to select spectacles for persons at a distance, without a personal examination. A person with normal sight should be able to read No. 1 at a distance of six inches from the eye, and No. 20 at a dis- tance oi twenty feet. If this cannot be done it would indi- cate a defect in the sight, and further tests will enable an oculist to select proper spectacles. The person desiring spectacles should take the test types to a good light, and then carefully measure the distances DISEASES OF THE LIDS. 559 from the eye, at which the various types can be clearly read. These distances should then be written down and sent to the oculist, who can, by their aid, select the proper lenses. The results of the tests should be written out clearly, thus: Nearest point at which No. I can be read inches. Greatest distance at which No. I can be read inches, and so on, for the entire twenty tests. If the smaller types cannot be read at all, the fact should be so stated. DISEASES OF THE LIDS. The eyelids are liable to be attacked by erysipelas in common with the general integument, and must be treated as recommended in the article on that disease. They are also liable to a number of special diseases and deformities that require the special care of a competent oculist. Cystic Tumors of the Lids.-Small tumors are often seen immediately under the integument of the eyelids, and they frequently attain a size sufficient to produce a deformity. These tumors are produced by an obstruction in one or more of the hair follicles on the margin of the lid, and a conse- quent accumulation of sebaceous matter. They should be removed by making an opening from the inside of the lid, and then removing the sac containing the matter. The opera- tion is slight, and is performed with little or no inconvenience to the patient. PUSTULES.-Many persons suffer much annoyance from the frequent formation of pustules on the outer edges of the lids. This affection attacks the roots of the lashes and the small glands around them, and one or more pustules show themselves. They first appear as little pimples, not larger than the head of a pin. Inflammatory symptoms soon set in, which, after two or three days, result in suppuration. Sev- eral lashes are thus loosened and drop out, and the pus es- capes through the openings left by the displaced hairs. Be- fore the matter escapes the pustules are often larger than a pea. As soon as one crop disappears another begins to form, and thus the disease maybe continued for an indefinite length of time. THE. EYE AND ITS DISEASES. 560 The constant irritation attendant upon this disease pro- duces a thickening and redness of the edges of the lids, and a stiffened and distorted condition of the lashes, which greatly weaken the eyes, and occasion the patient much discomfort. The treatment of this condition should not be neglected. As soon as a pustule appears it should be opened with a large needle to allow the pus to escape. The following should be applied to the margins of the lids: Iodine, 5 grains; Brandy, 1 ounce. Mix, and apply twice a day, with a camel's hair brush. It is always well to annoint the eyelids and lashes with Vaseline at bed time. This relieves the irritation and prevents the lids from sticking together in the morning. Fowler's Solution of Arsenic should be given internally in doses of 3 drops, three times a day, after meals. A sty is a minute boil, and differs but little from the pus- tules just described, only in its deeper location and greater size. A sty commences in the tarsal glands, or Meibomian follicles, as they are sometimes called. Several days elapse from the commencement of the inflammation to the complete formation. After the pus discharges it disappears quite rapidly, but after having once formed, others are apt to de- velop after a short interval. Though stys are troublesome they seldom require much treatment. It is rarely advisable to use poultices, for matter forms in a few days, without interference. The pustule should be punctured with a needle or knife as soon as the pus has formed, and then the part should be kept clean with tepid water. PTOSIS.-By ptosis is meant an inability to rai^e the upper lid so as to properly uncover the pupil. It is due to a variety of causes, and can rarely be successfully treated ex- cept by a surgical operation. The operation is slight and comparatively free from pain, and invariably overcomes the difficulty. DlSTlCHIASIS.-The proper meaning of the term disti- chiasis is a double row of lashes, but it is applied by the pro- fession, to scattered and irregular hairs. These hairs turn inward, and by rubbing on the cornea, irritate it, causing an ECTROPION. 561 inflammation and haziness that finally results in opacity and consequent blindness. Trichiasis.-By trichiasis is understood a bending in- ward of the normal eyelashes. When this condition exists for any length of time the hairs become very irregular in size, and, by the constant irritation of the cornea they keep up, serious disorder of that tissue is occasioned, and an entire loss of sight is sure to follow. This is the condition com- monly spoken of as "wild-hairs." Both scattered and inverted lashes were formerly treated by pulling out the hairs by the roots, and continuing to do so till they ceased to be reproduced. This method proved unsat- isfactory, and has been almost entirely abandoned. A simple operation is now performed that completely overcomes the difficulties and prevents a loss of sight. Neglect of these cases for any length of time, is sure to be followed by im- paired vision, if not complete blindness. ENTROPION.-Entropion is an inversion, or turning in, of the margins of the lids. It affects the lower lids of one or both eyes, but the upper lids are exempt from it. The lashes are turned in with the margins of the lids, and they irritate the cornea in the same manner as in the two affec- tions previously mentioned. A surgical operation is the only method of overcoming the difficulty. Ectropion.-Ectropion is an eversion, or turning out of the lid. It is usually found in the lower lid, although the upper one is not exempt from it. There are various degrees of this affection, ranging from a slight eversion of the mar- gin of the lid to a complete exposure of its entire inner surface. When slight, the tears do not pass through the lachrymal apparatus readily, but collect between the margin of the lid and the globe of the eye, thus giving to the eye a suffused appearance. In the severer cases the tears flow over and excoriate the cheek, and the exposed conjunctiva be- comes so inflamed as to produce an unsightly deformity. Sometimes a properly adjusted compress resting on the everted lid, and supported by a bandage, may effect a cure of 562 THE EYE AND ITS DISEASES. ectropion. As a rule, however, a surgical operation is the only treatment that promises satisfactory results, and it should be performed as early as possible in order to preserve the sight. As before stated, the lachrymal apparatus consists of a lachrymal gland for the secretion of tears to lubricate the eye, the tear canals for conveying the tears to the eye, and a canal for conveying the tears into the nose. On the inner margin of each lid, near the inner angle of the eye, can be seen two little points, or openings, called punctae, which mark the commencement of the canal for carrying off the tears. These open into small canals, called canaliculi, which unite and terminate in the lachrymal sac, which is lodged between the inner angle of the eye and the nose. This sac is the commencement of a canal or duct, called the nasal duct, which con- veys the waste tears into the nose. Fig. 58 represents the outlines of the tear appara- tus with the names of the several parts printed on them. Now, these different parts of the lachrymal apparatus are liable to disease and obstructions which will require our at- tention. The lachrymal gland is rarely the seat of disease or in- jury. When it is affected it is more apt to be by cancerous growth, and should then be removed without delay. Weeping or Watery Eyes.-The puncta may be ob- structed by inflammation, or the canaliculus or nasal duct may be constricted from some cause, so that the tears cannot THE LACHRYMAL OR TEAR APPARATUS. Fig. 58. STRABISMUS, OR CROSS-EYE. 563 pass through the proper channel from the eye, and as a con- sequence they collect in the eye for a time, and finally flow over the cheek. This condition is called weeping or watery eye. If of long standing, the eye becomes very weak and sight is impaired; but long before this occurs, the annoyance to the patient is very great, in consequence of being obliged to keep constantly wiping the tears from the eye. Usually only one eye is affected, but sometimes the trouble is found in both. The difficulty will constantly grow worse if neglected, but is easily overcome by a slight operation. Fig. 59 represents the canaliculus slit from the puncta to the lachrymal sac, with a probe introduced into the nasal duct. This method is the most effectual one for overcoming the annoying obstruc- tions of this passage. Inflammation of the lachrymal sac sometimes takes place, and the passage of tears is obstructed thereby. In this case, if a pressure is made with the finger, just below the inner angle of the eye, matter may be forced out of the puncta. This accumulation obstructs the passage and the tears must necessarily flow over the cheek. Whenever the tears collect in the eye, or flow over the cheek, if the lower lid is not everted, some obstruction of the canal that carries off the tears, must necessarily exist, and much trouble can be averted by having it properly treated without delay. Fig- 59- STRABISMUS, OB CROSS-ETE. Cross-eye, or squinting, is a deformity that arises from an unequal power of the muscles that mo/e the eyeball. If the internal rectus muscle is. weakened from any cause, the eye is turned outward and gives rise to divergent strabismus, or squint. If the external rectus muscle is weakened, the eye is drawn inward toward the nose and convergent strabismus or squint is produced. 564 THE EYE AND ITS DISEASES. rig. 60 represents the position of the ball of the eye in internal strabismus. The line A. marks the position of the centre of the pupil in a squinting eye, while B indicates where it should be in a normal eye. The distortion destroys the parallelism of the axis of the eyes, and consequently only one eye can be used at a time in viewing any object. This soon results in impaired vision, so that personal appearance is not tne only thing to be looked to in consider- ing the advisability of an operation. It is generally supposed that squinting is confined to one eye, but a careful examination will show that both are fre- quently affected. The difficulty is rarely congenital, but often develops during the "teething time" in children, in consequence of some nervous irritation. Whooping-cough, measles, scarlet fever, and other infantile diseases often derange the nervous system so as to give rise to squinting after the disease passes away. The operation for cross-eye is a very simple one, and when skillfully performed effects a perfect restoration of the sight and personal appearance. Fig. 60. THE CONJUNCTIVA. The conjunctiva is the name given to the mucous tissue that lines the lids and covers the front portion of the eyeball. In the normal condition it is bathed with tears, and thus admits of the free motion of the eye without irritation. This membrane is liable to be the seat of severe inflammations which constitute by far the larger proportion of all diseases of the eye. Many writers speak of six or seven different forms of the disease, but there are properly only four that require any special attention. These are commonly spoken of as simple, chronic,purulent and granular. Simple Conjunctivitis.-Simple conjunctivitis is the mildest form of inflammation that attacks the conjunctiva. It is recognized by the filling up of the minute blood-vessels CHRONIC CONJUNCTIVITIS. 565 so that they can be distinctly seen; by an increased secretion of tears, and by an uneasy feeling in the eye, as if sand or dust had lodged between the eyeball and the lids. These symptoms may be caused by a slight injury in the region of the eye, by particles of dust, by a cinder or bit of steel lodging in the cornea, by riding in a cold wind, or by the contact of smoke'and irritating vapors. In the treatment of this simple inflammation, the first thing to be looked to is the removal of the exciting. cause. To effect this object the reader is referred to the remarks on the hygiene of the eye, on page 554. After this is done the eye should be bathed in cool or tepid water for a few minutes, and then kept closed for a short time. As an eye wash the following will certainly relieve'this inflammation in a day or two: Hydrastin, 5 grains; Powdered Borax, 3 grains; Mor- phine, 1 grain; Rose water, 1 ounce. Mix and filter, and drop 3 or 4 drops in the inflamed eye three or four times a day. If the exciting cause cannot be removed, or if the irrita- tion increases till a severe acute inflammation is produced, surgical aid should be sought without delay. As this condi- tion develops, the eye becomes intolerant of light and should be protected by means of a shade. Tight bandages, wet compresses bound on the eye, and poultices of all kinds, are highly injurious, and should be avoided in all diseases of the eye. Chronic Conjunctivitis.-Chronic inflammation of the conjunctiva is never met with except as a sequence of an acute inflammation. Where the acute disease has been neg- lected or improperly treated, the chronic form is gradually produced, and the patient becomes a constant sufferer. This condition is recognized by the red and thickened appearance of the edges of the lids, redness and fullness of the folds of the conjunctiva (fleshy appearing bodies) in the inner corner of the. eye, stiffness of the lids, a feeling as of sand in the eye, watering of the eyes when exposed to a bright light or wind, and an accumulation of matter on the lashes and in the corners of the eyes, particularly during THE EYE AND ITS DISEASES. 566 sleep. In addition to these symptoms the sight becomes weak and is often permanently impaired. With proper attention to any acute inflammation this chronic condition can be entirely avoided, but persons who are so unfortunate as to be afflicted with chronic conjuncti- vitis, should* place themselves under proper treatment without delay. In addition to the wash just recommended, the lids should be turned over and their under surfaces touched with Powdered Sesquicarbonate of Potash. A small camel's hair brush is dampened and dipped into the powder, it is then gently pressed against the mucous surface of the everted lid, raised and again applied in another place, till the whole sur- face is touched with the powder. In about half a minute the surface of the lids should be washed off with a stream of tepid water from a small syringe. This application should be made twice a week. Purulent Conjunctivitis.-Purulent conjunctivitis is a violent inflammation of the conjunctiva, which soon extends to the whole eye. It is due to the irritation of some specific poison, which may be communicated from an old ulcer, or other sore, or from the mother at the birth of a child. We also find this disease becoming epidemic at times, and sweep- ing over a large extent of country. The symptoms are similar to those of simple conjuncti- vitis, only much more violent and rapid in their progress. The entire eye becomes involved, sight becomes impossible in a very short time, and a profuse purulent discharge escapes from between the lids. Neglect of these cases is often fol- lowed by a destruction of the eye in a few days. Prompt and energetic treatment is therefore required, and the inex- perienced should not tamper with such cases. Granular Conjunctivitis ^Trachoma).-Granular con- junctivitis, or granular lids, is a very common and annoying disease. Thousands suffer with this condition of the lids for years and finally lose their sight, all through neglect, when a proper treatment might have cured them. These granulations never occur except as a sequence of the diseases of the conjunctiva just described. At first they GRANULAR CONJUNCTIVITIS. 567 appear as very minute bodies designed by nature to heal over the conjunctiva, but in consequence of the continued irrita- tion they increase in size, become hard and prominent, pro- duce a great thickening of the lids, and keep up a constant irritation of the cornea, which soon results in serious disease of that tissue and consequent loss of sight. Fig. 61. Fig. 6l shows the lids everted and the appearance of their inner surfaces in granular lids, as well as the method of mak- ing applications to them with a brush. The treatment of granular lids must be first directed to the removal of the granulations. If they are not severe, the Pow- dered Sesquicarbonate of Potash, should be used as recom- mended on page 566 for chronic conjunctivitis. Some cases will require to have the granulations scarifyed or shaved off with a sharp knife, before any improvement can be effected by treatment. The following ointment will also be found valu- able : Yellow Oxide of Mercury, 8 grains; Tincture of Aconite, 10 drops; Vaseline, 1 ounce. This must be so thoroughly mixed in a mortar, that no small particles can be seen or felt in the mass. A small portion of this ointment should be in- troduced into the eye by drawing down the lower lid and placing the ointment upon it with a brush. The lid is then released and the ointment is spread between the lids and ball 568 THE EYE AND ITS DISEASES. of the eye, by rubbing the closed lids over the ball with the fingers. This application should be made every night at bed time. If decided improvement is not noticed in a short time a surgeon should be consulted before the cornea becomes involved, and sight impaired. PTERYGIUM.-The term pterygium is applied to a thick- ened growth of a portion of the conjunctiva, that extends from the angle of the eye toward the cornea. It is usually seen on the inner side of the eye, and often extends over part of the cornea, and thus interferes with the sight. It has the appear- ance of a fleshy growth, is tri- angular in shape, with the base toward the angle of the eye, and often attains such a $ize as to produce a deformity, as well as to affect the sight. This growth can be removed by a slight operation, the first step of which is represented in Fig. 62. The ligatures represented in the cut are tied over the growth, and it thus becomes strangulated and disappears in a short time. Fig. b2. THE CORNEA. The cornea constitutes the anterior, transparent sixth of the firm tunic that gives shape to the globe of the eye. It is the window of the eye, so to speak, and its transparency is absolutely necessary for perfect vision. It is, therefore, of great importance that we understand the nature and treat- ment of the diseases of this tissue that tend to produce an opacity, and thus impair or destroy sight. Inflammation of the Cornea.-Keratitis or cor- neitis are both terms applied to inflammation of the cornea. When an inflammation sets in, the cornea loses its brilliancy and transparency and becomes hazy, and little blood-vessels THE CORNEA. 569 may be seen to start from the outer edge and extend toward its centre, vision becomes dim, the pupil contracts, there is an intolerance of light, an increased secretion of tears, and con- siderable pain. This disease may come on as the result of an injury to the cornea, or may occur as a primary affection in persons ol a weak and debilitated constitution. It is also produced by the contact of foreign bodies, chemical vapors, and inverted lashes; but it occurs far more frequently as a sequence of con- junctivitis and granular lids. Sometimes an inflammation of the cornea may only last a few days, and terminate in its restoration to a normal condi- tion. At other times it may run an acute and rapid course, and terminate in an ulceration and abscess. An abscess of the cornea often softens the whole tissue, till finally it bursts and vision is destroyed. Again it may result in various deformities that impair or destroy the sight in a short time. Ulceration of the cornea necessarily destroys part of the tissue, thus leaving a sore on the cornea similar to an old ulcer on the leg. This ulcer has a tendency to eat the tissue away, and if not arrested in its progress will soon perforate the whole thickness of the cornea, and finally destroy the sight. Ulcers, however, often heal without treatment, but they leave the cornea opaque, and consequently the sight remains impaired. Opacity of the Cornea.-An opacity of the cornea is that condition that renders it impossible for the rays of light to pass through it. It is characterized by a white appearance of the front part of the eye, which is usually spoken of as a "film on the sight." Many persons erroneously call it "ex- ternal cataract." Opacity results from the healing of a corneal ulcer, from the continued irritation of inverted lashes rubbing on the cornea, and from the irritation of chronic conjunctivitis and granulated lids. The last of these causes is, however, the most common one, and more eyes are permanently destroyed by it than by all others combined. 570 THE EYE AND ITS DISEASES. The large majority of cases of opacity of the cornea can be cured; and even where vision is almost lost it can be re- stored by a proper course of treatment. It however, requires the constant attention of the oculist, as the conditions are such that neglect or improper treatment may result in loss of sight. THE IRIS. The iris is the dark curtain of the eye that surrounds the pupil. It is made up of circular and radiating muscular fibres, the former of which contract and the latter dilates the pupil. This action regulates the amount of light admitted to the in- terior of the eye. This membrane is liable to inflammation, but it is not often that an inexperienced person can distinguish between it and inflammation of other parts of the eye. As a result of inflammation of the iris the pupil is some- times obliterated. This destroys sight, as no light can pass into the eye, and to remedy the difficulty, an operation must be performed. CATARACT. Cataract is a term used to denote an opacity of the crys- talline lens or its capsule. It may be partial or complete, and the sight is diminished in proportion to the degree of the opacity. The first symptom of cataract is a gradual diminution of the power of vision, particularly in a bright light. This may continue for some time before any defect of the lens can be detected by a casual examination, but an experienced ob- server can readily recognize it by a proper examination, at a very early stage. As the disease advances, the cloudy or white appearance of the lens can be seen behind the pupil, while the cornea retains its normal lustre and transparency. As the white appearance behind the pupil increases, vision becomes less distinct, till it is finally lost. The white spots often seen on the cornea are not cataracts, as many suppose, and must not be mistaken for them. THE OPTIC NERVE. 571 Instances occur where children are born with cataract, and these cases are described by writers under the head of congenital cataract. They are often unrecognized for years, and are afterward operated on with perfect success. Cataract often results from an accident to the eye, in which the lens or its capsule sustains injury. These cases develop rapidly, and are often attended with other complica- tio.ns that render the results of an operation doubtful. Cataract is most commonly met with in persons over fifty years of age. It usually appears in one eye first, and, after developing there for some time, similar changes begin to affect the other eye. All attempts to remove cataract by medicines have proved futile, and he who strives to persuade the public that such can be done, may at once be set down as an impostor. True, the pupil may be dilated with atropia, and more light admitted to the eye for a time, but such a step can accom- plish nothing toward removing the cataract. A surgical operation is the only means that can be adopted for restoring the sight after the development of cata- ract. Several methods of operating have been tried from time to time, but the entire removal of the lens is now invari- ably resorted to by all advanced surgeons, as the only one that offers satisfactory results. THE OPTIC NERVE. The optic nerve is the special nerve of sight, and it is along its course that all impressions are conveyed from the retina to the brain. After it enters the globe of the eye it spreads out into a great number of minute filaments. These are connected by a delicate membrane or tissue that has pre- viously been described as the retina. The retina is liable to inflammation, and to be detached from the choroid coat of the eye. Both these difficulties re- quire an examination with the ophthalmoscope before they can be recognized, and this can only be done by an experienced surgeon. 572 THE EYE AND ITS DISEASES. THE CHOROID. The choroid coat of the eye is situated between the sclerotic and the retina, and has a layer of black pigment for the absorption of the light and the consequent prevention of reflection of light in the eye. It is sometimes the seat of inflammation, but the morbid process established is usually so complicated that none but experienced oculists can detect it. GLAUCOMA. Glaucoma is a term applied to a defect of vision which modern science has demonstrated to be the result of an in- flammation involving all the coats of the eye, and producing morbid changes in the cornea, vitrous humor, and lens. This name was derived from the sea-green reflection from the interior of the eye, observed in this affection, and does not convey any idea of the true nature of the disease. This is a very serious difficulty, and speedily results in the destruction of sight. An operation will sometimes arrest the disease and save the eye. AMAUROSIS. Amaurosis is a term commonly used to indicate gradual loss of sight from changes in the deeper structures of the eye. It is a very indefinite term and may result from entirely differ- ent conditions. It is a name commonly applied to defects of the optic nerve, but is frequently used by the physician when he is at a loss to know what name to give to an affection of the eye producing blindness. This condition seldom occurs excepting after great ner- vous prostration, or following diseases of the brain in which there is some brain lesion involving the origin of the optic nerve. After a severe and protracted illness there may be impaired vision for some time, but the sight will usually im- prove with the general strength of the patient. TEST TYPES. 573 TEST TYPES. These types should be used as recommended on pages 558 and 559. A person who can read the No. 2 type as near as eight and as far off as twelve inches from the eye, and No. 20 at a distance of twenty feet, has normal vision. If this can- not be done, each eye should be tested separately and the results written down. No. I. W» again turn from the «tete of Bolton, to the invasion oi Canada. wh>ch at that time shared the anxioua thoughts of Washington Hi# last accounts of the movement* of Arnold left him at Point Levi. opposite to Qurbec Something brilliant from that daring offlrer was anticipated. It wu hm intention to cross the river immediately Had he dour so. hr might have carried the town by a coup da. mam for tenor as well as disaffection prevailed among thr inhabitants At Poiul Levi, however, hr was brought to a aland not a* No- 2. We again turn from the siege of Boston to the invasion of Canada, which at that time shared the anxious thoughts of Washington. His last accounts of the movements of Arnold left him at Port Levi, opposite to Quebec Something brilliant was anticipated. It was bls intention to cross the river immediately. Had he done an. he might « No. 3. We again turn from the siege of Boston to the irfv&sion ui CtAtada. which at that time shared the anxious, thoughts of Washington His last accounts of the movement* of Arnold left him aa Port Levi, opposite to Quebec. Something brilliant from that daring officer waa anticipated. It wax his intention to cross the river No. 4. Immediately. Had he done so, he might have carried the town by a coup de main. Cor terror as wHl as disaffection pievalled among the Inhabitants. At Port Levi, however, he was brought to a stand; not a boat was to be found there. Letters which he had despatched No. 5. some days previously, by two Indians, to Generals Schuyler and Montgomery, had been carried by his faithless messengers to Carambe, the Lieutenant-Govei nor, who thus appr sed of the impending danger, had caused all the boats of Point Levi to be No. 6. either removed or destroyed. Arnold was not a man to be disheartened by difficulties. With great exertions he procured about forty birch canoes from the Canadians and Indians, with forty of the latter to 574 THE EYE AND ITS DISEASES. No. 7. navigate them; but stormy winds arose, and for some days the river was too boisterous for such frail craft. In the mean time the gairison at Quebec was gaining strength. Rereuits arrived from Nova Scotia. No. 8. The veteran Maclean, too, who had been driven front the mouth of the Sorel by the detachment under Brown and Livingston, arrived down the river with his corps of Royal No. 9. Highland Emigrants, and threw himself into the place. The Lizard frigate, the Hornet sloop-of-war, and two armed schooners were stationed in the river, and No. IO. guard-boats patrolled at night. The prospect of a successful attack upon the place was growing des- perate. On the 13th of November, Arnold received No. II. intelligence that Montgomery had captured St. John. He was in- stantly roused to emulation. His No. 12. intelligence that Montgomery had captured St. Johns. He was in- stantly roused to emulation. His TEST TYPES. 575 No. 17. with the first division,prin- No- 18- Schooners were No 19 Schooners No. 20. eort CHAPTER XV THE EAR AND ITS DISEASES. A knowledge of the structure and function of the ear is essential to even a general understanding of the conditions that give rise to deafness. Nearly all of the diseases of this organ occasion more or less impairment of hearing, which, though simple at first, may soon become permanent and complete. It is therefore important that the people should make themselves sufficiently familiar with the conditions of the ear in health and disease to enable them to guard against the approach of deafness. To do this the anatomy, physiology and hygiene of the ear must first be studied, and then the symptoms of the various diseases can be better understood. ANATOMY OF THE EAR. For the sake of description, anatomists divide the ear into three portions, viz.: the external, middle and internal. These parts are shown in Fig. 63, which represents a vertical section of the ear. The external ear has a broad expansion, composed mostly of fibro-cartilage covered by a thin skin, to which the ANATOMY OF THE EAR. name auricle is applied. In the interior of this portion, sit- uated in front of the broadest part of the expansion, an open- ing may be seen leading to a canal. This opening is called the external auditory meatus. The canal to which it leads is about an inch in length and tortuous in its course, (Fig. 63) 577 Fig. 63.-Vertical Section of the Ear. I. external auditory canal; 2, drum of the ear; 3, 4 5, the chain of three bones stretching across the mid- dle ear, popu- larly called the hammer, the anvil, and the stirrup; 7, part of internal ear called the semi- circular canals; 11, 12, another part of internal, ear, called the cochlea or shell; 13, auditory nerve; 14, Eustachian tube leading from the throat. Fig, 6g. and is called the external auditory canal. This canal is lined with skin, which is supplied by a great many little glands for the secretion of a wax-like substance, called cerumen. There are also numerous projecting hairs situated around the meatus, which, with the wax, aid in excluding foreign matter which would otherwise interfere with the function of hearing. The inner extremity of the external auditory canal is closed by the membrana tympani, or " drum of the ear," (2 Fig. 63) which completely separates the external from the middle ear. This membrane is funnel-shaped, and is thin and translucent. It is composed of three layers, and is so arranged that it is alternately tightened and relaxed by the action of two small muscles, called respectively the tensor and laxator tympani. The middle ear, or tympanum, is situated deeply in the temporal bone, and is thus protected from injury. It measures 578 THE EAR AND ITS DISEASES. about one-sixth of an inch from the" drum of the ear" inward, and about half an inch in breadth and height. It is lined with a mucous membrane, and is connected with the throat by a canal called the Eustachian tube (14, Fig. 63). Through this tube a current of air passes to the middle ear at every act of swallowing, which is necessary for the proper function of the ear. Stretching across the cavity of the middle ear is a chain of three small bones (3,4, 5 Fig. 63), so arranged that, by the action of muscles attached to them, they move upon each other. One of these bones is lodged against the inner surface of the " drum of the ear," and another against a por- tion of the internal ear. The internal ear is more deeply seated in the temporal bone than the middle ear. It contains the entire distribution of the auditory nerve (13 Fig. 63) the special nerve of hearing. Anatomists divide it into the labyrinth and the internal audi- tory meatus; and the labyrinth is again divided into the ves- tibule, semi-circular canals and cochlea. The structure of these cavities is very complicated. The auditory nerve is so distributed to them as to receive the im- pressions of sound to be conveyed to the brain in the same manner as the impressions of light are received by the retina. The internal auditory meatus receives the auditory nerve which is distributed to the internal ear. PHYSIOLOGY OF HEARING. The sense of hearing is dependent upon the vibrations of the atmosphere and the existence of an auditory apparatus. The physiology of hearing is as interesting as it is wonderful, and will now be briefly described. The broad expansion of the external ear collects and aug- ments the vibrations of the air, and these sonorous vibrations are reflected into the external auditory tube until they reach the membrana tympani, or " drum of the ear." This delicate membrane is moved by the influence of these vibrations, and the motion is communicated from the first to the second bone, and from the second to the third. The third bone is then moved upon the oval opening of the internal ear, thus throwing THE HYGIENE OF THE EAR. 579 a somewhat movable liquid into motion. The motion of this liquid upon the delicate nervous tissues that line the cavities of the internal ear makes an impression which is conveyed by the auditory nerve to the brain, thus creating sound. Air must be freely admitted through the Eustachian tube to the middle ear in order to allow of the free motion of the " drum" and the chain of bones; and the external tube must be free to admit the vibrations of the air to the " drum." The "drum" must also be intact, and free from any irritation or disease, to admit of its natural motion. THE HYGIENE OF THE EAR. It is not often that the medical profession are called upon to caution people against efforts at cleanliness. In regard to the proper-management of the ear, however, so much ignor- ance prevails that we feel called upon to caution the public against the prevailing notions regarding the cleansing of the ear. No effort of ours is necessary to keep a healthy ear clean. Nature does that by means of the wax that forms in the ear. When the secretion of wax is normal, it dries up into thin scales, and these peel off gradually and fall out imperceptibly, leaving the surface behind them perfectly clean and smooth. Now, if we attempt to clean the ear by brushes, sponges &c., we are sure to do mischief that is not easily overcome. The following rules in regard to the proper care of the ear, if observed, will do much toward averting many annoying difficulties: First: Washing of the ear should extend only as far as the fingers can reach. The .corner of a towel, screwed up, ear sponges and brushes, should never be introduced into the ear, as they are sure to produce irritation of the canal and pack the wax into its inner part. Second: The ear should not be washed out with soap and water, as it keeps the wax soft when it ought to become dry and scaly, unduly increases its quantity, and makes it collect the dust from the atmosphere. 580 THE EAR AND ITS DISEASES. Third: Ear-picks should never be used. If there is any desire to use them, it shows that the ear is unhealthy, and it wants soothing rather than further irritation. Fourth: It is better never to cover up the ears in cold weather, except when exposed to unusually severe storms; but no one should sit or ride with the ear exposed to a side wifid. Fifth: When a person is suffering from a severe cold, with slight deafness accompanying it, attention should be given to reducing the inflammation of the throat, in order to admit of the opening of the Eustachian tubes. Some astringent gargle is desirable for this purpose, and the patient should make repeated efforts to force air into the middle ear, by closing the mouth and nose, and then blowing as if in the act of blowing the nose while making an effort to swallow. This opens up the Eustachian tube and admits air to the middle ear, and thus removes the deafness. Sixth: Strong medicines, oils, &c., should never be dropped into the ear unless by the advice of a competent surgeon. Seventh: Children should never be boxed on the ears, for blows of this kind often force the air into the ear with great violence, and thus rupture the "drum" of the ear. Blows about the head also produce a sudden jar or shock which may result in deafness. Many children are deafened in this way. Eighth: When children cry and complain of pain in the ears, they should be attended to at once. If hot flannels or hop fomentations applied over the external ear do not relieve them, a physician should be consulted, for abscesses often form and occasion serious mischief in a very short time. Ninth: Discharges from the ears after measles, scarlet fever, &c., should be attended to without delay, for, if ne- glected, they frequently result in permanent deafness of one or both ears. Tenth: Whenever a discharge of matter from the ear is noticed warm water should be poured in night and morning to keep it clean. If it does not disappear in a few days, medical advice should be sought. Eleventh: When foreign bodies are in any way introduced into the ear no attempt should be made to remove them with DISEASES OF THE EAR. 581 ear-picks or forceps. They are best removed by an injection of warm water with a common ear syringe. If the injection is repeated a few times the body is sure to be dislodged. Insects may first be killed by a few drops of sweet oil, when their removal is easily effected by the injection. Twelfth: Cold water should never be introduced into the ear, as it produces instant dizziness, and is sure to affect the hearing. It is always advisable even while bathing to pro- tect the ears with cotton. Care must, however, be taken that the cotton is entirely removed after coming from the bath. To insure this a large piece should always be used for each ear. DISEASES OF THE EAR. In giving a brief description of the most common diseases to which the ear is liable, it is not our purpose to lay down any detailed treatment. Should we attempt to do this it might lead to more harm than good, for few persons out of the medical profession would have the appliances, or the skill necessary for the treatment of so important a class of diseases. If, however, we can succeed in making our readers understand the most prominent symptoms of the various diseases, and impress upon them the importance of prompt attention to all affections of the ears, we shall feel as if we had accomplished some good work. The majority of the cases of deafness we meet with might be prevented by proper treatment of the causes that produce them, and many cases of partial or complete deafness can be greatly benefited or entirely cured. The diseases of the ear are divided into three classes according to the anatomical divisions of the ear viz.: those of the external, middle, and internal ear. The first-class includes all affections that attack the ear external to the "drum of the ear;" the second-class embraces those of the " drum," tympanum, Eustachian tube, and the throat adjacent to the opening of the tube; and the third- class embraces those of the labyrinth, and of the auditory nervous apparatus. 582 THE EAR AND ITS DISEASES. Malformation and Injuries.-The surgeon is occa- sionally consulted regarding malformations and injuries of the ear, and each case must be met by such treatment as will apply to the special conditions it presents. The external meatus may be closed, or various tumors maybe found in por- tions of the auricle. The ear may be wounded by blows or torn by ear-rings. Simple operations can always be successfully performed to correct deformities arising from such causes. Accumulation of Cerumen.-In a large number of cases an undue accumulation of hardened wax is the sole cause of a deafness that may have existed for months, and even years. Deafness caused by the accumulation of wax presents characteristic symptoms. The hearing varies; it is better in the morning, or is improved by eating, or, by rubbing the meatus; the deafness often comes on suddenly, and may be increased or diminished by efforts to cleanse the ear with a pick. These symptoms are due to the location of the plug of wax. When it is pressed in against the drum the deafness is increased, and when freed from it the hearing is slightly improved. This accumulation often gives rise to distressing nervous symptoms, such as various noises in the head, giddiness, con- fusion, and unsteadiness of gait. It also excites chronic inflammation of the auditory tube, absorption of the bony walls of the tube, and inflammation and thickening of the "drum." This wax should be removed by syringing with warm water, and the ear should then be treated according to the nature of the complications that may be found to exist. Usually the ear requires syringing with warm Carbolic Acid water, of the strength of 5 drops of Carbolic Acid to the ounce of water. This should be used once a day. At bed time the following should be used: Carbolic Acid 10 drops; Glycerne, 1 ounce; Rose water, 1 ounce. Mix, and fill up the ear with the mixture, on going to bed. ABSCESS OF the Meatus.-The formation of small ab- scesses just within the meatus are frequently met with. They POL YPI. 583 are extremely painful, though not otherwise serious. The pain is of a darting, throbbing nature, and often extends over the entire side of the head during the formation of the abscess. After matter has formed, the acute pain subsides. The hear- ing is temporarily impaired by the narrowing of the canal and the severity of the pain. When these symptoms manifest themselves relief is best obtained by the use of hot poultices and fomentations to the external ear. In some cases lancing of the abscess is abso- lutely necessary to save the patient from days of great suffer- ing. Inflammation of the External Tube.-Inflamma- tion of the canal leading to the " drum" is often met with. It may be confined to a small compass, or may extend over the entire surface of the canal. The symptoms are less acute than those of abscess, and the pain is of a dull, aching char- acter. A continual discharge is thrown off from an ulcer in the canal, and care should be taken to allow the matter to escape from the ear. All such cases should be promptly cared for by a surgeon. Inflammation of the Membrana Tympani.-The "drum of the ear," is frequently the seat of inflammation, either acute or chronic. The inflammation may be so slight as only to produce a sense of uneasiness inside the ear, or it may be so great as to entirely destroy the hearing and occa- sion violent buzzing noises in the head. The extent and nature of these inflammations are such that they cannot be fully considered in these pages; but treatment should never be neglected when any symptoms of deep-seated uneasiness are felt in the ear. Extensive ulceration and rupture of the "drum" fre- quently follow this inflammation, and in many cases the drum is entirely destroyed through neglect of proper treat- ment. POLYPI.-Polypi are little tumors that develop in the ear, and by filling up the cavity cause deafness. They commence 584 THE EAR AND ITS DISEASES. most frequently from the inner surface of the drum, but are also found starting from the walls of the middle ear. In either of these cases they rupture the " drum" of the ear by their pressure, and thus escape into the external auditory canal, where they continue to grow till they can be seen at the meatus. Other kinds again start from the walls of the external canal, and cause deafness from closing the canal, without affecting the "drum." In any variety of polypus there is a considerable discharge of matter, which has usually an offensive odor. Constant noises in the ears and often severe pain in the whole side of the head, are usual attendants on these growths. These tumors should be removed by operation, and the complications treated afterward as they present themselves. Obstructions of the Eustachian Tube.-Deafness often results from obstructions of the Eustachian tube, such as prevent the free passage of air to the middle ear. These ob- structions are usually due to inflammations that begin in the throat and extend to the mucous membrane of the tube. The deafness in these cases is considerable, but most of them can be speedily cured by simple procedures on the part of the surgeon. Cases of this kind are more common before middle age than after it; and the patient can have some idea of the nature of the deafness by the following: With the nose and mouth closed tightly, the patient should make an effort as if to blow the nose, at the same time that he swallows some water previously taken into the mouth. If the Eustachian tubes are obstructed, there will be no sensation of fullness or pressure in the ears, if not, a sensation of pressure against the drums can be distinctly felt. If no fullness is thus felt, it is presum- able that the deafness is due to obstruction of these tubes, and an aurist should be consulted at once. Affections of the Tympanum.-The tympanum, or cavity of the middle ear is liable to inflammations, the de- posits of membranous bands, rigidity of its mucous membrane great thickening of the inner coats of the drum of the ear, and diseases of the small bones that stretch across the cavity. NERVOUS DEAFNESS. 585 These affections are all complicated, and seriously affect the hearing. Their nature and symptoms cannot be satisfactorily explained in the narrow limits of a popular treatise, but the public should understand that impaired hearing in these and other affections of the ear may soon be followed by perma- nent deafness if the proper treatment is neglected or delayed. Affections of the Inner Ear.-A number of com- plicated affections are met with in the labyrinth of the inner ear, that can only be understood by one who is thoroughly familiar with the anatomy of the parts involved. These re- quire careful examinations to detect them, and skill and experience to treat them successfully. Any candid surgeon will give these cases the attention they require without try- ing to deceive his patients. Nervous Deafness.-Various affections of the nervous system produce deafness by the special influence exerted on the auditory nerve. Old persons become deaf from a gradual paralysis of the special nerve of hearing. In cases of this kind, attention must be given to the nervous condition from which the patient is suffering. No special treatment of the ears is necessary in the majority of these cases. In deafness from paralysis of the auditory nerve the proper application of electricity is often highly beneficial, and even in deafness from other nervous affections it often proves the most efficient remedy the surgeon can command. Discharges from the ears and noises in the head are often present as sequences or symptoms of the various diseases just described. They are often annoying to the patient, and their continuance is productive of much mischief. The sufferer should always consult a surgeon as early as possible, and have the cause of these annoyances ascertained and removed, if possible, and thus prevent deafness. Delay in all cases of ear diseases is extremely dangerous; for simple affections, that can be readily cured at first, often extend so as to produce such changes in the hearing apparatus as to defy all treat- ment, and leave the sufferer deaf for life. Surgical Diseases and Accidents. CHAPTER XVI. GENERAL SURGERY. The numerous diseases and accidents usually classed under the heading of surgery cannot be satisfactorily des- cribed in a popular work. Many of them are obscure and cannot be easily recognized, while others require surgical operations for their relief that can only be performed by the expert anatomist and experienced surgeon. There are, how- ever, many conditions in which home treatment may be employed with advantage; while in a large class of surgical diseases a popular knowledge of the causes that develop them and the symptoms that indicate their approach may prevent much suffering and deformity. In this chapter we shall consider such diseases and injuries as may affect the general system, or are not confined to any particular part of the body. Such home treatment as can be employed will be given in full, and when operations are required, their importance and probable results will be frankly stated. ABSCESS. 587 INFLAMMATION. All the organs and tissues of the body are liable to be attacked by inflammation, and this condition constitutes many of our most severe diseases. In surgery we have, how- ever, only to deal with inflammation resulting from injuries, or attending diseases that require surgical operations for their relief. By inflammation is meant an increased circulation of blood in the capillary vessels, which extends to the escape of the watery portion of the blood into the surrounding tissue. It is always excited by some irritation of the nerves of the affected part, and is recognized by the presence of pain, heat, redness and swelling. It is divided into acute and chronic inflammation. The former develops rapidly, runs its course in a short time, and terminates in the restoration of the part to its normal condition, or in its destruction, while the latter is slower in its progress, and may continue for a long time, before terminating in either way. Treatment.-If the cause of the inflammation can be ascertained that must be removed as the first step in the treatment of the disease. When the symptoms first appear, cold applications, as cold water or ice bags, will be found the most serviceable; but if the part is much swollen and very red, hot applications must be used. Perfect rest of the af- fected part and the horizontal position must also be enforced. With the view of relieving pain and controlling the febrile symptoms that are often present, Fluid Extract of Gelsem- ium may be given in 5 drop doses, and repeated every half hour, till the patient is relieved, or till six or eight doses are taken. If these means do not relieve a surgical inflammation a surgeon should be sent for before serious complications develop. ABSCESS. When a deep-seated, throbbing pain is felt during the progress of an inflammation, it indicates the destruction of 588 GENERAL SURGERY. tissue, which will soon result in the collection of matter in a cavity, called an abscess. When the matter forms, the throb- bing pain is much relieved, but will not entirely cease till the abscess is opened or breaks and the matter is allowed to escape. When near the surface, an abscess causes a swelling of the affected part, which is soft to the touch, and easily made to fluctuate by pressure. Treatment.-Much suffering may be prevented by making a free cut into the inflamed part as soon as the deep-seated, throbbing pain is felt. This treatment at once relieves the pain, and prevents destruction of tissue, and is now adopted by all advanced surgeons. When circumstances are such that a surgeon cannot be reached at once, a large, hot poultice of Flaxseed meal should be applied, and changed often enough to keep the part well heated. This will relieve the pain and hasten the maturing of the abscess. It is al w sys best, however, not to wait till it "breaks" itself, but instead, to have it lanced as soon as pos- sible. After the matter is discharged, the poultice should be continued for a day or two, till the surrounding hardness dis- appears. Then the cavity should be syringed out once or twice a day with a solution of Carbolic Acid, containing 20 drops of the Acid to a gobletful of water; and the opening should be dressed with cloths saturated in the same solution. This treatment should be continued till the part is healed. SEPTICEMIA AND PYEMIA. By the term septicemia is meant a poisoning of the blood by the absorption of the putrid matter from accumulated pus. Pyemia is a term that was introduced by the old writers to designate the same condition of blood poisoning, though at the present day it is applied to blood poisoning associated with the formation of abscesses in different parts or organs of the body. If there is any difference in the meaning of the terms, it is only one of degree and not of kind. The long illness of the late President Garfield made the public familiar with these terms, and in spite of the assertions of the doctors to the contrary, the people know that he died ULCERS. 589 of pyemia, and that the treatment of his case from beginning to end was a disgrace to American surgery. The symptoms of blood poisoning are severe chill, fever, nausea, diarrhea, great prostration, and rapid emaciation; and when these are associated with an open wound or follow the symptoms of abscess, they clearly point to blood poison- ing. Treatment.-Stimulants, tonics, and nutritious foods must be given from the start, and Morphine, or Opium in any form, must not be used. President Garfield always improved when the Morphine was withheld, and the system was thus allowed to throw off the poison. When open wounds are present, these should be treated according to the Antiseptic method described on another page in this chapter. In all cases, the treatment should be directed by a surgeon, but should he insist on giving Opium, the friends of the patient will do well to make a change with- out delay. ULCERS. Ulcers are large open sores in which a destruction of the skin and underlying tissues has resulted from a severe inflam- mation. They are called acute when they retain the pain, heat and redness of the inflammation that causes them, and are inclined to spread; and chronic when they become slug- gish and refuse to heal, and present a livid color of the skin surrounding them. Old ulcers are often met with on the legs and other portions of the body, and may remain discharging for years. The popular notion that such sores serve as a drain to the system, which would, if arrested, give rise to consumption or some other disease, is a fallacy that was born of ignorance, and must not be credited by intelligent people. Treatment.-For the successful treatment of ulcers, abso- lute rest in the recumbent position is essential. In a recent case, hot poultices should be applied for twenty-four hours, while in chronic cases they should be continued for three or four days, with the view of softening the surrounding parts. GENERAL SURGERY. 590 The Antiseptic dressings described below should then be applied, and continued till the ulcer is healed. MORTIFICATION, OR GANGRENE. Mortification means the death of a part. It not infre- quently follows a high grade of inflammation, and is some- times caused by too tight bandaging in the treatment of fractures. The symptoms are swelling of the part, heat, intense pain, marked discoloration of the skin, and finally a loss of sensa- tion and coldness. If the toes or fingers present these condi- tions after the dressings of a fracture have been applied, the friends should loosen the dressings at once and then send for the surgeon. In old persons the small arteries are frequently obstructed by earthy deposits, and thus the supply of blood is cut off from the extremities. This gives rise to a slow inflammation which soon terminates in a gradual death of the toes or fingers. These cases are serious, and as a rule, result in the death of the patient in a short time. The treatment of these cases can only be conducted by the surgeon. ANTISEPTIC DRESSINGS. The theory on which the antiseptic treatment is based may be briefly stated in a few words. The air is filled with minute living organisms. These deposit themselves in an open sore or wound, and cause an irritation which keeps up the discharge of matter, and prevents or retards the healing process. These organisms are called septic germs, or germs causing purification; and the dressings used to destroy them or to prevent their entrance into wounds, are called anti- septic dressings. Many agents possess antiseptic properties, but Carbolic Acid has thus far proved the most valuable. The strict anti- septic dressings introduced by Prof. Lister, of London, should always be employed if possible, but modifications of them ANTISEPTIC DRESSINGS. 591 may often be substituted in minor surgical cases with equally good results. The materials that may be employed for the antiseptic dressings, without the aid of the surgeon, are the following: First: Pure 95 per cent. Carbolic Acid. Second : A solution of Carbolic Acid, containing 10 drops of the Acid, to the ounce of water. Third : Lister's antiseptic gauze, which is prepared by satur- ating thin cotton gauze in a hot solution of Carbolic Acid, wax, and paraffin, so that the Acid is retained in the meshes of the cloth. This gauze can be procured, ready for use, at any instrument or drug store. Fourth: A prepared oiled-silk, which is called "the pro- tective." Fifth : Macintosh cloth, commonly used for the inside bands in hats. In treating recent wounds the parts are washed out with the 10 drops to the ounce solution of Carbolic Acid, and then covered with a narrow strip of the prepared oiled-silk dipped in the same solution. A single layer of the antiseptic gauze is then saturated in the Acid solution and laid over the oiled- silk, and over this a pad of eight layers of the gauze is applied dry. The whole is then secured by a bandage, and the dressing is complete. The gauze must extend some dis- tance beyond the wound; and if there is much discharge, a piece of the Macintosh cloth, a little smaller than the gauze, should be placed under the outer layer with the glazed sur- face down, to prevent the dressings from being wet through. When an ulcer is to be treated, the surface should be thoroughly dried, and then the pure Carbolic Acid should be applied with a pine stick till every point is touched. The dressings are then applied as just described. When old fissures or cavities are to be treated, a solu- tion of 20 drops of Carbolic Acid to the ounce of water should be injected into them first, and the dressings afterward ap- plied as described above. The pure Acid, or the strong solu- tion, should only be used before the first dressings, unless the parts look unhealthy and require stimulating. 592 GENERAL SURGERY. These dressings should be changed once in twenty-four hours, and Prof. Lister recommends that this should be done while a spray of Carbolic Acid water is being thrown on the part. As this can only be properly used by the surgeon, the part can be washed with a stream of the weak solution of the Acid, just as the first parts of the dressing are being applied. Under this treatment all wounds heal rapidly, and old sores of years' standing, will soon take on a healthy appear- ance and be entirely well in a few weeks. If there is any tendency to the destruction of the new skin, after the part has filled up to a level with the surround- ing skin, the Carbolic Acid dressings may be discontinued, and Borated Cotton used instead. A thin layer of Vaseline should be spread on a sheet of the Borated Cotton and laid over the part. This can be changed daily till the scar is fully formed. WOUNDS. When wounds occur the first thing to be done is to con- trol the bleeding. Then all foreign bodies should be removed, by means of a syringe and water, and the surfaces should be brought together, and retained in position. When this is done the antiseptic dressings, just described, should be em- ployed to secure a union. In gunshot wounds it is important that the surgeon should place the patient as nearly as possible in the position he was in when the wound was inflicted, and then make an effort to find the ball. Had this been done in the case of President Garfield, the fatal mistakes that were made could not have occurred, and he might have been alive to-day. When it is clearly seen that the ball has entered the abdomi- nal cavity no surgeon is justified in probing the wound. After the ball has been removed, the wound should be syringed daily with the weak solution of Carbolic Acid, and a piece of the gauze should be pushed into the orifice to keep it open at the surface till it heals from the bottom. When stitches are not required, wounds are best held together by means of strips of Rubber Adhesive plaster. HOW TO ARTEST BLEEDING. 593 Each strip is first fastened to the skin on one side, and then by gently pulling on the plaster while the opposite side of the wound is pushed toward it, the edges are brought in direct contact, when the other end of the plaster is held against the skin till it sticks. The antiseptic dressings are placed over the plasters, and when these become loose fresh ones should be applied. HOW TO ARREST BLEEDING. The bleeding from a slight wound is easily arrested by bathing the part in cold water, or by applying a slight com- press over the wound. If these means do not arrest it, and it is certain that no large artery is divided, the solution of Per- sulphate of Iron should be applied to the bleeding surface on a piece of cotton, and the cotton may then be bound over the surface of the wound. If a small stream of blood is thrown out in jets, it may be necessary to make firm pressure between the wound and the heart, so as to occlude the di- vided artery. When a large, full stream of bright red blood is thrown out in pulsating jets, it indicates that a large artery has been divided, and prompt measures must be taken to stop the bleeding. Firm pressure with the fingers or thumbs, applied near the edge of the wound, over the point from which the blood comes, may arrest the flow till a surgeon can be called. If this fails, a knot should be tied in the middle of a handker- chief and this placed over the position of the artery between the wound and the heart. The handkerchief is then tied around the limb, and by placing a stick between it and the limb, it may be twisted till the first knot is pressed into the soft parts deep enough to compress the artery. In severe wounds of the arm, with profuse bleeding, it may be best for the by-stander to grasp the upper part of the arm so that the fingers of both hands are in the arm-pit. By pressing the fingers in this position firmly against the bone of the arm, the main artery is compressed, and can thus be held till a handkerchief is applied as above described, or till a sur- geon arrives. When the wound is in the leg, pressure should 594 GENERAL SURGERY. be made with the thumbs in the centre of the front part of the thigh, about two or three inches below the groin. If the leg is drawn well out from its fellow, the outlines of a triangular space can be traced with the base along the groin. The pressure should be made in the centre of this space to prop- erly reach the artery. Wounds in the head or body are not so severe, and the bleeding may .easily be controlled by a compress or by the Persulphate of Iron solution. If the large vessels in the thoracic and abdominal cavities are wounded, the person would bleed to death in a few seconds. TUMORS. A tumor is an abnormal enlargement of any part, struc- ture or organ of the body. The size and shape of tumors vary according to their location and character. Some are very small while others attain enormous size. Tumors are divided into benign and malignant. Benign tumors do not affect the general health except when they attain a large size or press upon vital parts; while malignant tumors are themselves capable of destroying life. These latter are popularly called cancers, and will be described under that heading. Whenever any kind of tumor is noticed, a surgeon should be consulted to ascertain its character. If it can be clearly diagnosed as belonging to the benign class, it need not be interfered with unless it attains a large size. It is always the safest, however, to have all tumors removed by operation as soon as they are discovered. Such operations, when performed early, are usually simple, and they guard against all possibility of serious complications in the future. CANCER. The term cancer is improperly applied to all malignant tumors. It was first used when it was supposed that these growthshad roots resembling the claws of the crab. It is now CANCER. 595 definitely proven that such roots do not exist, and those who assert to the contrary are either ignorant or striving to deceive. Any portion of the body may be affected by cancer, but it is most commonly met with in the breasts, lips, womb, and rectum. Several varieties are recognized, and all prove fatal if not treated in the early stages of the disease. It has long been claimed that cancer was a blood disease, and that it was usually hereditary. We have taught for years that it was, at first, local in its character; that it was caused by some injury to the part affected, and that it became consti- tutional as a result of the absorption of the poison into the system. This theory is rapidly gaining ground, and has already been adopted by many leading surgeons in Europe and America. The hard, or stone, cancer is the most commonly met with. It usually begins as a small, hard lump, with occasional darting, shooting pains extending from it in all directions. It soon begins to increase in size and hardness, till it finally attains considerable dimensions After a time it becomes adherent to the surrounding parts, the integument becomes hard and purplish, the glands in the neighborhood are en- larged, and the pain becomes severe and continuous. If the disease is located in the breast, the nipple is drawn in soon after the hard lump is discovered, and in a short time the glands under the arm become enlarged. In periods ranging from six to eighteen months the tumor breaks down and becomes an open, running sore. The interior of the tumor usually softens before the integument is broken, and it is at this time that the poison is absorbed into the blood, and the disease becomes constitutional. Now the patient loses flesh and strength rapidly, the face is sunken, and the skin assumes a yellowish gray color. The soft cancer, commonly called the rose cancer, de- velops more rapidly than the hard, is attended with less pain, affects the system sooner, and when it breaks down is liable to frequent and copious discharges of blood. 596 GENERAL SURGERY. Cancer of the lip usually begins as a crack in the mucous surface or integument, which shows no tendency to heal. The parts around it soon become hard, and the slightest pressure causes a darting pain. An ulcer next develops, the disease spreads rapidly, and will soon attack the glands under the tongue and also the bone. Cancer of the womb is characterized by a dragging sen- sation in the pelvis, and pain in the back and hips, the same as in other diseases of the womb. These are soon followed by the characteristic darting pain, which is occasional at first, but soon becomes constant. When softening takes place the discharge is generally profuse, very offensive, and frequently mixed with considerable blood. When cancer attacks the internal organs, the character of the pain is the only early symptom we have to guide us in diagnosis, but as the disease advances the constitutional dis- turbances cannot be mistaken by an experienced surgeon. Treatment.-A tumor that is attended by darting pains, or an open crack or ulcer that refuses to heal requires im- mediate attention. A surgeon should be consulted as soon as a tumor is discovered, and if any of the symptoms of cancer can be detected, the morbid growth should be removed. In spite of all that has been said to the contrary the knife is the surest method of relief. By this means the entire tumor is removed at once, and there is nothing left but a sim- ple wound to heal. The reason so many bad results have fol- lowed the use of the knife is that the operations are usually delayed too long. The use of plasters and caustics in the treatment of cancers does more harm than good. We believe that these methods of treatment, rarely, if ever, cure cases of genuine malignant tumors, while they often hasten their development, and always cause the patient much suffering. Cancer doctors call every little tumor or pimple, " cancers," and when they apply their plasters to these, they usually succeed in slough- ing them out, and then obtain certificates of having cured a cancer. The only way to insure success in the treatment of cancer is by the removal of the tumor so that no poisonous CANCER. 597 matter can come in contact with the surrounding tissues to be absorbed. This can only be done by the early use of the knife. Traveling doctors usually advertise that they treat can- cers without the use of the knife and without pain. As a rule they are incompetent men, without experience or skill, whose chief business is to humbug the people. In surgery they are especially ignorant, and their advertisements should be suffi- cient to warm people against consulting them. CHAPTER XVII. SPECIAL SURGICAL DISEASES. In a work devoted exclusively to surgery it would be proper to consider in separate chapters the various diseases and injuries that affect each of the tissues and organs of the body. In a work on domestic medicine such a plan is not practical, and we shall therefore consider, in one chapter, such general facts connected with the most common surgical dis- eases, as will be of service in enabling the people to recognize their presence and to obtain some general ideas as to the nature of the treatment required. DISEASES OF THE BONES. The bones are liable to inflammation, ulceration and death, the same as other tissues of the body. The periosteum, or covering of the bones, may also be affected by similar diseases. INFLAMMATION.-Inflammation of the periosteum and bones is usually produced by direct injuries from falls and blows, or by the inoculation of specific poisons. The symp- toms are severe, deep-seated pain, of a gnawing character; NECROSIS. 599 intense heat in the part; general febrile symptoms; and if the affected bone lies close to the skin, redness and swelling are present. If the inflammation is very severe pus may begin to form, when the pain will become throbbing, and will continue for a long time. Treatment.-Rest and hot fomentations are necessary from the start; and the treatment must be under the direc- tion of a surgeon. CARIES.-The term caries is applied to an ulcer of the bone, which always follows as a sequence of inflammation. The destruction of the bone tissue results in the formation of matter, which gradually works its way to the surface and makes one or more openings in the skin, along the course of the bone. As the ulceration of the bone goes on, the dis- charge of matter from these openings continues, and after a time the condition exhausts the vitality of the patient. If allowed to go on, the bone becomes so diseased that the part affected can be no longer used. An operation, which consists in scraping the bone to re- move all the diseased parts, should be performed, as no other treatment will arrest the progress of the disease. NECROSIS.-By necrosis is meant the death of a large portion of bone. This is also a result of inflammation, and is described as one of its terminations. A large section is sep- arated from the rest of the bone and it thus becomes a foreign body which nature is constantly making an effort to throw off. Pus is formed, works its way to the surface, and escapes through openings made in the skin, similar to those met with in caries. If left to itself, it would require years for nature to throw off the dead bone, and during most of that time the patient is a cripple. The dead bone can be removed by a simple operation, in a few minutes, and with the proper after treatment, new bone is rapidly reproduced and the disease entirely cured. SOFTENING.-Softening of the bones may take place after inflammation, or as a result of a lack of earthy material in the 600 SPECIAL SURGICAL DISEASES. system. This condition is most commonly met with in chil- dren, and it is often present at the birth of the child. When it occurs the bones of the legs bend from the weight of the body, thus producing a condition called bow-leg. Rickets is a similar condition to softening, but in this disorder there is a deficiency of the animal as well as the earthy matter in the bones. When deformity has been developed it should be over- come by a proper surgical appliance attached to the shoe, as represented in Fig. 64. In addition to this, attention must be given to the diet. Rare beef and mutton will probably supply the required ingredients better than any other kind of food, but a general meat diet is de- sirable. In the way of medicines, the Syrup of the Lacto-Phosphate of Lime, given in tea- spoonful doses three or four times a day, will materially aid in hardening the bones. TUMORS.-The bones are liable to be the seat of various kinds of tumors, includ- ing cancers. The presence of these conditions soon becomes apparent, when the surgeon should be consulted without delay, so that their nature and best mode of treatment maybe decided on. Fig. 64. FRACTURES. A fracture is a broken bone, and it may be produced by external injuries or by muscular contractions. The ordinary symptoms of fracture are deformity, a grating noise at the seat of the injury when the part is moved, sharp cutting pain on motion, preternatural mobility where no motion should be present, and an inability of the patient to move the injured part. When these symptoms are present immediately after an injury, they point conclusively to the occurrence of frac- ture, and a surgeon should be sent for at once, so that the bones may be restored to their normal positions and fastened there with appropriate dressings before inflammation sets in. SPRAINS. 601 If a surgeon cannot be obtained at once, the patient should be placed on a board or shutter, with the injured part in the most comfortable position possible, and thus conveyed to his home. ' After a fracture has been set and the splints applied, neither the . patient nor his friends must tamper with the dressings in the absence of the surgeon. If severe pain, fol- lowed by numbness, is felt after the dressings have been applied, the surgeon should be sent for at once. If he can- not be found, and there is any appearance of discoloration of the fingers or toes, it would be proper to loosen the dress- ings, so as to prevent the strangulation and subsequent mor- tification of the limb. This, however, must be done as the last resort, as an officious interference with the dressings often leads to bad results, for which the surgeon is usually blamed.. SPRAINS. The term sprain is applied to a wrenching of a joint in which the ligaments are stretched or torn. Falls, blows, and sudden twists of a joint are the common causes of sprains. When a sprain occurs, severe pain is instantly felt in the joint, there is more or less faintness, and the motion of the joint is impaired or entirely lost. After a short time, es- pecially if the injury is severe, the joint is swollen and the overlying skin discolored. When a sprain is slight the symp- toms gradually subside, and the joint is soon restored to its normal condition; but if severe, it may prove more serious than either a fracture or dislocation. The treatment of sprains requires absolute rest of the injured part, and when the injury first occurs the application of ice bags to the joint will often prevent the development of inflammation. After swelling has taken place, hot fomenta- tions of hops should be used, and the limb must be kept in an elevated position. Beyond this the treatment must be con- tinued under the direction of the surgeon, as serious chronic diseases of the joints are liable to follow improper or neg- lected treatment of sprains. 602 SPECIAL SURGICAL DISEASES. DISLOCATIONS. By a dislocation is meant a forcible separation of the extremities of bones that form a joint. These accidents also occur from direct injuries or muscular contraction. The symptoms that indicate the presence of a disloca- tion are deformity, loss of function, absence of the grating sound heard in fractures, and unusual stiffness of the injured joint. When these symptoms follow an injury, a surgeon should be sent for so that the dislocation may be recognized and reduced before much swelling takes place around the joint. BACKWARD CURVATURE OF THE SPINE. Posterior angular curvature, or Pott's disease of the spine, has long been considered of so-called scrofulous origin, and consequently mechanical treatment was for a long time neg- lected. In fact this notion precluded the possibility of making any advance in our knowledge of the nature and causes of this disease, or the treatment best adapted for its cure. It is now over fourteen years since we first taught the students of Bennett Medical College, Chicago, that Pott's disease and all other diseases of the bones, resulted from some direct local injury to the part involved; that this injury gave rise to inflammation which was in turn followed by some one or more of its sequences; that the constitutional condition resulted from the local disease, and did not give rise to it. Since then we have persistently adhered to this opinion, and have publicly advocated, that too much importance has been, and still is, attached to the belief in the hereditary transmis- sion of disease, per se. Prof. Sayre has long held and advocated this opinion in regard to diseases of the joints, while the profession in general considered them of strumous origin. In speaking of Pott's disease, he says: "With regard to this affection, I have arrived at the conclusion, based upon an accurate and care- fully recorded experience, that it is produced almost always BACKWARD CURVATURE OF THE SPINE. 603 if not always, by some injury to the bone or cartilage, and is traumatic in its origin." Accepting this modern view of the cause of posterior an- gular curvature of the spine, we find that concussions or blows, spending their force on the vertebrae, invariably give rise to the symptoms met with in the first stage of the dis- ease. An injury of this kind usually occasions a disturbance of the ossific centres, which is followed by either an arrest of ossification and subsequent softening, or an active inflamma- tion of one or more of the vertebrae. In the first case the disease progresses slowly, and finally terminates in absorption of the bones involved, while in the latter the inflammatory action runs its course rapidly and terminates in ulceration of the bones and the formation of abscesses. As the bodies of the vertebrae are of a soft spongy texture, they are the most liable to suffer from the results of concussion, and are conse- quently the most common seat of this disease. The interver- tebral elastic cartilages, being also of a soft spongy texture, are involved in the same morbid action. A long time may elapse between the receipt of the injury and the development of the deformity, and constitutional dis- turbances of a serious character may be developed in the meanwhile. The suffering consequent upon the local irrita- tion and the blood-poisoning from pus that fails to find vent, usually reduces the patient before the deformity is recognized, and for this reason it was supposed that Pott's disease was of scrofulous origin. After softening has taken place, the weight of the over- lying portions of the body upon the diseased part causes absorption of the bodies of the vertabrae. As the absorption progresses, the weight of the body causes the bones to press more closely upon each other, and the spinous processes are thus made to project backward, so as to form a marked angular curvature. This disease may occur at all periods of life, but is more common in childhood. Boys are more liable to it than girls, and those accustomed to the rougher forms of sports more so than inactive children. 604 SPECIAL SURGICAL DISEASES. It may result from direct injuries, such as blows upon the vertebrae or from indirect violence, as a concussion of the bodies of the bones from jumping from a height and striking violently on the feet, or falls upon the knees or buttocks. In- vestigation shows, however, that indirect violence is by far the more frequent cause of this disease. Symptoms.-Till a comparatively recent date, surgeons have not been able to arrive at a diagnosis of Pott's disease until a deformity was produced. To form a correct diagnosis we must understand the significance of every symptom, for it is only in this way that we can recognize the early stages of the disease. When the patient complains of difficulty in swallowing, a choking sensation, an irritable and continuous cough and pain in the thorax, with an entire absence of any evidence of disease of the larynx, lungs, or heart, we have reason to sus- pect disease of the cervical vertebrae. When the pain is in the lower part of the chest and in the region of the stomach and liver, with a sense of constriction around the body, ac- companied by indigestion, flatulence and constipation, and pain in the cardiac region, which treatment has failed to relieve, the careful physician should not fail to examine the dorsal vertebrae. Again, when the chief disturbing symp- toms are felt in the rectum and bladder, with a frequent desire to urinate, an annoying tenesmus, and darting pains running down the thighs, we have indicated the possibility of some trouble in the lower part of the spine. Muscular contractions resulting from reflex action may be recognized early in the disease, no matter what part of the spine may be affected. When an examination is made the patient should be stripped naked, and each vertebrae should be carefully exam- ined with the fingers. A considerable degree of soreness will be felt on pressure, at the seat of the disease, long before there is any marked protrusion of the vertebrae. You will observe that in walking, the patient will elevate the shoulders and fix the muscles of the back so as to prevent the move- ments of the bones upon each other, which will at the same time BACKWARD CURVATURE OF THE SPINE. 605 relieve the spine from the weight of the arms. The patient will also reach from one article of furniture to another, while walking across a room, and thereby support himself and relieve the pressure on the spine, and when no other sup- port can be obtained the hands are almost invariably placed on the thighs. The manner in .which a patient stoops to pick up an article from the floor should also be carefully observed. If the shoulders are elevated and the spine fixed, the knees and hips must be bent in a squatting posture, which will allow one hand to reach the floor without bending the spine. When this motion is observed it almost invariably indicates disease ot the bones of the spine. For a further examination it is important to produce some extension of the spine. This may be done by means of the suspension apparatus, or an assistant may support the patient under the arms in such a manner as to take nearly all his weight off the feet. As soon as this extension is made, the difficult breathing and other symptoms are at once re- lieved, but are immediately reproduced as soon as the support is removed. When the cervical vertebrae are involved, the extension must be made from under the chin and back of the head. In whatever way extension is made, there is liable to be more or less spasmodic muscular action as soon the extension is removed. This is due to the direct pressure made upon the nerve trunks at the seat of the disease. When the sides of the bodies of the vertebrae are affected, the symptoms heretofore described are not so prominent, and the disease may make considerable progress before its true character is recognized. It is always important to examine the sides of the vertebrae, by making pressure on the sides of the body, so that the heads of the ribs may be made to press against their articulations with the vertebrae. This gives the patient pain, and thus the key to the difficulty is obtained. Pressure on each rib separately, in the same man- ner, will then enable us to ascertain the exact location of the disease. 606 SPECIAL SURGICAL DISEASES. Paralysis may occur as a sequence of Pott's disease in the lower portion of the spine, and may affect one or both legs. It is due either to the distortion of the spine, or an effusion resulting from the inflammation of the cord and its membranes. One more symptom of disease of the cervical region should not be overlooked. A patient will often be found sleeping with the head hanging over the edge of the bed, and can sleep comfortably in this way when it is impossible to do so in any other position. We have known this symptom to be present long before any of the other symptoms described. The terrible deformities that follow this disease, do not occur when it is recognized early, and are not considered in making a diagnosis in these cases. Treatment.-All authorities agree that in the early stages of this disease, absolute rest in the recumbent position is of the first importance. An air or water bed should be used, as either will accommodate itself to the shape of the body and thus prevent undue pressure on the spinous processes. Slight extension and counter extension from the head and feet, may be made once or twice daily, to aid in separating the inflamed bones. Should active inflammation be present, ice bags should be placed on either side of the spine, at the seat of the disease. Dry cupping will be found useful if the pain is acute. This should be repeated every six or eight days, and may be followed by the ice bags. Gelsemium, given internally, will be found a valuable agent in these cases, and it may be used freely with perfect safety. It is important that the patient should have plenty fresh air and sunlight, as well as good nutritious food, as softening, degeneration, and absorption are likely to take place more rapidly if the vitality of the body becomes reduced. Strict attention to this method of treatment, although a long time is often required, will so improve the condition of the patient as to arrest the inflammatory action and relieve the pain on pressure over the affected part. If the patient is now allowed to assume the erect position, and walks about, EACRWARE CURVATURE OF THE SPINE. 607 the weight of the body above the seat of the disease will either reproduce the inflammation, or cause absorption of the bodies of the vertebrae, and consequent deformity. The con- dition of the bones of the spine in the advanced stage of the disease is represented by Figs. 65 and 66; and the general Fig. 65. Fig. 6b. condition of deformity in a severe case is shown in Fig. 67, which represents the spine bent backward, the breast bone crowded forward, the ribs drawn out of position, and an entire change made in the shape of the cavity of the chest, which must interfere with the normal action of the organs it con- tains. Fig. 68 represents the appearance of a posterior cur- vature near the centre of the spine, and we frequently find a much greater protrusion on a level with the shoulders. To prevent the occurrence of these terrible deformities, some mechanical support is necessary to keep the body in a natural position and to relieve the diseased vertebrae from pressure. Various instruments have been devised for this purpose, but each was found to have serious defects, and in spite of every effort with such appliances, deformity after 608 SPECIAL SURGICAL DISEASES. Pott's disease was the rule. To Prof. Sayre, however, belongs the honor of giving to the profession, in the shape of the Fig. 6^. Fig. 68. Plaster-of-Paris jacket, an appliance which, 'if properly used, will insure against deformity in the majority of cases. A full description of this jacket and the method of ap- plying it, will be given on another page. LATERAL CURVATURE OF THE SPINE. Lateral curvature of the spine is produced by abnormal muscular contractions, and is not associated with disease of the vertebrae. This deformity commences with a twisting of the bodies of the vertebrae upon each other, which continues till the vertebrae have their spinous processes turned toward the side on which the contracted muscles are located, while the anterior surface of the bodies look toward the opposite side. The spinous processes are then drawn toward each other by the contracted muscles, and thus the intervertebral LATERAL CURVATURE OF THE SPINE. cartilages are compressed on the posterior or concave side of the bent spine, and expanded on the opposite. Soon after this contraction commences a second curve begins to form, which is spoken of as a compensatory curve. These curves are usually met with in the dorsal and lumbar regions, the latter being the more frequently the first curve, though it is sometimes the curve of compen- sation. This deformity is repre- sented in Fig. 69, C marking the position of the lumbar curve, while D represents the dorsal curve, with the spine crowded under the shoul- der blade. This deformity is almost invari- ably the result of mal-position. Children who are allowed to lean to one side constantly, as with one arm elevated on a high desk at school, are the most liable to it. Injuries to the muscles of one side of the back, sufficient to prevent their action for some time, may be followed by contractions of those on the opposite side and subsequent deformity. Shortening of one leg from any cause will also give rise to lateral curvature. It is also of the greatest importance that children should always be compelled to sit erect, either at home or in the school-room, for careless habits of sitting are sure to result in some degree of spinal curvature, if not in serious disease. One of the first symptoms of this deformity is a marked prominence of one of the shoulder blades. When this is pres- ent even to a slight degree, an examination of the spine will show a curve in the line of the spinous processes. In the early stages of the deformity this curvature will disappear, if the patient is supported from under the arms so as to remove the weight of the head and shoulders from the spine. If the case is neglected, the muscular contraction continues till a promi- 609 Fig. 69. 610 SPECIAL SURGICAL DISEASES. nently marked double curvature is developed, with a material shortening in the height of the patient. Treatment.-In the early stages of this deformity, such active exercise as will bring into action and develop the con- tracted muscles should be resorted to. When the deformity has become well pronounced, however, I believe the Plaster- of-Paris jacket, in conjunction with the self-suspension appar- atus, will give by far the most satisfactory results. THE PLASTER-OF-PARIS JACKET. For the proper application of the Plaster-of-Paris jacket, the surgeon must be supplied with a seamless shirt, plaster bandages, a flexible strip of lead, a number of narrow strips of perforated tin, a suspension apparatus, and if the disease is in the cervical region, a jury mast. The seamless shirt is put on and drawn down as tightly as possible, by means of a handkerchief fastened in front and behind in the form of a perineal strap. Before fastening the shirt a small pad of muslin should be placed over the abdomen, and another across the chest on a line with the arm-pits, and held in po- sition by the shirt. These admit of the distention of the abdomen after eating, and a free respira- tory movement of the lungs. The patient is then suspend- ed by means of the suspension apparatus shown in Fig. 70; and close attention must be given to the amount of exten- sion made on the neck. This should simply extend the neck fully before the axillary exten- sion is felt. As the head and shoulders are thus drawn up the spine is straightened by the counter extension of the weight of the lower part of the body Fig. 70. THE PLASTER-OF-PARIS JACKET. 611 When the extension is complete, everything L ready for the application of the bandages. The bandages, having been placed on end in warm water, are allowed to remain till the air bubbles cease to rise when they are ready for use. A bandage is now taken in the hand and the surplus water squeezed out. We then commence to wind it around the pelvis about two inches above the great trochanter, and con- tinue winding it around the body, in such a way that each layer overlaps the previous one about a quarter of an inch. One roller after another is used till the body in encased to a point well up under the arms. The bandage should never be twisted, but simply smoothed down with the hand, and thus made to conform accurately to i.he shape of the body. After a couple of layers are thus applied, the tin strips maybe held perpendicularly at different points till they are caught by the next layer of bandage. These give additional strength without increasing the thickness. From four to six layers may be applied, according to the strength required for the case in hand. The patient is now kept sus- pended till the plaster sets, when he may be placed in a recumbent posi- tion till it is thoroughly dry. Then the edges are trimmed so as to give the patient no discomfort while walk- ing or standing,and the jacket is then bound with chamois skin. When the cervical vertebrae are involved the jacket is applied in the same way, but as this will not sup- port the head, the jury-mast repre- sented in Fig. 71 is fastened to the jacket by means of one or two addi- tional rollers; the head is then placed in the head piece, and the steel rod is lengthened so as to lift the entire weight of the head from the spine. When the dressing is complete Fig- 7i- 612 SPECIAL SURGICAL DISEASES. the head can be readily moved in any direction, and a cap can be worn under the steel bar. Figs. 72 and 73 repre- sent side and back views of the jacket with the jury-mast attached. Fig. 72. 13' This method of treatment first extends the spine while in the erect position, and the jacket and jury-mast make it im- possible for the spine to sink down again. The relief obtained is noticed immediately, but sometimes there will be a little muscular soreness resulting from the dampness of the bandages. This soreness must not be mistaken for the results of a misfit jacket,and the patient should be told that it is likely to occur. It is not to be supposed that these jackets can be worn without some discomfort. The complete fixation of the spine renders many of the usual motions of the body impossible, and some time must elapse before the patient can become accustomed to moving around in this fixed position. Even in LATERAL CURVATURE OF THE SPLNE. 613 this respect, however, it is no more objectionable than the various kinds of braces formerly used. When a jacket is properly applied, it may be worn three or four months without removal. In cases where the deform- ity is very marked, it is not wise to attempt complete exten- sion at first. It should only be carried to a point where it will relieve the breathing, and the constriction of the body. In this position the first jacket may be applied, and should be worn about three or four weeks. Further extension can now be made, and the second jacket put on. In this way,a new jacket every month or six weeks, will soon com- pletely straighten the spine, and then a longer time may elapse before changing. When therehas been con- siderable deformity in either form of curvature, Sayre's self- suspension apparatus (Fig.74) may be used with great ad- vantage as a daily exercise. It consists of a compound pul- ley attached to a cross-bar, on which is suspended an ar- rangement to support the head. The pulley may be fastened to a hook in the ceiling, or to a tripod, and with the head supported the patient draws himself up so that only the toes reach the floor, and then swings back and forth. Daily exercise in this way will aid materially in straightening even badly deformed spines. When the spine is thoroughly straightened a leather jacket can be made over a cast of the body taken with the Fig- 74- 614 SPECIAL SURGICAL DISEASES. last plaster jacket as a mold,. This can be used with or with- out the jury-mast, and can be taken off at night. This jacket with jury-mast attached is represented in Fig. 75. Fig- 75- 76. Figs. 76 and 77 represent the back and front views of a soft buck-skin padded jacket, designed by Mr. Harz, of the firm of John Reynders & Co. This is also a valuable instru- ment to keep up the extension after the use of the plaster jackets. The extension bars at the back and on either side admit of any desired amount of extension. We have employed this method of treating spinal de- formities for a number of years, and have succeeded in curing cases that had been pronounced incurable after all other varieties of braces had been tried. It is a mistake to suppose that this method of treatment is more severe than the use of steel braces. On the contrary SYNOVITIS. 615 immediate relief from the distressing symptoms is experi- enced as soon as the jacket is properly applied. It is important to understand what cases are benefited by this ex- tension treatment. We may state in brief that so long as the spine can be straightened, even a lit- tle, by raising the patient by the head and arms, the continued extension will prove beneficial. If the bones of the spine have become solidified, as rep- resented in Fig. 67, page 608, and the patient has been deformed for a long time, no treatment can be of service in relieving the deformity. Our greatest hope is that by a rational management of spinal curvatures, all such deformities can be prevented in the future. Pig- 77- SYNOVITIS. By synovitis is meant an inflammation of the synovial membrane, which lines the cavities of joints and supplies the fluid which acts as a lubricator of the articular surfaces. The disease may result from direct injury, from extension of an inflammation from contiguous tissues, from exposure to cold and damp, and from various forms of blood poisoning. Pain, heat, redness and swelling are present in all cases of acute synovitis. The pain is increased by movement of the affected joint and is attended by a feeling of distention. The swelling is very marked and pressure around the joint 616 SPECIAL SURGICAL DISEASES. causes fluctuation, which indicates the presence of fluid. When the inflammation is severe, general febrile symptoms are developed, and in many cases pus forms in the diseased joint. Treatment.-Complete rest is the most important condi- tion to be observed in the treatment of acute synovitis. When a joint has been severely injured, the application of ice bags for twenty-four hours may prevent the development of inflam- mation. If the disease is well marked, the surgeon should be sent for before serious complications arise. HIP-JOINT DISEASE. The hip joint is often attacked by inflammation which soon extends to the formation of matter in the joint, the des- truction of the head of the hip bone, and serious deformity. It is invariably caused by some injury to the structures of the joint, and not to scrofula as was formerly supposed. In some cases, a violent inflammation sets in at once, but in the majority of cases the disease develops slowly, and usually escapes recognition till it is well advanced. During the first stage there is a slight stiffness of the joint, a limping gait, and a disposition to stand on the sound leg. The limb on the affected side soon becomes smaller than the other; there is a tenderness on pressure around the joint; and if the patient is placed on his back and a sharp blow is struck upon the sole of the'foot with the limb extended, a decided pain is felt in the joint. Sometimes the lameness will be noticed and a pain is felt on the inner side of the knee. In the second stage, the foot is turned outward and the leg is bent at the knee and groin. As the disease advances, the hip is thrown upward and backward, the toe is turned inward and the leg is drawn over the other. At this time pus forms in some cases, and the structure of the joint is entirely destroyed. Treatment.-It is important that this disease should be properly treated as soon as the first symptoms begin, as it is DISEASES OF THE KNEE AND ANKLE JOINTS. 617 only in this way that the serious deformities and terrible suf- fering that attend hip-joint disease can be prevented. When a person is seen to limp and stand on one leg, and complains of slight pain on the inner side of the knee, a surgeon should be consulted without delay, so that the exact nature of the trouble may be ascertained. The proper treatment consists in the application of in- struments that will produce sufficient extension to separate the surfaces of the bones that form the joint, and at the same time allow the patient to take daily exercise in the open air. Such appliances when used in the early stages of the disease will prevent it from extending, and will effect a radical cure. DISEASES OF KNEE AND ANKLE JOINTS. The knee and ankle joints are also frequently affected by inflammation of all their tissues, which may extend to the formation of pus and to complete destruction of the functions of the joints. Whenever these joints are affected in any way no time should be lost in obtaining proper treatment, as deformity and permanent lameness may take place in a short time. In these cases, as in hip disease, the early application of instruments that will extend the joints so as to free their sur- faces from the irritation caused by contact, will prevent serious complications and speedily restore the joint to a healthy condition. We have made an improvement on Prof. Sayre's instrument for the extension of these joints, which renders the splints easy of application, makes them more com- fortable to wear, supplies the proper extension when the limb is in use, and admits of their removal at night, when the ex- tension is not required. ANCHYLOSIS, OR STIFF JOINTS- Stiffness is liable to follow all diseases of the joints, and when this is present to any degree, it is called anchylosis. This condition may be caused by the formation of fibrous bands in the cavity of a joint, or by a bony deposit that SPECIAL SURGICAL DISEASES. 618 solidifies the joint structure. If slight motion can be pro- duced, or if pain is felt in the joint when attempts are made to forcibly move it, the anchylosis is certainly caused by the fibrous bands; but if neither motion or pain is present it must be of bony origin. Whenever stiffness of a joint begins to develop the case should be placed under the care of a surgeon. The stiffened joint should be persistently moved many times a day, and the degree of motion gradually increased till it becomes normal. In some cases the surgeon may find it necessary to apply in- struments to enable the patient to keep up a continued and gradual motion of the joint. Fig. 78 represents an instrument used in anchylosis of the knee-joint, which secures extension and bending of the joint by simply turning a small screw at- tached to the rod under the knee. Fig. 79 represents a similar instrument for the forcible movement of the elbow-joint. Fig- 78. Fig. 79- KNOCK KNEE. Knock knee is a term applied to a deformity in which the feet are spread apart below the knees, while the knees CLUB-FOOT. themselves knock against each other while walking. It is usually present in early childhood, and if treatment is neglected, the deformity will become more promi- nent as age advances. Treatment should be commenced as soon as the condition is noticed, and thus a radical cure can be effected. The nature of the deformity and the apparatus used in the treatment are represented in Fig. 80. When the in- strument is applied the deformity is gradually overcome by drawing the knees toward the steel side bars by tightening the straps represented by I, 2, 3 and 4 in the cut. 619 Fig. So. CLUB-FOOT. By club-foot is meant a deformity of the foot character- ized by a deviation of its natural position. It is usually a con- genital deformity though it may be developed in children and even in adults by permanent muscular contraction, and by holding the foot for a long time in an unnatural position. Whatever may have caused the deformity, it is usually kept up by the action of shortened muscles, and these often require to be cut before the deformity can be overcome. The drawing of the foot in- ward so that its outer side rests on the ground is the most common variety. Treatment should be begun before a child begins to walk, in which case the deformity is easily overcome. If this is not done changes take place in the structure of the ankle-joint that will cause deformity for life. The surgeon divides the tendon of the shortened Fig. Si. 620 SPECIAL SURGICAL DISEASES. muscle or muscles, and then applies an instrument attached to a special kind of shoe, as represented in Fig. 8l. The foot is thus held as near straight as it can be, and by means of a screw on the side, of the shoe it may be straight- ened a little every day. The surgeon should always watch the case till the deformity is overcome. IN-GROWN TOE NAILS. As a result of carelessly cutting the toe nails, in such a manner that the side of the nail is cut, the nails, especially of the great toe, are made to grow on the side. As the nail continues to grow on the side it buries itself into the flesh of the toe and frequently causes great suffering. In such cases the side of the nail must be cut off so as to relieve the soft tissues of the toe. The top of the nail should then be scraped as thin as possible, and the flesh from which the nail has been removed should be painted with Tincture of Iron. This will harden the tissue, when it should be dug out with a knife and the Iron again applied. This application should be made daily till the soreness is entirely removed and the nail is so tanned that its growth is very slow. Now a small piece of cotton saturated in the Tincture of Iron should be crowded under the nail, and renewed every day or two. This turns up the edge of the nail and causes it to grow over the soft tissue instead of into it. ANEURISM. An aneurism is a pulsating tumor of an artery, caused by the dilatation of the coats of the artery at some weak point. Usually one or more of the coats is ruptured from some cause before the dilatation of the remaining coats takes place. The development of aneurism is obscure, and the diag- nosis can only be made by the physician or surgeon. After a time the patient is aware of the presence of a tumor along the course of an artery; he complains of a dull, heavy pain, and sometimes a feeling of numbness below the seat of the VARICOSE VEINS. 621 tumor. It has been demonstrated that 10 grain doses of the Iodide of Potassium, given three times a day for a week, will relieve the pain of aneurism. This may be tried if any doubt exists concerning the nature of the trouble. In some localities an operation can be performed which will radically cure aneurism, but in others, again, nothing can be done to afford relief. VARICOSE VEINS. The veins are sometimes so diseased that they become dilated or ruptured, and thus the superficial ones appear large twisted and knotted. The circulation of the blood becomes sluggish and a general congestion of the affected part de- velops. In severe cases the skin over a ruptured vein is ulcerated through, and a free flow of blood takes place. This condition is commonly spoken of as varicose veins. The legs are the most common seat of this disease, and the patient is worse at night after having been on his feet all day. After a time the pain becomes so great that the patient can no longer keep about, and then the disease is liable to extend to the veins higher up on the thigh. The use of elastic stockings or flannel bandages, applied before getting up in the morning, will always afford tempor- ary relief. In some cases the internal use of 5 drops of the Fluid Extract of Witch Hazel, three times a day, will improve the condition of the veins and relieve their fullness. Rest in the recumbent position, with the feet elevated, will also give good results for the time being. For a permanent cure, however, an operation must be performed. ABSCESS OF THE ANUS. The loose tissue surrounding the anus is often the seat of inflammation, which may terminate in an abscess. The formation of the abscess is characterized by a severe throbbing pain around the back passage, a violent contraction of the muscles of the anus, irritation of the neck of the blad- der with frequent desire to urinate, and excruciating pain 622 SPECIAL SURGICAL DISEASES. during a motion of the bowels. In a short time an examina- tion will show a protrusion at some point near the anus, and when the skin breaks a free discharge of pus takes place. Treatment.-A surgeon should be called upon to open the diseased part as soon as the throbbing pain is felt. If this is not done, hot Flaxseed meal poultices should be applied till the matter escapes. The opening should then be syringed twice a day with a solution of 20 drops of Carbolic Acid to a half gobletful of water, and a piece of antiseptic gauze should be pushed into the opening after syringing it. This is in- tended to keep the orifice open on the surface till the cavity heals from the bottom. If this treatment is not closely car- ried out a fistula may be produced. FISSURE OF THE ANUS. Sometimes there is a constant feeling of irritation about the anus, with a feeling of contraction in the part. A chafed condition of the neighboring skin is frequently noticed, and a slight moisture of the parts may be present a good deal of the time, Constipation also exists, and when a passage from the bowels occurs it causes a scratching or tearing sensation. These symptoms point to a little crack in the mucous surface, just within the verge of the anus, which is commonly called a fissure of the anus. It may be present a long time without being discovered, and yet it may have caused the person great annoyance. On examination it will be found between two folds of the mucous membrane, and it will look somewhat irritated. Sometimes the fissure may be touched with pure Carbolic Acid two or three times, at intervals of a day or two, and the part then washed with a solution of 5 drops of Carbolic Acid to the ounce of water injected into the anus with a small syringe. Before this treatment is commenced the lower bowel should be cleared by an injection of warm soap suds, and then the bowels should be bound up by a I grain Opium pill given at bed time. This prevents the stretching of the anus and favors the speedy healing of the fissure. In FISTULA OF THE ANUS. 623 severe cases an operation must be performed before a cure can be effected FISTULA OF THE ANUS. Fistula of the anus is an unnatural pipe or canal in the vicinity of the anus. When it opens into the lower bowel and also penetrates the skin near the anus it is called a com- plete fistula; when it opens externally, and is not connected with the bowel it is called an external blind fistula; and when it only opens into the bowel it is called an internal blind fistula. When any of these conditions are present more or less discharge is always noticed around the anus, and there is a feeling of tenderness and soreness always present. Sometimes the matter may disappear for a short time and then show itself again in greater quantities than before. When such conditions are present the parts should be examined by a surgeon and the real character of the disease determined. Treatment.-An operation is the only means by which a positive cure can be effected. In the majority of cases the use of the knife is the only sure method of treatment, and those who try to create public prejudice against it are usually persons who are ignorant of the first principles of surgery. When an operation is properly performed the patient can attend to his usual business after two or three weeks. ULCERS OF THE RECTUM. Ulcers of the rectum sometimes develop and cause great annoyance. A burning pain in the rectum, and a free dis- charge of matter either before or after stool suggest the nature of the disease. As soon as these symptoms are recognized a thorough examination should be made, and if ulcers are found they should be treated at once by the surgeon. HEMORRHOIDS, OR PILES. The term hemorrhoids, or piles, is the name applied to those tumors so frequently found in the lower part of the rectum and at the verge of the anus, formed by an enlarged, 624 SPECIAL SURGICAL DISEASES. distended, and inflamed condition of the hemorrhoidal arteries and veins and the superimposed tissue. There are two varie- ties of the disease, known as external hemorrhoids and inter* nal hemorrhoids. These differ as materially in their struc- ture and in the treatment required for their relief as they do in their situation. External Hemorrhoids.-The external pile is the most common form of this disease, yet it is the least under- stood. It is situated at the verge of the anus, and is caused by the rupture of a hemorrhoidal vein, and the consequent extravasation of blood into the adjacent cellular tissue. A tumor is thus formed, which is partially covered by integu- ment, and partially by mucous membrane. The extravasated blood soon coagulates, and renders the tumor hard, firm and inelastic. Sometimes the tumor is formed by a sac-like dis- tention of the distal portion of the vessel, with a coagulation of the blood at this point and for a short distance above the verge of the anus; but in the majority of cases the vessel is ruptured, and the sac is formed partly of the ruptured coats of the vein, and partly by the surrounding areolar tissue, the cells of which have been closed, and a new membrane formed by the plastic matter deposited as the result of the inflamma- tory condition in the part. External piles vary greatly in size. At the side of the anus, where the largest hemorrhoidal veins are located and cellular substance is found in the greatest quantities, the tumors may often be as large or even larger than a pigeon's cggj while, anterior or posterior to the anus, it is usually found no larger than a pea. The number of tumors also varies. There may be only one, or as many as three, four, or even five. The color of that portion of the tumor covered by mucous membrane is a dark purple, while the cutaneous part is usually light. Inflammation, which may be produced by a slight degree of irritation, caused by riding, walking, working, or defecation, always heightens the color of the entire tumor, is attended with great suffering to the patient, and may terminate in suppuration and the formation of an abscess. INTERNAL HEMORRHOIDS. 625 These tumors sometimes occur at an early period in life. Before puberty girls are more liable to be afflicted than boys, but after puberty males suffer more frequently from them than females. The causes that tend to produce external hemorrhoids are divided into predisposing and exciting. Anything that has a tendency to produce congestion and dilation of the hemorrhoidal veins, as accumulation of feces in the rectum, tumors in the pelvis, tight-lacing, venereal excess, standing constantly in the erect position, and an abnormal develop- ment of the veins, may be classed as the predisposing causes; while impacted feces, straining at stool, horseback riding, and the pressure of the child's head during parturition are among the most common exciting causes. Treatment.-The patient does not complain of much suf- fering till after the effused blood has coagulated, and even then the coagula may be absorbed without great inconven- ience. As soon as the coagula has formed, however, it is best to make an incision into the center of the tumor, and gently press out the contents, after which the sac can be washed out with a solution of Carbolic Acid, five grains to the ounce of water. This, with a little attention to rest, is all that is necessary to effect a cure, no matter what may be the con- dition of the tumors. A ligature should never be thrown around an external pile when in an inflamed condition. As a rule, the sac does not refill after it has been evacu- ated, but it may sometimes do so on account of the com- municating hemorrhoidal vein not being perfectly occluded. Should this occur, and the tumor be not inflamed, a liga- ture should be thrown around it, and the distal portion immediately cut off with a knife. If any inflammation be present, this interference should be postponed. Internal Hemorrhoids.-This variety of piles is sit- uated above the verge of the anus, at distances varying from half an inch to three inches. The structure of the tumors differs materially from that of external piles, being composed of plexuses of arteries and veins in a varicosed condition. The 626 SPECIAL SURGICAL DISEASES. changes which give rise to this disease begin in the blood' vessels of the lower part of the rectum. These vessels grad- ually enlarge, attain a considerable size, become saculated and tortuous, and assume the appearance of an intricate net- work. When the coats of the vessels and tissue connecting them become thickened and indurated the condition is spoken of as blind piles. When thickened in some places and atten- uated in others they attain considerable size, and are readily forced below the sphincters, thus producing what is called protruding piles. When softening or ulceration takes place the vessels are liable to give way, either from the impulse of their contents, or from the pressure of the feces, and considera- ble hemorrhage, both arterial and venous, results, thus giv- ing rise to the term bleeding piles. When extensive ulcera- tion of the mucous covering and the thickened walls of the vessels takes place, the condition is spoken of as tilcerated piles. Internal hemorrhoids are covered by mucous membrane only which is usually thickened and changed in color and consistence according to the length of time the disease has been standing, and the condition it has assumed. When the disease is recent the color of the tumor is a bright red, but when of long standing it presents a purple appearance. When the tumors protrude and are strangulated by the con- striction of the muscles of the anus, they assume a dark- bluish or livid aspect. These tumors are soft, spongy, and erectile, and when recent diminish under pressure, but regain their former size when the pressure is removed. In cases of long standing the enlarged condition of the diseased vessels and the connecting tissue renders them unyielding, and causes them to encroach upon the caliber of the outlet of the rectum. The tumors vary in number, shape and size. Sometimes we meet with a single tumor as large as a pullet's egg, but more often there are as many as three, five, or even seven, ranging from the size of a pea to that of a hickory-nut. In shape they are usually globular, but they are also found pyriform and in ver- tical ridges an inch or more in length, by several lines in diameter. INTERNAL HEMORRHOIDS. 627 Internal hemorrhoids very rarely occur before the age of puberty. Both sexes are equally affected by them after pu- berty, and no class of society is entirely free from them. Se- dentary life, dyspepsia, habitual constipation of the bowels, diarrhea, dysentery, worms, rectal tumors, horseback exer- cise, the standing posture, mechanical obstructions to the passage of urine-as stricture of the urethra, enlargement of the prostate glands, and stone in the bladder-the pressure of pelvic tumors, and the gravid uterus are among the predispos- ing causes of the disease. The pain attending internal piles is not very severe, as a rule, the feeling being a sense of weight and distention of the rectal region, with an itching, burning sensation. When the tumors are large and protruding, however, the pain is often very severe, especially during the act of defecation which causes spasms of the sphincter muscles. Very often a protrud- ing pile is* so constricted by the sphincters as to produce a congestion or even inflammation of the tumor, and if the pro- truding parts are not replaced the pain becomes so great as to produce free perspiration and even fainting in the patient. After the parts are replaced the pain gradually subsides and the patient remains comparatively comfortable till the parts become again protruded and constricted. The disease may continue in this way for years without rendering the patient unfit for business, and yet he may never be entirely free from pain. In cases of bleeding piles, where the hemorrhages occur frequently, the general health of the patient soon becomes impaired from the great loss of blood. In many cases of this variety of the disease the vessels are so enlarged that they become passive tubes, through which the blood flows without impediment, and the loss thus sustained often produces the most frightful debility in a very short period of time. Treatment.-A great diversity of opinion prevails regard- ing the treatment of internal hemorrhoids. Some writers claim that they can always be cured by internal or constitu- tional treatment, while others claim that a radical cure can not be effected without the use of the knife. It appears to us 628 SPECIAL SURGICAL DISEASES. that a correct knowledge of the nature of the different forms of the disease must lead us to take a position between these two extremes. Our own experience has taught us that many cases will yield to what is usually called the palliative treat- ment, and so far as we can see, the disease entirely disappears; while, on the other hand, where the disease is of long standing and the tumors are constantly protruding below the sphincters, an operation offers the only certainty of a cure. The palliative treatment consists in regulating the bowels, improving the condition of the digestive organs, and allaying local irritation. A person who is subject to piles will find the following mixture one of the best that can be used: Fluid Extract of Podophyllum, 2 drams; Cascara Cordial, 2 ounces; Glycerine, enough to make 6 ounces. Mix, and give a tea- spoonful after each meal and at bed time. If the bowels become loose the dose may be decreased to half a teaspoonful. If the patient is debilitated, efforts should be made to give tone to the system. If he is pale and bloodless, io drops of Dialyzed Iron may be given in water, three or four times a day; and if there is nervous prostration present the following will be serviceable: Sulphate of Strychnia, I grain; Dilute Muriatic Acid, 3 or 4 drops; water, 4 ounces. Mix, and give one teaspoonful before each meal. In addition to these remedies, good nutritious food must be provided, and care should be taken not to swallow the seeds of fruits or other irritating substances that cannot be digested. After each action of the bowels great relief is obtained by injecting into the rectum an ounce of hot water containing a teaspoonful of the Fluid Extract of Witch Hazel. If there is a persistent bleeding, however, it will be best to use cold water with the Witch Hazel. When there is severe local irritation, the following ointment will give great relief: Ex- tract of Conium, 10 grains; Tannic Acid, 12 grains; Morphine, 4 grains; Vaseline, I ounce. Mix thoroughly, apply to the part with the finger, morning and evening. If there is much INTERNAL HEMORRHOIDS. 629 itching in the rectum, this ointment should be introduced by means of an ointment syringe. This treatment, with strict attention to the diet and con- dition of the bowels at all times will invariably relieve an attack of piles, and a long time may elapse before another occurs. In some cases, however, the trouble becomes perma- nent, and the tumors are found constantly protruding, or frequent an 1 profuse hemorrhages take place. These condi- tions require the more vigorous methods of treatment. When we undertake to treat a case of piles for the pur- pose of effecting a radical cure the object is to entirely re- move the diseased parts. Three methods are employed to accomplish this end. First: Each pile is tied at its base with a strong silk thread, which cuts off the supply of blood, and causes the tumor to drop off in a few days. Second: The piles are injected with a strong solution of Carbolic Acid, which acts as a caustic and destroys the tumors. Third: The entire tumor is grasped in a clamp and cut off at once, while the edge of the cut is cauterized with a hot iron. The galvanic battery may be used to cut off and cau- terize the part after the clamp is applied. Whatever method of operating is employed, skill and close attention are required. We have adopted the last two methods entirely of late years, and can invariably succeed in effecting a radical cure in all cases of piles by one or the other. Some cases can be treated by injections of the Carbolic Acid without necessitating the patient's leaving work, while even with the clamp, a week or ten days is all the time required to recover entirely from the effects of the operation. As soon as a pile remains permanently down, the comfort, and the future health of the patient demand that the radical treatment should be resorted to. 630 SPECIAL SURGICAL DISEASES. HERNIA, OR RUPTURE. By hernia, or rupture, is meant a protrusion of some part of the abdominal contents through an opening in the walls of the abdomen In the region of the groin and at the navel the abdominal walls are very weak in consequence of open- ings having existed at these points during foetal life, and it is at these localities that rupture usually occurs. Sometimes the rupture is present at the birth of the child, when a prominent enlargement is seen in the groin, and in the male may extend into the scrotum. The majority of cases, however, are produced by severe muscular efforts that crowd the contents of the abdomen forcibly against the weak points, thus causing them to give way and to allow the intes- tine or some other viscus to protrude. When a rupture is thus produced a sudden tearing or giving way of the abdominal wall is felt, which is accom- panied by a sharp, cutting pain. In a short time afterward an enlargement is noticed at the seat of the pain, which is usually less marked when the patient lies on his back. If there is any doubt about the nature of the difficulty, the fingers may be placed over the enlargement while an effort to cough is made. If a rupture is present the coughing crowds the intestine downward so as to make a decided pressure against the fingers. Whenever a rupture occurs it should be reduced as soon as possible. The patient should at once lie down on his back and draw up his legs. Then by gentle pressure over the pro- truding lump it may be easily returned to the abdominal cavity. If this cannot be done, a surgeon should be called without delay. In long standing cases the rupture may remain out for a long time without inconvenience, and in some cases the parts may have become so changed that it is impossible to return the protruding part into the abdominal cavity. It is never safe, however, to leave a rupture unreduced, as it is liable at any time to become strangulated, and will then require a HERNIA, OR RUPTURE. 631 serious surgical operation for its relief, or may cause the death of the patient. To retain a rupture in position the opening in the ab- dominal walls must be closed by a surgical operation, or by mechanical means in the form of an instrument called a truss. It is only in severe cases that the operation for the radical cure of rupture is resorted to, though as now performed it can be done with safety in the majority of cases, as it is not in the least painful, and is attended with but little inflammation. In selecting a truss to keep up a rupture a surgeon should always be consulted, as truss manufacturers are always anxious to sell their particular invention without regard to the comfort or best interests of the patient. When properly applied, a good truss will invariably keep a rupture from coming down, and ought to be free from discomfort and un- cleanliness. The hard rubber trusses, as a rule, are the best, and when properly fitted, they can be worn for years without rusting, breaking or becoming offensive. Elastic trusses should never be used. It must be remembered, however, that it is not enough to put on a truss. It must be properly ad- justed to the shape of the body, and the rupture must be reduced before the pad is applied to the opening, and these things can only be satisfactorily done at first by the surgeon. When once fitted, the patient can be instructed how to man- age afterwards. Trusses should always be removed at night, after the patient has assumed the recumbent position, and should be applied in the morning before he stands up. By strangulated hernia is meant a constriction of a pro- truding section of intestine which prevents the effete material from passing through the intestinal canal. It is marked by swelling and pain in the protruding part, which is soon followed by the symptoms of inflammation. If not relieved, nausea and vomiting take place, and after a time the material vomited smells like fecal matter. At this time great prostra- tion takes place and the body is bathed with cold perspir- ation. » 632 SPECIAL SURGICAL DISEASES. In all such cases a surgeon should be sent for as soon as the first symptoms are noticed, and if the intestine cannot be readily returned to the cavity of the abdomen, an operation should be performed without delay. If the constriction is not relieved promptly the entire protruding part dies and is thrown off, and in the majority of cases death of the patient occurs. To prevent such results a ruptured person should always wear a truss, and if at any time he fails to reduce the rupture he should send for a surgeon at once. Books of Reference. The Practice of Medicine. By Roberts Bartholow, M. A. M. D., LL. D. Eclectic Practice of Medicine. By John M. Scudder, M. D. The Principles and Practice of Physic. By Sir Thomas Watson, M. D., F. R. S. Clinical Lectures on The Principles and Practice of Medicine. By John Hughes Bennett, M. D., F. R. S. E. Science and Practice of Medicine. By Wm. Aitken, M. D. A Practical Treatise on the Diseases of Women. By T. Gaillard Thomas, M. D. Clinical Lectures on The Diseases Peculiar to Women. By Lombe Atthill, M. D. A System of Surgery. By Samuel D. Gross, M. D., LL. D. A System of Surgery. By T. Holmes, M. D. Lectures on Orthopedic Surgery and Diseases of the Joints. By Lewis A. Sayre, M. D. Clinical Notes on Uterine Surgery. By J. Marion Sims, M. D. American Obstetrics. By John King, M. D. Treatise on Diseases of the Eye. By Carl Stellwag Von Carion, M. D. A Clinical Manual of Diseases of the Ear. By Laurence Lurnbull, M. D. Treatise on Diseases of the Skin. By Dr. J. Moore Neligan. Photographic Illustrations of Skin Diseases. By Geo. Henry Fox, A. M., M. D. PART THIRD. MEDICINES AND THEIR ACTIONS. POISONS AND THEIR ANTIDOTES- GLOSSARY. INTRODUCTION. In describing the remedies recommended in Part II, we can do little more than give the name, action and dose of each. This will, however, be sufficient to give the reader a general idea of each medicine that will aid him in properly administering it to others, or taking it himself. It is needless to urge the importance of pure drugs in the treatment of all forms of disease. It is always safest to go to the best drug stores for medicines, and to ask for the prep- arations of pharmacists who have the reputation of making good articles. In speaking of doses we often state the minimum and maximum dose, but it must be remembered that it is always best to give the least quantity of any medicine that will pro- duce the desired effect. In some of the more powerful reme- dies the dose is regulated by putting a certain quantity of medicine to four ounces of water, and giving a teaspoonful of the mixture at a dose. All persons who undertake to use medicines in any form should be provided with a drop measure, and also one that 636 INTRODUCTION. will measure any quantity from a dram to four ounces of fluid; and powders of all kinds should be carefully weighed before being added to prescriptions. In every case when a remedy is to be used, reference should be made to the index, which will direct the reader to the page on which the description of the medicine is to be found. This should then be carefully read, so that the treat- ment can be intelligently carried out. It is especially impor- tant to observe the table regarding the regulation of the doses of medicines for children, which will be found on the next page. In considering poisons we only refer to those that are most commonly used either by accident or design; and while we give the most efficient antidotes, no time should be lost in sending for a physician in such cases, as important legal ques- tions are likely to arise in connection with them. The Glossary is devoted entirely to medical terms, and the definitions given are according to Dunglison and Webster. CHAPTER I. THE ACTIONS AND DOSES OF MEDI- CINES. In the following descriptions of remedies, when not otherwise stated, the doses given are those appropriate to adults, so that if the remedy is to be given to a child, refer- ence should be made to the following table, by means of which the dose can be easily estimated : Table of Proportionate Doses for Different Ages. Under 1-2 year, I-I5th. of a full dose. " I " I-I2th. " " " 2 " i-8th. " " " 3 " i-6th. " " " 4 " i-5th- " 7 " i-3d. " 14 " 1-2 " " " 18 " 2-jds. " " " 21 " the full dose. With some medicines this rule does not hold good, but when such is the case, the doses for children will be given. In all cases where remedies have been recommended in the treatment of diseases of childhood, the doses recom- mended should be given without reference to this table. 638 THE ACTIONS AND DOSES OF MEDICINES. As some persons are peculiarly susceptible to the action of remedies the doses recommended should be diminished whenever it is found that their action is too severe. Acetic Acid.-Strong Acetic Acid is a powerful irritant and is never used internally. When applied to the skin on a piece of flannel it acts quickly as a counter-irritant and if continued long enough it will even produce a blister. When applied along the spine it stimulates the spinal nerves, and if it causes too much burning of the skin, this can be relieved by the use of hot water. Acetate Of Lead.-Acetate of Lead, or Sugar of Lead, was formerly used extensively as an internal remedy. We do not use it in this way as we believe we have remedies that are more efficacious in the diseases in which lead has been recommended. Sometimes it may be used as an eye wash, of the strength of 2 grains to an ounce of Rose water. It is also used with advantage as an injection in gonorrhea and leucorrhea, especially when combined with Laudanum. From I to 3 grains to the ounce of water is enough to use in any case. Acetate Of Potash.-Acetate of Potash was formerly called the Diuretic Salt in consequence of its decided action in increasing the flow of urine. It is a valuable remedy in acute rheumatism and in all conditions where a free action of the kidneys is desired. The dose for an adult is from 20 to 30 grains three times a day, and it should always be given in solution in water, or in Marsh Mallow tea. Aloes and Iron Pill.-The Aloes and Iron pill, recom- mended in Part IL, is a 3 grain pill, and contains the fol- lowing ingredients: Aloes, 1 grain; Sulphate of Iron, I grain; Jamaica Ginger, one-half grain; Extract of Conium, one-half grain. This pill is given in cases of suppression of the menses, in which there is a weak condition of the .stomach and constipation. The dose for an adult ranges THE ACTIONS AND DOSES OF MEDICINES. 639 from two to four pills at bed time. They act freely on the bowels, give tone to the stomach, and in full-blooded girls and women, cause a determination of blood to the womb. They should not be given to children before the age of puberty. -Alum.-Alum was formerly used as a purgative in large doses, but it is now never employed for that purpose. It is sometimes used internally for bleeding from the lungs, stomach or kidneys, and it is considered almost a spe- cific in lead colic. It is also used as a gargle in inflam- mation of the mucous membrane of the pharynx, and as an injection in inflammation of the vagina, in which cases it acts as an astringent, thus contracting or drawing up the mucous surfaces, so as to control the inflammation and arrest the secretion. When used internally for bleed- ing, the dose is 5 grains repeated every hour or two. For lead colic, from 20 to 30 grains may be given at a dose, and repeated every two or three hours till the pain is relieved. As a gargle, 5 grains should be added to each ounce of water; and as an injection for the vagina, one dram should be dissolved in a pint of tepid, water. Alum Whey.-Alum whey is made by boiling 30 grains of Alum with 6 ounces of milk, and then straining off the thin liquor (the whey) from the curds. It may be given internally, for its stimulating and astringent properties, in diarrhea, dysentery and other wasting diseases. The dose is from a tablespoonful to one or two tablespoonfuls, according to the condition of the patient. -Aniseed Tea.-Aniseed Tea is prepared by pouring a pint of boiling water on an ounce of crushed seeds of the Anise plant. It is used in flatulent colic of infants and to relieve nausea. It may be given freely in wineglassful doses, every two or three hours. -Aqua Ammonia.-Ammonia water is a powerful stimu- lant in small doses. The vapor inhaled through the 640 THE ACTIONS AND DOSES OF MEDICINES. nostrils also acts as a powerful stimulant, and is used to arouse persons from fainting. When mixed with Carbolic acid, the vapor inhaled into the nostrils will promptly relieve a cold in the head. When given internally the dose is from 5 to 20 drops, largely diluted in water. Aromatic Spirit of Ammonia.-Aromatic Spirit of Ammonia is an antacid and stimulant. It is sometimes used in sick headache dependent on an acid condition of the stomach. It will also relieve flatulence, and is fre- quently given in hysteria. Whenever fainting occurs from any cause it is a useful stimulant. It may be given in doses of from 10 drops to a teaspoonful, in sweetened water, and may be repeated at intervals of half an hour. Balsam Of Fir.-Balsam of Fir is also known as Canada Balsam and Canada Turpentine. In small doses it stimu- lates the general system and increases the flow of urine. It acts specially on the mucous surfaces, and is given internally in all inflammations of those membranes. It frequently constitutes one of the ingredients in prescrip- tions given for chronic laryngitis, bronchitis and catarrh. The maximum dose is a teaspoonful three times a day, but in combination it is usually prescribed in much smaller doses. Balsam of Peru.-Balsam of Peru is a remedy that pos- sesses stimulating and expectorant properties. It is sometimes applied to old ulcers, either in an ointment or in its pure state. We have recommended it in combina- tion with other remedies for its expectorant properties, and it is one of the ingredients in most of the popular cough mixtures. When given alone the dose is from 10 to 30 drops, but when combined with other medicines is usually given in from 3 to 5 drop doses. Balsam Of Tolu.-Balsam of Tolu is a stimulant, tonic and expectorant, and is used in inflammations of the air THE ACTIONS AND DOSES OF MEDICINES. 641 passages. It is prescribed in cough mixtures with the Balsam of Peru and other expectorants. The dose is from io to 30 grains frequently repeated. Belladonna Leaves.-Belladonna, or Deadly Night- shade, is a powerful narcotic poison, and must be used with caution in any of its forms. A few of the dried leaves are often burned so that the smoke may be inhaled for the relief of severe paroxysms of asthma. The relief is, however, only temporary, and in many cases no effect is noticed from the inhalation. Bicarbonate Of Soda.-Bicarbonate of soda, or common baking soda, is used as an antacid, in temporary acidity of the stomach. A strong solution will promptly relieve the burning pain of a scald or burn. The severe heat of fevers is often diminished, and the patient rendered com- fortable, by sponging the body with a solution of this salt. The dose, when taken internally, may range from 5 to 30 grains for an adult. It should always be given largely diluted in water. Boneset Tea.-Boneset is an old and valuable household remedy. It is usually given in the form of an infusion, or tea, which is made by pouring a pint of boiling water on an ounce of the leaves, and allowing it to gtand fifteen or twenty minutes before using. It is serviceable in all cases where a free perspiration is desired, and when this is produced it is apt to cause a free motion of the bowels. From one-half to a teacupful of the tea may be given ata dose, and repeated at inter/als of half an hour till per- spiration is produced. While taking it for this purpose the patient should be well covered up in bed. Bonjean'S Ergotin.-Bonjean's Ergotin is a preparation of the active principle of Ergot, made in the form of a thick paste. We have recommended it as a local appli- cation in one of the forms of Acne. When applied to a congested skin or mucous membrane it contracts the 642 THE ACTIONS AND DOSES OF MEDICINES. minute blood-vessels, and thus relieves the inflamed con- dition. It should be applied freely over the entire red- dened surface, twice a day, and the surface should be washed off before making each application. Boracic Acid.-Boracic Acid is a valuable antiseptic, and a saturated solution may be used as a wash in old sores or wounds, as a gargle in sore throat or chronic catarrh, as an injection in leucorrhea, or in any inflammation of mucous surfaces It may be used as a dressing for heal- ing sores in the form of an ointment composed of 20 or 30 grains of the salt to an ounce of Vaseline. Borax.-Borax is seldom given internally at the present day, its use in medicine being confined to its local appli- cation to the skin and mucous membranes. In various skin diseases a solution of 10 grains of Borax to the ounce of water can be used to wash the affected part. It can be used in the same strength as a gargle, or as an injection in inflammatory diseases of the vagina and womb. We have found it a valuable addition to washes and injections containing Golden Seal, and have recommended it prin- cipally in that combination. Bromide Of Sodium.-Bromide of Sodium is a remedy that has of late been highly recommended in all cases of determination of blood to the head. It is used in epilepsy, in sleeplessness, and in congestion of the brain. It is also a valuable remedy in sea-sickness. The dose for an adult is from 10 to 20 grains, three times a day. When given in cases of epilepsy its use should be continued for several months. Burnt Alum.-Burnt Alum is prepared by heating alum till it ceases boiling, and becomes dry. It differs from alum only in having the water thrown off by evaporation. It is used in removing proud flesh, from a wound or sore For this purpose it is sprinkled over the proud flesh, and left on for a few hours. The unhealthy tissue turns black and can be easily removed in a day or two. THE ACTIONS AND DOSES OF MEDICINES. 643 Calcined Magnesia.-Calcined Magnesia is a valuable antacid and laxative. It is a common remedy for acidity of the stomach, and is frequently used in combination with Rhubarb and other medicines, to act on the bowels. It is a valulable remedy in constipation when there is ac- cumulation of feces in the rectum. In such cases it liquefies the passages, and gives decided relief in a few hours. It may be given in doses ranging from 30 grains to 1 dram, and the dose maybe repeated in three hours if it does not operate. Carbolic Acid.-Carbolic Acid, when pure, is a clear white or pinkish substance, that crystalizes in needle-like crys- tals at low temperatures. When 5 per cent, of water or Glycerine is added to it, it becomes a permanent liquid. It is this 95 per cent, solution that we recommend for use in all cases where Carbolic Acid is referred to. This rem- edy is one of our most valuable antiseptic agents, and is used with advantage internally as well as externally. As a solution for external use, it is generally employed oi the strength of 5 drops to the ounce of water. Its use for surgical dressings is fully described in Part II, under the title of Antiseptic Dressings. Internally it is given with advantage in all fevers and diseases that are due to the introduction into the system of minute organisms. It is also useful in preventing the decomposition of food in the stomach, and the consequent formation of gases. The dose for an adult is from 1 to 3 drops, largely diluted in water, mucilage or syrup. Carbonate Of Ammonia.-In large doses Carbonate of Ammonia is a poison, and in small doses it is a diffusi- ble stimulant and antispasmodic. It is given in low fevers, in inflammation of the lungs and air passages, in chorea and in hysteria. The dose is from 5 to 20 grains, every three or four hours, and it should always be given largely diluted in water, or in some watery mixture. Carbonate of Iron.-Carbonate of Iron is a valuable tonic in all cases where Iron is-required. It is particularly ser- THE ACTIONS AND DOSES OF MEDICINES. 644 viceable in cases of constitutional syphilis when it is des- irable to give a tonic. In these cases it can be advantage- ously combined with Carbonate of Manganese. The dose is from 2 to 20 grains, but the continued use of a small dose is preferable to large doses. Carbonate Of Manganese.-Carbonate of Manganese is a valuable tonic in all cases of anemia. When combined with Carbonate of Iron its tonic properties are increased, but even when used alone it increases the strength and improves the blood after a few days. It may be given in doses ranging from 2 to 20 grains, three or four time a day. Castor Oil.-Castor oil is a mild and speedy cathartic. Though not given as often now as it was a few years ago, it is still the best remedy that can be usedin many condi- tions. When it is desired to carry off undigested foods from the intestinal canal, Castor Oil will be found the surest remedy in its action that can be used. It is also valuable when given after worm medicines have been taken. The dose for an adult is two tablespoonfuls, and a teaspoonful may be given to a child under twelve months of age; while children over that age may take from one to four teaspoonfuls. It is best given in sweetened coffee, or in soft elastic capsules. Cascara Cordial.-Cascara Cordial is a pleasant elixir of Cascara Sagrada, and Berberis Aquifolium. It is more pleasant to take than other preparations of Cascara, and is one of our most valuable remedies for the treatment of habitual constipation. It may be given to children in from 2 to 5 drop doses, three or four times a day, and to adults in from 15 drops to a teaspoonful four times a day. It is always best to begin with a small dose, and gradually increase it till.a free action of the bowels is produced. The dose should then be decreased gradually, as the bowels are found to be moving every day. When these directions are observed ordinary constipation can invari- ably be overcome. Chamomile.-Chamomile is one of the household reme- dies that is known in nearly all civilized countries. It has decided tonic properties, and is used in flatulency, colic, hysteria, and in disorders of menstruation. The tea is made by pouring a pint of boiling water on an ounce of Chamomile flowers, and allowing it to stand on the stove for half an hour. Of this, from two tablespoon- fuls to a teacupful may be given four or five times a day. Chloride of Zinc.-Chloride of Zinc is rarely used internally at the present day. It is used as a local application to destroy diseased structures, and is the chief ingredient in most of the so-called cancer plasters. It is useful in gonorrhea and gleet when used as an injection, pf the strength of 2 grains to the ounce of water. The same solution is also valuable in inflamed conditions Df the internal ear. Chlorate of Potash.-Chlorate of Potash contains a large amount of oxygen, and is given with advantage in all cases where oxygen is required in the system. A dram of this salt to six ounces of water constitutes a valuable gargle in all cases of inflammation of the mucous mem- brane of the throat, and a similar solution may be used with advantage in inflammation of the vagina or other mucous surfaces. Chlor-Anodyne.-Chlor-Anodyne is a compound manu- factured to take the place of the English patented remedy known as Chlorodyne. It contains Morphine, Indian Hemp, Prussic Acid, Chloroform, Oil of Peppermint and Capsicum. The combination forms a valuable remedy for colic, cholera morbus, neuralgia, and spasmodic pains. The average dose is from 20 to 30 drops, in water, re- peated every half hour till the pain is relieved. In severe cases of spasm a teaspoonful may be given for the first dose. Chloroform.-Chloroform is used principally as an inhala- tion for the relief of pain, and to destroy sensibility THE ACTIONS AND DOSES OF MEDICINES. 645 THE ACTIONS AND DOSES OF MEDICINES. 646 during the performance of surgical operations. It should never be used in this way without the advice of the phy- sician, and under his immediate supervision. It may be given internally, in doses ranging from 3 to 20 drops, in water or syrup, for the relief of intense pain, such as is present during the passage of gall or kidney stones. Chromic Acid.-Chromic Acid is only used externally to destroy unhealthy or superfluous tissue. When diluted one-half with water, it maybe applied to warts and corns for their removal. Citrate of Magnesia.-Citrate of Magnesia is prepared for use in a pleasant solution that tastes like lemonade. It is a mild cathartic, and operates in a couple of hours. It is put up in twelve-ounce bottles, and the entire quan- tity is necessary for a cathartic action. Cod-Liver Oil.-Cod-liver Oil is prepared from the livers of codfish. It is usually spoken of as an animal tonic, and is a valuable remedy in all wasting diseases, such as consumption and low fevers. A great many preparations of cod-liver oil are on the market, many of which are undoubtedly good, but when it is required, we believe the pure Norwegian oil, in tablespoonful doses, three times a day, will give the best results. Compound Jalap Powder.-The Compound Jalap Powder, or Anti-bilicms Physic, is composed of the following ingredients; Alexandria Senna, 2 ounces; Powdered Jalap, 1 ounce; Powdered Ginger, I dram. It is an excellent purgative and always produces free watery evacuations from the bowels. The dose is one dram, made into a tea as follows: A half pint of boiling water is poured on the dram of the powder, and it is then allowed to stand till it cools. The tea is then strained, and a dram of Cream of Tartar is added to it, when the whole is taken at a draught. It is best taken in the morning, and may be repeated in two or three hours if a free action has not been obtained. THE ACTIONS AND DOSES OF MEDICINES. 647 Compound Lobelia Powder.-Compound Lobelia Powder, or emetic powder, is composed of Lobelia, Blood Root, Skunk Cabbage, Ipecac, and Capsicum, and is used when a prompt emetic is required. The dose is 30 grains every fifteen minutes till vomiting is produced. It acts best when given in Boneset tea. Compound Phosphorus Pills.-Each Compound Phos- phorus Pill contains one one-hundredth of a grain of Phosphorus and one-quarter of a grain of Extract of Nux Vomica. They are made in all forms and coated with sugar or gelatine. The oviform pill is the most readily swallowed, and the sugar-coated is the most easily dis- solved in the stomach, and these should always be ob- tained if possible. This is applicable to all kinds of pills. The pills here spoken of are given in all cases of nervous prostration or general debility. The average dose is one pill after each meal, but after a short time two may be given at each dose. Compound Podophyllin Pills.-The Compound Podo- phyllin Pill contains one-half grain of Podophyllin, one-, eighth of a grain Extract of Henbane, and one-sixteenth of a grain of Extract of Nux Vomica. It is a valuable pill in all conditions of constipation associated with a brownish coated tongue, as the Podophyllin increases the flow of the fluid constituants of the bile. The dose is one pill at bed time, and this should be repeated every night till copious actions of the bowels are obtained. Compound Syrup of Stillingia.-Compound Syrup of Stillingia is used as a menstruum in which Iodide of Po- tassium and other medicines are given. It possesses slight properties as an eliminator of blood poisons and is given in teaspoonful doses. Compound Syrup of Rhubarb and Potash.-Com- pound Syrup of Rhubarb and Potash is commonly called Neutralizing Cordial. It is an agreeable laxative, antacid 648 THE ACTIONS AND DOSES OE MEDICINES. and tonic, and is used with advantage in intestinal disor- ders. The dose for an adult is a tablespoonful every one or two hours, and in proportion for children. Compound Tincture of Cinchona.-Compound Tinc- ture of Cinchona is made with Peruvian bark, Snakeroot, Saffron and Bitter Orange-peel, with Brandy as a solvent. It is a valuable stomach bitters, and may be used where- ever a mild bitter tonic is desired. The dose ranges from two teaspoonfuls to a tablespoonful. Compound Tincture of Iodine.-Compound Tincture of Iodine is used as an alterative, or blood purifier, and also as a local application to promote absorption and in some skin diseases. The dose is from 5 to 20 drops, in water, three times a day. Corrosive Sublimate.-Corrosive Sublimate is a mercurial preparation, and is a deadly poison. We do not use it internally, but have found it useful, when applied as a wash of the strength of one grain to the ounce of alcohol or water. It is used to stimulate the action of the skin in acne. Cream Of Tartar.-Cream of Tartar in moderate doses will act on the kidneys and bowels. It should only be given in combination with other remedies to cause watery evacuations from the bowels. From one to three drams may be given at a dose. Dialyzed Iron.-Dialyzed Iron is comparatively a new form of preparing Iron for internal use. It is a valuable tonic in all cases of impoverished blood where Iron is in- dicated. It does not constipate the bowels or injure the teeth. The dose for an adult is 15 drops, in water, after each meal and at bed time. Dilute Muriatic Acid.-Dilute Muriatic Acid is given in- ternally as a tonic in cases of fevers, and also for its action on the liver. The dose is from 10 to 30 drops three times a day, which should be largely diluted in THE ACTIONS AND DOSES OE MEDICINES. 649 water and sucked through a glass tube, to prevent its injuring the teeth. It is also used to dissolve strychnia, when ordered in solution. Dilute Sulphuric Aad.-Sulphuric Acid, or Oil of Vitriol, when diluted is used as a solvent for Quinine and other salts. It is also used internally as a tonic, and especially to check night-sweats. The dose is from io to 60 drops three times a day about an hour before eating. It should be largely diluted in water and sucked through a glass tube. Elixir Calisaya, Iron and Strychnia.-Elixir Cali- saya, Iron and Strychnia is a valuable tonic, combining a bitter stomachic with a blood and nerve tonic. It is use- ful in all cases of general debility or prostration after long-continued sickness. The dose is a teaspoonful three times a day. Elixir Guarana.-Elixir Guarana is a pleasant prepara- tion of Guarana that is given with good results in sick headache. The dose is a teaspoonful every half hour or hour till relieved, or till four or five doses are taken. Essence Of Ginger.-Essence of Ginger is a strong tinc- ture of Ginger. It is a stimulant, and is often given in dyspepsia, and for the relief of flatulant colic. The dose is from 5 to 20 drops, in water, and it may be repeated at intervals of half an hour till relieved. Ether.-Ether, or more properly, Sulphuric Ether, is princi- pally used as an inhalation to destroy sensibility to pain during surgical operations. It is similar in its action to Chloroform, but not so dangerous. It should only be ad- ministered by the physician. Extract of Conium.-Extract of Conium is prepared from the Hemlock. We have recommended it for its soothing effect, as one of the ingredients in an ointment for piles. In such cases it has a good effect. 650 THE ACTIONS AND DOSES OF MEDICINES. Eclectic Compound Podophyllin Pill.-The Ec- lectic Compound Podophyllin pill contains only an eighth of a grain of Podophyll,in with minute quantities of several other ingredients. It is milder in its action than the Compound Podophyllin pill, and may be continued longer to keep up the action of the bowels. To produce a full action of the bowels, 4 pills should be given at bedtime, for several nights if .required. The action may then be kept up with one pill every night. In some cases it is best to begin with the single pill, and continue it every night till the bowels become regular. FLUID EXTRACTS. Fluid Extracts are fluid preparations of vegetable reme- dies, made on a uniform plan so that a drop of the Fluid Extract is equivalent to a grain of the crude drug. The fol- lowing have been recommended for use in treatment of the various diseases: Aconite.-Aconite, or Monkshood, when given in large doses is a deadly poison. In small doses it acts as a depressant to the nervous system, and reduces the force and fre- quency of the heart's action. It is a valuable remedy in fevers, and is given to keep down the temperature. The leaves and root are both used, but we prefer the prepara- tion from the root. The dose of the fluid extract of the root is stated to be from 2 to 3 drops, but this is the max- imum, and should only be given in extreme cases. It is best given in minute doses, frequently repeated. From 5 to 10 drops should be put in 4 ounces of water, and of this a teaspoonful may be given every half-hour or hour. Eennbevry.-Bearberry is an astringent and tonic and has a specific action on the urinary organs. It is used in com- bination with other remedies in chronic diseases of the kidneys, bladder and urethra. The dose of the fluid ex- tract is from 10 to 30 drops three times a day. Belladonna.-Belladonna is a powerful narcotic poison when given in large doses. In small doses it relieves congestion THE ACTIONS AND DOSES OF MEDICINES. 651 of the nerve centres, and is said to be valuable in prevent- ing scarlet fever. It is best administered by adding from io to 30 drops of the fluid extract to 4 ounces of water, of which a teaspoonful should be given every one, two or three hours, according to circumstances. Black Cohosh.-Black Cohosh is a valuable remedy in controlling nervous irritability. It also relaxes muscular contraction, and is used with advantage in painful men- struation and in muscular rheumatism. The dose of the fluid extract is from 10 to 30 drops, three times a day. Black Haw.-Black Haw is tonic and astringent in its ac- tion. It is used principally to prevent threatened miscar- riage, for which it is almost a specific. The dose of the fluid extract is from 20 drops to a teaspoonful three or four times a day. Blue Cohosh.-Blue Cohosh, or Squaw-root, is a valuable agent in all chronic uterine diseases. It is especially serviceable in suppression of the menses, uterine leucor- rhea and painful menstruation. It also acts on the kid- neys, and causes perspiration. The dose of the fluid extract is from 10 to 30 drops three or four times a day. Cascara Sagrada.-Cascara Sagrada is one of our new California remedies. It stimulates the secretory glands of the stomach and intestines, and increases their peris- taltic action. It acts as a laxative in small and as a cath- artic in large doses; and many cases of habitual constipa- tion have been reported cured by it. The dose of the fluid extract is from 5 to 20 drops for a laxative, and from 30 to 60 drops for a cathartic, night and morning, and is best given in a teaspoonful of Glycerine. The Cascara Cordial makes a palatable mixture, and may be used in all cases where the Cascara is indicated. Colchicum Seeds.-Colchicum, or Meadow Saffron, acts as a sedative, cathartic and emetic. It is generally pre- scribed in gout and rheumatism, and acts best when com- bined with Black Cohosh. The dose of the fluid extract 652 THE ACTIONS AND DOSES OF MEDICINES. of the seeds is from one to ten drops three times a day. If it acts too freely on the bowels the dose must be de- creased. Collins onia.-Collin sonia is known by the popular names of Stone-root, Ox-balm, Horseweed., Heal-all, &c It is used with advantage in chronic diseases of the air pass- ages as well as in disorders of the urinary organs. The dose of the fluid extract is from io to 20 drops three or four times a day. Ergot.-Ergot, or Smut Rye, is one of our most valuable remedies. It causes powerful muscular contractions of the womb, and is, for that reason, used to hasten labor and also in the treatment of uterine tumors. It will contract the small blood-vessels, especially of the brain and spinal cord, and is therefore of great benefit in congestion of those parts. In vertigo it will often give relief, and has of late been recommended in the treatment of dia- betes. The dose of the fluid extract ranges from 10 drops to a teaspoonful, according to the condition for which it is given. Eucalyptus Globulus.-Eucalyptus Globulus is a new remedy introduced into this country from Australia. It is said to possess great anti-malarial properties. It is a good antiseptic and tonic, and is coming largely into use. One ounce of the fluid extract, with one ounce of Gly- cerine, and four ounces of water makes a good gargle or wash for inflamed mucous surfaces. When given internally the dose is from 20 drops to a teaspoonful. Gelsemium.-Gelsemium, or Yellow Jessemine, has a powerful influence in controlling irritation of the nerve centers. It is a valuable relaxant and antispasmodic, and is extensively used in all forms of malarial fever. It is almost a specific in neuralgia of the face, and acts equally well in all cases of spasmodic contraction of muscles. When given in full doses it causes drooping of the eyelids and double vision. These conditions THE ACTIONS AND DOSES OF MEDICINES. 653 when caused by small doses frequently repeated, need occasion no alarm, as they will pass off soon after the medicine is discontinued. In fact, it is necessary, in some cases, to push the remedy till these symptoms are produced, before the good effect can be noticed. There is a great difference between the preparations made from the dried and fresh root of this plant, and the former should never be used. The dose of the fluid extract of the fresh root is 5 drops in water, repeated every half hour till the desired effect is produced. In severe cases of neuralgia or nervous headache, 10 drops should be given for the first dose, and 5 drops every half hour after- ward. When taking the medicine in this way the patient should lie down and should not attempt to talk. If no effect is noticed after six or eight doses are taken, it should be discontinued for two or three hours. Golden-Seal.-Golden-Seal is a powerful tonic, and exerts special influence on the mucous surfaces. It is used in dyspepsia and other diseases of the stomach and bowels. An infusion, made by pouring a pint of boiling water on an ounce of the crushed root, is also used as a wash for inflamed mucous surfaces. The dose of the fluid extract is from 5 to 30 drops three times a day. Grindelia Robusta.-Grindelia Robusta is a compara- tively new remedy, and has proved a valuable medicine for the relief of asthma when all other remedies have failed. The dose of the fluid extract is from 30 drops to one teaspoonful, repeated every three or four hours if required. Hydrangea.-Hydrangea, or Seven Barks, is used in chronic inflammation of the mucous surface of the bladder and urethra. It is also claimed that it aids in the re- moval of gravelly deposits from the bladder. The dose of the fluid extract is from 20 drops to a teaspoonful. If dizziness occurs after taking the medicine, the dose should be reduced. 654 THE ACTIONS AND DOSES OF MEDICINES. Indian Hemp.-Indian Hemp acts powerfully on the kid- neys and bowels, causing copious watery evacuations from the bowels and a free discharge of urine. It is chiefly employed in dropsical conditions of the legs and abdomen. The dose of the fluid extract is from 3 to 10 drops three or four times a day. A decoction made by boiling an ounce of the root in a pint of water is often used in preference to the fluid extract. Of this, a table- spoonful may be given every two or three hours till an action is produced. Ipecacuanha.-Ipecac, is a valuable emetic in large doses, while in small doses it induces perspiration. When given in minute doses in conjunction with Aconite, it is a valu- able remedy in cholera infantum, and other acute intes- tinal disorders. The dose of the fluid extract is 20 drops for an emetic, and from 1 to 2 drops every three hours to produce an action on the skin. From 10 to 15 drops may be added to 5 ounces of water, and of this a teaspoonful may be given every two or three hours, in cholera in- fantum Lobelia.-Lobelia is an emetic, sedative and expectorant. It is used in all cases when muscular relaxation is desired, and is a common ingredient in cough mixtures. The dose of the fluid extract is from a half to one teaspoonful for an emetic, and from 3 to 10 drops as an expectorant. Manaca.-Manaca is a new remedy introduced from Brazil. It is said to be of great value in rheumatism and syphilis. We have used it with good results in rheumatism. The dose of the fluid extract is from 5 to 20 drops three or four times a day. Mango Bark.-Mango Bark has been found of great ser- vice in excessive hemorrhage from the womb, either after miscarriage or in profuse menstruation. The dose of the fluid extract is from 5 to 15 drops three or four times a day. THE ACTIONS AND DOSES OF MEDICINES. 655 Nux Vomica.-Nux Vomica is one of our most valuable nerve tonics. It is used in all cases where there is pros- tration of the nervous system. In intestinal diseases of children from 5 to 10 drops of the fluid extract may be added to 4 ounces of water, and a teaspoonful of the mix- ture may be given every two or three hours. For adults the dose of the fluid extract is from 1 to 5 drops three times a day. Pleurisy Root.-Pleurisy Root is largely used to promote perspiration and expectoration in pleurisy, and inflamma- tion of the lungs and air passages. The dose of the fluid extract is from 20 drops to a teaspoonful three or four times a day. Podophyllum.-Podophyllum, or Mandrake, when given in large doses is an active cathartic, and causes griping and nausea. When given in small doses it increases the action of the liver. The dose of the fluid extract is from 5 to 10 drops, to be repeated every night till the bowels move freely. Poke Root.-Poke Root has a special action on the gland- ular system, and is therefore a valuable remedy for elimi- nating poisons, such as syphilis. When applied to inflamed glands it will often prevent the formation of abscess. The fluid extract is used in from 5 to 10 drop doses three times a day. It is applied full strength to inflamed glands or joints. Prickly Ash Berries.-Prickly Ash Berries act as a stimulant and anti-spasmodic. They are used with ad- vantage in nervous diseases, spasms of the intestines, flatulency and diarrhea. The dose of the fluid extract is from 5 to 20 drops, three or four times a day. Pulsatilla.-Pulsatilla is a remedy that has been exten- sively used in the disorders of menstruation, especially in nervous women. About a teaspoonful of the fluid ex- tract may be added to 4 ounces of water, and of this a teaspoonful may be given every two or three hours. 656 THE ACTIONS AND DOSES OF MEDICINES. Veratrum Viride.-Veratrum Viride, or American Hel- lebore^ one of our most valuable remedies for controlling fevers and inflammations. It is especially valuable in fevers due to blood-poisoning from any cause. The fluid extract of the fresh root should always be used. The dose is from I to 5 drops every hour or two. It is best to begin with the small dose, and gradually increase it till the skin becomes moist or slight nausea is produced. Witch. Hazel.-Witch Hazel is tonic and astringent in its action. It is used externally and internally, in piles and other diseases of the veins. The dose of the fluid extract is from 30 drops to a teaspoonful three or four times a day. As a wash 1 ounce may be added to 6 or 8 ounces of water. Fowler's Solution of Arsenic.-Fowler's Solution of Arsenic is a combination of Arsenic and Bicarbonate of Potash, and it is employed as a tonic, as an anti-malarial remedy, and in a great variety of skin diseases. The dose is from 1 to 5 drops three or four times a day. In most cases the small dose more frequently repeated will serve the best purpose. Glycerine.-Glycerine is the sweet principle of animal oils, and it is extensively used in the arts and for the toilet. It is often prescribed for the purpose of holding medicines in solution, but is also claimed by many to possess decided medicinal properties. It may often be substituted for Cod-liver oil, and is given in tablespoonful doses three times a day. A teaspoonful taken after meals will often prevent the formation of gases in persons who suffer from flatulency. Hydrastin.-Hydrastin is prepared from the Golden Seal. It is a good tonic in chronic diseases of the stomach and bowels, and is also one of the best remedies we know of for an eye-wash. The dose is from 2 to 5 grains after each meal. About 5 grains should be thoroughly rubbed with an ounce of Rose water; the mixture is THE ACTIONS AND DOSES OF MEDICINES. 657 then filtered when it is ready for an eye wash. Of this 3 or 4 drops should be put into the inflamed eye three or four times a day. Ingluvin.-Ingluvin is prepared from the gizzard of the domestic fowl. It is used in indigestion and in nausea of pregnancy. It should be given in 5 grain doses imme- diately after each meal. Iodide of Ammonium.-Iodide of Ammonium is used in syphilis, glandular enlargements, chronic rheumatism and consumption. It possesses the power of eliminating from the body poisonous and effete material. The dose is from 5 to 10 grains three times a day. Iodide Of Potassium.-Iodide of Potassium is an altera- tive and antisyphilitic. It aids in removing poisons and prevents abnormal deposits. The dose is from 5 to 10 grains three times a day, and it is usually given in solu- tion in some syrup or elixir. Jalap and Senna Tea.-This tea is the same as the In- fusion of the Compound Jalap powder, described on page 646. Laudanum.-Laudanum is the popular name for tincture of Opium. It is used internally, but we have only recom- mended it in combination with other ingredients in cough and diarrhea mixtures. It serves a valuable purpose when mixed with acetate of lead for an injection in in- flammation of the neck of the womb and the vagina. For this purpose a tablespoonful may be added to a pint of tepid water. When taken internally, 15 drops is the dose for an adult, and a child under six months of age should not have more than a drop at a dose. Marsh Mallow.-The root of Marsh-Mallow is used to increase the flow of urine in all diseases of the kidneys and bladder when such an action is desired. It is usually given in the form of a decoction, or strong tea, made by boiling 2 ounces of the root with a quart of water. When 658 THE ACTIONS AND DOSES OF MEDICINES. thus prepared a gobletful may be drank every two or three hours, if necessary. The ground root is also used as a poultice. Morphine.-Morphine is one of the active principles of Opium. The sulphate is the form in which it is most com- monly used, and it is this that is generally meant when morphine is spoken of. It is a powerful anodyne, and is used in all cases where there is severe pain. It is a dan- gerous remedy, and should be used with great caution. The dose for an adult is from one-eighth to one-quarter of a grain every six hours. It is used extensively to in- ject under the skin, and in this way it does much harm. It should only be resorted to in extreme cases after other remedies have failed. Muriate of Ammonia.-Muriate of Ammonia promotes absorption of abnormal deposits, and relieves glandular enlargements. It is used externally as well as internally. When used internally the dose is from io to 20 grains three times a day. A dram dissolved in six ounces of water, and applied to any inflamed gland, will speedily relieve the inflammation, Nitrate of Silver.-Nitrate of Silver is very seldom used as an internal remedy at the present day. When pure and moulded in stick form, it is used as a caustic on old ulcers. It is also used to destroy proud flesh. In solu- tion it is employed locally to allay inflammation of mucous surfaces. In chronic inflammation of the throat it is often useful when applied with a brush or spraying apparatus. For use in the spray only one grain of Nitrate of Silver should be added to an ounce of water. For other purposes from 2 to 5 grains to the ounce may be used as required. Nitrite of Amyl.-Nitrite of Amyl, is a powerful stimu- lant to the brain when used as an inhalation. It is ser- viceable in all cases where there is stupor from any cause. THE ACTIONS AND DOSES OF MEDICINES. 659 A three-drop glass capsule should be broken in a hand- kerchief, and held so that the patient can inhale the vapor. This will often arouse a patient after a long-continued unconsciousness. It is not given internally. N itro- Glycerine.-Nitro-Glycerine is a new and power- ful remedy. It is reccommended in Neuralgia, and es- pecially in Angina Pectoris. The dose ranges from one- two-hundredth to one-tenth of a grain, and the desired dose can be obtained in pill form. Nitrate Of Potash.-Nitrate of Potash, or saltpetre, is a valuable remedy to act on the kidneys, and is used in all cases where there is a scanty secretion of urine, and in dropsical conditions. The dose is 20 grains three times a day. Oil of Male Fern.-The oil of Male Fern is extensively used for the expulsion of tape-worms. The average dose is 30 drops night and morning. It should be given in syrup or mucilage, after fasting for twelve hours, and about two hours after the morning dose is taken, a full dose of Castor oil should be given. In some cases a much larger dose is required to expel the worm. The medi- cine is unpleasant to take, and for that reason it may be given in soft elastic capsules. Oil of Erigeron.-The Oil of Erigeron, or Fleabane, is a powerful astringent, and is used chiefly in hemorrhages. In bleeding from the lungs, nose, kidneys or womb, it may be given with advantage in doses of from 2 to 10 drops in mucilage or syrup. The dose should be repeated every twenty minutes or half hour in severe cases. In loss of voice from cold, 5 drops on a lump of sugar, held in the mouth till the sugar dissolves, and repeated four or five times a day, will often prove highly beneficial. Opium.-Opium is prepared from the juice of poppy heads. In large doses it is a narcotic poison, and in medicinal doses it is anodyne. It is used to relieve pain and pro- duce sleep, and may be administered either in powder or 660 THE ACTION'S AND DOSES OF MEDICINES. pill form. The average dose for an adult is one grain every four or six hours; but in cases of severe pain the dose maybe repeated once an hour till two or three doses are taken. Paregoric.-Paregoric is an elixir of opium, and is generally given to children in preference to the other preparations of opium. The dose for an adult is from I to 2 teaspoon- fuls, and for infants from 5 to 20 drops. It should not, however, be given to children excepting in extreme cases. Peppermint.-Peppermint is a powerful diffusive stimulant and antispasmodic.-It is used in flatulant colic, hysterics, and cramps in the stomach. A tea is made by pouring a pint of boiling water on an ounce of the leaves, and this may be drank freely. The essence may be given in doses of from 10 to 30 drops in water. The oil of peppermint is often applied to the skin to relieve neuralgia. Phosphorus and Strychnia Pill.-This is the same pill as described on page 647, as the Compound Phos- phorus Pill. Pp m egrana te Bark.-The bark of Pomegranate root is a valuable remedy for the removal of tape-worm. A de- coction is made by pouring 3 pints of water on 8 ounces of the fresh bark of the root, and boiling it down to 2 pints. Of this tea, a cupful should be drank every hour or two till the worm is expelled. Sometimes vomiting and purg- ing will be produced before the worm is expelled. Quinine.-Quinine is prepared from Peruvian Bark, and is a valuable tonic and antiperiodic. In large doses it reduces the temperature in fevers, and prevents the recurrence of attacks of malarial fevers. The Sulphate of Quinine is the form in which it is generally used, though it is in- variably spoken of as Quinine. The dose of the Sulphate is from I to 3 grains fora tonic; from 5 to 10 grains as an antiperiodic; and from 15 to 20 grains, when used for re- ducing the temperature. It may be given in capsules. THE ACTIONS AND DOSES OF MEDICINES. 661 in pill form or in solution, a drop of Dilute Sulphuric Acid to each grain, being required to dissolve it. Rochelle Salts.-Rochelle Salts is a Tartrate of Soda and Potash, and is a mild, cooling cathartic. It acts quickly and should always be taken in the morning, before break- fast. The dose is from half an ounce to an ounce, dissolved in water. Saccharine Carbonate of Iron and Manganese.- Saccharine Carbonate of Iron and Manganese is a sugary preparation of the two remedies named. The combination increases the tonic and alterative properties of both drugs. It is given in syphilis, and other condi- tions of blood-poisoning where tonics are required. The dose is from 5 to 20 grains three times a day, after meals. Salicin.-Salicin is a medicine prepared from the Brook Willow. It is a valuable tonic, and is especially advan- tageous in the treatment of inflammatory rheumatism. The dose is from 10 to 20 grains every three hours. Salicylic Acid.-Salicylic Acid is also used extensively in the treatment of rheumatism. It is a valuable anti- septic when used as a wash and in ointments. The dose internally is from 5 to 20 grains, but we have found it in- ferior to Salicin. A solution containing 2 grains to an ounce of water may be used as a wash to inflamed mucous surfaces. An ointment is prepared by adding 10 or 15 grains to the ounce of Vaseline. This is good in eczema and other skin diseases. Santonin.-Santonin is a remedy that is largely used for the expulsion of stomach worms. The dose is from 2 to 5 grains twice a day, and the morning dose should be followed by a dose of some cathartic. Sesquicarbonate of Potash.-Sesquicarbonate of Pot- ash, is commonly called the mild vegetable caustic. It is a valuable remedy in granulated eyelids, and ulceration 662 THE ACTIONS ANU DOSES OF MEDICINES. of the womb. The powder is applied to the affected part, and after it has acted on the diseased tissue it is washed off with a fine brush and water. It should only be used by the physician. Slippery Elm Tea--Slippery Elm Tea is made by boil- ing an ounce of the bark in a pint of water. It makes a soothing drink in inflammatory conditions of the digestive and urinary organs, and may be drank freely. The ground Slippery Elm bark is also used for poultices. Spirit of Turpentine.-Spirit of Turpentine is a stimu- lant and diuretic. It is given internally in ulcerated con- ditions of the stomach and bowels, and in some diseases of the urinary organs. It is also given to aid in the re- moval of intestinal worms. When applied to the skin it causes irritation and redness, and is frequently used over the abdomen in inflammation of the bowels, ovaries and womb. The dose is from 5 to 20 drops, every two or three hours. It should be given in gum arabic water, syrup or oil. Stramonium Leaves.- Stramonium is known by the popular names of Jamestown Weed and Stinkweed. It is rarely used as an internal medicine at the present day, its use being confined to the inhalation of the smoke from the burning leaves for the relief of paroxysms of asthma. Strychnia and Phosphorus Pill.-See Compound Phosphorus Pill, page 647. Subnitrate Of Bismuth.-Subnitrate of Bismuth is said to possess tonic and antispasmodic properties. It has a soothing effect on irritated mucous surfaces, and is there- fore employed in chronic diseases of the digestive organs. The dose is from 2 to 20 grains three times a day. Succinate Of Iron.-The Succinate of Iron is a valuable remedy for preventing the formation of gall-stones. The preparation used is known as the Hydrated Succinate of the Peroxide of Iron, and it is given in teaspoonful doses THE ACTIONS AND DOSES OF MEDICINES. 663 three times a day. It should be used continuously for six or twelve months to insure against a recurrence of the biliary calculi. Sulphite of Soda.-Sulphite of Soda is a valuable agent in all diseases of which there are symptoms of blood poisoning. It is, therefore, used in the eruptive and mias- matic diseases with advantage. The dose is from 5 to 20 grains, in water, three or four times a day. Sulphate Of Strychnia!-Sulphate of Strychnia is a powerful nerve tonic, and is used in all cases of great nervous prostration. The dose is one-thirty-second of a grain, and it may be given in solution or in pill form. The solution is prepared as follows : Sulphate of Stry- chnia, 1 grain; Dilute Muriatic Acid, 3 drops; water, 4 ounces. Mix, and give a teaspoonful three times a day Sulphur.-Sulphur was formerly used extensively as an alterative and laxative, and children were dosed with it regularly every spring, to purify the blood. It is now prin- cipally employed externally in the treatment of skin dis- eases. The Sulphur ointment may be applied to the skin full strength, or reduced one-half with Vaseline. Sweet Spirit of Nitre.-Sweet spirit of Nitre acts in increasing the flow of urine and perspiration. The dose is from half to'one teaspoonful, every two or three hours. If given alone to act on the kidneys, the dose should be increased to two teaspoonfuls. Syrup of Lacto-Phosphate of Iron,-The Syrup of Lacto-Phosphate of Iron is a valuable and agreeable tonic. It is used with advantage in various diseases of the bones. The dose is a teaspoonful three times a day. Syrup of Lobelia.-The Syrup of Lobelia is a pleasant form in which to take Lobelia when it is required. It is often combined with other ingredients in cough mixtures. The dose is from one to four teaspoonfuls. 664 THE ACTIONS AND DOSES OF MEDICINES. Syrup Of Rhubarb and Potash-The same as Com- pound Syrup of Rhubarb, on page 647. Syrup of Seneka.-Seneka, or Seneca Snakeroot, is a stimulant and expectorant. It is employed principally as an ingredient of cough mixtures. It is usually pre- scribed so that each teaspoonful of a mixture contains about 20 drops of the Syrup of Seneka, and this dose is repeated every two or three hours. Syrup of Squills.-Squillsis a nauseant, emetic and ex- pectorant. It is given in combination with other reme- dies in diseases of the respiratory organs. The dose of the Syrup is from 10 to 20 drops, repeated several times a day. Syrup of Tolu.-Syrup of Tolu is used in coughs and colds, and is a common ingredient in cough mixtures. The dose is from one-half to two teaspoonfuls, three or four times a day. Tannic Acid.-Tannic Acid is a pure astringent. It is given in chronic dysentery and diarrhea, and in bleeding from the womb, bowels or lungs. It is also used as a gargle for inflamed conditions of the throat, and as an in- jection in inflammation of the vagina, neck of the womb and urethra. The dose is from one-half grain to 5 grains; and for an injection or gargle, about 5 grains should be added to each ounce of water. Tincture of Cactus Bonplandii.-The Cactus Bon- plandii is a valuable heart tonic, and is used in the sev- eral functional and organic diseases of the heart. The dose is from 5 to 10 drops, in water, after each meal or at bed time. Tincture of Cactus Grandiflorus.-Tincture of Cac- tus Grandiflorus, or Nig Jit-Blooming Cereus, is also used in diseases of the heart, as a powerful heart tonic. The dose is from 5 to 10 drops four times a day. THE ACTIONS AND DOSES OF MEDICINES. 665 Tincture Of Can'tharides.-Tincture of Cantharides is used in cases of chronic diseases of the bladder. It is also used in hair washes as a stimulant to the scalp. The dose is from 5 to 15 drops every three or four hours. About 2 drams may be added to a 6 ounce mixture, for an application to the scalp. Tincture Of Capsicum,-Capsicum, or Red Pepper, is a stimulant when applied to the skin as well as when taken into the stomach. The dose of the tincture is from 10 to 30 drops in water, every three or four hours. Tincture Of Catechu--Tincture of Catechu is a power- ful astringent, and is used in diarrhea and dystentery, as well as in injections for the urethra and vagina. The dose is from 20 drops to a teaspoonful, given in sweetened water. As an injection about half an ounce may be added to a six ounce mixture. Tincture of Columbo.-The Tincture of Columbo is a bitter tonic. It is usually prescribed with Iron and other tonics. The dose is from one to two teaspoonfuls three or four times a day. Tincture of Chloride of Iron.-Tincture of Chloride of Iron, or Tincture of Iron as it is commonly called, is a valuable tonic in all cases where Iron is required. The dose is from 3 to 6 drops, in water, three or four times a day. It should be taken through a glass tube, to pre- vent injury to the teeth. Tincture of Ginger.-The same as Essence of Ginger, for which see page 649. Tincture of Opium.-The same as Laudanum, for which, see page 657. Tincture Of Rhubarb.-Tincture of Rhubarb is purga- tive in large, and tonic in small doses. It is usually com- bined with other ingredients as a remedy for diarrhea. The dose for its tonic effect is from 20 to 30 drops, re- peated every hour or two. 666 THE ACTIONS AND DOSES OF MEDICINES. Vaseline.-Vaseline is a preparation made from Petro- lium. It is slightly antiseptic in itself, and does not be- come rancid. For this reason it is now used almost ex- clusively in making ointments, instead of lard and simple cerate. Wild Cucumber.-Elaterium, or Wild Cucumber, is a powerful cathartic. It causes free watery evacuations from the bowels, and is chiefly given in cases of Dropsy. The dose is from one-sixth to one-quarter of a grain of the powder, and this should be repeated every hour or two till the action is produced. Wine of Opium.-The Wine of Opium maybe used in place of any of the preparations of opium. We have recommended it as an ingredient in injections. For this purpose half an ounce may be added to a four ounce mix- ture. The dose for an adult is 15 drops. Yellow Oxide of Mercury.-The Yellow Oxide of Mercury is used chiefly as an ingredient of an eye oint- ment, which is referred to in the treatment of granulated lids and opacity of the cornea. It will work well in these cases when all other remedies fail. CHAPTER IL MECHANICAL AGENTS. Under the general head of Mechanical agents we include those methods of treatment that are not properly classified as medicines or surgical operations. A few of the most im- portant of these are described below. ARTIFICIAL RESPIRATION. By artificial respiration is meant the mechanical move- ments of the chest kept up by pressure upon the ribs. This is performed by placing a hand on either side of the chest, a little above the borders of the lower ribs, and pressing the ribs in as far as possible and then removing the pressure. When the ribs are thus pressed in, the air is forced out of the lungs, and when the ribs are allowed to regain their natural position the lungs expand and fresh air rushes into them. If this is kept up long enough, the oxidation of the blood may be carried on for a time, and the vital actions that were almost suspended are thus renewed. This treatment is resorted to in all cases of poisoning where the breathing begins to fail, MECHANICAL AGENTS. 668 for the resuscitation of persons from drowning, and to estab- lish respiration in newly born infants who appear inanimate. BLISTERS. Blisters are agents that have the power of destroying the cuticle and causing a throwing out of the watery portions of the blood. When a blister is applied the skin under it should be examined from time to time, till it is seen that the blister rises. It is then removed, and the blistered cuticle is cut with a pair of scissors to allow the water to escape. A thick hot flaxseed poultice is then applied to favor a more free escape of water, and after that is kept on for twelve or twenty-four hours, a little Vaseline is applied on a fine piece of linen to heal up the surface. Blisters are good in all cases of severe inflammation where a counter-irritation is required. Spanish Fly is the blister that serves the best purpose. CUPPING. By cupping is meant drawing away the blood from an in- flamed part by suction. Dry clipping consists of taking a small wineglass or a glass for the purpose, and smearing the inside with alcohol, which is then set on fire. While the alcohol is burning the glass is applied so that its rim presses firmly against the skin. The alcohol continues to burn till a vacuum is produced, when the skin is forcibly sucked into the glass, thus drawing the blood to the surface, and away from the inflamed part. Wet Cupping consists in making two or three little cuts in the skin before applying the glass as above described. Then, when the suction takes place the blood is drawn into the glass. Cupping is employed to relieve local congestion and inflammation. ELECTRICITY. The proper application of electricity is a valuable auxi- liary in the treatment of many diseases. The faradic current is an interrupted one, and occasions a series of shocks to the nerves, which produce muscular contraction. The galvanic HOP FOMENTATION. 669 current is a continuous current and does not cause a shock. Much harm can be done by the use of both of these currents, and they should never be employed without full instructions from the physician, regarding the method of using the battery, and the variety of electricity required for each case. HOP FOMENTATION. To properly apply a hop fomentation the dry hops should be put in a bag, so that the hops are about an inch or two thick. The bag is then stitched through like a mattress, after which it is dipped in hot water and squeezed dry before being applied to the skin. When applied, it should be covered with a towel, then with a piece of oiled-silk, and over this another towel or two should be placed. This keeps in the heat for an hour or two, when the bag should be again wet in the hot water and applied in the same manner. MAGNETISM. Much has been said about Animal Magnetism, both for and against it. We believe that many persons possess con- siderable power for relieving pain by gently stroking a patient with the fingers. This has been so often demonstrated that it can no longer be denied, and the time may not be far distant when magnetism will play an important part in medicine and surgery. We believe that the most successful physicians owe much of their success to the influence of their personal mag- netism upon their patients. As yet we can do little in the way of explaining what it is, and we must, therefore, be con- tent to note the results. This is a subject that should not be overlooked or condemned, even though much humbug is practiced under the name of magnetism. MASSAGE. Massage, or rubbing and kneading the skin and muscles, is also a valuable means of treating some diseased conditions. Systematic massage arouses the circulation of the blood, and gives tone to the vzhole system. 670 MECHANICAL AGENTS. MUSTARD PLASTERS. Mustard plasters are designed to produce counter irrita- tion for the relief of deep-seated inflammations. Where a speedy effect is desired the ground mustard should be mixed with a little water or vinegar and the white of an egg, so as to make a thick paste. This is then spread on a piece of mus- lin and applied directiy to the skin, or separated from it by a thin piece of gauze. This should be kept on for twenty or thirty minutes. In cases where it is desirable to continue the irritation for any length of time, half flour may be added to make the plaster. POULTICES. Poultices are used to relieve local inflammation and has- ten suppuration. They should always be made with boiling water and the meal or powder to be used, and should be applied to the part as hot as can be borne. CHAPTER III. POISONS AND THEIR ANTIDOTES. The term poison is applied to any substance that is capable of destroying life, when taken into the stomach. Many of our most valuable medicines act as poisons when given in large doses, and there are few poisons that are not used medicinally in some form. As a rule, the cases of poison- ing in which home treatment can be employed with advan*- tage, are those in which it is known what drug has been taken. As all cases of poisoning are serious in their nature the physi- cian should always be sent for. We, therefore, only give here the immediate treatment to be adopted in the cases most commonly met with. It is well to remember that in all cases of poisoning, an emetic should be given as soon as possible, excepting where the poison itself produces vomiting. A tablespoonful of mus- tard, in a cupful of hot water will often serve the purpose, or 30 drops of Fluid Extract of Ipecac, may be given, and re- peated every twenty minutes till vomiting is produced. The Compound Lobelia Powder may also be given in 30 grain 672 POISONS AND THEIR ANTIDOTES. doses, in hot water, every fifteen minutes till the effect is pro duced. ACONITE. Poisoning from an over dose of Aconite is followed in a few minutes by a numbness and tingling in the mouth and throat, by dizziness, by numbness and loss of power in the legs, and by severe pains in the abdomen followed by vomit- ing and purging. The pupils are dilated, the pulse almost ceases, the skin is cold and livid, and the breathing is diffi- cult. Treatment.-An emetic of Fluid Extract of Ipecac, Com- pound Lobelia Powder, or a tablespoonful of mustard to a cup- ful of warm water, should be given at once. Friction and hot applications to the extremities should then be resorted to, and brandy or whiskey should be given freely. Inhalations of Nitrite of Amyl will also be found valuable; and artificial res- piration should be resorted to as soon as the breathing fails. ARSENIC. Arsenic is a common form of poison, and is frequently taken by accident or design. It is also used with criminal intent more than any other poison. It is the chief ingredient in the poisons used for killing rats, flies and vermine of various kinds. When swallowed in poisonous doses, it produces faintness, depression, nausea and vomiting, in from half an hour to an hour after it is taken. There is also an intense burning pain in the stomach, that is increased by pressure. This continues to increase, and is usually attended with violent cramps of the abdomen and legs. These symptoms are followed by severe purging. The throat is dry and constricted, there is intense thirst, the pulse is very feeble, and the skin is cold and clammy. Treatment.-Friction and hot applications should be applied to the extremities, and Dialyzed Iron should be given in doses of two tablespoonfuls every half hour. When the severe symptoms subside hot fomentations should be applied CHLOROFORM. 673 to the abdomen, and a quarter of a grain of Morphine maybe given and repeated in an hour, if necessary. BELLADONNA. The symptoms of Belladonna poisoning are heat and dry- ness of the mouth and throat, nausea, vomiting, dizziness, impaired or double vision, dilated pupils, great excitement, delirium, and convulsions. Treatment.-An emetic should be given to empty the stomach, full doses of brandy or whiskey are administered, and a quarter of a grain of Morphine may be given by the stomach or hypodermically. Artificial respiration should be kept up for an hour or two, if necessary. CARBOLIC ACID. When Carbolic Acid is swallowed, half a gobletful of Olive oil should be given as soon as possible. Then an emetic should be used to empty the stomach, and after this has acted hot brandy and water may be freely given. Warmth to the extremities, and the faradic current of electricity are also valuable. CHLOROFORM. When an over dose of Chloroform is taken by inhalation or by the stomach, the action of the heart fails rapidly, and the breathing is almost suspended. Treatment.-Artificial respiration should be resorted to immediately, and Ammonia should be held to the nostrils so that the fumes may be inhaled. The head should be lowered, even to the ground, while the legs are elevated. Inhalations of Nitrite of Amyl should also be given. COAL GAS. When Coal gas or illuminating gas has been inhaled the doors and windows should be opened so as to admit plenty of fresh air. Artificial respiration should be steadily kept up, Ammonia should be held to the nostrils, and mustard poul- tices applied to the extremities. Warm and cold water alter- nately dashed on the head and chest, will often serve a good POISONS AND THEIR ANTIDOTES. 674 purpose, as will also the faradic current of electricity. As soon as the patient can swallow, stimulants should be given. GELSEMIUM. Over doses of Gelsemium produce complete muscular paralysis, double vision, and great fullness and pain in the head. Treatment.-Brandy should be freely used, and the fumes of Ammonia should be inhaled In severe cases an inhalation of Nitrite of Amyl will invariably overcome the symptoms. HYDRATE OF CHLORAL. Over doses of Hydrate of Chloral always produce stupor. Treatment.-If the patient can swallow, an emetic should be given as soon as possible. If not, the inhalation of Nitrite of Amyl will almost invariably overcome the effect of the Chloral. The patient should be kept awake if possible, and heat and friction should be applied to the extremities. OPIUM. The symptoms of Opium poisoning are dizziness, drowsi- ness, stupor and finally complete insensibility. The patient may be aroused, but speedily relapses into stupor. The pulse is at first quick, but soon becomes slow and full, the breath- ing slow and difficult, the skin is cold and pale though some- times bathed in perspiration, and the pupils are usually con- tracted. Treatment.-It is always best to give an emetic to unload the stomach. The patient should then be kept awake by walking him around the room or in the open air, and by pinch- ing or slapping him. Ammonia may be held to the nostrils, and strong coffee should be administered freely. Fluid Ex- tract of Belladonna should also be given in from 2 to 5 drop doses. When Morphine, Laudanum, Paregoric, Godfrey's Cordial, or soothing Syrup is given in over doses, the treatment is the same as the above. STRYCHNIA. 675 Poisonous Mushrooms produce symptoms of intoxication, and all objects appear to be of a blue color. Sometimes irri- tation of the stomach and bowels is produced, but not as a rule. Treatment.-An emetic should first be given, and this should be followed by an ounce of Castor Oil. Then 5 drops of the Fluid Extract of Belladonna should be given in water, every hour or two. Stimulants should also be given, and hot applications should be applied to the abdomen and extremi- ties. POISONOUS MUSHROOMS. OXALIC ACID. If Oxalic Acid is swallowed, a hot burning acid taste is experienced during the act of swallowing, which extends to the stomach. Vomiting occurs in a few minutes, and there is present a sense of choking or suffocation. There is a burn- ing pain in the stomach, tenderness of the abdomen, and a drawing up of the legs upon the abdomen. Treatment.-Lime water should be given freely, and an ounce of Castor Oil is required to clear out the intestines. STRYCHNIA. In from fifteen minutes to an hour or more after a poison- ous dose of strychnia has been swallowed, the patient is sud- denly seized with a feeling of suffocation and great difficulty of breathing. Twitching of the head and limbs, and a trem- bling of the entire body are next noticed, and then violent convulsions develop. These continue for a time, and then subside for a few moments, but soon recur with greater severity than before. Treatment.-The inhalation of Chloroform to control the spasms, and teaspoonful doses of Chloroform with io grains of Camphor internally, is the best treatment that can be adopted. If the case is seen soon after the poison has been taken, an emetic should be used. When the worst symptoms are overcome, 20 grains of Bromide of Sodium may be given three or four times a day. CHAPTER IV. GLOSSARY. Abdomen, The belly. Abortion, Premature birth; miscarrriage. Abscess, A cavity containing pus. Acetabulum, The cavity for the head of the thigh bone, that forms the hip joint. Acne, A pimply disease of the skin. Albumen, An element of living bodies; as the white of eggs. Albuminuria, Albumen in the urine; Bright's disease. Alopecia, Falling out of the hair. Alterative, A medicine that slowly im- proves the condition of the system. Amaurosis, A gradual loss of sight. Amenorrhea, Absence of the menses. Amphiarthrosis, Permitting of -but slight motion. Anemia, Bloodlessness. Anchylosis, Stiffness of a joint. Aneurism, Dilatation of an artery. Angina Pectoris, A disease of the nerves of the heart. Anodyne, A drug that produces sleep. Antidote, A medicine that counteracts the effect of another. Antiseptic, That prevents putrifaction. Anus, The lower extremity of the bowel. Aorta, The great artery leading from the left side of the heart. Aphasia, Inability to speak the proper words to make sense. Aphonia, Loss of voice. Aphthae, White ulcers in the mouth; the thrush. Aphthous, Affected with the thrush. Apoplexy, A disorder ot the brain caused by pressure of blood escaped from the vessels. Aqueous, Watery. Aqueous Humor, A fluid in the front part of the eye. Arthrodia, A movable joint. Asthma, A disease of the air passages at- tended by difficult breathing. Astigmatism, A defect of the eye that causes irregular vision. Atlas, The first bone of the spinal column. Auditory, Belonging to the ear. GLOSSARY. 677 Auricle, The expansion of the external ear. Auricles, The upper cavities of the heart. Axis, The second bone of the spine. Balanitis, Inflammation of the mucous membrane of the head of penis and prepuce. Biceps, Two headed. Bicuspids, The first grinding teeth. Bronchi, Tubes that convey air to the lungs. Bronchial, Relating to the Bronchi. Bronchitis, Inflammation of the bron- chial tubes. Bubo, An inflamed gland in the groin. Calcined, Reduced to a fine powder by heat. Calculi, Gravel stones. Canaliculus, A small canal that carries the tears from the eye. Capillaries, Very minute blood-vessels. Capsule, A covering sac or membrane. Carditis, Inflammation of the heart. Caries, Ulceration of a bone. Carotid, The large artery of the neck. Carpus, The wrist. Caruncle, A small fleshy excrescence. Catalepsy, A condition resembling death. Cataract, An opacity of the crystalline lens, or its capsule, that causes loss of sight. Catarrh, A flow of mucus. Caustic, A substance that destroys tissue. Cecum, A part of the large intestine. Cerebellum, Posterior and lower part of the brain; the little brain. Cerebrum, The large, or superior brain. Cerebro-Spinal, Belonging to the brain and spine. Cerumen, The ear wax. Cervical, Belonging to the neck. Chancre, A primary syphilitic sore-a pox. Charlatan, A quack; an impostor. Chilblain, A slight frost bite. Chlorosis, Green sickness. Choroid, A name given to several mem- branes. Clavicle, The collar bone. Clitoris, The erectile body of the female sexual organs. Coccyx, The lowest part of the spine. Cochlea, A spiral cavity of the internal ear. Coitus, The sexual act. Colon, Thelaigest part of the intestines. Condyle, A large projection of bone. Confluent, Running together. Congestion, A distention of blood-vessels. Conjunctiva, The external coat of the eye ball. Conjunctivitis, Inflammation of the con- junctiva. Cornea, The anterior transparent part of the eye. Corneitis, Inflammation of the cornea. Coryza, Acute catarrh. Cranium, The skull. Cuticle, The scarf-skin. Decoction, A tea made by boiling. Defecation, The act of having an action of the bowels. Deglutition, The act of swallowing. Delirium, Temporary insanity. Delirium Tremens, Insanity, of drunken- ness; the horrors. Deltoid, The large triangular muscle cov- ering the shoulder. Dementia, Idiocy. Dengue, An epidemic fever, accompanied by severe muscular pains; break-bone fever. Dentition, Teething. Depletion, Diminishing the fullness of a part, as by bleeding. Derma , The skin. Desquamation, Scaling off of the cuticle, as after scarlet fever. Diabetes, A. disease in which sugar is found in the urine. Diagnosis, The art of recognizing dis- eases. 678 GLOSSARY. Diaphoretics, Medicines that cause per- spiration. Diaphragm, The partition separating the thorax and abdomen. Diarrhea, A looseness of the bowels. Diarthrosis, A movable articulation. Digestion, The changing of the food into nutritive material. Dislocation, A displacement of a joint. Dorsal, Pertaining to the back. Dropsy, Water in the tissues or cavities of the body. Ducts, Little canals that convey secretions from organs. Duodenum, First part of small intestine. Dysentery, Inflammation of lower intes- tine, with frequent mucus and bloody passages from the bowels ; bloody flux. Dysmenorrhea, Painful menstruation. Dyspepsia, Indigestion. Dyspnea, Difficult breathing. Ectropion, Eversion of the eyelids. Eczema, An eruption of the skin in the form of small blisters. Effusion, Pouring out. Elixir, A flavored preparation of alcohol and syrup, in which medicines are dissolved. Emetic, A njedicme that produces vomit- ing. Emollient, Applications that possess the power of softening. Emulsion, A milk-like mixture. Enarthrosis, Ball and socket joints, as the hip and shoulder. Encysted, Inclosed in a sac. Endemic, A disease confined to a certain district. Endocarditis, Inflammation of the lining membrane of the heart. Enema, An injection into the back passage, used to move the bowels. Entropion, Inversion of the eyelids. Epidemic, Prevailing over an extensive district. Epiglottis, The valve of the wind-pipe. Epilepsy, A nervous disease; falling sick- ness. Epistaxis, Bleeding from the nose. Erysipelas, An inflammatory disease of the skin; St. Anthony's fire. Ethmoid, Sieve-like. Eustachian Tube, A canal leadmg from the throat to the middle ear. Excretion, Anything thrown off. Excretory, Organs that throw off excre- tions. Fallopian Tubes, Tubes that convey the ovum from the ovary to the womb. Femoral, Belonging to the thigh. Femur, Thigh bone. Fibula, The small bone of the leg. Filament, A minute fibre. Fistula, An abnormal channel discharg- ing matter. Flatulence, Wind in the stomach and bowels. Follicle, A little sac. Foramen, A little opening. Ganglia, Knots of nerve tissue. Gangrene, Death of a part. Gastric, Belonging to the stomach. Gastric Juice, The digestive fluid of the stomach. Gastritis, Inflammation of the stomach. Ginglymus, A hinge joint, as the knee and elbow. Gland, An organ of secretion. Glaucoma, Opacity of vitreous humor ot the eye. Glottis, The opening into the windpipe. Gonorrhea, A discharge from the ure- thra; clap. Gout, Inflammation of the small joints from an acid condition of the blood. Hemoptysis, Bleeding from the lungs. Hemorrhage, Bleeding. Hemorrhoids, Piles; a disease of the veins of the lower bowel. Hernia, A rupture. Hives, A disease of the skin; nettle rash GLOSSARY. 679 Humerus, The bone of the upper arm. Hydrocele, Dropsy of the scrotum. Hysteria, A spasmodic nervous disease. Idiopathic, A primary condition or dis- ease. Incontinence, Inability to retain the nat- ural evacuations. Influenza, Epidemic catarrh. Infusion, A medicine prepared by steep- ing. Iris, The curtain of the eye that surrounds the pupil. Jaundice, A disease in which the bile en- ters the blood and causes a yellowness of the skin and eyes. Lachrymal, Belonging to the tears. Lachrymal Gland, The gland that se- cretes the tears. Laryngitis, Inflammation of the larynx. Larynx, The upper part of wind-pipe. Ligament, A cord or band of elastic fibres. Lupus, An ulcerative disease of the skin. Lymph, The fluid found in the lymphatics. Malaria, A condition developed by the inhalation of noxious gases from de- composing matter; miasm. Malar, Belonging to the cheek. Malignant, Dangerous; destructive to life. Mania, Insanity. Meatus, A mouth, an opening into a canal. Medulla, The marrow. Medulla Oblongata, The division of the brain that connects with the spinal cord. Membrane, Any thin tissue. Meningitis, Inflammation of the mem- branes of the brain. Menstruation, The monthly flow from the womb. Metacarpal, Next to the wrist. Metatarsal, Next to the ankle. Miasm, Animal or vegetable emanations. Mortification, Death of a part. Myopia, Short sightedness. Narcotic, Stupefying. Nasal, Pertaining to the nose. Nausea, Sickness at the stomach without vomiting. Necrosis, Death of a bone. Neuralgia, Pain in a nerve. Nitrogenous, Containing nitrogen. Occipital, Connected with the back part of the head. Occiput, The back part of the head. Occlusion, A shutting up. Occulist, A surgeon who makes a spe- cialty of treating the eye. Odontoid, Tooth-like. CEdema, Dropsical condition of the tissues which causes a puffiness of the skin. (Esophagus, The tube leading from the throat to the skin. Olecranon, The back angle of the elbow. Olfactory, Pertaining to smell. Omentum, A fold of peritoneum covering the front of the bowels. Opacity, A condition that prevents the passage of light. Ophthalmoscope, An instrument for ex- amining the interior of the eye. Opiate, A medicine containing opium or some of its preparations. Optic, Belonging to the eye. Orbit, The cavity containing the eye. Osseous, Bony. Ovary, The body in the female that de- velops the egg from which the foetus is developed. Ozena, A disease of the bones of the nose, attended with fetid odor. Palate, The back part of the roof of the mouth. Palliative, Giving temporary relief. Papilla, Little elevations indicating the termination of nerves and vessels on the skin and mucous membrane. 680 GLOSSARY. Paraplegia, Paralysis of one or of both lower extremities, properly, of any ex- tremity. Parasite, An animal that lives on another living body. Parotid Gland, A gland situated behind the angle of the lower jaw, that se- cretes saliva. Patella, The knee cap. Pectoral, Relating to the chest. Penis, The male organ of copulation. Pericarditis, Inflammation of the sac containing the heart. Periostitis, Inflammation of the covering of the bone. Peristaltic, A worm-like motion of the bowels. Peritonitis, Inflammation of the mem- brane lining the abdominal cavity. Pessary, An instrument to support the womb after it has been displaced. Phalanges, The bones of the fingers and toes. Pharyngeal, Relating to the pharynx. Pharyngitis, Inflammation of the phar- ynx. Pharynx, The lower part of the cavity of the throat. Phthisis Pulmonalis, Consumption. Piles, Enlarged veins of the rectum. Placenta, The afterbirth. Plastic, That which forms. Plethora, Full blooded. Pleuritis, Inflammation of the covering of the lungs. Pneumonia, Inflammation of the lungs. Polypus, A tumor in the mucous cavities of the body. Pregnancy, Being with child. Presbyopia, Old sight, in which near ob- jects must be carried from the eye to be seen distinctly. Ptosis, Drooping of the upper lid. Pyemia, Blood poisoning. Quartan, Occurring every fourth day. Quinsy, Inflammation of the tonsils. Quotidian, Returning every day. Rabies, Madness. Radical, Root; a permanent cure. Rectum, The lower portion of the intes- tines. Reduction, Putting in place. Reproduction, Producing anew. Respiration, Breathing. Retina, The back of the eye that receives the impressions of sight. Retroversion, Backward displacement. Rickets, An impoverished condition of all the tissues, with bending of the bones. Rubeola, Measles. Saliva, The spittle. Salivary, Belonging to the saliva. Scabies, The itch. Scapula, The shoulder blade. Scarlatina, Scarlet fever. Scrotum, The bag containing the testicles. Sedative, Depressing; quieting. Septicemia, A partial blood poisoning. Serous, Thin; watery. Serum, The fluid portion of the blood. Spermatorrhea, An unnatural flow of semen. Spinous, Sharp, or thorn-like. Squamous, Like a scale. Sterility, Barrenness. Sternum, The breast bone. Stimulant, An agent that excites the nerv- ous system. Stomatitis, Inflammation of the mouth. Strabismus, Cross-eye. Stricture, A narrowness of a natural passage. Synarthrosis, An immovable articulation. Synovia, The fluid that lubricates the joints. Synovial Membrane, The membrane that lines the cavities of joints. Synovitis, Inflammation of the lining membrane of joints. Tenesmus, Spasm of muscles of the anus. Tertian, Occurring every third day. Testes, The testicles. GLOSSARY. 681 Thorax, The chest. Tibia, The shin bone. Tonic, A medicine that gives strength. Tonsillitis, Inflammation of the tonsils. Torsion, Twisting. Trachea, The wind-pipe. Traumatic, Resulting from injuries. Tympanum, The middle ear. Typhoid, Resembling typhus; a low fever. Urea, A constituent of the urine. Ureter, The passage from the kidneys to the bladder. Urethra, The canal leading from the bladder. Urethritis, Inflammation of the urethra. Uterine, Pertaining to the womb. Uterus, The womb. Vaccination, Inserting a poison into the blood under the delusive notion that it prevents small-pox. Vagina, The passage from the vulva to the womb. Vaginal, Pertaining to the vagina. Vaginitis, Inflammation of the vagina. Varicocele, Enlargement of the veins of the testicles. Variola, Small-pox. Varioloid, Mild small-pox. Vascular, Belonging to the blood-vessels. Venereal, Belonging to sexual inter- course. Ventricles, Cavities in the brain and heart. Vermiform, Worm-like. Vertigo, Dizziness. Vesicle, A bladder; a blister. Virus, Poisonous and contagious matter. Viscus, An organ within a cavity. Volatile, Diffusible. Volition, The power of willing. Vulva, The exterior of the female sexual organs. Whites, Common name for leucorrhea. INDEX PAGE. Abdomen 56 " Dropsy of the 354 Abscess 587 " of the Anus 621 Absence of the Menses, or Amen- orrhea 507 Accessory Organs 54 Acetic Acid, Dilute.... * 638 Acetate of Lead 638 " Potash 638 Acid, Boracic 642 " Carbolic 643 " Chromic 646 " Dilute Muriatic 648 " " Sulphuric 649 " Oxalic, Poisoning from... 675 " Salicylic 661 " Tannic 664 Acne 483 " Miliaris 484 " Punctata 484 " Rosacea 484 Aconite, Fluid Extract of 650 " Poisoning from 672 Action of Great Sympathetic.... 97 Acute Bronchitis 403 " Gastritis 300 " Laryngitis 392 " Inflammation of the Blad- der. 437 " Inflammation of the Kid- neys 428 Agents, Mechanical 667 Air and Ventilation 166 Albuminuria, or Bright's Disease 431 Alcoholic Beverages 129 Alcohol, Asa Food 132 " As a Medicine 136 " As a Poison 141 Alimentary Canal 51 Aloes and Iron Pill 638 Alopecia, or Falling out of Hair. 486 Alum 639 Alum-whey 639 Amaurosis 572 Amenorrhea, or Absence of the Menses 507 Ammonia, Aqua 639 " Carbonate of 643 " Muriate of 658 PAGE. Ammonium, Iodide of 657 Amyl, Nitrite of 658 Anatomy of the Eye 547 " of the Ear 576 " of the Pelvic Organs of Woman 504 Anaemia 511 Anchylosis 617 Aneurism 620 Angina Pectoris. 374 Animal Foods 114 Aniseed Tea 639 Ankle, The 35 " Joint, Diseases of 617 Antidotes for Poison 671 Antiseptic Dressings 590 Anus, Abscess of the 621 " Fissure of the 622 " Fistula of the 223 Aphasia 458 Aphonia 398 Apoplexy 448 Apparatus, Circulatory 61 " Digestive 50 Aphthous Form of Stomatitis.... 295 Aqua Ammonia 639 Aromatic Spirit of Ammonia.... 640 Arm 33 Arsenic, Fowler's Solution of.... 656 " Poisoning from 672 Arteries 62 Artificial Respiration 667 Asthma 411 Atlas 31 Automatic Motion gi Axis 31 Backward Curvature of the Spine 602 Balanitis 53g Balsam of Fir 640 " of Peru 640 " of Tolu 640 Bark, Pomegranite 660 Barber's Itch 488 Bath, Hot Water 152 " The Sponge 152 Bathing, River 154 " Sea 153 Baths, Hot Air 154 INDEX. 684 PAGE. Baths, Steam 155 Bedsores 488 Beers 14° Belladonna, Fluid Extract of... 650 " Leaves 641 " Poisoning from.... 673 Beverages, Alcoholic 129 Bicarbonate of Soda 641 Bilious Headache 453 Bismuth, Subnitrate of 662 Black Haw, Fluid Extract of.... 651 Black Cohosh, Fluid Extract of. 651 Bladder 68 " Acute Inflammation of the 437 " Chron. Inflammationofthe 438 " Stone in the 439 Bleeding, How to Arrest 593 " of the Nose, or Epistaxis 381 " from the Kidneys 436 " from the Lungs 421 Blisters 668 Blood, Circulation of the 85 Blue Cohosh, Fluid Extract of.. 651 Body, Elements of the 81 Boils 489 Bone, Ethmoid 27 " Frontal 26 " Hyoid 32 " Inferior Maxillary 28 " Sphenoid 38 " Structure and Develop- ment of 39 Bonjean's Ergotin 641 Bones, Carpal or Wrist 34 " Diseases of the 598 " Inferior Turbinated 28 " Lachrymal .. 27 " Malar 28 " Metacarpal 34 " Palate 28 " Parietal 26 " Superior Maxillary 28 " Temporal 26 Boneset Tea 641 Bordeaux White Wines 139 Boracic Acid 642 Borax 642 " Powdered 642 Bowels, Inflammation of the.... 324 Brain 72 " and Spinal Cord 71 " Congestion of the 442 " Inflammation of the 442 " Water on the 446 Brandy 137 Breasts, Gathered 518 Bright's Disease, or Albuminuria 431 Bronchial Tubes 65 PAGE. Bronchitis, Acute 403 " Chronic 408 Bromide of Sodium 642 Burgundy 139 Burns and Scalds 487 Cactus Bonplandii, Tincture of.. 664 Cactus Grandiflorus, Tincture of 664 Calcined Magnesia 643 Calisaya. Iron and Strychnia, Elixir of 649 Canal Alimentary 51 Cancer 594 " of the Intestines 331 " of the Stomach 210 " of the Womb 525 Cantharides, Tincture of 665 Capillaries 62 Capiscum, Tincture of 665 Carbolic Acid 643 " " Poisoning from... 673 Carbonate of Ammonia 643 of Iron 643 " of Manganese 644 Carbuncles 489 Care of the Infant 515 Care of the Mother 516 Cascara Cordial 644 " Sagrada, Fluid Extract of 651 Castor Oil 644 Catalepsy 471 Cataract 570 Catarrh, Chronic 384 " Intestinal 320 Catechu, Tincture of 665 Cecum, Inflammation of the 325 Cerebellum 72 Cerebro Spinal Centre 70 Cerebro-Spinal Meningitis, or Spotted Fever 256 Chamomile Tea 645 Champagnes 13g Chancre 286 Chicken-Pox, or Varicella 237 Chilblains 490 Child-bed Fever 517 Chlorate of Potash 645 Chlor-Anodyne 645 Chloride of Iron, Tincture of.... 665 " of Zinc 645 Chloroform 645 " Poisoning from 673 Chlorosis 510 Cholera 262 " Infantum , 317 " Morbus 316 Chorea, or St. Vitus' Dance 470 Choroid, The 572 INDEX. 685 PAGE. Chromic Acid 646 Chronic Bronchitis 408 " Catarrh 384 " "of the Stomach.. 301 " Diarrhea 322 " Enteritis 322 " Inflammation of the Bladder 438 " Inflammation of the Kid- neys 43° " Laryngitis 394 " Pneumonia 417 Cinchona, Compound Tincture of 648 Circulation of the Blood 85 Circulatory Apparatus 61 Citrate of Magnesia 646 Clarets 139 Cleanliness and Bathing 151 Clothing and Modes of Dress... 156 Club-Foot 619 Coal Gas, Poisoning from 673 Coca 128 Coccyx 32 " The 37 Cocoa and Chocolate 128 Cod-Liver Oil 646 Cecum 53 Coffee 127 Colchicum Seeds, Fluid Extract of 651 Colic 332 Collinsonia, Fluid Extract of.... 652 Colon 54 Colombo, Tincture of 665 Compound Jalap Powder 646 " Lobelia Powder.... 647 " Phosphorus Pill.... 647 " Podophyllin Pill... 647 " Syrup of Rhubarb and Potash 647 " Syrup of Stillingia.. 647 " Tincture of Iodine.. 648 Condition of Dwellings 164 Congestion of the Brain 442 " of the Kidneys 427 " of the Liver 339 Congestive Headache 452 Conium, Extract of 649 Conjunctiva, The 564 Constipation 347 Constitutional Syphilis 288 Consumption, or Phthysis Pul- monalis 418 Convulsions 465 Cordial, Cascara 644 Cord, Spinal 74 Cords, Spermatic 69 Cornea, The 568 Corns 490 PAGE. Corrosive Sublimate 648 Coryza, or Nasal Catarrh 378 Cranial Nerves 76 Cream of Tartar 648 Croup 399 " Membranous 401 " Mucous 399 Cross-Eye, or Strabismus 564 Cupping 668 Dandruff 491 Defects of Vision requiring Spec- tacles 555 Delirium Tremens 475 Dengue 230 Development, Physical 147 Diabetes 432 Dialyzed Iron 648 Diaphragm, The 48 Diarrhea 313 " Chronic 322 Digestive Apparatus 50 " Organs 51 Dilatation of the Heart 371 Dilute Acetic Acid 638 " Sulphuric Acid 649 " Muriatic Acid 648 Diphtheria 258 Diseases from Specific Poisons.. 277 " General 213 " Hip-Joint 616 " of Knee and Ankle Joints 617 " of the Bones 598 " of the Digestive System.... 294 " of the Ear 581 " of the Eye 559 " ot the Lids 559 " of the Male Generative Or- gans 537 " Miasmatic 247 " of the Nervous System.... 442 " of the Respiratory Appara- tus 376 " of the Skin 482 " of the Urinary Organs 426 Dislocations 602 Disorders of Nutrition 265 Displacements of the Womb .... 519 Distribution of Nerves 78 Dorsal Vertebrae 31 Dress for Women, Proper 150 Dressings, Antiseptic 590 Dress, Woman's 157 Dropsy of the Abdomen 358 Dr. Tanner's Fast 118 Duodenum 53 Dyspepsia 304 " Intestinal 307 686 INDEX. PAGE. Ear and Its Diseases 577 Eye and Its Diseases 546 Eczema 492 Education of the Sexes 172 " Present System of.... 173 Eggs 114 Electricity 668 Elements of the Body 81 Elixir of Calisaya, Iron and Strychnia 649 Endocarditis 365 Enlarged Prostate 543 Enlargement of the Spleen 351 Enteritis, Chronic 322 Epidemic Catarrh, or Influenza 247 Epilepsy 466 Epistaxis, or Bleeding of the Nose 381 Ergot, Fluid Extract of 652 Ergotin, Bonjean's 641 Erigeron, Oil of 659 Eruptive Fevers 232 Erysipelas 244 Essence of Ginger 649 Ethmoid Bone 27 Ether 649 Eucalyptus Globules, Fluid Ex- tract of 652 Eye, Anatomy of the 547 " Hygiene of the 553 Excretions 87 Extract of Conium 649 Extremities, Lower 34 " The Upper 33 Fallacies Concerning Food 105 Falling Out of Hair, or Alopecia 486 Fatty Degeneration of the Heart 372 Fever, Child-Bed 517 " Eruptive 232 " Hay 250 ' Idiopathic .. 213 " Intermittent 215 " Relapsing 226 " Remittent 220 " Scarlet 240 Stages of 214 " Symptomatic 213 " Typhoid 222 " Typhus 225 " Yellow 228 Fevers 213 Fibroid Tumors of the Womb... 523 Fir, Balsam of 640 Fish 115 Fissure of the Anus 622 Fistula of the Anus 623 Fluid Extract of Aconite 650 PAGE. Fluid Extract of Bear Berry 650 " Black Haw 651 " " Black Cohosh.. 651 '* Belladonna 641 " Blue Cohosh... 651 " ColchicumSeeds 651 " " Collinsonia 652 " " Ergot 652 " " Eucalyptus Glo- bulus 652 " " Gelsemium 652 " " Golden Seal.. . . 653 " " Grindelia Ro- busta .. 653 " " Hydrastis Cana- densis 653 " " Indian Hemp... 654 " Ipecac 654 " " Lobelia 654 " " Manaca 654 " Mango Bark.... 654 " Nux Vomica... 655 " " Pleurisy Root.. 655 " Podophyllum... 655 " " Poke Root 655 " Prickly Ash Ber- ries 655 " " Pulsatilla 655 Fomentations, Hop 669 Food, Fallacies Concerning .... 105 Foods, Animal 114 " Relative Values of 113 " Vegetable 117 Foot, The 35 Forearm 33 Fowler's Solution of Arsenic.... 654 Fractures '.... 600 Freckles. 493 Frost-Bites 493 Fruits 117 FunctionsandDiseasesofWoman 503 Future Relation of the Sexes.... 190 Gall Stones 342 Gangrene 590 Gastritis, Acute 300 Gathered Breasts 518 Gelsemium, Fluid Extract of.... 652 " Poisoning from.... 674 General Diseases 113 " Surgery 586 Generative Organs, Diseases of the Male 537 Genital Organs 69 Genito-Urinary Organs 68 German Wines 61 Gin 138 Ginger, Essence of 649 INDEX. 687 PAGE. Ginger Tincture of 665 Glaucoma 572 Gland, Prostate 69 Glanders 282 Glands, Salivary. 54 Gleet . 639 Glossitis 297 Glottis, CEdema of the 397 Glycerine 656 Golden Seal, Fluid Extract of... 653 Gonorrhea 537 Gout 271 Gravel, or Renal Calculi 434 Great Sympathetic Nerve 78 " " " Action of 97 Grindelia Robusta, Fluid Extr. of 653 Growth, Period of 103 Gymnastics 148 Hand, The 34 Haunch Bone 36 Hay Fever 250 Head , 250 " Scald 500 Headache 451 " Bilious 453 " Congestive 452 of Indigestion 453 " Nervous 454 " Organic 455 " Plethoric 452 '* Renal 455 " Rheumatic 454 Heart 61 " Fatty Degeneration of the.. 372 " Palpitation of the 373 " Dilatation of the 371 " Diseases of the. 362 " Inflammation of the 365 " Rheumatism of the 366 " Hypertrophy of the 370 Heat, Prickly 499 Hemoptisis, or Bleeding from the Lungs 421 Hemorrhage of the Stomach 311 Hemorrhoids 623 External 624 " Internal 625 Heredity 194 Hiccough 474 Hip-Joint Disease 616 Hip, The 34 Hives, or Nettle Rash 497 Hop Fomentations 669 Hot Air Baths 154 " Water Baths 152 How Are We Made? 21 " Do We Live? 80 PAGE. How to Arrest Bleeding 593 " to Keep Well 146 Hydrastin 656 Hydrate of Chloral, Poisoning from 674 Hydrocele 543 Hydrophobia 277 Hygiene of the Ear 579 " " Eye 553 Hyoid Bone 36 Hysteria 468 Hypertrophy of the Heart 370 Idiopathic Fevers 210 Ills and Their Remedies in Incontinence of Urine 440 Indian Hemp, Fluid Extract of.. 661 Infant, Care of the 517 " Feeding. 106 Infantile Paralysis 460 Inflammation 587 " of the Bowels 324 " " Brain 444 " " Cecum 325 " •* Heart 364 " " Liver 340 " " Lungs 414 " " CEsophagus.. 298 " " Ovaries 525 " " Pericardium. 365 " " Rectum 327 " " Spleen 350 " " Tongue 297 " " Vagina 527 " " Vulva 531 " " Womb 518 Influenza, or Epidemic Catarrh.. 247 Ingluvin 657 In-Grown Toe Nails 620 Inherited Conditions 197 Injections, Vaginal 523 Inorganic Substances 113 Insanity 199 Intermittent Fever 215 Intestinal Catarrh 320 Dyspepsia 307 " Parasites, or Worms.. 335 Intestines, Cancer of the 331 Neuralgia of the 332 Iodide of Ammonium 657 " Potassium '. 657 Ipecac, Fluid Extract of 654 Iris, The 570 Iron and Aloes Pill 638 " Carbonate of 643 " Dialyzed 648 " Tincture of 665 Irritation, Spinal 463 Iris, The. 688 INDEX. PAGE. Itch 494 " Barber's 488 Itching of the Vulva 532 Jalap and Senna Tea 646 Jalap Powder, Compound 646 Jaundice 345 Jejunum 53 Joints and Ligaments 37 " Immovable 37 " Movable 38 Kidneys, Acute Inflammation of the 428 Kidneys, Bleeding from the 436 " Chronic Inflammation of the 430 " Congestion of the 427 Knock Knee 618 Knee, Diseases of the 617 Labor, Management of... 5*4 Lachrymal Bones 27 " or Tear Apparatus.. 562 Lacteal Vessels 60 Lacto-Phosphate of Iron, Syrup of 663 Lager Beer 14° Large Intestine, The 53 Laryngitis, Acute 392 " Chronic 394 Larynx 64 Lateral Curvature of the Spine.. 610 Laudanum 657 Leaves, Belladonna 641 " Stramonium 662 Leg, The 35 Leucorrhea 528 Lice 495 Ligaments 3$ " and Joints 37 Liver 54 " Congestion of the 339 " Inflammation of the 340 Lobelia, Fluid Extract of 654 " Powder, Compound... 647 " Syrup of 663 Lock Jaw, or Tetanus 474 Locomotor Ataxia 463 Lower Extremities 34 Lupus 495 Lungs 66 Magnesia, Calcined 643 " Citrate of 646 Magnetism 669 Male Fern, Oil of 659 Malar Bones 28 Manaca, Fluid Extract of 654 Management of Labor 519 PAGE. Manganese, Carbonate of 644 Mango Bark, Fluid Extract of.. 654 Massage 669 Marsh Mallow 657 Maxillary Bones, Superior 18 Meat 114 Measles, or Rubeola 238 Medical Intolerance 205 Medulla Oblongata ..... 73 Membranous Croup 401 Meningitis, Spinal 461 Menstruation, or Monthly Period 506 " Painful 509 " Profuse 519 Mental Impressions 201 Mercury, Yellow Oxide of. 666 Metacarpal Bones 34 Miasmatic Diseases 247 Milk 114 Miscarriage 513 Mixed Joints 38 Moles 496 Morphine 658 " Sulphate of.. 658 Monthly Period, or Menstruation 506 Mortification. 590 Motion, Automatic. 91 " and Sensation 89 Mother's Marks .. 497 Mouth 51 Movable Joints 38 Mucus Croup 399 Mumps, or Parotidis 255 Muriate of Ammonia 658 Muriatic Acid, Dilute 648 Muscles of the Face 46 " " Head 46 " " Head and Face.. 46 " * Lower Extremity 50 " " Neck 47 " " Trunk 47 " " Upper Extremity 49 " The Voluntary 41 " The Involuntary 40 Muscular System, The i... 40 Mustard Plasters 670 Nasal Bones 27 " Catarrh, or Coryza 378 Neck, Muscles of the 47 Nerve, Great Sympathetic 68 Nerves, Cranial 76 " of Special Sense 76 " Spinal 77 " The 76 Nervous Headache 454 " System, Diseases of the 442 " " The 70 IND EX. 689 PAGE. Nettle Rash, or Hives 497 Neuralgia of the Intestines 332 " " Stomach .. 307 Nitrate of Silver 658 " Potash 659 Nitre, Sweet Spirit of 663 Nitrite of A?nyl 658 Nitro-Glycerine 659 Non-Alcoholic Stimulants 126 Nutrition, Disorders of 265 Nux Vomica, Fluid Extract of.. 655 Occipital Bone 25 Occupations 170 (Edema of the Glottis 397 (Esophagus 52 " Inflammation of the.. 298 " Stricture of the 299 Offensive Perspiration 498 Oil of Erigeron 659 " Male Fern 659 Opium, Poisoning from 674 " Tincture of 657 " Wine of 666 Optic Nerve, The 571 Organs, Accessory 54 " Genital 69 " Respiratory .... 64 " Urinary 68 Organic Headache 455 Ovarian Tumors 526 Ovaries, Inflammation of the.... 525 Ozena 382 Painful Menstruation 509 Palate Bones 28 Palsy, Shaking 473 Palpitation of the Heart 373 Pancreas 55 Paralysis 477 " Infantile 464 Paraphimosis 540 Paregoric 660 Parietal Bones 26 Parotiditis, cr Mumps 255 Patella 35 Pelvis, Front View of 36 " The 36 Penis 69 Peppermint Tea 660 Peritonitis 352 Peroxide of Iron, Succinate ot the 662 Peru, Balsam of 640 Pertussis, or Whooping Cough . 252 Perineum, Rupture of the 517 Period of Growth 103 " Decay 112 " Interchange 108 Perspiration, Offensive 498 Pharynx 52 Pharyngitis 383 Phalanges.. 34 Physical Development.... 347 Phymosis 540 Phosphorus in Food m " and Strychnia Pills. 660 " Pill, Compound .... 647 Phthisis Pulmonalis, or Con- sumption 418 Physiological Differences of the Sexes 183 Physiology of Hearing 578 Piles 623 Pin, or Thread Worms 338 Plaster-of-Paris Jacket 610 Plasters, Mustard 670 Plethoric Headache 452 Pleurisy.. 422 " Root, Fluid Extract of.. 655 Pleuro-Pneumonia 416 Pneumonia, or Inflammation of the Lungs 414 Pneumonia, Chronic 417 Podophyllin Pill, Compound... 647 Podophyllum, Fluid Extract of.. 655 Poke Root, Fluid Extract of.... 655 Poisoning from Aconite 672 " " Arsenic 672 " " Belladonna 673 " " Carbolic Acid ... 673 " " Chloroform 673 " " Coal Gas 673 " " Gelsemium 674 " " Hydrate of Chloral 674 " " Opium 674 " " Poisonous Mush- rooms 675 " Oxalic Acid 675 " " Strychnia 675 Poisonous Insect Wounds 283 " Mushrooms 675 Poisons and their Antidotes... . 671 Polypus, Uterine 524 Pomegranate Bark 660 PonsVarolii 72 Port Wine 140 Potash, Acetate of 638 " Chlorate of 645 " Nitrate of 659 Potassium, Iodide of 657 Poultry and Game 115 Poultices 670 Powdered Sesquicarbonate of Potash 661 Powdered Borax 642 Pregnancy 512 690 INDEX. PAGE. Present System of Education.... 173 Prickly Ash Berries, Fluid Ex- tract of 655 Profuse Menstruation 510 Proper Dress for Women 160 Prostatitis 542 Prostate Gland 69 " Enlarged 543 Pulsatilla, Fluid Extract of 655 Quinine 660 " Sulphate of 660 Radius ... 33 Rectum, Inflammation of the... . 327 " Ulcers of the 623 Redundant Fingers 195 References: 207 Relative Values of Foods 213 Relapsing Fever 226 Remittent Fever 220 Renal Calculi, or Gravel 434 " Headache 455 Reproduction 98 Rest and Sleep 161 Respiratory Organs 64 Respiratory Apparatus, Diseases of the 376 Retention of the Urine 436 Rhubarb, Tincture of 665 Rheumatic Headache 454 Rheumatism 268 " of the Heart 366 Ribs, The 32 Rickets 267 Right Lymphatic Duct 60 Ringworm... L 499 River Bathing 154 Rochelle Salts 661 Round, or Stomach Worms 337 Rubeola, or Measles 238 Rum 138 Rupture of the Perineum 517 Sacrum 32 " The 37 Saccharine Carbonate of Iron and Manganese 661 Salicin 661 Salicylic Acid 661 Salt Rheum and Tetter 501 Salivary Glands 54 Santonin 661 Scald Head 500 Scarlatina 240 Scarlet Fever 240 Sciatica 481 Scrofula 265 , PAGE. Scurvy 275 Sea Bathing 153 Sea-Sickness 474 Seminal Vesicles 69 Seneka, Syrup of 664 Septicemia and Pyemia 588 Sesquicarbonate of Potaft, Pow- dered 661 Sewage and Drainage. 165 Sexes, Education of the 172 " Future Relation of the 190 " Physiological Differences of 183 Shaking Palsy 473 Sherry Wine 140 Shell Fish 116 Shingles 500 Shoulder 33 Sick Headache 453 Silver, Nitrate of 658 Simple Stomatitis... . 295 Skeleton, The 22 Skin. Diseases of the 1 482 Sleep, Rest and 161 Slippery Elm Tea 662 Small Intestine, The 53 Small-Pox or Variola 233 Soda, Bicarbonate of 641 " Sulphite of 663 Sodium, Bromide of . 642 Sore Nipples 532 Sore Throat 391 Spectacles 557 Spermatorrhea 544 Spermatic Cords 69 Special Sense, Nerves of 76 Sphenoid Bone 26 Spine, The 30 Spinal Cord 74 " Irritation 463 " Meningitis 461 " Nerves 77 Spine, Backward Curvature of the 602 " Lateral Curvature of the.. 608 Spirits 662 Spirit of Turpentine 137 Spleen 55 " Enlargement of the 351 " Inflammation of the 350 Sprains 601 Spotted Fever, or Cerebro-Spinal Meningitis 256 Squills, Syrup of 664 Stages of Fever 214 Statistical Table of the Fast 120 Steam Baths 155 Sternum 32 Sterility 527 Stillingia, Compound Syrup of.. 647 INDEX. 691 PAGE. Stimulating Beverages 126 Stimulation, the Theory of 131 Stiff Joints 617 Stomach 52 " Cancer of the 310 " Chronic Catarrh of the. .. 301 " Hemorrhage of the 310 " Ulceration of the 208 " Neuralgia of the 207 Stomatitis 294 " Aphthous Form of.... . 295 " . Simple 295 " Ulcerative Form of... . 295 Stone in the Bladder 439 Stramonium Leaves 662 Strychnia and Phosphorus Pills. 662 " Poisoning from 675 " Sulphate of 663 Strabismus, or Cross-Eye 663 Stricture 541 " of the (Esophagus 299 Structure and Development of Bone 39 St. Vitus' Dance, or Chorea 470 Substances, Inorganic 113 Sublimate, Corrosive 648 Submitrate of Bismuth 662 Succinate of Peroxide of Iron... 662 Sulphate of Morphine 658 " Quinine 663 " " Strychnia 663 Sulphite of Soda 663 Sulphur 663 Sulphuric Acid, Dilute 649 Sun-Stroke 45° Surgery, General 586 Swelled Testicle 541 Sweet Spirit of Nitre 663 Syphilis 285 " Constitutional 288 Syphilitic Buboes 293 Symptomatic Fevers 213 Synovitis 615 Syrup of Seneka 664 " " Lacto-Phosphate of Iron 663 " " Squills 664 " " Lobelia 663 " " Tolu 664 " " Rhubarb and Potash, Compound 647 System, the Nervous 70 Tannic Acid 664 Tape Worms 335 Tea, Aniseed 639 . " Boneset 641 " Chamomile 645 " Jalap and Senna 646 PAGE. Tea, Peppermint 660 " Slippery Elm 662 Testes 69 Teeth, the 29 Teething, or Dentition 534 Temporal Bones 26 Testicle, Swelled 541 Tetanus, or Lock-Jaw 472 Tetter and Salt Rheum 501 The Ankle 35 " Choroid 572 " Coccyx 37 " Conjunctiva 564 '' Cornea 568 " Diaphragm 38 " Ear and Its Diseases 577 " Eye and Its Functions 547 " Foot 35 " Hand 34 " Hip 34 " Involuntary Muscles 41 " Iris 570 " Large Intestine 53 " Leg 35 " Lymphatic System 59 " Medulla Oblongata 101 " Muscular System 40 " Nameless, or Haunch Bone 36 " Nerves 76 " Nervous System 70 Optic Nerve 571 " Organs of the Special Senses 79 " Pelvis 36 " Period of Decay 112 " Period of Interchange 108 " Pharynx 52 " Plaster-of-Paris Jacket 610 " Ribs 32 " Sacrum 37 " Skeleton 22 " Small Intestine 53 " Spine 30 " Sponge Bath 152 " Teeth 29 " Theory of Stimulation 131 " Thigh 35 " Thoracic Duct 59 " Trunk 29 " Upper Extremities 33 " Voluntary Muscles 40 " Vomer 37 Thigh, The 35 Thoracic Duct, The 69 Thought and Sensation 95 Thread, or Pin Worms 338 Tight Lacing 159 Tincture Cactus Bonplandii 664 " " Grandiflorus ... 664 692 INDEX. I'AGE. Tincture of Catechu 665 " " Cantharides 665 " " Capsicum 665 " " Chloride of Iron 665 " " Columbo 665 " " Ginger 665 " " Iron , 665 " " Opium 665 " " Rhubarb 665 Toe Nails, In-Grown 620 Tolu, Syrup of. 664 " Balsam of ... 640 Tonsilitis 390 Tongue, Inflammation of the... . 297 Toothache 480 Trunk, Muscles of the 47 " The 29 Tubes, Bronchial 65 Tumors 594 " Ovarian 526 " of the Urinary Passage.. 531 Turbinated Bones, Inferior 28 Turpentine, Spirit of 662 Typhoid Fever 222 Typhus Fever 225 Ulcers 589 " of the Rectum 623 Ulceration of the Stomach 308 Ulcerative Form of Stomatitis .. 295 Ulna 33 Upper Extremities, The 33 " Extremity, Muscles of the 49 Urethra 69 Ureters 60 Urinary Organs 68 " " Diseases of the.. 426 " Passage, Tumors of the 531 Urine, Incontinence of 436 " Retention of the 436 Uterine Polypus 524 Vaccination 236 Vagina, Inflammation of the 527 Vaginismus 530 Vaginal Injections 529 Variola, or Small-pox .. , 233 Varicocele 543 Varicella, or Chicken-pox 237 Varioloid 235 PAGE. Varicose Veins 621 Vaseline 666 Veins 63 " Varicose 621 Vegetable Foods 117 Vertebrae 30 " Dorsal : 31 Vertigo 458 Veratrum Viride, Fluid Extract of 654 Vesicles, Seminal 6g Vessels, Lacteal 60 Volition •.... 93 Voluntary Muscles, The 40 Vomer, The 28 Vulva, Inflammation of the 521 " Itching of the 522 War of the Pathies 202 Warts 502 Water 113 " on the Brain 446 What shall We Eat? 44 Whiskey .. 142 Whooping-Cough, or Pertussis.. 252 Wild Cucumber, or Elaterium... 666 Wines 138 " Bordeaux White 139 " German 139 " of Opium 666 " Port 140 " Sherry 140 Witch Hazel, Fluid Extract of... 656 Woman, Anatomy of the Pelvic Organs of 504 Woman, Functions and Diseases of 503 Woman's Dress 157 Womb, Cancer of the 525 " Displacements of the.... 519 " Fibroid Tumors of the. . 523 " Inflammation of the 518 Worms, Stomach 337 " Tape 335 Wrist 34 Wounds 592 " of Venemous Serpents... 284 Yellow Oxide of Mercury 666 Zinc, Chloride of 645